Epidemiologic and Histopathologic Characterization of Cutaneous Metastases in Patients Who Visited 2 Hospitals in Santiago de Chile Between 2005 and 2017. / Caracterización epidemiológica e histopatológica de metástasis cutáneas en la población consultante de 2 hospitales de Santiago durante los años 2005 a 2017.

BACKGROUND AND OBJECTIVE: Cutaneous metastases (CMs) account for 2% of skin tumors and their incidence varies between 0.7% and 9% in patients with cancer. The objective of this study was to describe and analyze the demographic, clinical, and histopathologic characteristics of CM in patients who visited 2 hospitals in the Santiago de Chile metropolitan region. MATERIAL AND METHOD: We performed a retrospective, descriptive, analytical, observational, cross-sectional study. We reviewed the pathology reports, patient records, pathology slides, and dates of death for diagnosed cases of CM from the anatomic pathology departments of 2 hospitals in the Santiago de Chile metropolitan region between 2015 and 2017. RESULTS: Ninety-six patients with CM were included in the study; 60.42% were women and 39.58% were men. The mean (SD) age was 67.95 (13.74) years, with a range of 28 to 96 years. The most common primary tumor was melanoma in 27.08% of cases (n=26), followed by breast cancer (18.75%, n=18), and adenocarcinoma (15.63%, n=15). The median time between diagnosis of the tumor and cutaneous metastasis was 9 months. Patients with CM of melanoma had a higher survival rate than patients with metastasis of other primary tumors (P<.05). A histopathologic study of 91 slides showed that diffuse infiltration of the tissue with tumor cells was the most common pattern and vascular invasion was rare. CONCLUSIONS: The results are similar to those found worldwide. CM is a rare manifestation of internal tumors. It presents mainly at an advanced age and is equally prevalent in both sexes.

Evaluation of the analgesic efficacies of Dexketoprofen Trometamol and Dexketoprofen Trometamol + Thiocolchicoside combinations in the impacted third molar surgery: Randomised clinical trial.

BACKGROUND: Postoperative pain is one of the most common complications. The aim of this study is to evaluate the analgesic efficacies of dexketoprofen trometamol and two different dosages of dexketoprofen trometamol + thiocolchicoside combination in the impacted third molar tooth operation. MATERIAL AND METHODS: This randomized, double-blind study included 75 patients who did not have any disease. Patients were assigned to 3 groups. Group 1 received 25 mg dexketoprofen trometamol + 4 mg thiocholchicoside, Group 2 received 25 mg dexketoprofen trometamol +8 mg thiocholchicoside, and Group 3 received 25 mg dexketoprofen trometamol. In each group, the analgesic medication was administered twice a day, starting 1 hour before the operation. The level of pain was assessed with VAS. RESULTS: Patient age varied from 18 to 36 years. Of all patients, 59.2% (n=42) were female and 40.8% (n=29) were male. Drug side effects were observed in 28.17% (n=20) of the patients. Mean 24th hour VAS score was lower in dexketoprofen trometamol + 8 mg thiocolchicoside group compared to dexketoprofen trometamol group (p<0.05). There was no statistically significant difference between the three groups regarding drug side effects (p>0.05). CONCLUSIONS: Dexketoprofen trometamol + 8 mg thiocolchicoside combination has higher analgesic efficacy compared to dexketoprofen trometamol. More studies are needed to interpret the analgesic and anti-inflammatory effects of thiocholchicoside + dexketoprofen trometamol combination.

Fat necrosis of the breast--a review.

Fat necrosis of the breast is a benign condition that most frequently affects peri-menopausal women. It can mimic breast cancer clinically or radiologically. In other cases it can obscure malignant lesions. The core of this review is derived from a MEDLINE database literature search from 1966-2004. Further references were from lateral search. In this paper, we review the pathogenesis and pathology clinical and radiological features of fat necrosis of the breast. The implication of fat necrosis in the management of patients with breast lump is also discussed. Fat necrosis of breast is a complex process. Therefore, a systematic review of this condition will enable surgeons, radiologists and oncologists working in the field of breast disease to understand it better and improve its management.

Real world experience with antiphospholipid antibody tests: how stable are results over time?

OBJECTIVE: To determine the stability and the degree of variation of antiphospholipid antibody (aPL) results over time in a large cohort of well evaluated aPL positive patients; and to analyse factors contributing to aPL variation and the validity of aPL in a real world setting in which aPL tests are done in multiple laboratories. METHODS: The clinical characteristics, drug treatment, and 1652 data points for lupus anticoagulant (LA), anticardiolipin antibodies (aCL), and anti-beta2 glycoprotein I antibodies (anti-beta2GPI) were examined in 204 aPL positive patients; 81 of these met the Sapporo criteria for antiphospholipid syndrome (APS) and 123 were asymptomatic bearers of aPL. RESULTS: 87% of initially positive LA results, 88% of initially negative to low positive aCL results, 75% of initially moderate to high positive aCL results, 96% of initially negative to low positive anti-beta2GPI results, and 76% of initially moderate to high positive anti-beta2GPI results subsequently remained in the same range regardless of the laboratory performing the test. Aspirin, warfarin, and hydroxychloroquine use did not differ among patients whose aCL titres significantly decreased or increased or remained stable. On same day specimens, the consistency of aCL results among suppliers ranged from 64% to 88% and the correlation ranged from 0.5 to 0.8. Agreement was moderate for aCL IgG and aCL IgM; however, for aCL IgA agreement was marginal. CONCLUSIONS: aPL results remained stable for at least three quarters of subsequent tests, regardless of the laboratory performing the test; the small amount of variation that occurred did not appear to be caused by aspirin, warfarin, or hydroxychloroquine use.

Signal processing technique for non-invasive real-time estimation of cardiac output by inductance cardiography (thoracocardiography).

Inductance cardiography (thoracocardiography) non-invasively monitors changes in stroke volume by recording ventricular volume curves with an inductive plethysmographic transducer encircling the chest at the level of the heart. Clinical application of this method has been hampered, as data analysis has not been feasible in real time. Therefore a novel, real-time signal processing technique for inductance cardiography has been developed. Its essential concept consists in performance of multiple tasks by several, logically linked signal processing modules that have access to common databases. Based on these principles, a software application was designed that performs acquisition, display, filtering and ECG-triggered ensemble averaging of inductance signals and separates cardiogenic waveforms from noise related to respiration and other sources. The resulting ventricular volume curves are automatically analysed. Performance of the technique for monitoring cardiac output in real time was compared with thermodilution in four patients in an intensive care unit. The bias (mean difference) among 76 paired thoracocardiographic and thermodilution derived changes in cardiac output was 0%; limits of agreement (+/- 2 SD of the bias) were +/- 25%. It is concluded that the proposed signal processing technique for inductance cardiography holds promise for non-invasive, real-time estimation of changes in cardiac output.

Omental infarction associated with right-sided heart failure.

A 31-year-old man with a known congenital heart disease presented with cardial decompensation and an acute abdomen with tenderness in the right inferior abdominal quadrant. Because infectious parameters were slightly elevated, acute appendicitis was suspected. A CT scan showed an isolated focal infiltration of the omentum, superficial to the ascending colon, small amounts of ascites, and dilated hepatic and mesenteric veins. Laparoscopic resection and histopathologic examination confirmed hemorrhagic omental infarction due to thromboses of several small omental veins. This is a report on the pathogenesis, differential diagnoses, and CT findings of omental infarction.

A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment.

Our purpose was to compare the effectiveness and side effects of a novel, single-piece mandibular advancement device (OSA-Monobloc) for sleep apnea therapy with those of a two-piece appliance with lateral Herbst attachments (OSA-Herbst) as used in previous studies. An OSA-Monobloc and an OSA-Herbst with equal protrusion were fitted in 24 obstructive sleep apnea patients unable to use continuous positive airway pressure (CPAP) therapy. After an adaptation period of 156 +/- 14 d (mean +/- SE), patients used the OSA-Monobloc, the OSA-Herbst, and no appliance in random order, using each appliance for 1 wk. Symptom scores were recorded and sleep studies were done at the end of each week. Several symptom scores were significantly improved with both appliances, but to a greater degree with the OSA-Monobloc. Epworth Sleepiness Scale scores were 8.8 +/- 0.7 with the OSA-Herbst, and 8.6 +/- 0.8 with the OSA-Monobloc devices, and 13.1 +/- 0.9 without therapy (p < 0.05 versus both appliances). The apnea/hypopnea index was 8.7 +/- 1.5/h with the OSA-Herbst and 7.9 +/- 1.6/h with the OSA-Monobloc device, and 22.6 +/- 3.1/h without therapy (p < 0.05 versus both appliances). Side effects were mild and of equal prevalence with both appliances. Fifteen patients preferred the OSA-Monobloc, eight patients had no preference, and one patient preferred the OSA-Herbst device (p < 0.008 versus OSA-Monobloc). We conclude that both the OSA-Herbst and the OSA-Monobloc are effective therapeutic devices for sleep apnea. The OSA-Monobloc relieved symptoms to a greater extent than the OSA-Herbst, and was preferred by the majority of patients on the basis of its simple application.

Detection of inspiratory flow limitation during sleep by computer assisted respiratory inductive plethysmography.

The potential of respiratory inductive plethysmography (RIP) to detect inspiratory flow limitation during sleep was investigated. Sixteen sleep apnoea patients underwent polysomnography. Airflow by a flowmeter attached to a nasal mask, oesophageal and mask pressure were recorded along with calibrated RIP. Presence of inspiratory flow limitation was defined by constant or decreasing flow without pressure dependence throughout significant portions of inspiration, its absence by a linear or mildly alinear pressure:airflow relationship. Based on this standard, three of various computerized RIP derived parameters, with highest performance to detect flow limitation, were identified. They were combined to an inspiratory flow limitation, (IFL)-Index(RIP), which was validated prospectively in another 10 sleep apnoea patients. RIP derived fractional inspiratory time, peak to mean inspiratory flow ratio, and ribcage contribution to tidal volume had the highest accuracy to detect flow limitation (area under the receiver operating characteristic (ROC) curves 0.81, 0.76, 0.76, respectively, 160 comparisons). Prospective validation revealed an area under the ROC curve for the IFL-Index(RIP) to detect flow limitation of 0.89 (95% confidence interval 0.85 to 0.93, 200 comparisons) with sensitivity and specificity at the point of equality of 80%. It is concluded that inspiratory flow limitation may be assessed by computer assisted analysis of respiratory inductive plethysmography derived breathing patterns with clinically acceptable accuracy.

Diagnosis of Cardiobacterium hominis endocarditis by broad-range PCR from arterio-embolic tissue.

A case of culture-negative endocarditis is reported, in which the diagnosis of Cardiobacterium hominis endocarditis was made from arterio-embolic tissue removed by percutaneous transluminal embolectomy by broadrange polymerase chain reaction amplification of the 16 rRNA gene, followed by single-strand sequencing. The use of this technique to identify etiologic agents from arterio-embolic material has not been reported so far. A serologic assay employing complement fixation against a crude antigen of Cardiobacterium hominis confirmed the diagnosis of endocarditis caused by this unusual fastidious etiologic agent.

Whole-lung lavage in alveolar proteinosis by a modified lavage technique.

Whole-lung lavage is the only efficient treatment in pulmonary alveolar proteinosis. A 36-year-old woman with severe pulmonary alveolar proteinosis confirmed by video-assisted thoracoscopic lung biopsies underwent repetitive whole-lung lavages without improvement. A modified technique consisting of manual ventilation between instillation and aspiration of half the amount of saline used for conventional lavage was applied. Impressive clinical and functional improvement occurred and persisted for 1 year. We believe that the amelioration can be attributed to the technique described above.

Fatal air embolism in an airplane passenger with a giant intrapulmonary bronchogenic cyst.

Considering the large number of airplane passengers with a variety of medical conditions, the incidence of in-flight emergencies on commercial airline flights is low. Only few cases of pulmonary barotrauma in airplane passengers with prior lung pathologies have been reported. We present the unusual case of a female airplane passenger with a previously diagnosed asymptomatic giant intrapulmonary bronchogenic cyst who experienced fatal air embolism on a commercial airline flight. We believe that preventive surgical resection is mandatory in asymptomatic patients with large intrapulmonary cysts prior to exposure to even small alterations in ambient pressure as, for instance, prior to airplane flight or use of mountain cable cars. However, screening for pre-existent lung pathologies in the growing mass of commercial airline travelers is not justified.

Effect of training on repeatability of cardiopulmonary exercise performance in normal men and women.

The effect of gender and training on repeatability of cardiopulmonary exercise performance has not been well defined. Therefore, we performed two bicycle exercise tests 1 wk apart in each of two groups: In 19 normal subjects (age 24 to 64 yr, 10 females), with a mean maximal oxygen uptake (VO2max) of 42 mL.kg-1.min-1, who had been in an ongoing training program including bicycle exercise, and in 19 untrained volunteers (23 to 54 yr, 11 females) with a mean VO2max of 36 mL.kg-1.min-1 (P < 0.05). Mean differences in physiologic variables measured during tests 1 and 2 were calculated. Repeatability coefficients were defined as 2 SD in percent of the means. In untrained subjects mean (+/- SD) maximal heart rate decreased by 4 +/- 5 beats.min-1 from the first to the second test (P < 0.05). VO2max and maximal work rate (Wmax) remained unchanged. No significant changes in these or other variables occurred in trained subjects. Repeatability coefficients for VO2max were 8 and 13% in trained and untrained subjects, respectively (P = NS). For Wmax the repeatability coefficient in untrained (11%) exceeded that in trained subjects (4%, P < 0.05). Repeatability coefficients did not differ among males and females. Our study provides normal values for repeatability of various parameters assessed during exercise testing and demonstrates that interpretation of performance during repeated tests has to account for training of the subjects.

Impact of physical activity on cardiovascular risk factors in IDDM.

OBJECTIVE: To study the impact of physical activity on glycemic control and plasma lipids [HDL cholesterol (HDL-C), HDL-C subfractions, triglycerides, lipoprotein(a)], blood pressure, weight, and abdominal fat and to determine the necessary short-term adaptations in diabetes management during intensive endurance training in patients with IDDM. RESEARCH DESIGN AND METHODS: Well-controlled subjects with IDDM (n = 20; HbA1c = 7.6%) engaged in a regular exercise program over a period of 3 months involving endurance sports such as biking, long-distance running, or hiking. Subjects were instructed to exercise at least 135 min per week. If baseline activity exceeded this level, subjects were to increase further their physical activity as much as possible and record the type and time of such activity. RESULTS: During the 3-month intervention, physical activity increased from 195 +/- 176 to 356 +/- 164 min (mean +/- SD) per week (P < 0.001). Physical fitness as assessed by VO2max increased from 2,914 +/- 924 to 3,092 +/- 905 ml/min (P < 0.001), and insulin sensitivity increased significantly (steady-state plasma glucose [SSPG] decreased from 10.5 +/- 4.8 to 7.0 +/- 3.3 mmol/l; P < 0.01). Subsequently, LDL cholesterol decreased by 14% (P < 0.05), and HDL and HDL3-C subfraction increased by 10 (P < 0.05) and 16% (P < 0.05), respectively. Systolic and diastolic blood pressure decreased significantly from 127 +/- 9 to 124 +/- 8 (P < 0.05) and from 80 +/- 5 to 77 +/- 5 mmHg (P < 0.01), respectively. Resting heart rate decreased from 63 +/- 6 to 59 +/- 7 bpm (P < 0.01). Waist-to-hip circumference ratio decreased from 0.882 +/- 0.055 to 0.858 +/- 0.053 (P < 0.001), body weight decreased from 70.7 +/- 10.4 to 68.7 +/- 10.2 kg (P = 0.003), with a consequent decrease in body fat from 21.9 +/- 8.2 to 18.0 +/- 6.3% (P < 0.001) and an increase in lean body mass from 54.9 +/- 12.2 to 56.8 +/- 11.0 kg. These effects occurred independently of glycemic control. The overall frequency of severe hypoglycemic episodes was reduced from 0.14 to 0.10 per patient-year during the study period. CONCLUSIONS: This study shows that increasing physical activity is safe and does not result in more hypoglycemic episodes and that there is a linear dose-response between increased physical activity and loss of abdominal fat and a decrease in blood pressure and lipid-related cardiovascular risk factors, with a preferential increase in the HDL3-C subfraction.

Effect of surgical lung volume reduction on breathing patterns in severe pulmonary emphysema.

Surgical lung volume reduction may improve pulmonary function and dyspnea in advanced pulmonary emphysema. To investigate mechanisms of these beneficial effects we studied breathing patterns before and after surgery. Nineteen patients with diffuse pulmonary emphysema (FEV1 < 35% of predicted, total lung capacity > 130% predicted) were studied within 1 mo before, and 1.5 to 7 mo after thoracoscopic volume reduction. Changes of rib cage and abdominal volumes were monitored with calibrated respiratory inductive plethysmography for 20 to 60 min during natural breathing at rest. Pulmonary function and dyspnea were also assessed. Postoperative tidal volumes, respiratory cycle times, and minute ventilation were not significantly different from preoperative values. The contribution of abdominal volume changes to tidal volumes increased from a mean +/- SD of 43 +/- 17% preoperatively to 58 +/- 14% postoperatively (p = 0.03). The fraction of inspiratory time with abdominal paradoxical motion decreased from 12.3 +/- 8.3% preoperatively to 5.1 +/- 5.1% postoperatively (p = 0.02). The phase shift between rib cage and abdominal motion was reduced postoperatively. Hyperinflation, airway obstruction, and subjective ratings of dyspnea were significantly improved. The better synchronization of rib cage-abdominal motion and the greater contribution of abdominal volume changes to tidal volumes are consistent with a reduction of inspiratory loading and a greater force-generating capacity of the diaphragm after surgery.