The cost effectiveness of vacuum-assisted versus core-needle versus surgical biopsy of breast lesions. / Estudio de costo-efectividad de la biopsia mamaria asistida por vacío versus biopsia con aguja gruesa o arpón.

OBJECTIVES: To determine the cost effectiveness of breast biopsy by 9G vacuum-assisted guided by vertical stereotaxy or ultrasonography in comparison with breast biopsy by 14G core-needle biopsy and surgical biopsy. MATERIAL AND METHODS: We analyzed a total of 997 biopsies (181 vacuum-assisted, 626 core, and 190 surgical biopsies). We calculated the total costs (indirect and direct) of the three types of biopsy. We did not calculate intangible costs. We measured the percentage of correct diagnoses obtained with each technique. To identify the most cost-effective option, we calculated the mean ratios for the three types of biopsies. RESULTS: Total costs were €225.09 for core biopsy, €638.90 for vacuum-assisted biopsy, and €1780.01 for surgical biopsy. The overall percentage of correct diagnoses was 91.81% for core biopsy, 94.03% for vacuum-assisted biopsy, and 100% for surgical biopsy; however, these differences did not reach statistical significance (p=0.3485). For microcalcifications, the percentage of correct diagnoses was 50% for core biopsy and 96.77% for vacuum-assisted biopsy (p<0.0001). For nodules, there were no significant differences among techniques. The mean cost-effectiveness ratio considering all lesions was 2.45 for core biopsy, 6.79 for vacuum-assisted biopsy, and 17.80 for surgical biopsy. CONCLUSION: Core biopsy was the dominant option for the diagnosis of suspicious breast lesions in general. However, in cases with microcalcifications, the low percentage of correct diagnoses achieved by core biopsy (50%) advises against its use in this context, where vacuum-assisted biopsy would be the technique of choice because it is more cost-effective than surgical biopsy, the other technique indicated for biopsying microcalcifications.

[Update on the radiological study of pulmonary tuberculosis]. / Puesta al día en el estudio radiológico de la tuberculosis pulmonary.

Tuberculosis has made a comeback in recent years. This upsurge has been attributed to factors such as increased immigration and the human immunodeficiency virus epidemic. Primary pulmonary tuberculosis manifests radiologically with parenchymal involvement, lymph node involvement, pleural effusion, and/or miliary disease. In post-primary tuberculosis, the earliest radiological sign is small nodules and branching centrilobular lesions that increase in size and coalesce to form ill-defined patchy consolidations; cavitations are very characteristic of active disease. The aim of this article is to describe the radiologic findings for pulmonary tuberculosis and its complications.

Pulsed dye laser treatment for facial flat warts.

The facial flat wart is not only a contagious viral disease, but also a cause of a distressing cosmetic problem. Although there are many therapeutic options, including salicylic acid, imiquimod, cryotherapy, retinoids, intralesional immunotherapy, and topical 5-aminolevulinic acid photodynamic therapy among others, no monotherapy has been proved to achieve complete remission in every case. Treatment with pulsed dye laser (PDL) seems to be a promising therapeutic option. To assess the efficacy and safety of PDL in a series of patients with viral flat warts on the face, in this prospective study, 32 patients were treated with PDL at 595-nm wavelength, a laser energy density of 9 or 14 J/cm(2) with a spot size of 7 or 5 mm, respectively, with air cooling and a pulse duration of 0.5 millisecond. A complete response was noted in 14 patients (44%), and an excellent response was observed in 18 patients (56%) with 1-year follow-up, with only four recurrences. No significant side effects were reported except intense transitory purpuric response. We consider that PDL is a good option of treatment for flat warts on the face due to its good clinical results, fast response, and low incidence of side effects.

New reference nomograms for the study of ventricular size in preterm infants.

INTRODUCTION: Transfontanellar brain ultrasound is an essential tool for monitoring the size of the ventricles in preterm neonates and has many advantages over other alternative diagnostic techniques, including its accessibility and non-use of ionizing radiation. When considering the normal ventricular size, it is essential to have reference measurements based on age-matched populations. The objective of this article is to present our reference measures, based on a sample of preterm infants that we have studied. METHODS: A retrospective observational study was conducted. Measurements of the Levene index, frontal horn thickness, and Evans index were obtained in preterm neonates from 25 to 45 weeks, over a period of 5 years, between January 2016 and December 2020. After applying the exclusion criteria, a sample of 199 patients and 350 ultrasound scans were obtained. The independent samples t-test and the Mann-Whitney test were used for the comparison of samples. RESULTS: The distribution of the right and left Levene indices was normal (Shapiro-Wilk test with p = 0.16 and 0.05, respectively), unlike the thickness distribution of the frontal horns (p < 0.05 on both sides). No significant differences were detected between the sexes (p = 0.08). A linear correlation was found between the biparietal diameter and the Levene index. CONCLUSION: From the results obtained in our study, we present reference tables for ventricular size, with the 3rd, 25th, 50th, 75th, and 97th, being the first ones made in our country.

Dermatologic emergencies: descriptive analysis of 861 patients in a tertiary care teaching hospital.

INTRODUCTION AND OBJECTIVES: Most Spanish hospitals do not have an on-call dermatologist. The primary objective of our study was to determine the profile of patients visiting our hospital's emergency department for dermatologic conditions; our secondary objective was to analyze the case-resolving capacity of the on-call dermatologist. MATERIAL AND METHODS: Prospective study that included patients with dermatologic conditions treated in the emergency department of a hospital with an on-call dermatology resident during a 2-month period. We collected data on sex, age, diagnosis, days since onset, whether or not the emergency visit was justified, referral (self-referral or other), continued care, and the main reason for the visit. To analyze the case-resolving capacity of the on-call dermatologist we assessed the percentage of direct discharges, the diagnostic tests performed, and the percentage of revisits. RESULTS: The on-call dermatologist attended 861 patients (14.4 patients per day), of whom 58% were women and 42% men. In total, 131 different diagnoses were made; the most common were infectious cellulitis, acute urticaria, and herpes zoster. Only half of the visits were justifiable as emergencies (95% of patients <30 years of age had conditions that did not justify emergency care, compared to 6% of patients >65 years, P<.005). The on-call dermatologist discharged 58% of the patients directly and the revisit rate was 1%. In 4 of 5 emergency visits no diagnostic tests were required. CONCLUSIONS: The profile of patients seeking emergency dermatologic care is variable. Half of the emergency visits were not justified, and unjustified visits were especially common in younger patients. The case-resolving capacity of the on-call dermatologist was high.

Update on meningioma: Clinical-radiological and radio-pathological correlation.

Meningiomas are tumors that originate in the arachnoid villi and are the most common non-glial neoplasm in the central nervous system. The clinical manifestations associated with meningioma depend, fundamentally, on its location. The location in the cerebral convexity is the most frequent, especially in the frontal lobes, manifesting with headache, motor disturbances, seizures and even neurocognitive disorders. There are 15 histologic subtypes of meningioma and three histologic grades. Within these, grades two and three have a worse prognosis and a higher rate of recurrence, as well as a radiological behavior that is generally more aggressive. Although there are some imaging features that can suggest a specific subtype, the definitive diagnosis will always require histological/molecular confirmation.

Sorption and desorption of Cd, Cu and Pb using biomass from an eutrophized habitat in monometallic and bimetallic systems.

This work examines the sorption capacity of a natural biomass collected from an irrigation pond. The biomass mainly consisted of a mixture of chlorophyte algae with caducipholic plants. Biosorption experiments were performed in monometallic and bimetallic solutions containing different metals commonly found in industrial effluents (Cd, Cu and Pb). The biosorption process was slightly slower in the binary system comparing with monometallic system which was related to competition phenomena between metal cations in solution. The biosorbent behaviour was quantified by the sorption isotherms fitting the experimental data to mathematical models. In monometallic systems, the Langmuir model showed a better fit with the following sorption order: Cu ~ Pb > Cd; and biomass-metal affinity order: Pb > Cd ~ Cu. In bimetallic systems, the binary-type Langmuir model was used and the sorption order obtained was: Pb ~ Cu > Cd. In addition, the effectiveness of the biomass was investigated in several sorption-desorption cycles using HCl and NaHCO(3). The recovery of metal was higher with HCl than with NaHCO(3), though the sorption uptake of the biomass was sensitively affected by the former desorption agent in subsequent sorption cycles.

Mechanism of adsorption of ferric iron by extracellular polymeric substances (EPS) from a bacterium Acidiphilium sp.

The aim of this study was to assess the sorption of Fe(III) by extracellular polymeric substances (EPS) of the Acidiphilium 3.2Sup(5) bacterium, which has promising properties for use in microbial fuel cells (MFC). The EPS of A. 3.2Sup(5) was extracted using EDTA. The sorption isotherms were determined using aliquots of purified EPS. The exosubstances loaded with metal were characterized by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), X-ray diffraction spectroscopy (XRD) and Fourier transform infrared spectroscopy (FTIR). The sorption uptake approaches to 536.1 +/- 26.6 mg Fe(III) (g EPS)(-1) at an initial ferric concentration of 2.0 g l(-1). The sorption of Fe(III) by EPS can be fitted to the Freundlich model. The sorption process produces hydrated iron (III) oxalate [Fe(OH)(C2O4) x 2H2O] by a reversible reaction (log K = 1.06 +/- 0.16), indicating that a shift in the sorption of the cation can be easily achieved. Know the magnitude and form of iron sorption by EPS in MFC can foresee the potential impact on the metabolism of iron-reducing and iron-oxidazing bacteria and, therefore, on the feasibility of the system.

Optimization of the continuous biosorption of copper with sugar-beet pectin gels.

Sugar-beet pectin xerogels obtained from residues of the sugar industry are an adequate material for metal recovery from effluents in continuous systems. The xerogels were used as a biosorbent for copper removal in a fixed-bed column. The performance of the system was evaluated in different experimental conditions: flow rate, bed height, inlet metal concentration and feeding system (drop and reverse). The effect on the biosorption parameters (saturation time, amount of adsorbed and treated metal, column performance and metal uptake) and the shape of the breakthrough curves was determined. The saturation time increased with increasing bed height but decreased with increasing feed flow rate and inlet metal concentration. Preferential flow channels greatly influenced the metal uptake and column performance. Copper was completely desorbed with 0.1M HNO(3). Additionally, the column data fitted both the linear and nonlinear expressions of the Thomas model.

Extraction of extracellular polymeric substances from the acidophilic bacterium Acidiphilium 3.2Sup(5).

Extraction of extracellular polymeric substances (EPS) from Acidiphilium 3.2Sup(5) was investigated using five methods: EDTA, NaOH, ion exchange resin, heating and centrifugation. The bacterium studied presents promising application in microbial fuel cells (MFCs). The degree of cellular lysis provoked by each method was determined by UV-visible spectroscopy of cultures before and after EPS extraction. In addition, two electron microscopy techniques (TEM and SEM) were employed to determine the degree of attachment and the growth of the biofilm overtime on two solid supports: carbon fibre cloth and graphite rods. The main constituents of the EPS extracted by all methods were proteins and carbohydrates, as confirmed by FT-IR analysis, showing the major presence of carboxylic, hydroxylic and amino groups. The greater extractions of EPS were obtained using EDTA. This method also produced a less degree of cellular lysis. Furthermore, both the amount and the chemical composition of EPS strongly depended on the extraction method used.

Cost-effectiveness of hydrogel plugs in CT-guided lung biopsies. / Estudio de coste-efectividad sobre la utilización de un tapón de hidrogel en las biopsias pulmonares guiadas por tomografía computarizada.

OBJECTIVE: Using a hydrogel plug decreases the number of cases of pneumothorax and reduces the need for pleural drainage tubes in CT-guided lung biopsies. We aimed to analyze the cost-effectiveness of using hydrogel plugs. MATERIAL AND METHODS: We analyzed 171 lung biopsies divided into three groups: Group 1 (n=22): fine-needle aspiration cytology (FNAC) without hydrogel plugs; Group 2 (n=89): FNAC with hydrogel plugs; and Group 3 (n=60): FNAC plus core-needle biopsy (CNB) with hydrogel plugs. We calculated the total costs (direct and indirect) in the three groups. We analyzed the percentage of correct diagnoses, the average and incremental rations, and the most cost-effective option. RESULTS: Total costs: Group 1 = 1,261.28 + 52.65 = € 1,313.93; Group 2 = 1,201.36 + 67.25 = € 1,268.61; Group 3 = 1,220.22 + 47.20 = € 1,267.42. Percentage of correct diagnoses: Group 1 = 77.3%, Group 2 = 85.4%, and Group 3 = 95% (p = 0.04). Average cost-effectiveness ratio: Group 1 = 16.99; Group 2 = 14.85; and Group 3 = 13.34. CONCLUSIONS: Group 3 was the best option, with the lowest average cost-effectiveness ratio; therefore, the most cost-effective approach is to do FNAC and CNB using a dehydrated hydrogel plug at the end of the procedure.

Biosorption of heavy metals by Fucus spiralis.

The sorption uptake of cadmium, nickel, zinc, copper and lead by marine brown alga Fucus spiralis was investigated in bimetallic, trimetallic and multimetallic solutions. The experimental data fitted very well to Langmuir model. In bimetallic systems, the affinity of biomass for lead and copper increased and the sorption uptake of these metals was not affected by increasing concentrations of cadmium, nickel or zinc. However, in solutions with both metals there was a significant mutual decrease of their sorption levels at high concentrations of the other metal. The sorption uptake of cadmium, nickel and copper was investigated in trimetallic aqueous systems. Based on the kinetic parameter b, the affinity of F. spiralis for copper was considerably higher than for cadmium or nickel: bCd=6.39, bNi=1.82 and bCu=17.89. In all tests, the maximum sorption uptake remained practically constant around 1 mmol/g, indicating that the number of active sites on the biomass was limited. Tests with four and five metals showed that copper was preferentially adsorbed. The differences between the experimental sorption data and those given by the chemical speciation program PHREEQCI were negligible. In general, the software used provided satisfactory estimated data for each metal and hence can be a useful tool to predict or simulate the real process.

Study of cadmium, zinc and lead biosorption by orange wastes using the subsequent addition method.

The biosorption of several metals (Cd2+, Zn2+ and Pb2+) by orange wastes has been investigated in binary systems. Multicomponent sorption isotherms were obtained using an original procedure, similar to that proposed by Pagnanelli et al. [Pagnanelli, F., Petrangeli, M.P., Toro, L., Trifoni, M., Veglio, F., 2001a. Biosorption of metal ions on Arthrobacter sp.: biomass characterization and biosorption modelling. Environ. Sci. Technol. 34, 2773-2778] for monoelement systems, known as subsequent addition method (SAM). Experimental sorption data were analysed using an extended multicomponent Langmuir equation. The maximum sorption uptake was approximately 0.25mmol/g for the three binary systems studied. The reliability of the proposed procedure for obtaining the equilibrium data in binary systems was verified by means of a statistical F-test.

Characterization of the biosorption of cadmium, lead and copper with the brown alga Fucus vesiculosus.

The recovery of cadmium, lead and copper with the brown alga Fucus vesiculosus was characterized and quantified. The biosorption data fitted the pseudo-second order and Langmuir isotherm models, but did not adjust to the intraparticle diffusion model. The metal uptakes deduced from the pseudo-second order kinetic model and the Langmuir isotherm model followed a similar sequence: Cu>Cd approximately Pb. The Langmuir maximum metal uptakes were: 0.9626 mmol/g, Pb 1.02 mmol/g, and Cu 1.66 mmol/g. According to the equilibrium constants of this isotherm model, the affinity of metals for the biomass followed this order: Pb>Cu>Cd. Biosorption was accomplished by ion exchange between metals in solution and algal protons, calcium and other light metals, and by complexation of the adsorbed metals with algal carboxyl groups. FTIR spectra showed a shift in the bands of carboxyl, hydroxyl and sulfonate groups.

Increased polyamines may downregulate interleukin 2 production in rheumatoid arthritis.

Polyamines downregulate immune reactivity. RA is associated with decreased IL 2 production. In this study, we present evidence to suggest that excessive polyamines can contribute to the IL 2 deficiency in RA. Blocking polyamine production with inhibitors of ornithine decarboxylase results in increased IL 2 production by RA PBMC. Moreover, polyamine oxidase (PAO) inhibitors and catalase also increase IL 2 production by RA PBMC. This effect of PAO inhibition is monocyte mediated. After 3 d in culture, RA PBMC produce three times more IL 2 than do normal PBMC. This rise is prevented by exogenous spermidine but only in the presence of monocytes. The concentration of polyamines in RA PBMC and synovial fluid MNC is 2-20-fold higher than in normal cells. Thus, polyamines and their oxidation products downregulate IL 2 production by RA PBMC and may account for the decreased T cell effector function seen in this disease.

A conserved idiotype and antibodies to retroviral proteins in systemic lupus erythematosus.

22 of 61 systemic lupus erythematosus (SLE) patients produced antibodies to the p24 gag protein of HIV-1 demonstrated by Western blotting. 20 of these 22 patients (91%) also express the 4B4 idiotype (Id 4B4) previously identified on a human anti-Sm monoclonal antibody called 4B4. This represents an enrichment for this Id (seen in only 52% of SLE patients generally). Eight of these 22 SLE patients also have anti-Sm antibody activity. Sm partially inhibits the antibody binding of p24 gag suggesting immunologic cross-reactivity between the retroviral antigen p24 gag and the autoantigen Sm. Anti-Id 4B4 also inhibits p24 gag antibody binding by as much as 40%. Finally the monoclonal antibody 4B4 showed cross-reactivity to Sm and p24 gag. The following points emerge from our studies: (a) SLE patients make antibodies to p24 gag of HIV-1, (b) there is a relationship between immunity to p24 gag and a conserved idiotype, and (c) anti-Sm antibodies can cross-react with p24 gag.

Comparative study of biosorption of heavy metals using different types of algae.

Sorption capacity of six different algae (green, red and brown) was evaluated in the recovery of cadmium, nickel, zinc, copper and lead from aqueous solutions. The optimum sorption conditions were studied for each monometallic system. The optimum pH was 6 for the recovery of Cd, Ni and Zn, and less than 5 for Cu and Pb. The best results were obtained with the lowest biomass concentration used (0.5 g/L). Experimental data fitted a Langmuir model very well according to the following sequence of the sorption values: Pb>Cd> or =Cu>Zn>Ni. The brown algae achieved the lowest metal concentration levels in solution; the best results were obtained with Fucus spiralis. Finally, a software computer program was used to simulate the process by comparison of theoretical with experimental results and show minimum differences between both types of data.

Microbial activity in weathering columns.

The aim of the present work was to evaluate the metabolic activity of the microbial population associated with a pyritic tailing after a column-weathering test. For this purpose, a column 150cm high and 15cm diameter was used. The solid was a tailing with 63.4% pyrite and with minor amounts of Cu, Pb and Zn sulfides (1.4, 0.5 and 0.8%, respectively). The column model was the habitual one for weathering tests: distilled water was added at the top of the column; the water flowed down through tailings and finally was collected at the bottom for chemical and microbiological analysis. Weathering was maintained for 36 weeks. The results showed a significant presence of microbial life that was distributed selectively over the column: sulfur- and iron-oxidizing aerobic bacteria were in the more oxygenated zone; anaerobic sulfur-reducing bacteria were isolated from the samples taken from the anoxic part of the column. Activity testing showed that (oxidizing and reducing) bacteria populations were active at the end of the weathering test. The quality of the water draining from the column was thus the final product of biological oxidation and reduction promoted by the bacteria consortia.