Aberrant axillary breast tissue with pseudoangiomatous stromal hyperplasia in a man.

Diagnosing accessory breast tissue in a male patient is difficult when the condition is unilateral, and there is no areola or nipple. Pseudoangiomatous hyperplasia of the mammary stroma is an uncommon benign mesenchymal proliferation that may mimic low-grade angiosarcoma. We report herein an example of tumoriform pseudoangiomatous hyperplasia of the stroma arising in the accessory breast tissue of a 38-year-old man. The condition presented as a palpable tender axillary mass. Histopathologically, there were no changes of gynecomastia. Only two cases of pseudoangiomatous hyperplasia of the stroma have been previously reported in the accessory breast tissue of men showing unilateral or bilateral gynecomastia. Our case is the first report without associated gynecomastia. Radiologic imaging features are not sufficiently specific to enable a prospective diagnosis of pseudoangiomatous hyperplasia of the stroma. Microscopic examination of the lesion is indispensable in making a definitive diagnosis. Awareness of the condition can avoid difficulty in diagnosing it. Aberrant breast tissue with mass-forming pseudoangiomatous hyperplasia of the stroma, whilst rare, should be included among the benign proliferative mesenchymal lesions of the axilla. Keywords: aberrant breast tissue-accessory breast tissue-pseudoangiomatous stromal hyperplasia-gynecomastia-angiosarcoma-axilla.

Herramienta de alfabetización informacional dirigida a bibliotecarios de ciencias médicas en la provincia de Artemisa, Cuba / Informational alphabetization tool directed to people who work in the medical sciences libraries in Artemisa province, Cuba

Resumen El logro de este proceso informacional en la salud se encuentra centrado en el personal bibliotecario, por lo que resulta necesario fortalecer su desempeño en correspondencia con la identificación de sus necesidades de aprendizaje mediante la aplicación de una herramienta de alfabetización informacional en la provincia de Artemisa, Cuba durante el curso del período 2016-2017. Se realizó una investigación organizada por dos momentos y, con el empleo de métodos empíricos y teóricos, se propuso una herramienta de alfabetización informacional en soporte digital. La metodología utilizada se basó en un medio de enseñanza-aprendizaje de tipo software educativo. La herramienta contribuirá a la calidad en el desempeño del personal que labora en la red de bibliotecas médicas de la provincia de Artemisa.

Abstract The performance of librarians in the medical sciences is enhanced by identifying their training needs through the use of an information literacy tool. We performed this study between 2016 and 2017 with the staff of the medical libraries network at Artemisa province in Cuba. In the first stage of the study we assessed the initial state of the staff's information literacy, and in a second stage, we used empiri-cal and theoretical methods to propose an information literacy tool in digital format. The methodology used was based on educational software. The tool will contribute to enhancing the performance of librarians working in the network of medical libraries in the prov-ince of Artemisa, Cuba.

Merkel cell polyomavirus and human papilloma virus in proliferative skin lesions arising in patients treated with BRAF inhibitors.

The potential role of oncogenic viruses mediating development of proliferative skin lesions in patients treated with RAF inhibitors is poorly understood. The objective of this study was to investigate human papilloma virus (HPV) and Merkel cell polyomavirus (MCPyV) in skin lesions among patients treated with RAF inhibitors with the help of a case series describing prevalence of HPV, MCPyV, and RAS mutations in skin biopsies obtained from patients receiving RAF inhibitors and developing cutaneous lesions. HPV-DNA was amplified by PCR utilizing multiple nested primer systems designed for detection of a broad range of HPV types. MCPyV copy number determination with real time PCR technology was performed by a "Quantification of MCPyV, small t region" kit. Thirty-six patients were tested (squamous cell carcinoma (SCC) = 14; verruca vulgaris = 15; other = 11). Nine of 12 SCCs (75 %) and eight of 13 verruca vulgaris lesions (62 %) tested positive for MCPyV whereas none of the normal skin biopsies obtained from nine of these patients tested positive for MCPyV (p = 0.0007). HPV incidence in cutaneous SCCs was not different compared to normal skin (50 vs. 56 %, p = 0.86). The association between MCPyV and proliferative skin lesions after RAF inhibitor therapy merits further investigation.

[Impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life and sexuality: A 3-year prospective study]. / Impact de la promontofixation cœlioscopique sur les symptômes pelviens, la qualité de vie et la sexualité : résultats à 3ans d'une étude prospective.

OBJECTIVES: To evaluate the impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life and sexuality after a 36 month-follow-up. We also reported anatomical outcomes and reoperation rate. PATIENTS AND METHODS: A prospective monocentric study was carried out including 82 women with symptomatic Pelvic Organ Prolapse (POP) stage≥2 according to Pelvic Organ Prolapse Quantification classification. Symptoms were evaluated using the Pelvic Floor Distress Inventory (PFDI-20) and health-related quality of life by the Pelvic Floor Impact Questionnaire (PFIQ-7). Sexual function was evaluated using the Pelvic Incontinence Sexual Questionnaire (PISQ-12). Measurements were recorded at the preoperative examination, then at 3, 12 and 36 months after surgery. RESULTS: PFDI-20 scores were significantly improved at 3 months (91.9 vs. 31.8, P<0.05) and PFIQ-7 scores also (60.8 vs. 16, P<0.05). This scores improvement remained significant at 12 months. There was no significant difference between results obtained at 12 and 36 months for PFDI-20 (36.8 vs. 42.2, P>0.05) and for PFIQ-7 (18.4 vs. 24.7, P>0.05). PISQ-12 score remained significantly improved at 3, 12 and 36 months compared to baseline (34.8, 35.3, 38.5 and 38.5, respectively). Ten patients (12.8%) had anatomical recurrence at 36 months for posterior compartment, 4 (5.1%) for anterior compartment and 1 (1.2%) for medium compartment. Four patients (4.9%) required reintervention. CONCLUSION: Laparoscopic sacrocolpopexy improved early functional outcome that remained significant after at least a 36 months follow up. LEVEL OF EVIDENCE: 4.

Endoscopic medial maxillectomy as a procedure of choice to treat inverted papillomas.

CONCLUSIONS: Endoscopic medial maxillectomy (EMM) is a safe, effective method for the treatment of inverted papillomas (IPs) of the paranasal sinuses. OBJECTIVE: To evaluate the efficacy of EMM as a surgical technique in the treatment of IP compared with non-endoscopic techniques. PATIENTS AND METHODS: This was a retrospective study of 52 patients with an IP diagnosed by biopsy from 1990 to 2004. EMM was performed in 34 patients (65.4%), whereas non-endoscopic techniques were used in 18 (34.6%). The mean duration of follow-up was 54.2 months. RESULTS: Recurrence occurred in 4 of the 34 patients who underwent EMM (11.8%; 95% confidence intervals (CI) = 39 at 26%) and in 8 of the 18 patients treated using non-endoscopic techniques (44.4%; 95% CI = 23.2 at 67.3%). There was a statistically significant difference (p < 0.05) between treatments, assessed by Kaplan-Meier estimator and log-rank testing. Of the 12 patients who suffered a recurrence, 6 (50%) were treated with endoscopic surgery, 4 (33%) with mediofacial degloving and 2 (17%) were merely followed up; no malignant degeneration occurred.

[Foreign language syndrome as a first sign of multiple sclerosis]. / Sindrome del acento extranjero como primera manifestación de esclerosis múltiple.

INTRODUCTION: Foreign accent syndrome (FAS) is a little known disorder affecting language which has been described in a few cases after acute strokes or traumatic brain injuries, but until now has not been reported in multiple sclerosis (MS). It is characterised by the appearance of what is perceived to be a foreign accent in the language of the patient. Although it could be included within the dysprosodias that accompany motor aphasias, it should be considered as an entity in its own right, since it may appear without the accompanying aphasia. Aphasia is an infrequent manifestation of MS and even less so when it appears as an initial symptom of the disease. When it does occur it usually accompanies large demyelinating lesions in the dominant hemisphere, and it is usually of a motor type. CASE REPORT: Patient, aged 38 years, who presented FAS that accompanied mild non fluent aphasia as the first manifestation of MS with pseudotumoral lesions. Initially the clinical features were interpreted as a somatoform disorder, which delayed diagnosis. CONCLUSIONS: Like aphasia, FAS can occur in MS as a manifestation of a cortical language disorder. It is important to recognise this in order to prevent mistaken diagnoses.

Short- and medium-term clinical efficacy of three endoscopic therapies for achalasia: a single-blinded prospective study.

OBJECTIVE: to compare the efficacy of three endoscopic therapies for achalasia and to identify predictors of response. DESIGN: prospective, single-blinded study at short and medium term. MATERIAL AND METHODS: 22 patients (9M/13 F; mean age: 47.45 +/- 21.01 years) with confirmed clinical and manometric achalasia were randomised in three groups: intrasphincteric injections of botulinum toxin (group 1: 10 patients ), injections of 1% polidocanol (group 2:6 patients), and a combined therapy with both of them (group 3: 6 patients). Clinical response was evaluated by a score (0-5) of tested symptoms (dysphagia, regurgitation and chest pain) at 1 and 24 weeks post-treatment. RESULTS: at 24 weeks post-treatment group 2 had the best complete response (CR) rate (33.33%), whereas CR in both the botulinum toxin and combined therapy groups was 10 and 0%, respectively. Groups 1 and 2 got an overall improvement in clinical score at 1 (p= 0.02) and 24 weeks (p= 0.04). Five patients (50%) in group 1, two patients (33.33%) in group 2, and three patients (50%) in group 3 needed other therapies (dilation or surgery) because of treatment failure. Separately, neither age nor sex, time from diagnosis or type of therapy could distinguish responders from non-responders in these three groups. However, absence of response within the first week, and an initial clinical score above 7 were predictive factors of poor response at six months. CONCLUSIONS: short- and medium-term clinical response to these endoscopic therapies was limited. The absence of response at seven days and a severe initial clinical score were predictive factors of poor medium-term response.

Role of peroxynitrite in macrophage microbicidal mechanisms in vivo revealed by protein nitration and hydroxylation.

The cytotoxins produced by phagocytic cells lacking peroxidases such as macrophages remain elusive. To elucidate macrophage microbicidal mechanisms in vivo, we compared the lesion tissue responses of resistant (C57Bl/6) and susceptible (BALB/c) mice to Leishmania amazonensis infection. This comparison demonstrated that parasite control relied on lesion macrophage activation with inducible nitric oxide synthase expression (iNOS), nitric oxide synthesis, and extensive nitration of parasites inside macrophage phagolysosomes at an early infection stage. Nitration and iNOS expression were monitored by confocal microscopy; nitric oxide synthesis was monitored by EPR. The main macrophage nitrating agent was shown to be peroxynitrite derived because parasite nitration occurred in the virtual absence of polymorphonuclear cells (monitored as peroxidase activity) and was accompanied by protein hydroxylation (monitored as 3-hydroxytyrosine levels). In vitro studies confirmed that peroxynitrite is cytotoxic to parasites whereas nitric oxide is cytostatic. The results indicate that peroxynitrite is likely to be produced close to the parasites and most of it reacts with carbon dioxide to produce carbonate radical anion and nitrogen dioxide whose concerted action leads to parasite nitration. In parallel, some peroxynitrite decomposition to the hydroxyl radical should occur due to the detection of hydroxylated proteins in the healing tissues. Consequently, peroxynitrite and derived radicals are likely to be important macrophage-derived cytotoxins.

New modified eremophilanes from the roots of Psacalium radulifolium.

The investigation of the chemical constituents from the roots of Psacalium radulifolium, a member of the matarique complex of medicinal plants, which includes several members of the Asteraceae, resulted in the isolation of four new modified eremophilanes: radulifolin A (4), epi-radulifolin A (5), radulifolin B (6), and radulifolin C (7), together with the known natural substances cacalol, cacalone, epi-cacalone, O-methyl-1,2-dehydrocacalol, adenostin A, decompostin, and neoadenostylone. Antimicrobial evaluation of the extracts and the isolated compounds indicated that cacalol was the major active compound.

Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group.

BACKGROUND: Although it is generally accepted that lowering elevated serum levels of low-density lipoprotein (LDL) cholesterol in patients with coronary heart disease is beneficial, there are few data to guide decisions about therapy for patients whose primary lipid abnormality is a low level of high-density lipoprotein (HDL) cholesterol. METHODS: We conducted a double-blind trial comparing gemfibrozil (1200 mg per day) with placebo in 2531 men with coronary heart disease, an HDL cholesterol level of 40 mg per deciliter (1.0 mmol per liter) or less, and an LDL cholesterol level of 140 mg per deciliter (3.6 mmol per liter) or less. The primary study outcome was nonfatal myocardial infarction or death from coronary causes. RESULTS: The median follow-up was 5.1 years. At one year, the mean HDL cholesterol level was 6 percent higher, the mean triglyceride level was 31 percent lower, and the mean total cholesterol level was 4 percent lower in the gemfibrozil group than in the placebo group. LDL cholesterol levels did not differ significantly between the groups. A primary event occurred in 275 of the 1267 patients assigned to placebo (21.7 percent) and in 219 of the 1264 patients assigned to gemfibrozil (17.3 percent). The overall reduction in the risk of an event was 4.4 percentage points, and the reduction in relative risk was 22 percent (95 percent confidence interval, 7 to 35 percent; P=0.006). We observed a 24 percent reduction in the combined outcome of death from coronary heart disease, nonfatal myocardial infarction, and stroke (P< 0.001). There were no significant differences in the rates of coronary revascularization, hospitalization for unstable angina, death from any cause, and cancer. CONCLUSIONS: Gemfibrozil therapy resulted in a significant reduction in the risk of major cardiovascular events in patients with coronary disease whose primary lipid abnormality was a low HDL cholesterol level. The findings suggest that the rate of coronary events is reduced by raising HDL cholesterol levels and lowering levels of triglycerides without lowering LDL cholesterol levels.

Possible roles of nitric oxide and peroxynitrite in murine leishmaniasis

Activated macrophages simultaneously synthesize nitric oxide and superoxide anion which can react with each other producing peroxynitrite. Consequently, it has been difficult to assess the precise contribution of each of the formed reactive oxygen- and nitrogenderived species to the microbicidal activities of macrophages, particularly in vivo. To explore this problem, we are examining the formation and potential roles of nitrogen-derived intermediates in Leishmania amazonensis murine infection. Thus far, our results have demonstrated that peroxynitrite is a potent leishmanicidal agent in vitro and that both nitric oxide and peroxynitrite are formed during infection of susceptible BALB/c mouse strain. Nitric oxide was detected as the nitrosyl-hemoglobin complex by electron paramagnetic resonance analysis of blood drawn from mice at different times of infection, and it was shown to increase with the evolution of the disease. These results will be discussed in the context of the dual physiological role of nitric oxide either as a signaling molecule or as a deleterious agent.

Antimicrobial and cytotoxic activities of some crude drug extracts from Mexican medicinal plants.

31 crude extracts derived from 28 plants highly valued as anti-infective agents in Mexican folk medicine have been screened for antimicrobial activity against four bacteria, a yeast and two molds. The results of the quantitative study indicated that the extracts derived from five species (Malmea depressa, Heliopsis longipes, Datura lanosa, Cnidosculus tehuacanensis and Helianthella quinquenervis) possessed significant antiseptic properties, therefore supporting the ethnomedical uses of these species. The cytotoxic activity was assayed against three cell lines HT-29 (Colon adenocarcinoma), MCF-7 (Breast carcinoma), A-549 (Lung carcinoma) and only the extract of Helianthella quinquenervis possessed significant activity against the MCF-7 cell line.

Cystic dilatation of the cystic duct: a new type of biliary cyst.

A case of a patient with a congenital cyst that was localized solely to the cystic duct is presented. We propose including this anomaly in the biliary cyst classifications, which currently include choledochal and intrahepatic and extrahepatic biliary cysts. The diagnosis and management of this new type of cyst in addition to other types of biliary cysts are discussed.

[Biliary ascariasis. Experience at the Dr. Manuel Gea Gonzáles General Hospital]. / Ascariasis biliar. Experiencia en el Hospital General Dr. Manuel Gea González.

Six cases of biliary ascariasis were treated at Dr. Manuel Gea González General Hospital in the last sixteen years. The patient population consisted of five female and one male subjects. With a median age of 39 years. Main clinical manifestations were abdominal pain mimicking biliary colic, nausea, vomiting and jaundice. Diagnosis was established during surgery in four patients and by means of abdominal sonogram and endoscopic retrograde cholangiopancreatogram in two cases. Cholecystitis diagnosis was considered preoperatively in three patients and cholangitis in another one. Five patients were operated on and in one case the worm was successfully removed with the endoscope. Only one patient was complicated with biliary peritonitis, hepatic abscess and reinfestation. No deaths occurred. Mexican literature published in the lasts 25 years is reviewed and the current state in diagnosis and treatment concerning this entity is discussed in this paper.

[Cystadenocarcinoma of the appendix. Report of a case]. / Cistadenocarcinoma del apéndice. Informe de un caso.

Primary adenocarcinoma of the appendix is an uncommon disease frequently diagnosed surgery. It has an occurrence between 0.01 and 0.11% of all appendectomized patients, and it is more often found in patients older than fifty years. Symptoms are usually similar to those seen in acute appendicitis. Some authors consider the mucocele of the appendix a primary carcinoma as it is related with obstruction of the appendix lumen followed by a cystic dilatation with mucosal changes, mucus hypersecretion and extension outside of the appendix. We present one case with abdominal pain, constipation, weight loss of 26 kg, and a mass localized in the right lower quadrant. An exploratory surgery showed a partially retroperitoneal mass of 15 by 20 cm, irregular, cystic, with mucus content and the appendix included in it. The mass was removed and appendectomy was performed. Postoperatively the patient did well. The final pathologic report was a cystadenocarcinoma of the appendix.