Phytotoxic and antimicrobial activity of volatile and semi-volatile organic compounds from the endophyte Hypoxylon anthochroum strain Blaci isolated from Bursera lancifolia (Burseraceae).

AIMS: To evaluate the phytotoxic, antifungal and antioomycete activity; and, determine the chemical composition of the volatile organic compounds (VOCs) and semi-volatile metabolites produced by the endophyte Hypoxylon anthochroum strain Blaci isolated from Bursera lancifolia. METHODS AND RESULTS: Based on its macro- and micro-morphological features, the strain Blaci was identified as Nodulisporium sp.; partial analysis of its ITS1-5.8-ITS2 ribosomal gene sequence revealed the identity of the teleomorphic stage of the fungus as H. anthochroum. Phytotoxic and antimicrobial activities of VOCs, and culture medium and mycelium organic extracts from H. anthochroum Blaci were determined by simple and multiple antagonism bioassays, and gas phase and agar dilution bioassays respectively. The volatile and semi-volatile metabolites were identified by gas chromatography-mass spectrometry. VOCs from a 5-day H. anthochroum strain Blaci culture caused the inhibition of seed germination, root elongation and seedling respiration on Amaranthus hypochondriacus, Panicum miliaceum, Trifolium pratense and Medicago sativa. In addition, extracts, phenylethyl alcohol and eucalyptol main compounds present in the VOCs and extract displayed a high phytotoxic activity, inhibiting the three physiological processes on the four test plants in a concentration-dependent manner. CONCLUSIONS: The results revealed that H. anthochroum strain Blaci produces a mixture of VOCs. These VOCs showed a strong phytotoxic activity on seed germination, root elongation, and seedling respiration of four plants and slightly affected the growth of phytopathogenic fungi and oomycetes. Also, the culture medium and mycelium extracts of H. anthochroum showed a high phytotoxic activity on the four test plants and, generally, the culture medium extract was more phytotoxic than the mycelium extracts. SIGNIFICANCE AND IMPACT OF THE STUDY: This work firstly reports the phytotoxic activity of volatile and semi-volatile compounds produced by the endophyte H. anthochroum strain Blaci on seed germination, root elongation, and seedling respiration of four different plants; consequently, these compounds could be useful in biocontrol of weeds and plant pathogens.

Swallowed topical corticosteroids reduce the risk for long-lasting bolus impactions in eosinophilic esophagitis.

BACKGROUND: Long-lasting food impactions requiring endoscopic bolus removal occur frequently in patients with eosinophilic esophagitis (EoE) and harbor a risk for severe esophageal injuries. We evaluated whether treatment with swallowed topical corticosteroids is able to reduce the risk of occurrence of this complication. METHODS: We analyzed data from the Swiss EoE Cohort Study. Patients with yearly clinic visits, during which standardized assessment of symptoms, endoscopic, histologic, and laboratory findings was carried out, were included. RESULTS: A total of 206 patients (157 males) were analyzed. The median follow-up time was 5 years with a total of 703 visits (mean 3.41 visits/patient). During the follow-up period, 33 patients (16 % of the cohort) experienced 42 impactions requiring endoscopic bolus removal. We evaluated the following factors regarding the outcome 'bolus impaction' by univariate logistic regression modeling: swallowed topical corticosteroid therapy (OR 0.503, 95%-CI 0.255-0.993, P = 0.048), presence of EoE symptoms (OR 1.150, 95%-CI 0.4668-2.835, P = 0.761), esophageal stricture (OR 2.832, 95%-CI 1.508-5.321, P = 0.001), peak eosinophil count >10 eosinophils/HPF (OR 0.724, 95%-CI 0.324-1.621, P = 0.433), blood eosinophilia (OR 1.532, 95%-CI 0.569-4.118, P = 0.398), and esophageal dilation (OR 1.852, 95%-CI 1.034-3.755, P = 0.017). In the multivariate model, the following factors were significantly associated with bolus impaction: swallowed topical corticosteroid therapy (OR 0.411, 95%-CI 0.203-0.835, P = 0.014) and esophageal stricture (OR 2.666, 95%-CI 1.259-5.645, P = 0.01). Increasing frequency of use of swallowed topical steroids was associated with a lower risk for bolus impactions. CONCLUSIONS: Treatment of EoE with swallowed topical corticosteroids significantly reduces the risk for long-lasting bolus impactions.

Overall survival and self-reported fatigue in patients with esophageal cancer.

PURPOSE: A prospective cohort study was conducted to analyze whether self-reported fatigue predicts overall survival in patients with esophageal cancer. METHODS: Patients enrolled in the Mayo Clinic Esophageal Adenocarcinoma and Barrett's Esophagus Registry between September 2001 and January 2009 who completed a baseline quality of life instrument were eligible for evaluation. The fatigue component was scored on a 0-10 scale, with 0 as extreme fatigue. Patients were categorized as having a decreased energy level if they reported a score of ≤ 5. Fatigue scores ≥ 6 reflect normal levels of energy. RESULTS: Data from a total of 659 enrolled patients were analyzed. A total of 392 (59 %) and 267 (41 %) patients reported decreased and normal energy, respectively. Univariate analysis indicates patients with normal energy had improved 5-year survival compared to patients with decreased energy (37 vs 28 %, hazard ratio (HR) 0.74, p = 0.006). Among the patients with locally advanced disease, the same relationship was seen (28 vs 17 %, HR = 0.67, p = 0.003); this remained significant on multivariate analysis (HR = 0.71, p = 0.015). CONCLUSIONS: A decreased energy level is associated with poor survival in patients with esophageal cancer. Thus, patients with high levels of fatigue should be referred for psychological support and be considered for therapy aimed at amelioration of fatigue symptoms.

Electrospun Polylactic Acid-Based Fibers Loaded with Multifunctional Antibacterial Biobased Polymers.

Here, we report the development of antibacterial and compostable electrospun polylactic acid (PLA) fibers by incorporation of a multifunctional biobased polymer in the process. The multifunctional polymer was synthesized from the bio-sourced itaconic acid building block by radical polymerization followed by click chemistry reaction with hydantoin groups. The resulting polymer possesses triazole and hydantoin groups available for further N-alkylation and chlorination reaction, which provide antibacterial activity. This polymer was added to the electrospinning PLA solution at 10 wt %, and fiber mats were successfully prepared. The obtained fibers were surface-modified through the accessible functional groups, leading to the corresponding cationic triazolium and N-halamine groups. The fibers with both antibacterial functionalities demonstrated high antibacterial activity against Gram-positive and Gram-negative bacteria. While the fibers with cationic surface groups are only effective against Gram-positive bacteria (Staphylococcus epidermidis and Staphylococcus aureus), upon chlorination, the activity against Gram-negative Escherichia coli and Pseudomonas aeruginosa is significantly improved. In addition, the compostability of the electrospun fibers was tested under industrial composting conditions, showing that the incorporation of the antibacterial polymer does not impede the disintegrability of the material. Overall, this study demonstrates the feasibility of this biobased multifunctional polymer as an antibacterial agent for biodegradable polymeric materials with potential application in medical uses.

A CFSE-based assay of proliferative response of lymphocytes to stimulation with dengue viruses.

Dengue viruses (DENVs) are human pathogens that constitute a significant threat worldwide. Since they up-regulate MHC class I molecules; the cell-mediated immunity may play an important role in the defense against viruses. In this work, we tested a CFSE-based assay in determining proliferative response of lymphocytes isolated from mice or monkeys previously immunized with various DENV antigens to in vitro stimulation with DENVs. A positive proliferative response was obtained with lymphocytes of animals immunized with either live DENV-2 or its recombinant proteins. A similar result was also obtained with CD8+ T cells from mice immunized with live DENV-1 or DENV-2 following stimulation with homologous viruses. A comparison of the carboxyfluorescein diacetate succinimidyl ester (CFSE)-based and a 3H-thymidine incorporation-based assays of proliferative response of total lymphocytes showed a fair correlation of results of both assays. However, the CSFE-based assay offers in addition the determination of contribution of the CD8+ or other subsets of T cells to total proliferative response. These results represent the first and successful application of a CFSE-based assay to the evaluation of cell-mediated immunity to DENVs. This assay might be also exploited in testing candidate DENV vaccines.

Ivor Lewis approach is superior to transhiatal approach in retrieval of lymph nodes at esophagectomy.

Lymph node involvement may impact postoperative therapeutic decision-making and prognosis in patients undergoing esophagectomy. This study evaluates which surgical approach yields the most lymph nodes. We undertook a retrospective chart review of esophagectomies performed by six surgeons from April 1994 to February 2004 using a prospective general thoracic surgery database at Mayo Clinic, Rochester, Minnesota, US. Lymph nodes were categorized into one of 17 regions per the American Joint Committee on Cancer, with the total number of lymph nodes, summed over each region, used as the primary outcome. A total of 517 esophagectomies were performed: 68 transhiatal, 392 Ivor Lewis, and 57 extended Ivor Lewis. A mean of 18.7 (SD 8.5) lymph nodes were retrieved with the Ivor Lewis approach as compared to 17.4 (SD 9.2) with the extended Ivor Lewis approach (P = 0.30). Since there was no statistical difference between the number of nodes collected in either Ivor Lewis approach, they were collapsed into one group for comparison with the transhiatal cases. Significantly more lymph nodes were collected with an Ivor Lewis approach (mean 18.5, SD 8.6) than with a transhiatal approach (mean 9.0, SD 5.0, P < 0.001). As expected, more thoracic lymph nodes were retrieved with the Ivor Lewis approach [mean 12.4 (SD 7.0) vs. 4.7 (SD 5.3), P < 0.001]. The Ivor Lewis approach was also superior for retrieval of abdominal nodes [mean 6.1 (SD 5.6) versus 4.3 (SD 4.4), P = 0.01]. More lymph nodes are obtained at esophagectomy with an Ivor Lewis than a transhiatal approach.

Impact of endoscopic ultrasonography and physician specialty on the management of patients with esophagus cancer.

While endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) are the most accurate techniques for locoregional staging of esophageal cancer, little evidence exists that these innovations impact on clinical care. The objective on this study was to determine the frequency with which EUS and EUS-FNA alter the management of patients with localized esophageal cancer, and assess practice variation among specialists at a tertiary care center. Three gastroenterologists, three medical oncologists, three radiation oncologists and four thoracic surgeons were asked to independently report their management recommendations as the anonymized staging information of 50 prospectively enrolled patients from another study were sequentially disclosed on-line. Compared to initial management recommendations, that were based upon history, physical examination, upper endoscopy and CT scan results, EUS prompted a change in management 24% (95% CI: 12-36%) of the time; usually to a more resource-intensive approach (71%), for example from recommending palliation to recommending neoadjuvant chemoradiation therapy. EUS-FNA plus cytology results altered management an additional 8% (95% CI: 6-15%) of the time. Agreement between specialists ranged from fair (intraclass correlation [ICC=0.32) to substantial (ICC=0.65); improving with additional information. Among specialists, agreement was greatest for patients with stage I disease. EUS and EUS-FNA changed patient management the most for patients with stages IIA, IIB or III disease. EUS, with or without FNA, significantly impacts the management of patients with localized esophageal cancer. With respect to the optimal treatment for each patient, agreement among physicians incrementally increases with endoscopic ultrasound results. Specialty training appears to influence therapeutic decision-making behavior.

[Surgical practice in the Mexican Empire]. / El ejercicio de la cirugía en el imperio mexica.

The prehispanic medicines of Mexico are considered as testimony of the splendor of the Meso-American cultures; their great scientific advance and technical allowed them to accumulate a vast collection of clinical and pathological data based on the observation and experimentation. They integrated a nomenclature medical surgical that reflected their advance in those fields of the knowledge, where the anatomy and surgery occupied a preponderant paper. The medicine was known generically as ticiotl, of where it derives the term tícitl for the doctor. In their concept health-illness the limits among the magic, religion and the empiricism for natural causes were not clear, therefore they considered that the divine, human or natural origin of the illnesses influenced in an important way in its nature. Inside this complex causal system, the illnesses caused by the gods, spirits and celestial beings were considered as hot, while those caused by beings of the other realm were cold. The practice of the medicine had a very established organization designing a very advanced system of specialties that allowed them to accumulate a vast experience for the handling of chronic and acute illnesses in different progression phases, which managed with an integral therapy that had a plurality of resources of vegetable origin, animal, and mineral. The surgery was designated as texoxotlaliztli and its cures tepatiliztli. The surgeon was designated as texoxotlaticitl and it developed advanced techniques in the handling of sutures, wounded, drainage of abscesses, fractures and joint dislocations, pterygium, tonsillitis, circumcision, and amputations.

The changing incidence of oesophageal and gastric adenocarcinoma by anatomic sub-site.

BACKGROUND: The incidence rates of gastric and oesophageal adenocarcinoma are changing significantly, but little is known about specific sub-sites. AIM: To use a population-based approach to describe the trends in the site-specific incidence of oesophageal and gastric adenocarcinoma. METHODS: Using the Rochester Epidemiology Project, all cases of gastric and oesophageal adenocarcinoma among Olmsted County, Minnesota, residents first diagnosed between 1971 and 2000 were identified (n = 186). Complete in-patient and out-patient records were reviewed and site determined from pathological, surgical, endoscopic and radiological reports. RESULTS: Between the decades of 1971-1980 and 1991-2000, the incidence of oesophageal adenocarcinoma increased significantly from 0.4 to 2.5 per 100 000 person-years. The incidence of adenocarcinoma of the oesophagogastric junction also increased from a rate of 0.6 to 2.2 per 100 000 person-years. The incidence rate of cancer involving the gastric cardia was stable but the incidence of adenocarcinoma involving distal gastric sites declined. Combined oesophageal and oesophagogastric junction adenocarcinoma (4.7 per 1 000 000 person-years) was as common as gastric adenocarcinoma (3.4 per 100 000 person-years) in 1991-2000. CONCLUSIONS: The incidence rates of adenocarcinoma involving proximal gastric sub-sites do not appear to be increasing in a manner similar to those involving oesophageal sub-sites.

[Penile calciphylaxis: case report and literature review]. / Calcifilaxis del pene: reporte de un caso y revisión de la bibliografía.

BACKGROUND: Calciphylaxis is a serious condition characterized by ischemic ulceration of the skin and necrosis secondary to dystrophic calcification of the subcutaneous tissue and small arteries. It affects primarily patients with end-stage renal disease with prevalence up to 4%. However, penile calciphylaxis has been reported in only 37 cases in the international literature. We report one case, to review the literature and to provide the basis for a rational treatment of calciphylaxis of the penis that reduces the associated mortality. CASE REPORT: We report the case of an 82-year-old male with a 15-year history of type 2 diabetes mellitus and renal insufficiency during the past 2 years. He presented an increase of consistency of the distal portion in the penis' glans and scrotal swelling, evolving to complete penile glans necrosis. CONCLUSIONS: With the increase of the number of patients on dialysis treatment, the prevalence of calciphylaxis will increase. A high index of suspicion is warranted in all patients with end-stage renal disease and who present the characteristic genital lesions. Treatment of this complication must include avoidance of all exogenous calcium, administration of calcitriol analogues to offset the PTH, emergency parathyroidectomy in the case of overt hyperparathyroidism and aggressive surgical treatment with total or partial penectomy.

[Distinguished doctors of the University of Padua and their works: 16th to 18th centuries]. / Médicos notables de la Universidad de Padua y sus obras. Siglos XVI a XVIII.

Italian universities have been distinguished since their beginnings, within different specialties. One of them, if not the most important, is the teaching of medicine. One of the leaders is the University of Padua, founded in 1222, establishing itself as the second most important institution after the University of Bologna. In spite of the difficulties faced by this university, as with most other universities during the medieval period, it continued to perform and consolidate once again during the Renaissance as one of the most outstanding universities in Europe. The University of Bologna and the University of Padua shared the leadership in teaching during this period. At the University of Padua, the lectures were always full with teachers and students of great fame, such as Andreas Vesalio, Gabriele Falopio, William Harvey, Giovanni Battista Morgagni, Antonio Scarpa, to name just a few. In this article we discuss the rights the University had since it beginnings, from its establishment to the Renaissance, and the great influence of some of the teachers and students in the art and science of medicine.

[Teaching of medicine of the University of Bologna in the Reinaissance]. / La enseñanza de la Medicina en la Universidad de Bolonia en el Renacimiento.

The foundation date of the University of Bologna was 1150, was the first European University and set the pattern. The combination of structured teaching and students association marked the origin of the studium generale. The presence of teaching legists encouraged teachers in others fields to come to Bologna. Ars dictaminis, grammar, logic, philosophy, mathematical arts and especially medicine were taught there by the middle of the thirteenth century. The university had to offer advanced instruction in law, medicine, and theology, had a minimum of six to eight professors teaching civil law, canon law, medicine, logic, natural philosophy and usually rhetoric. Many professors bearing local names were able scholars and commanding figures in medicine and surgery. Taddeo Alderotti (1210-95) began to teach medicine in Bologna about 1260. He soon raised medicine to a prestigious position in the university. The geographical distribution demonstrates the international character of the student body 73% were Italians and 26% non Italians. The decision of the commune of Bologna to wrest control of the university from the students by paying professors was probably the most important decision in the history of Italian universities. Examination of the distribution of professors offers a detailed picture of the faculty. In 1370 the university had 11 professors of civil law, seven professors of canon law, three professors of medical theory, two of medical practice (the specific of diagnosis and treatment), and one professor of surgery. After growing steadily the numbers of teachers stabilized at 85 to 110 until 1530.

[Tagliacozzi: not just a plastic surgeon]. / Tagliacozzi: no sólo cirujano plástico.

Gaspare Tagliacozzi is known because of his great contributions to plastic surgery. He is considered a pioneer in the field, which has had more influence in his career than his other transcendental activity as a surgery and anatomy teacher in Bologna for almost 30 years. The aim of the present manuscript is to analyze his teaching activities which were equally important for us, and to recreate, with pictorial means, three unpublished historic moments in the life of this great man of science. Gaspare Tagliacozzi was born in Bologna in 1545 and is considered the father of plastic surgery. He obtained a degree in medicine and philosophy at the University. He was named surgery professor in 1576, and worked as such until his death in 1599. His De Curtorum Chirurgia per Insitionem treatise was published in 1589 and was considered the first exclusive treatise on plastic surgery. Bologna built a permanent operating theater (amphitheater) within the Archiginnasio in 1595. Because of his success, he increased his earnings; his first university teaching salary was 100 lire, but his earning increased to 1,140 lire later. Tagliacozzi's contributions, together with that of others such as Vesalius, Aldrovandi, Fallopian and Eustachian advanced the field and knowledge of anatomy.

[Foundation and organization of the University of Bologna from the XII century to the Renaissance]. / Fundación y organización de la Universidad de Bolonia desde el siglo XII al Renacimiento.

The University of Bologna was founded in 1150 and was the first European University to establish this educational trend. The combination of structured teaching and student associations marked the origin of the studium generale. The presence of teaching legists encouraged teachers in others fields to come to Bologna. Ars dictaminis, grammar, logic, philosophy, mathematics and especially medicine were taught there by the middle of the thirteenth century. The university offered advanced instruction in law, medicine, and theology and had a minimum of six to eight professors teaching civil law, canonical law, medicine, logic, natural philosophy and usually rhetoric. Many professors bearing local names were learned scholars and commanding figures in medicine and surgery. Taddeo Alderotti (1210-1295) began to teach medicine in Bologna in about 1260. He soon raised medicine to a prestigious position in the university. The geographical distribution demonstrates the international distribution of the student body: 73% were Italians and 26% non-Italians. The decision of the legislature of Bologna to take control of the university from the students by paying professors was probably the most important decision in the history of Italian universities. Examination of the distribution of professors offers a detailed picture of the faculty. In 1370 the university had 11 professors of civil law, 7 professors of canonical law, 3 professors of medical theory, 2 professors of medical practice (specifically of diagnosis and treatment), and 1 professor of surgery. After growing steadily, the numbers of teachers stabilized at 85 to 110 until the year 1530.

Lyophilized allografts without pre-treatment with glutaraldehyde are more suitable than cryopreserved allografts for pulmonary artery reconstruction.

Various methods are available for preservation of vascular grafts for pulmonary artery (PA) replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA) grafts and cryopreserved (CryoPA) grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP) in group III increased significantly at the end of the study compared with baseline (P=0.02) and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA)] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA). Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising.

Induction of apoptosis by 2-chlorodeoxyadenosine in B cell chronic lymphocytic leukemia.

We investigated whether 2-chlorodexoyadenosine could induce apoptosis in B cell chronic lymphocytic leukemia (B-CLL) cells in vitro using clinically achievable drug doses, measuring apoptosis ratio by flow cytometry. B cells were isolated from previously untreated patients and apoptosis was measured in these cells immediately after isolation and following incubation in vitro, without and with 2-chlorodeoxyadenosine at different concentrations, for 24 and 48 h. Distribution of cellular DNA content and quantitative analysis of apoptosis were determined by standard propidium iodide staining and flow cytometry. Spontaneous apoptosis occurred in B-CLL cells incubated in vitro in the absence of drug, but the level of apoptosis was greater in cells treated with 2-chlorodeoxyadenosine after the second day of culture. The present in vitro study of B-CLL cells from previously untreated patients suggests this chemotherapeutic agent activates a program of cell death by apoptosis using a drug dose equivalent to the physiological concentration used in patients in vivo. These data reveal an interesting possibility in the 2-chlorodeoxyadenosine treatment of untreated patients by neoplastic B cell apoptosis induction.

[Surgery and anatomy in the Renaissance]. / La cátedra de cirugía y anatomía en el Renacimiento.

The interest in the physical perfection and the corporal forms brings as a result the creation of new anatomical studies. The anatomical knowledge progressed in the second half of the XV century, conceiving the knowledge of the human body as a basic reality of Medicine. One of the greater contributions of the Italian Universities to medicine was the teaching of anatomy. The Universities of Padua, Bologna, and Pisa educated in their classrooms great physicians like Andres Vesalio, Gabriel Fallopio, Realdo Colombo, Mondino de Luzzi, Julio Ceasar Aranzio, and Gaspare Tagliacozzi, among others. The teaching of anatomy during the Renaissance was characterized by the development of dissection techniques and autopsy practice, which was recognized as an extremely valuable skill for anatomical study. The dissections were made in circular amphitheatres in the following way: a Medicine professor read the text book, another one made the dissection, and a third one indicated the structures referred.

[Maffucci's syndrome. Case reports and literature review]. / Síndrome de Maffucci. Informe de dos pacientes y revisión de la literatura.

Maffucci syndrome is a rare, congenital disease, which is associated with the appearance of multiple enchondromas (possibility of malignant transformation in 20 to 100%), soft tissue hemangiomas and other mesenchymatous injuries. Case 1 is a 33-year-old female who presented with multiple nodules predominantly in upper extremities. Upon examination, there was deformity in articulation and nodules on the hands, which were soft and moveable. There were bony shavings in the second and fourth fingers of the left hand (enchondromas and atypical cells associated with hemangioma esclerosante). Maffucci syndrome was diagnosed. Later, excision of subcutaneous nodules in superior extremities was performed along with excision of nodules in both hands and hypochondrium (enchondroma injuries of left hand and hypochondrium, hemangioma in right hand). There was dysarticulation of the second finger at the metacarpal level of the phalanges of the left hand (chondrosarcoma). The patient is being followed up currently. Case 2 is a 26-year-old female. The patient had a history of subcutaneous abdominal tumor, exostosis, nodules and nodule in right breast. Upon examination, a tumor was found in the right breast, exostosis of right tibia, injury to the right wrist and left thyroid nodule. A simple mastectomy and axillary dissection was performed (fibroadenoma to intracanalicular and 14 negative lymph nodes). Later, left thyroidectomy and lumpectomy in right wrist were performed (hyperplasia to nodular thyroid and hemangioma cavernous). There was injury in the carpus of the right hand and elbow (hemangioma cavernous and synovial tissue with fibrosis and enchondroma). A diagnosis was made of Marffucci syndrome associated with mesenchymatous tumors. The patient was in poor general health and did not survive this hospitalization.