Pancreatic panniculitis revisited: A series of 34 patients.

BACKGROUND: Pancreatic panniculitis is a rare form of panniculitis generally associated with acute or chronic pancreatitis, and less frequently with pancreatic carcinoma. Clinically, it presents with subcutaneous nodules usually located in the lower extremities, however, it presents an almost pathognomonic histopathological finding with enzymatic fat necrosis in the adipose tissue. METHODS: In this retrospective case series of five hospitals, biopsy specimens of cutaneous lesions of pancreatic panniculitis were reviewed. Clinical information was obtained through medical records. RESULTS: A total of 34 cases were included, 23 women and 11 men, aged between 31 and 92 years. The most common associated pancreatic disease was acute pancreatitis (23 cases) and its main triggering cause was gallstones (17 cases). In two patients it was related to chronic pancreatitis and six cases were associated with malignancy. Histopathological findings were always the key to diagnosis. In the biopsies reviewed, mostly lobular panniculitis with the characteristic necrosis of the adipocytes was observed. In addition, nine of the cases presented with Splendore-Hoeppli phenomenon. CONCLUSIONS: We present the largest series of pancreatic panniculitis. Clinically, the female predominance and biliary lithiasis as the main cause of acute pancreatitis are to be emphasized. Histopathologically, a peripheral eosinophilic striated rim surrounding aggregates of ghost adipocytes consistent with Splendore-Hoeppli is an additional clue to its diagnosis.

Clinical Outcomes after Surgical Resection Combined with Brachytherapy for Uveal Melanomas.

Currently, brachytherapy is the most commonly used therapeutic approach for uveal melanomas. Surgical resection by means of endoresection or exoresection is an alternative approach. The present report recounts our experience over 15 years in the treatment of uveal melanoma using a combined approach of resection surgery with brachytherapy. This is a single-center observational retrospective cohort study in which we describe clinical outcomes, complications and survival in 35 cases of melanoma of the iris or the ciliary body after a combination of surgery and brachytherapy or brachytherapy alone. Local treatment of the tumor was successful in all cases with surgery and brachytherapy. The most frequent complications were scleromalacia, bullous keratopathy, retinal toxicity, cataracts, hypotonia, and photophobia. There were three cases of recurrence, all of which were found in the group of patients who had received brachytherapy alone, and in one case we had to perform a secondary enucleation due to tumor growth after brachytherapy. At present, only one patient has died during follow-up due to liver metastases six years after the start of treatment. In carefully selected patients, this approach can be effective and safe, as long as a close follow-up is carried out after surgery.

Morphological and Molecular Study of Hybrid Oncocytic/Chromophobe Tumor of the Kidney Associated with Sporadic Renal Oncocytosis and Chronic B-Cell Lymphocytic Leukemia: The Possible Contribution of Lymphoma to Renal Oncocytosis.

Hybrid oncocytic/chromophobe tumor (HOCT) of the kidney arising from a precursor oncocytosis not associated with the Birt-Hogg-Dubé (BHD) syndrome is an unusual and highly interesting neoplasm. Immunohistochemical and molecular findings suggest that HOCT is an entity distinct from both oncocytoma and chromophobe carcinoma. Although uncertainty persists regarding the factors predisposing to the development of HOCT, experimental findings suggest that it may arise due to the effect of toxins or in association with chronic kidney failure. The potential role of prior renal lymphoma in the development of oncocytosis has not hitherto been examined. We present a morphological, immunohistochemical, and molecular analysis of an HOCT arising from renal oncocytosis in conjunction with CLL affecting the kidney. The findings suggest that this tumor belongs to a family of similar neoplasms including oncocytoma, the eosinophilic variant of chromophobe renal-cell carcinoma (CRCC), and low-grade oncocytic tumor, even though these neoplasms may arise from different precursor lesions. HOCT and oncocytosis revealed the same immunohistochemical profile consistent on positivity for epithelial membrane antigen (EMA), cytokeratin 7 (Ck7), E-cadherin, CAM 5.2 and negativity for Pax-8, vimentin, renal-cell carcinoma (RCC) antigen, CD117, racemase, progesterone receptor, and CD10. The Ki-67 proliferation index was <1%. Molecular analysis of the tumor revealed the AKT3 gene mutation variant, classified as probably pathogenic, together with FOS1 gene amplification and no copy number variations (CNVs). Finally, we present a case of HOCT arising from a nonhereditary renal oncocytosis in conjunction with B lymphoma that raises interesting questions regarding pathogenesis.

Assaying the use of sodium thiosulphate as a biostimulant and its effect on cadmium accumulation and tolerance in Brassica oleracea plants.

An optimal uptake of mineral elements is crucial to ensure both crop yield and quality. The use of biostimulants is taking relevance to improve the nutrition of crops. Sulphur (S) is one of the elements with great potential within biostimulants. Furthermore, soil contamination by heavy metals such as cadmium (Cd) has become a serious environmental problem. Different studies have suggested the use of thiosulphate (TS) as a biostimulant and to increase the phytoremediation capacity of plants. Therefore, in the present study, we use a crop plant with high S requirements such as Brassica oleracea, to test whether TS serves as a biostimulant and whether affects Cd accumulation and tolerance. B. oleracea plants were grown with two different TS doses (2 mM and 4 mM), under Cd toxicity, and with the combination of Cd toxicity and both TS doses. Parameters of biomass, mineral elements accumulation, and stress tolerance were analyzed. The results showed that TS reduced biomass of B. oleracea plants. The application of 2 mM TS increased Cd accumulation whereas the 4 mM dose reduced it. On the other hand, TS incremented micronutrient accumulation on plants subjected to Cd toxicity and increased Zn contents. Besides, the application of 2 mM to Cd-stressed plants enhanced photosynthesis performance and reduced oxidative stress. Finally, TS increased the antioxidant capacity of B. oleracea plants. Briefly, although TS can not be used as a biostimulant it could be used for Cd phytoremediation purposes and to enhance Zn accumulation in B. oleracea plants.

Expression patterns for nicotinic acetylcholine receptor subunit genes in smoking-related lung cancers.

Cigarette smoking is associated with increased risk for all histologic types of lung cancer, but why the strength of this association is stronger for squamous cell carcinoma than adenocarcinoma of the lung (SQC-L, ADC-L) is not fully understood. Because nicotine and tobacco-specific nitrosamines contribute to carcinogenesis by activating nicotinic acetylcholine receptors (nAChRs) on lung tumors and epithelial cells, we investigated whether differential expression of nAChR subtypes in these tumors could explain their different association with smoking. Expression of nAChR subunit genes in paired tumor and non-tumor lung specimens from 40 SQC-L and 38 ADC-L patients was analyzed by quantitative PCR. Compared to normal lung, both tumors share: i) transcriptional dysregulation of CHRNA3/CHRNA5/CHRNB4 (α3, α5, ß4 subunits) at the chromosomal locus that predisposes to lung cancer; and ii) decreased expression of CHRFAM7A (dupα7 subunit); this last subunit negatively modulates α7-nAChR activity in oocytes. In contrast, CHRNA7 (α7 subunit) expression was increased in SQC-L, particularly in smokers and non-survivors, while CHRNA4 (α4 subunit) expression was decreased in ADC-L. Thus, over-representation of cancer-stimulating α7-nAChR in SQC-L, also potentiated by smoking, and under-representation of cancer-inhibiting α4ß2-nAChR in ADC-L could explain the different tobacco influences on the tumorigenic process in each cancer type.

Merkel cell carcinoma with divergent differentiation: histopathological and immunohistochemical study of 15 cases with PCR analysis for Merkel cell polyomavirus.

AIMS: To report on 15 cases of Merkel cell carcinoma (MCC) with divergent differentiation, to characterize its clinicopathological spectrum and its relationship with Merkel cell polyomavirus (MCV). METHODS AND RESULTS: Fifteen patients with a mean age of 81 years were included. Follow-up was available for 13 cases (range 12 days to 6 years; median 6 months). Recurrence, metastasis and mortality rates were 15.4%, 53.8% and 61.5%, respectively. All tumours showed the typical histological and immunohistochemical features of MCC, with at least one additional divergent component. Eight cases had a single aberrant component (squamous in six cases, follicular in one case, and porocarcinoma in one case), six cases had two aberrant components (squamous and sarcomatous in three cases, glandular and squamous in two cases, and sarcomatous and neuroblastic in one case), and one case had three aberrant components (glandular, squamous, and sarcomatous). All cases had dysplastic changes in the overlying epithelium, and four of 15 showed epidermotropism. PCR analysis for Merkel cell polyomavirus (MCV) gave negative results in all 12 cases tested. CONCLUSIONS: Merkel cell carcinoma with divergent differentiation is a highly aggressive tumour that might be difficult to recognize, owing to its wide histological variability. Negativity for MCV suggests that the virus is not implicated in the development of this subtype of MCC.

Pólipos endometriales, fisiopatologíay factores de riesgo / Endometrial polyps, pathophysiology and risk factors

Objetivo: revisar la literatura disponible acerca de la fisiopatología en el desarrollo de lospólipos endometriales (EP).Metodología: se realizó una búsqueda bibliográfica en la base de datos Medline y en el buscadorPubmed, usando la palabra clave “endometrial polyps”, identificando aquella información relevanterelacionada con su fisiopatología, publicada entre los años 2000 – 2011, de artículos publicadostanto en castellano como en inglés.Resultados: se pueden resumir los fenómenos asociados con la aparición de los pólipos endometrialesen factores hormonales, inflamatorios, proliferativos y genéticos. Con respecto a la influenciahormonal se ha demostrado un aumento de los receptores de estrógenos y progestágenos, y unasobreexpresión de la aromatasa en el endometrio de los pólipos endometriales. Con respecto a losfactores inflamatorios y proliferativos, la presencia de pólipos se asocia con el aumento de la concentraciónde mastocitos activados, aumento de los niveles de cicloxigenasa 2 y el incremento de otras sustancias inhibidoras de la apoptosis, tales como, el Bcl2y el Ki67. Además, se han relacionado anormalidades genéticasen diversos cromosomas, junto con reacomodamientosproducidos por proteínas de alta movilidad, conla presencia de los EP.Conclusiones: aunque la etiología de los pólipos endometrialessigue siendo desconocida, se puede pensar quepara su aparición se requiere de un proceso proliferativoestimulado por algunos factores hormonales asociados aun fenómeno inflamatorio.

Objective: To make a review of the available literatureabout the pathophysiology of endometrialpolyps (EP) development.Methods: A search was conducted using Medlinedatabase and the browser Pubmed in orderto retrieve relevant information related to thepathophysiology of endometrial polyps, usingas search terms endometrial polyps, including publicationsfrom 2000 through 2011.Results: The factors associated with the endometrialpolyps can be summarized within hormonal,inflammatory, proliferative and geneticfactors. Related to the hormonal influence, ithas been demonstrated by an increase in estrogensand progestagen receptors, and overexpressionof aromatase in endometrial tissue ofEP. Related with inflammatory and proliferativefactors EP are associated with the increase ofmastocytes activated concentration, increase ofcycloxigenase2 levels and increase of other inhibitingapoptosis substances such as Bcl 2 andKi 67. Furthermore, EP has been associated withgenetic abnormalities in various chromosomes,together with rearrangement produced by highmobility proteins.Conclusions: In spite of the EP etiology beingunknown, it could be established that for it tooccur requires a proliferative process stimulatedby hormonal factors associated with an inflammatoryprocess.

Ammonium formation and assimilation in P(SARK)∷IPT tobacco transgenic plants under low N.

Wild Type (WT) and transgenic tobacco plants expressing isopentenyltransferase (IPT), a gene encoding the enzyme regulating the rate-limiting step in cytokinins (CKs) synthesis, were grown under limited nitrogen (N) conditions. We analyzed nitrogen forms, nitrogen metabolism related-enzymes, amino acids and photorespiration related-enzymes in WT and P(SARK)∷IPT tobacco plants. Our results indicate that the WT plants subjected to N deficiency displayed reduced nitrate (NO3⁻) assimilation. However, an increase in the production of ammonium (NH4⁺), by the degradation of proteins and photorespiration led to an increase in the glutamine synthetase/glutamate synthase (GS/GOGAT) cycle in WT plants. In these plants, the amounts of amino acids decreased with N deficiency, although the relative amounts of glutamate and glutamine increased with N deficiency. Although the transgenic plants expressing P(SARK)∷IPT and growing under suboptimal N conditions displayed a significant decline in the N forms in the leaf, they maintained the GS/GOGAT cycle at control levels. Our results suggest that, under N deficiency, CKs prevented the generation and assimilation of NH4⁺ by increasing such processes as photorespiration, protein degradation, the GS/GOGAT cycle, and the formation of glutamine.

Cytokinin-dependent improvement in transgenic P(SARK)::IPT tobacco under nitrogen deficiency.

Wild-type (WT) and transgenic tobacco plants overexpressing isopentenyltransferase (IPT), a gene coding the rate-limiting step in cytokinin (CKs) synthesis, were grown under limited nitrogen (N) conditions to evaluate the role of CKs in NUE (N-use efficiency) and in different parameters that determine the quality of tobacco leaves. The results indicate that WT tobacco plants submitted to N deficiency show a decline in the leaf/root ratio, associated with a decrease in the NUE and in tobacco-leaf quality, defined by an increase in the quantity of nicotine. On the contrary, the transgenic plants submitted to N deficiency maintained the leaf/root ratio, presenting a higher NUE and greater quality of tobacco leaves than the WT plants, as the latter showed reduced nicotine and an increase in reducing sugars under severe N-deficiency conditions. Therefore, the overexpression of CKs under N deficiency could be a useful tool to improve tobacco cultivation, given that it could reduce N-fertilizer application and thereby provide economic savings and environmental benefits, maintaining yield and improving tobacco leaf quality.

Does iodine biofortification affect oxidative metabolism in lettuce plants?

Plants produce low levels of reactive oxygen species (ROS), which form part of basic cell chemical communication; however, different types of stress can lead to an overexpression of ROS that can damage macromolecules essential for plant growth and development. Iodine is vital to human health, and iodine biofortification programs help improve the human intake through plant consumption. This biofortification process has been shown to influence the antioxidant capacity of lettuce plants, suggesting that the oxidative metabolism of the plant may be affected. The results of this study demonstrate that the response to oxidative stress is variable and depends on the form of iodine applied. Application of iodide (I(-)) to lettuce plants produces a reduction in superoxide dismutase (SOD) activity and an increase in catalase (CAT) and L-galactono dehydrogenase enzyme activities and in the activity of antioxidant compounds such as ascorbate (AA) and glutathione. This did not prove a very effective approach since a dose of 80 µM produced a reduction in the biomass of the plants. For its part, application of iodate (IO (3) (-) ) produced an increase in the activities of SOD, ascorbate peroxidase, and CAT, the main enzymes involved in ROS detoxification; it also increased the concentration of AA and the regenerative activities of the Halliwell-Asada cycle. These data confirm the non-phytotoxicity of IO (3) (-) since there is no lipid peroxidation or biomass reduction. According to our results, the ability of IO (3) (-) to induce the antioxidant system indicates that application of this form of iodine may be an effective strategy to improve the response of plants to different types of stress.

Paucisymptomatic retroperitoneal fibrosis unmasked soon after a colonoscopy: a prompt resolution.

A 60-year-old man was diagnosed with retroperitoneal fibrosis. Curiously, his back pain became intense immediately after the performance of a colonoscopy. The fibrotic mass was seen on computed tomography (CT) of the abdomen. The patient developed obstructive nephropathy secondary to bilateral encasing of the ureters. Early diagnosis and combined therapy with corticosteroids and ureteral stents led to clinical and radiological remission of the disease.

Encefalopatía hipóxico isquémica con lesiones ganglio-talámicas selectivas: presentación de un caso / The hypoxic-ischemic encephalopathy in neonate: a case report

El propósito de este informe es hacer notar la naturaleza selectiva de las lesiones encontradas en un neonato con encefalopatía hipóxico isquémica. Se hace mención de la utilidad del ultrasonido transfontanelar para identificarlas y, cómo se correlacionan los hallazgos con lo referido en la literatura médica. Caso clínico. Se presenta un recién nacido a término, que cursó con encefalopatía poshipóxica causada por la ruptura uterina. El paciente cursó con grave afectación neurológica y datos incompletos de muerte cerebral. Las imágenes del ultrasonido y la tomografía computarizada mostraron zonas hemorrágicas cuya extensión comprendió casi completamente los tálamos y los ganglios basales. Discusión. Los hallazgos ultrasonográficos y tomográficos encontrados en este caso suelen estar relacionados con una elevada letalidad y secuelas graves. Por lo tanto, son indicadores de valor pronóstico. Las lesiones encontradas son semejantes a las provocadas experimentalmente en primates mediante asfixia total.

Analgesia transdérmica con fentanyl de dolor postoperatorio / Transdermic analgesia with fentanyl in postoperative pain

El presente estudio se diseñó con el propósito de determinar la seguridad y eficacia analgésica, en el periodo postoperatorio, de fentanyl por vía transdérmica (F-TTS). Se reclutaron pacientes de ambos sexos, de 19 a 65 años de edad, con un peso entre 50 y 100 kg., ASA I-III, programados para cirugía abdominal, pélvica y ortopédica y que aceptaron particular en el estudio. Se les asignó en forma aleatoria a uno de 3 grupos de tratamiento: F-TTS 25 , f-TTS 50 y F-TTS 75 (25, 50, y 75 g/hr respectivamente). En los 3 grupos F-TTS se aplicó momentos antes de la cirugía en cara anterior del tórax y se retiró 72 hrs. después. Durante este periodo no se utilizó otro tipo de narcótico. Se monitorizó a los pacientes cada 4 hrs (primeras 24 hrs), durante 84 hrs evaluando signos vitales, intensidad del dolor, sedación, calidad del sueño y porcentaje de saturación de oxígeno. Se prescribió, cuando fue requerido, dimetilpirazolona como analgésico de rescate. Para el análisis de los resultados se consideró un total de 26 pacientes, 9 del grupo F-TTS 25, 9 de F-TTS 50 y 8 de FTTS 75. En los pacientes de los tres grupos, se encontró que no modificaron las constantes vitales, no se presentó desaturación de oxígeno, la respuesta analgésica fue satisfactoria a las diferentes concentraciones del parche, sin encontrarse diferencias estadisticamente significativas. Práctiamente en todos los pacientes se utilizó dimetilpirazolona en las primeras 8 hrs post aplicación del parche. Concluimos que fentanyl transdérmico constituye una buena opción para el manejo del dolor postoperatorio y su aplicación debiera hacerse al menos 6 hrs antes del procedimiento quirúrgico para alcanzar niveles plasmáticos adecuados y evitar analgésico de rescate en el postoperatorio inmediato

Mortalidad por tumores malignos, 1981-1985: estudio necrópsico / Malignant tumor mortality rates, 1981-1985: necropsic study

Se realizó un estudio de 2 500 protocolos de autopsia que se efectuaron en el período comprendido entre enero de 1981 y diciembre de 1985. Se encontraron 261 fallecidos con tumores malignos, que constituyeron el 10,4