Biopsia guiada por ecografía para el diagnóstico de masas ováricas. Revisión sistemática / Ecography guided biopsy for the diagnosis of ovarian masses. Systematic review

El diagnóstico definitivo del cáncer de ovario precisa de confirmación histológica. En determinadas situaciones, para evitar la morbilidad de la resección quirúrgica, es posible hacer una biopsia guiada por ecografía para obtener el diagnóstico anatomopatológico. El objetivo de esta revisión sistemática fue evaluar la adecuación, fiabilidad, precisión y perfil de seguridad de la biopsia guiada por ecografía de masas ováricas. Siguiendo el modelo PRISMA 2020, se hizo una búsqueda bibliográfica en PubMed, Embase y Scopus y se recopilaron un total de 10.245 artículos, de los cuales 24 fueron finalmente incluidos. Los trabajos incluían de forma mayoritaria pacientes con tumores inoperables avanzados, pobre performance status y otros factores de mal pronóstico, con masas de contenido sólido y márgenes irregulares, generalmente accesibles por vía transvaginal. En la mayoría de los artículos las pacientes presentaban historia previa de malignidad o tumores inoperables en estadios avanzados. Las masas ováricas biopsiables se definían en la ecografía como malignas o potencialmente malignas, con la presencia destacada de un componente sólido o mixto con márgenes irregulares o heterogéneos. La técnica más utilizada en los estudios incluidos fue la biopsia con aguja gruesa o tru-cut, con altos valores de adecuación, fiabilidad, precisión y rendimiento, así como un buen perfil de seguridad y bajas tasas de complicaciones. En conclusión, la biopsia con aguja gruesa de las masas anexiales guiada por ecografía, en pacientes subsidiarios de tratamiento neoadyuvante, es una técnica con altas tasas de adecuación, fiabilidad, precisión y buen perfil de seguridad.(AU)

The definitive diagnosis of ovarian cancer requires histological confirmation. In certain situations, to avoid the morbidity of surgical resection, it is possible to perform an ultrasound-guided biopsy to obtain the pathological diagnosis. The aim of this systematic review was to assess the adequacy, reliability, accuracy, and safety profile of ultrasound-guided biopsy of ovarian masses. Following the PRISMA 2020 model, a bibliographic search was carried out in PubMed, Embase and Scopus, collecting a total of 10,245 articles, of which 24 were finally included. The studies mainly included patients with advanced inoperable tumors, poor performance status and other poor prognostic factors, with masses of solid content and irregular margins, generally accessible through the transvaginal route. In most of the articles, the patients had a previous history of malignancy or had inoperable tumors in advanced stages. Biopsiable ovarian masses were defined ultrasonographically as malignant or potentially malignant, mainly highlighting the presence of a solid or mixed component and irregular or heterogeneous margins. The most widely used technique in the included studies was core needle or tru-cut biopsy, presenting high values of adequacy, reliability, precision and performance, as well as a good safety profile with low complication rates. In conclusion, ultrasound-guided core needle biopsy of adnexal masses in patients eligible for neoadjuvant treatment is a technique with high adequacy, reliability, and precision rates, as well as a good safety profile.(AU)

Morphometric analysis of brain lesions in rat fetuses prenatally exposed to low-level lead acetate: correlation with lipid peroxidation.

The effect of prenatal lead acetate exposure was studied microscopically together with the concentration of lead and lipid fluorescent products (LFP) in the brain of rat fetuses. Wistar rats were intoxicated with a lead solution containing either 160 or 320 ppm of lead acetate solution during 21 days through drinking water. The control group (ten rats) received deionized water for the same period. The rats were killed on gestation day 21 and fetuses were obtained; the placenta, umbilical cord and parietal cortex (Cx), striatum (St), thalamus (Th) and cerebellum (Ce) were collected for measuring tissue lead concentration, LFP as an index of lipid peroxidation and histopathologic examination. Lead contents were increased in placenta, umbilical cord, St, Th and Cx in both lead-exposed groups. Lead exposure increased (LFP) in placenta and umbilical cord, St, Th and Ce as compared to the control group. Histopathological examination showed severe vascular congestion in placenta, the Cx, St, Th and Ce with hyperchromatic and shrunken cells. Interstitial oedema was found in all regions studied of both lead exposed groups. The morphometric evaluation of the studied brain regions showed an absolute decrease in total cell number and increased number of damaged cells and interstitial oedema. Our results show that morphological changes in rat brain are correlated with increased lipid peroxidation, and the lead levels of the umbilical cord, however it is not clear whether oxidative stress is the cause or the consequence of these neurotoxic effects of lead.

Enhanced brain regional lipid peroxidation in developing rats exposed to low level lead acetate.

Neurotoxicity associated with lead exposure may be the result of a series of small perturbations in brain metabolism, and, in particular, of oxidative stress. Some studies have suggested a lead-induced enhancement on lipid peroxidation as a possible mechanism for some toxic effects of lead. However, there are no reports about the association between lipid peroxidation enhancement and brain lead content. In this study, we determined the concentration of lead and the formation of lipid fluorescence products in the blood, as well as in the parietal cortex, striatum, hippocampus, thalamus, and cerebellum of rats exposed prenatally and postnatally to variable concentrations of lead acetate through drinking water. Pregnant Wistar rats were intoxicated throughout gestation with solutions containing either 320 or 160 ppm of lead. The pups were treated after birth in the same way until 45 days of age. Control animals received deionized water for the same period of time. The developing rats were sacrificed at postnatal day 45 and lead level was assessed biochemically in the blood and different brain regions. Results showed that blood lead levels were increased in a dose-dependent manner. In the brain, lead accumulated preferentially in the parietal cortex, striatum, and thalamus as compared to the control group, while lipid fluorescence products were significantly increased in the striatum, thalamus, and hippocampus of the treated animals. These data suggest that in the brain of rats exposed to lead acetate, lead produces a neurotoxic effect with a complex correlation with both lead regional content and lipid peroxidation.

Histopathological alterations in the brain regions of rats after perinatal combined treatment with cadmium and dexamethasone.

Industrial and environmental exposure to cadmium (Cd) is well known to produce multiorgan toxicity in humans. Metallothionein (MT) is a cellular ligand for Cd. MT has been shown to protect against Cd-induced toxicity in many organs, including brain. In this study, we described the histopathological alterations in parietal cortex, striatum, hippocampus and cerebellum of rats following perinatal combined exposure to cadmium and dexamethasone (Dx), a drug known to induce MT synthesis in brain. Wistar rats of 13 days of age were treated for 5 days, as follows; (1) saline solution, (2) CdCl(2) 1 mg/kg per day, (3) Dx 2 mg/kg per day, (4) CdCl(2) 1 mg/kg per day + Dx 2 mg/kg/day. Rats were killed on either 18 or 28 days of age. The content of Cd in parietal cortex, striatum, hippocampus and cerebellum at 18 days old age increased 58.3-, 9.4-, 18.3- and 11.3-fold, while at 28 days of age in the same regions the increases were 6.6-, 5.8-, 25.3- and 11.3-fold in the Cd treated rats, respectively. No lesions were observed in the brain of control rats. Rats treated with Dx at 28 days of age showed interstitial edema in the four regions. Cd-treated rats at 28 days of age showed lesions in the four studied regions. In general, Dx treatment attenuated all Cd-induced lesions.

Efficacy and safety of atorvastatin in hyperlipidemic, type 2 diabetic patients. A 34-week, multicenter, open-label study.

Hyperlipidemia is common in type 2 diabetic patients and is an independent risk factor for cardiovascular disease. The aim of this trial was to evaluate the efficacy and safety of once-daily atorvastatin 10-80 mg for the treatment of hyperlipidemia in type 2 diabetics with plasma low-density lipoprotein cholesterol (LDL-C) levels exceeding 3.4 mmol/l (130 mg/dl). One hundred and two patients met the study criteria and received 10 mg/day atorvastatin. Patients who reached the target LDL-C level of

Alveolar lesions induced by systemic administration of cocaine to rats.

In this work, alveolar lesions induced after systemic administration of cocaine (30 mg/kg per day, i.p.) to rats were evaluated both by light microscope analysis for morphological assessment as well as by measurement of the alveolar area as a quantitative index of the alveolar damage. Rats were examined after different times of exposure: 7, 15, 30, 45, 60 and 75 days. The histopathological evaluation of cocaine-treated rats revealed a remarkable thickening in some interalveolar septa, with interstitial hemorrhages, progressive thrombosis and transformation of reticular and elastic fibers into diffuse fibrosis. A significant decrease of the alveolar area was also observed. These findings are indicative of severe changes in capillaries, alveoli and bronchiole after cocaine exposure, which in turn may progressively disrupt the general function of the lungs. Differential mechanisms of systemic toxicity after cocaine exposure are discussed.

Dapsone prevents morphological lesions and lipid peroxidation induced by quinolinic acid in rat corpus striatum.

Increasing doses of dapsone were tested on rats administered intrastriatally with quinolinic acid in order to evaluate a possible protective action of this drug on the striatal lesions produced after the excessive activation of N-methyl-D-aspartate receptors. Morphological lesions were evaluated 7 days after the intrastriatal injection of quinolinate (240 nmol/microl) by light microscopy, and the ratio of neuronal damage per field was also estimated as a quantitative index of the striatal toxicity. Quinolinate alone produced extensive necrosis and loss of striatal neurons. No protective effects on the striatal tissue from quinolinate-treated rats were observed at lower doses of dapsone (6.25 and 9.375 mg/kg). However, at higher doses (12.5 and 25 mg/kg), dapsone prevented significantly the striatum from quinolinate toxicity. Dapsone alone had no effect on the striatal tissue from control rats. A single dose of dapsone (12.5 mg/kg) was tested also on the index of lipid peroxidation 2 h after the striatal injection of quinolinate, resulting in a significant protection (78% vs. QUIN). Findings of this study, in accordance with our previous reports, demonstrate the ability of dapsone to prevent the neuronal damage associated with the excitatory action of quinolinate via overactivation of NMDA receptors, and provide evidences to support the hypothesis that this drug is acting against the pattern of toxicity elicited by agonists of glutamate receptors.

[Antibodies against Toxoplasma gondii in patients with HIV in Yucatan]. / Anticuerpos contra Toxoplasma gondii en pacientes con VIH en Yucatán.

OBJECTIVE: To determine the prevalence of antibodies type IgG to T. gondii in patients with HIV infection type 1 in the Yucatan peninsula. METHODS: 95 patients with HIV and 100 blood donors as controls were studied. The search for IgG antibodies to T. gondii was done with a third generation solid-phase enzyme immunoassay. Clinical and demographic data were obtained. RESULTS: The prevalence of antibodies was higher (p = 0.003) in controls (69%, CI95 = 59-78%) than in patients (47%, CI = 36-57%). No relation was found between seroreactivity and the variables evaluated (gender, urban or rural home, age) nor with CD4 T-cell counts and clinical categories. CONCLUSIONS: The high prevalence of T. gondii antibodies in both groups suggests that the zoonosis is endemic in the Yucatan peninsula. This justifies the routine determination of antibodies and the use of therapeutic protocols for preventing encephalitis by toxoplasma in HIV patients as a high percentage of them would be at risk of developing it.

Brain capillary lesions produced by cocaine in rats.

In the last 20 years, acute and chronic cocaine addiction has increased among young and adult people. The effects of cocaine on brain vasculature of young animals have not been histologically studied in depth. In the present study, we report the lesions of brain capillaries, including the choroid plexus, produced by chronic cocaine administration, in adult Wistar rats receiving i.p., 30 mg/kg/day of aqueous cocaine hydrochloride solution. Rats were sacrificed after several days of treatment. Histopathological examination of capillaries from different brain regions and cerebellum was performed using light microscopy. At 7 days, there were initial signs of dilatation, rupture and thrombosis of capillaries. At 15 days of treatment small interstitial oedema and hemorrhages by rupture of the basal membrane of the capillaries was found. At 30 days of treatment, many capillaries from different areas showed fibroid endothelial thickening, and wall fibrosis become evident after 60 days of daily cocaine. In numerous places (cortex, gray nucleus: thalamus, caudate, hippocampus and cerebellum) we observed capillaries with an occluded lumen probably due to fibrosis or thrombi after 90 days of treatment. In the latter treatment, capillaries from the choroid plexuses had their lumen dilated and the epithelial cells vacuolated or necrotic. We hypothesize that the chronic administration of cocaine in rats induced brain lesions in part as a result of capillary disruption and subsequent extravasation of erythrocytes to brain parenchyma.

Retinal lesions in rat fetuses prenatally exposed to cocaine.

The increased use of cocaine in the United States and worldwide has created great concern about its effects on fetuses and neonates of pregnant cocaine abusers. The effects on neonates are varied: fetal growth delay, microcephaly, abnormal neurological functions, microphthalmia, and maternal obstetric complications. In this study, the effect of prenatal cocaine administration was studied microscopically in the retina of rat fetuses. Twenty-five pregnant Wistar rats were injected i.p. with an aqueous cocaine solution using a 30 mg/kg daily dose for 45 days. Control group rats (15 pregnant animals) received saline solution for the same period. Day 0 of gestation was the day after mating. Dosing began on this day. The rats were killed on gestation day 21 and fetuses were obtained for examination. The histopathological light and electron microscope studies of the retinas showed interstitial oedema, areas depleted of cells, necrosis, and hyperchromatic ganglion cells. There also was a significantly lower number of retinal cells compared to control fetuses. In four cases, teratogenic lesions of the retina were observed whereas no changes were present in control fetuses. Results indicate that development of retina in fetuses prenatally exposed to cocaine was altered by cocaine exposure.

Complex angioplasty and stenting of a saphenous bypass graft using the percutaneous radial approach. Report of a case.

A severely diseased aortocoronary venous by-pass graft is reported. A successful angioplasty plus stenting was performed, via right radial artery, without using a guiding-catheter.

[Diagnostic and interventional heart catheterization through the radial artery]. / Cateterismo cardiaco diagnóstico e intervencionista a través de la arteria radial.

Diagnostic and interventional cardiac catheterization using the femoral approach demands hospitalization for more than 24 hours, and occasionally it is complicated by vascular events. This paper informs about out first 95 catheterizations using the radial percutaneous approach. We describe the technique, duration, length of hospitalization and complications. Eighty three male and 12 female patients, aged 54 +/- 12 years were included, 87 of them with coronary heart disease. There were 71 diagnostic procedures, 11 PTCA and 13 elective stenting. The initial success rate was 63% that reached 97% after three months. The mean duration was 46' for diagnostic procedures, 51' for PTCAs and 87' for stenting. Hospitalization length was 5, 31 and 39 hours respectively. Three patients lost the radial pulse, without distal ischemia. Pain was noticed in 16% of the cases. There were not other vascular complications. It is concluded that the percutaneous radial artery approach allows diagnostic and therapeutic procedures, with lesser hospitalization lengths and few vascular complications.

Experimental neuromyopathy induced by thallium in rats.

A histopathological study, with a light microscope, of experimental neuromyopathy produced by thallotoxicosis was undertaken in 40 newborn Wistar rats. Treatment consisted of a single i.p. injection of an aqueous solution of 16 mg kg-1 thallium(I) acetate 1 day after birth. Groups of ten animals were euthanized at either 8 or 50 days of age. Sural nerves, as well as peroneus muscle, were fixed in 10% formaldehyde solution for 15 days and then prepared for histopathological observation. At 8 days of age sural nerves of thallium-treated animals showed a moderate reduction in the large- and medium-sized fibres and several of the myelin sheaths had initial degeneration along the course of the axon. Interstitial oedema was found in both neural and muscular tissues. Distinct features of focal necrosis as well as small haemorrhages were seen in peroneus muscle. At 50 days of age, the lesions were more diffuse. Large and small myelinated fibres were found to be sinuous, fragmented and scanty. Alterations in the large- and medium-sized axons were seen and the myelin sheaths were altered along the course of the axon, suggesting a progressive distal axonopathy. Additionally, muscle fibres had myopathic changes with abnormal central nucleoli and the striated transverse fibres had disappeared in many areas of the sample. Several interstitial foci of muscular necrosis accompanied by phagocytosis and fibrosis were also present.

Vascular dynamics in isolated systolic arterial hypertension.

With a growing elderly population, the incidence of isolated systolic hypertension (ISH) has increased. This study characterizes dynamic vascular changes that occur with advanced age and with ISH. Fifty-five healthy individuals and seven with ISH were distributed in seven age groups from the second to the seventh decade. An index of aortic stiffness (delta P/delta V) was derived using a mercury sphygmomanometer to obtain pulse pressure, and ultrasonographic measurements were used to estimate aortic volumes applying the "cylinder formula." The mathematic derivation of this formula is explained in detail. Pulse pressure showed no significant change with age, but showed a significant increase with ISH. A decrease in volume change from systole to diastole was found with advanced age. Normotensive subjects aged 65 +/- 2 years had a 2.6-fold increase in aortic stiffness compared with young individuals. Elderly patients with ISH had a 7-fold increase in aortic stiffness compared with Group 1 (15 +/- 2 years) (p < 0.001) and a 2.7-fold increase compared with Group 6 (normotensive subjects aged 65 +/- 2 years). A strong correlation between systolic pressure and arterial stiffness was observed (r = 0.953) (p < 0.001). The proposed stiffness index was compared with the one described by Hirai, obtaining a high correlation, that is, r = 0.989 (p < 0.001). When compared with Stefanadis' index of distensibility, our index showed a correlation of r = 0.932 (p < 0.003). It is concluded that while systolic pressure is a main determinant of arterial stiffness, the delta P/delta V is a more sensitive method to estimate dynamic changes in elastic arteries such as the aorta.

Experimental nephropathy by chronic administration of cocaine in rats.

The recent and significant increase of cocaine abuse has emerged as a major public health problems. Cocaine abuse is frequently associated with multiorganic lesions, including renal failure. We report the light-microscopic features of the progression of renal lesions produced by chronic cocaine administration in rats. Male Wistar rats weighing 225-250 g were used. Twenty eight rats received an aqueous solution of cocaine hydrochloride (30 mg/kg/day i.p.) daily, while 28 control rats were injected i.p. daily with a saline solution. Rats from both groups were sacrificed after 7, 15, 30, 45, 60, 75 and 90 days of treatment. The histopathological study showed early changes on day 15, with damage to glomerular capillary walls and swelling of tubular epithelium, and lesions progressed to 90 days with development of glomerular atrophy and sclerosis. The tubular epithelial cells were necrotic and sloughed, and the lumen of papillary ducts contained destroyed red blood cell (RBC) casts. The interstitium had numerous foci of necrosis and haemorrhage. The results show that chronic treatment with cocaine in rats produce severe lesions both to glomerular, interstitium and tubular cells.

Combined D-penicillamine and prussian blue as antidotal treatment against thallotoxicosis in rats: evaluation of cerebellar lesions.

Rats were treated with a single dose of thallium acetate (32 mg/kg i.p.) and the antidotal effect of D-penicillamine and prussian blue given alone or in combination was assessed by means of evaluation of the thallium-induced cerebellar histological lesions. After thallium poisoning (24 h), antidotes were administered for 4 days as follows: D-penicillamine (DP) 25 mg/kg, i.p. twice daily; prussian blue (PB), 50 mg/kg p.o., twice daily. Mortality among the treatment groups was as follows: control, 87.5%; DP, 100%; PB, 56.25%; DP+PB, 25%. Three days after these treatments, rats treated with the combination DP+PB presented a significantly lower number of altered Purkinje cells in cerebellum as compared with those of the thallium alone treated animals, indicating adequate protection by this antidote treatment against thallium neurotoxicity. Prussian blue protected against thallium-induced neurotoxicity to a lesser extent as compared with the effects obtained by the DP+PB protection. DP did not protect against thallium-induced alterations of Purkinje cells. These results confirm the efficacy of the combined antidotal treatment of DP and PB against thallium toxicity in rats, and support the possible application in human cases of thallotoxicosis.

Testicular lesions by chronic administration of cocaine in rats.

Although cocaine is a common drug of abuse, its effects on the testicular structure have not been studied in depth. We report here the testicular lesions produced by chronic cocaine administration to rats. Twenty-eight male Wistar rats weighing 225-250 g were used throughout. Fourteen of them (controls) were injected i.p. with saline solution and the remaining 14 received 30 mg kg-1 day-1 i.p. of aqueous cocaine hydrochloride solution. Animals from both groups were sacrificed at variable times: 7, 15, 30, 45, 60, 75 and 90 days of treatment. Histopathological examination of the testes showed initial alterations at day 15: capillary dilatation; interstitial oedema with lipoid drops due to incipient necrosis of interstitial cells; and necrosis of the cells of the seminiferous tubules. Lesions progressed until 90 days of treatment, showing atrophic and necrotic cells and terminal tubule fibrosis. At this time, the testes were found to be diminished in size. The seminiferous tubules were shrunken, of small diameter and contained necrotic spermatogenic cells and fibrosis. These lesions may produce testosterone diminution and thus sterility due to the disappearance of spermatogenesis.