Hypersensitivity pneumonitis: application of a new diagnostic algorithm to a time series of the disease.

BACKGROUND: The diagnostic criteria for Hypersensitivity pneumonitis (HP) have changed over time. Our aim is to apply a recent diagnostic algorithm to a historical series of patients diagnosed with HP to assess its distribution according to current diagnostic criteria and the diagnostic confidence achieved. RESEARCH DESIGN AND METHODS: Application to each patient the algorithm criteria. The diagnosis was HP (≥90%), provisional high (70-89%) or low confidence (51-69%) or non-HP (unlikely) (≤50%); or HP, provisional or non-HP, if they had lung biopsy. RESULTS: 129 patients [mean age 64 ± 12 years; 79 (61.2%) women] were included of which 16 (12.4%) were diagnosed on the basis of high clinical suspicion. After applying the algorithm, 106 patients (82.2%) could be evaluated and 83 (78.3%) had a diagnosis of HP or high confidence. Lung biopsy was able to establish a diagnosis of certainty in another 21 patients and a provisional diagnosis in 9 more [total, 113 (87.6%)]. The 16 patients without strict diagnostic criteria for HP had a low confidence diagnosis. A total of 56 lung biopsies (64.4%) could have been avoided according to the new guidelines. CONCLUSIONS: The application of this algorithm achieves a high diagnostic yield in HP, significantly reducing the number of lung biopsies required.

Sarcoidosis. Disease progression based on radiological and functional course: Predictive factors.

BACKGROUND: Sarcoidosis is a multiorgan granulomatous disease with a variable course. OOBJECTIVES: The purpose of this study is to identify the patients that are more likely to experience disease progression. METHODS: A retrospective study in patients ≥18 years. Pulmonary function and radiological stage (Scadding criteria) were assessed at diagnosis, and at 1, 3 and 5 years. Sarcoidosis progression was established based on deterioration of radiological or pulmonary function (decrease ≥10% of FVC and/or ≥15% of diffusing capacity of the lung (DLCO). RESULTS: The sample included 277 caucasian patients [mean age, 50±13.6; 69.7% between 31-60 years; 56.3% men]. In total, 65% had stage II sarcoidosis, whereas only 8.3% had stage III/IV disease. Mean pulmonary function (FVC, FEV1, FEV1/FVC and DLCO) at diagnosis was 103±21.8, 96±22.2, 76.2±8 and 81.7±21.7, respectively. The percentage of patients with normal FVC and DLCO was 72.2% and 51.8%, respectively. Radiological stage did not change significantly during follow-up (5 years; p=0.080) and only progressed in 13 patients (5.7%). At 3 years, FVC improved, whereas DLCO exacerbated significantly (p<0.001 for the two). Disease progressed in 34.5% of the patients (57/165) whose pulmonary function and radiological stage were available (both baseline and at 3 years). Age was associated with disease progression [OR=1.04 (95%CI=1.01, 1.06)]. Risk increased by 4% for each year older a patient was at diagnosis. CONCLUSIONS: At 3 years, a third of patients experienced sarcoidosis progression. Age was the only factor associated with disease prognosis.

Pleuroparenchymal fibroelastosis: Clinical, radiological and histopathological features.

Pleuroparenchymal fibroelastosis (PPFE) is a rare, generally idiopathic form of interstitial pneumonia with unique clinical, radiological and histopathological features. It is named after the presence of upper lobe pleural and subjacent parenchymal fibrosis, with accompanying elastic fibers. Although it is usually an idiopathic disease, it has been linked to other co-existent diseases. Diagnostic suspicion of PPFE is based on the identification of typical abnormalities on chest CT scan, which are prevailingly located in the upper lobes, adjacent to the apex of the lungs. Diagnosis can be confirmed by histological analysis, although biopsy is not always feasible. The disease is generally progressive, but not uniformly. The course of the disease is frequently slow and involves a progressive loss of upper lobe volume, which results in platythorax, associated with a significant reduction of body mass. PPFE concomitant to other interstitial lung diseases is associated with a poorer prognosis. The disease occasionally progresses rapidly causing irreversible respiratory insufficiency, which leads to death. Currently, there is no effective pharmacological therapy available, and lung transplantation is the best therapeutic option. The purpose of this review is to draw the attention to PPFE, describe its clinical, radiological and histopathological features, analyze its diagnostic criteria, and provide an update on the management of the disease.

Educación de la memoria desde la literatura: pasado, (re)interpretación del presente y el recuerdo como praxis de formación / Education of the memory from the literature: past, (re)interpretation of the present and the memory as training praxis

Resumen El artículo analiza la memoria relacionada con el tiempo y la historia desde la narrativa contemporánea. Se parte de obras literarias de autores clave para el argumento, se expone que las ideas de la memoria y el tiempo, articuladas con lo histórico, juegan un papel transcendental para la formación de la vida humana como proyecto. El análisis enlaza los conceptos mencionados y forma una unidad experiencial, que amalgama y da sentido a la materialidad de la vida a través de los personajes literarios y de su generalización como experiencia social e individual humana. Desde la narrativa se presentan estos conceptos como unidad, y son considerados por filósofos, narradores e historiadores. Se argumenta la relación entre tiempos vividos, los que se viven y los que quedan por vivir, y se argumenta finalmente que la memoria es una dimensión individual humana, pero que, en su relación con el tiempo, es vivida como un contínuum: es una unidad temporal entre pasado, presente y futuro.

Abstract The article presents an analysis of memory in its relation to time and history, from the perspective of contemporary narrative. Taking as a starting point literary works of key authors for the work, such as Cortázar, Borges, Fournier, among others, from the concept of memory it is stated that, from the creation of literature, this idea along with that of time, both are articulated to the idea of the historical fact as past, but taking the latter as a future that flows into the concrete present that is projected into the future as an existential unit, not only of literary characters, but of the memory lived as a present experience. That is why this concept and its praxis play a transcendental role for the formation of human life, this time seen as a project, through literary creation, since it starts from the Bergsonian idea that, if the literary work wishes to be authentic, the author must expose himself as a unit in his feeling as a human being and in the creation itself. According to the analysis made to the authors brought to the study, the researchers manage to link the concepts memory, time and history; these ones, in their experiential amalgamation as an experience, give meaning to the materiality of life not only of the characters involved in the argument, but to their generalization as part of the human social experience. The narrative presents these concepts, according to the researchers, as part of the unit that is the human, an issue that is present in the arguments of philosophers, narrators and historians that were used as pertinent for the study, such as Borges, Heidegger, Nietzsche, Bergson, among others. Through a hermeneutical analysis of the fundamental work for the article, it is understood with Heidegger, for example, that, if one wants to live life, if the "being" wants to "be-together-with" (Mitsein from Dasein), one should stop looking at the past as history, and feel it as part of a flow of experiences that are born, in the past, but that are accentuated in the present, and are projected into the future as becoming without end. It is a continuous time in memory as a way of being of Dasein. Likewise, it is argued with Nietzsche that memory as history is useless for life, because if one wants to feel this, it is unnecessary to look at the past unless one wishes to disassemble oneself from the real human experience; that is, we are facing a continuity of the experience. It is thus possible to see the relationship between the times lived, those that are lived and those to be lived, finally considering that memory is certainly a human dimension, but that, in its relationship with time, it is lived as a continuum; that is, as a temporary unit formed by past, present and future. However, at the end of the argument, the past counts as the livelihood of the present life but also as a projection of future life (Peña, 2019), so it is concluded that the works analysed allow us to establish the course of temporality present inseparably from life itself. Without past there is no present, just as without it, there is no future. This allows researchers to rethink the issue of temporality in everyday life because individual life is combined with social life thus constituting a constant flow of living. Finally, the article establishes that memory is a fundamental dimension of formation in life, since, being Bergson at the right side, every work is part of the author's own temporality that creates it, and therefore, memory, as part from this temporality, permeates human life from the sense of its existence.

Effect of a Job Demand-Control-Social Support Model on Accounting Professionals' Health Perception.

The Job Demand-Control and Job Demand-Control-Support (JDCS) models constitute the theoretical approaches used to analyze the relationship between the characteristics of labor and occupational health. Few studies have investigated the main effects and multiplicative model in relation to the perceived occupational health of professional accountants. Accountants are subject to various types of pressure in performing their work; this pressure influences their health and, ultimately, their ability to perform a job well. The objective of this study is to investigate the effects of job demands on the occupational health of 739 accountants, as well as the role of the moderator that internal resources (locus of control) and external resources (social support) have in occupational health. The proposed hypotheses are tested by applying different models of neural networks using the algorithm of the Extreme Learning Machine. The results confirm the relationship between certain stress factors that affect the health of the accountants, as well as the direct effect that the recognition of superiors in occupational health has. Additionally, the results highlight the moderating effect of professional development and the support of superiors on the job's demands.

Breast cancer subtype discrimination using standardized 4-IHC and digital image analysis.

Breast cancer is a heterogeneous disease. Surrogate classification of intrinsic subtypes of invasive carcinomas by combined immunohistochemistry for estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki67 (4-IHC) has increased steadily since the 2011 St Gallen symposium, due to its rapid subtyping of tumors at a reasonable cost. An important step in improving 4-IHC reproducibility and reliability will be to provide reference values from the routine use of standardized 4-IHC followed by image analysis. The aims of the current study were (1) to analyze invasive breast carcinomas using standardized 4-IHC and quantitative image analysis and (2) to compare the results obtained in the classification of biological subtypes using current Ki67 and PR threshold values proposed by different authors to sub-classifying the luminal A-like and the luminal B-like (HER2-negative) subtypes. Five hundred twenty-one tumors were analyzed by standardized immunohistochemistry, with automatic image analysis, and HER2 FISH technique. Positivity for ER was found in 82.7% and for PR in 70.1% of cases. Using the Allred scoring system, hormone receptor results showed a bimodal distribution, particularly for ER. HER2 positivity was found in 15.7% of cases, and the mean Ki67 score was 32.3%. Using the most recently proposed surrogate definitions for the classification of luminal breast cancer subtypes, the percentages of different subtypes that we found were similar to those published with genomic platforms: 40.7% luminal A-like, 32.4% luminal B-like/HER2-negative, 9.8% luminal B-like/HER2-positive, 6.0% HER2-positive, and 11.1% triple negative. Standardized 4-IHC with automatic image analysis constitutes a low-cost method for surrogate definitions of biological subtypes of breast cancer that delivers accurate results in a day.

Fluorescence in situ hybridization analysis of the ALK gene in 2,045 non-small cell lung cancer patients from North-Western Spain (Galicia).

Identification of anaplastic lymphoma receptor tyrosine kinase (ALK) gene rearrangements is a standard diagnostic test in patients with advanced non-small cell lung cancer (NSCLC). The current study describes the experience of ALK rearrangement detection of a referral center in the public health care system of Galicia in North-Western Spain. The fluorescence in situ hybridization (FISH) patterns of the ALK gene and the clinical and pathological features of these patients are reported. This study is also of interest for comparative purposes due to the relative geographical isolation of the area, which could have contributed to particular genetic features. A total of 2,045 tissue samples from NSCLC patients were collected between October 2010 and July 2015 and tested for ALK rearrangements by FISH. Examination of 1,686 paraffin-embedded tissue specimens and 395 cytological samples (306 cell block preparations and 53 cytological smears) was conducted, and any associations between the FISH results and clinicopathological features were assessed. The rate of successful evaluation was marginally higher in tissue samples than in cytological samples (92.9% vs. 84.1%); this difference was not significant. ALK rearrangements were identified in 82 patients(4%): 65 (79.3%) in tissue specimens, 15 (18.3%) in cell block samples and 2 (2.4%) in cytological smears. This genetic translocation appeared to be associated with a non-smoking history, younger age, female gender, stage IV and adenocarcinoma histological type. The findings demonstrate that ALK evaluation by FISH is feasible in tissue and cytological samples. The clinical and pathological features of the ALK-positive series of patients are similar to those previously reported in the literature.

Recomendaciones para el estudio patológico de las metástasis hepáticas de cáncer colorrectal tras neoadyuvancia. Consenso Nacional de la Sociedad Española de Anatomía Patológica / Recommendations for the study of liver metastases of colorectal cancer after neoadjuvant therapy. National Consensus of the Spanish Society of Pathology (SEAP)

Las resecciones hepáticas por metástasis de cáncer colorrectal (CCR) son una pieza quirúrgica frecuente en muchos servicios de anatomía patológica. Si al aumento de la incidencia de CCR añadimos otros factores como la frecuencia de metástasis hepáticas sincrónicas o metacrónicas, la ampliación en los criterios quirúrgicos de resecabilidad y el tratamiento neoadyuvante que facilita la resecabilidad, nos encontramos con una patología en aumento. El estudio anatomopatológico de estas piezas quirúrgicas se ha modificado y ha aumentado su complejidad debido a que se deben valorar nuevos datos histológicos como son los cambios potenciales producidos por el tratamiento neoadyuvante quimioterápico en el hígado no tumoral, y en el tumor el grado de regresión tumoral patológico, por su valor pronóstico. Teniendo en cuenta estos antecedentes, un grupo de patólogos se propuso revisar su papel en el diagnóstico y pronóstico de los pacientes con metástasis hepáticas de CCR con el objetivo de elaborar unas recomendaciones prácticas de procedimiento. De esta revisión se han obtenido unas directrices que podrían ser adaptadas por los distintos departamentos de patología con el fin de unificar procedimientos y obtener diagnósticos comparables. En este trabajo se exponen los resultados de este consenso (AU)

Liver resections for colorectal cancer (CRC) metastasis are common in most pathology departments. In addition, the frequency of liver resections for CRC specimens has increased due to an increased incidence of CRC the frequency of synchronous or metachronous liver metastases, the use of neoadjuvant therapy, and the increased surgical criteria of resectability. The pathological study of the specimens should include new histological data, i.e.: changes caused by therapy, both in the tumour and in the liver parenchyma, such as the pathological tumour regression grade, and the histologic degree of liver damage by the therapy, because of its prognostic value. On this setting, a group of pathologists has elaborated a guideline proposal, in order to obtain a more uniform procedure and diagnosis of CRC liver metastasis specimens. The aim was to give useful recommendations in order to obtain homogeneous and comparable pathologic reports among different pathology departments. The results of this consensus are presented in this paper (AU)

Ética para una sociedad global: la bioética puente para el giro tecnocientífico

Introducción. La cultura de la vida es considerada desde hace algunos años eslabón necesario para la tecnociencia, pues esta resulta ser de alto impacto para la biodiversidad, cuestión que motiva una reconstrucción de las éticas contemporáneas, las cuales se basan, finalmente, en una cultura del cuidado. Desde aquí la crítica a la tecnociencia se centra en sus efectos sobre el entramado planetario. Objetivo. Reflexionar sobre la cultura de la vida y sus repercusiones éticas desde la tecnociencia. Materiales y métodos. Se aplica el método hermenéutico en la investigación bioética, considerando documentos y textos de primera y segunda fuentes. Resultados. 1) Las dimensiones de la ética aplicada recomponen una bioética de la complejidad; 2) Las éticas aplicadas sobre la tecnociencia replantean las reflexiones por la vida en virtud del deber de cuidado total de la existencia. Conclusión. Partiendo de la bioética en sus dimensiones éticas de la complejidad, se concluye que el cuidado de la vida, a partir del cuidado de sí, el cuidado del otro y el cuidado de lo otro conforman una ética compleja del cuidado; esta toma como entramado la vida global. Sin embargo, por estar el actual desarrollo descontextualizado de la preservación de la biodiversidad, es necesario incluir la crítica al método tecnocientífico, para sustentar los aportes socio-científicos, devenidos desde la Modernidad inconclusa. Finalmente, se estructura un argumento bioético global mediador entre el entorno vital y la preservación de la biodiversidad, pues las éticas emergentes se reconfiguran puente en su mediación hacia la tecnociencia del futuro.

Introduction. The culture of life has been considered for several years as a necessary link for techno science, because it has a great impact on biodiversity and this issue motivates a reconstruction of the contemporary ethics, which are finally based on a culture of care. From here, the critic to techno science focuses on its effects on the global framework. Objective. Reflect about a culture of life and its ethical consequences according to techno science. Materials and methods. The hermeneutical method is applied in bioethical research, considering documents and texts as first and second order sources. Results. 1). The dimensions of applied ethics re-compose a bioethics for complexity; 2). Ethics applied to techno science restate the reflections about life according to the duty of taking care of the existence as a whole. Conclusion. From bioethics, in its ethical dimensions of complexity, it can be concluded that the care of life, starting from self-care, the care of others and the care for other elements, form a complex ethics of care, which takes global life as a network. However, given the current decontextualized development of the biodiversity preservation, it is necessary to include a critic to the techno scientific method in order to sustain the socio-scientific contributions coming from the unfinished modernity. Finally, a global bioethical argument between the vital environment and the preservation of biodiversity is structured, given the fact that emerging ethics are re-configuring a bridge in their mediation for the future techno science.

Introdução. A cultura da vida é considerada desde faz alguns anos elo necessário para a tecnociência, pois esta resulta ser de alto impacto para a biodiversidade, questão que motiva uma reconstrução das éticas contemporâneas, as quais se baseiam, finalmente, numa cultura do cuidado. Desde aqui a crítica à tecnociência se centra em seus efeitos sobre o entrelaçado planetário. Objetivo. Reflexionar sobre a cultura da vida e suas repercussões éticas desde a tecnociência. Materiais e métodos. Aplica-se o método hermenêutico na investigação bioética, considerando documentos e textos de primeira e segunda fontes. Resultados. 1) As dimensões da ética aplicada recompõem uma bioética da complexidade; 2) As éticas aplicadas sobre a tecnociência reformulam as reflexões pela vida em virtude do dever de cuidado total da existência. Conclusão. Partindo da bioética em suas dimensões éticas da complexidade, conclui-se que o cuidado da vida, a partir do cuidado de si, o cuidado do outro e o cuidado do outro conformam uma ética complexa do cuidado; esta tomada como entrelaçado a vida global. No entanto, por estar o atual desenvolvimento descontextualizado da preservação da biodiversidade, é necessário incluir a crítica ao método tecnocientífico, para sustentar os contribuas sócio-científicos, devindos desde a Modernidade inconclusa. Finalmente, estrutura-se um argumento bioético global mediador entre o meio vital e a preservação da biodiversidade, pois as éticas emergentes se reconfiguram ponte em sua mediação para a tecnociência do futuro.

Immunohistochemical evaluation of EGFR expression in lip squamous cell carcinoma. Correlation with clinicopathological characteristics.

BACKGROUND: The majority of lip cancer is the squamous cell carcinoma (SCC) type that exhibits clinical and biological characteristics intermediate between skin and oral SCC. The aim of this study was to assess the impact of epidermal growth factor receptor (EGFR) expression on prognosis of lip squamous cell carcinoma (LSCC) and to relate it with clinicopathological features. The role of EGFR expression as a possible therapeutic target was also discussed. METHODS: A series of 55 patients with LSCC was analyzed. EGFR expression was determined by standardized immunohistochemistry (pharmDx assay) and evaluated by both manual and automated image analysis (ACIS III). The Kappa statistic test was used to evaluate the concordance of manual and automated scores. EGFR results were correlated with clinicopathologic characteristics. Statistical differences between proportions were determined by the chi-squared test (with linear-by-linear correction where appropriate). The Mann-Whitney and the Kruskal-Wallis test were employed for comparison of continuous variables. RESULTS: Correlation between manual and automated score was obtained in 50/55 cases (90.9%). EGFR expression was absent or weak in 14 cases (25.5%); borderline (2+) in 20 cases (36.4%) and positive (3+) in 21 cases (38.2%). Significant relationships were found between EGFR expression and tumour ulceration (p=0.022) and tumour thickness (p=0.002) and width (p=0.021). CONCLUSIONS: Our results revealed EGFR high expression in LSCC and its relationship with bad prognosis criteria (tumour size and ulceration).

Dual-colour CISH is a reliable alternative to FISH for assessment of topoisomerase 2-alpha amplification in breast carcinomas.

Anthracyclines are among the most powerful antineoplastic drugs available for breast cancer treatment. Although HER2 amplification has been postulated to predict anthracycline benefit, numerous reports have demonstrated that HER2/TOP2A co-amplification is the clinically useful predictive marker of response to anthracyclines. The standard technique to evaluate gene status for target therapy selection is fluorescence in situ hybridization (FISH), but this technique has some disadvantages. Dual-colour chromogenic in situ hybridization (CISH) is an extension of the FISH protocol that allows bright-field microscopy and thus represents a user-friendly alternative to FISH. In order to evaluate whether dual-colour CISH is a reliable alternative to FISH in determining TOP2A gene amplification and to determine the frequency with which TOP2A and HER2 were co-amplified, we analysed 100 invasive breast cancer specimens (70 consecutive and 30 HER2-amplified samples) using tissue microarrays. Thus, a 99 % agreement was found between TOP2A status determined by dual-colour CISH and FISH, as well as a high degree of correlation in TOP2A ratios using both techniques. TOP2A gene amplification was present in 8.6 % of the 70 consecutive samples studied, all of which were HER2-amplified. Co-amplification of TOP2A was observed in 46.5 % of the additional 30 HER2-amplified samples (no TOP2A amplification was seen in non-amplified HER2 samples). We conclude that dual-colour CISH represents an excellent alternative to FISH for determination of TOP2A gene status in invasive breast cancer. Our results showing TOP2A amplification only in HER2-amplified cases also add to the evidence that TOP2A determination should be restricted to those cases.

Role of blind closed pleural biopsy in the managment of pleural exudates.

INTRODUCTION: The performance of blind closed pleural biopsy (BCPB) in the study of pleural exudates is controversial. OBJECTIVE: To assess the diagnostic yield of BCPB in clinical practice and its role in the study of pleural exudates. METHODS: Data were retrospectively collected on all patients who underwent BCPB performed between January 1999 and December 2011. RESULTS: A total of 658 BCPBs were performed on 575 patients. Pleural tissue was obtained in 590 (89.7%) of the biopsies. A malignant pleural effusion was found in 35% of patients. The cytology and the BCPB were positive in 69.2% and 59.2% of the patients, respectively. Of the patients with negative cytology, 21 had a positive BCPB (diagnostic improvement, 15%), which would have avoided one pleuroscopy for every seven BCPBs that were performed. Of the 113 patients with a tuberculous effusion, granulomas were observed in 87 and the Lowenstein culture was positive in an additional 17 (sensitivity 92%). The overall sensitivity was 33.9%, with a specificity and positive predictive value of 100%, and a negative predictive value of 71%. Complications were recorded in 14.4% of patients (pneumothorax 9.4%; chest pain 5.6%; vasovagal reaction, 4.1%; biopsy of another organ 0.5%). CONCLUSIONS: BCPB still has a significant role in the study of a pleural exudate. If an image-guided technique is unavailable, it seems reasonable to perform BCPB before resorting to a pleuroscopy. These results support BCPB as a relatively safe technique.

Intraoperative molecular analysis of total tumor load in sentinel lymph node: a new predictor of axillary status in early breast cancer patients.

OBJECTIVE: To assess the intraoperative positive sentinel lymph node (SLN) total tumor load (TTL, defined as the amount of CK19 mRNA copies [copies/µL] in all positive SLNs) obtained by one-step nucleic acid amplification (OSNA) and to determine whether it is predictive of non-SLNs involvement. SUMMARY/BACKGROUND/DATA: The OSNA assay (Sysmex Corporation, Kobe, Japan) is a new diagnostic technique that uses molecular biological techniques to analyze SLN that has been validated as an accurate method for detection of positive SLN. Although the American College of Surgeons Oncology Group Z0011 trial has defined a select cohort of patients in whom a completion axillary lymph node dissection (cALND) may be safely omitted, there are a still a number of patients where prediction of non-SLN metastasis may be helpful for cALND decision making. Multiple studies suggest that specific pathologic characteristics of the primary tumor and the SLN metastases are associated with an increased likelihood of additional positive non-SLN. METHODS: This is a retrospective multicentric cohort study of 697 patients with cT1-3N0 breast cancer, who had had intraoperative SLN evaluation by OSNA assay with a cALND. TTL is defined as the amount of CK19 mRNA copies number in all positives SLN (copies/µL). RESULTS: Univariate logistic regression showed that, in addition to TTL (p < 0.001), the number of affected SLNs (p < 0.001), tumor size (p < 0.001), HER2 status (p = 0.007), and lymphovascular invasion (LVI, p < 0.001) were predictive of ALND status. The multivariate logistic regression analysis showed that TTL is an independent predictor of metastatic non-SLNs, after adjusting for the tumor size, HER2 status, LVI and, in particular, the number of affected SLNs. CONCLUSIONS: TTL by OSNA is a newly standardized and automated tool that predicts axillary node status better and independently of the number of affected SLNs and the type of surgery. This value can then help clinicians to personalize surgical treatment. Prospective studies will be carried out to determine the clinical impact of this variable in the management of patients.

Family history and breast cancer hormone receptor status in a Spanish cohort.

BACKGROUND: Breast cancer is a heterogenous disease that impacts racial/ethnic groups differently. Differences in genetic composition, lifestyles, reproductive factors, or environmental exposures may contribute to the differential presentation of breast cancer among Hispanic women. MATERIALS AND METHODS: A population-based study was conducted in the city of Santiago de Compostela, Spain. A total of 645 women diagnosed with operable invasive breast cancer between 1992 and 2005 participated in the study. Data on demographics, breast cancer risk factors, and clinico-pathological characteristics of the tumors were collected. Hormone receptor negative tumors were compared with hormone receptor postive tumors on their clinico-pathological characteristics as well as risk factor profiles. RESULTS: Among the 645 breast cancer patients, 78% were estrogen receptor-positive (ER+) or progesterone receptor-positive (PR+), and 22% were ER-&PR-. Women with a family history of breast cancer were more likely to have ER-&PR- tumors than women without a family history (Odds ratio, 1.43; 95% confidence interval, 0.91-2.26). This association was limited to cancers diagnosed before age 50 (Odds ratio, 2.79; 95% confidence interval, 1.34-5.81). CONCLUSIONS: An increased proportion of ER-&PR- breast cancer was observed among younger Spanish women with a family history of the disease.

Antivenomics of Atropoides mexicanus and Atropoides picadoi snake venoms: Relationship to the neutralization of toxic and enzymatic activities.

Viperid snakes of the genus Atropoides are distributed in Mexico and Central America and, owing to their size and venom yield, are capable of provoking severe envenomings in humans. This study evaluated, using an 'antivenomics' approach, the ability of a polyspecific (polyvalent) antivenom manufactured in Costa Rica to recognize the proteins of Atropoides mexicanus and A. picadoi venoms, which are not included in the immunization mixture. In addition, the neutralization of lethal, hemorrhagic, myotoxic, coagulant, proteinase and phospholipase A(2) (PLA(2)) activities of these venoms by the antivenom was assessed. The antivenom was highly-effective in immunodepleting many venom components, particularly high molecular mass P-III metalloproteinases (SVMPs), L-amino acid oxidases, and some serine proteinases and P-I SVMPs. In contrast, PLA(2)s, certain serine proteinases and P-I SVMPs, and a C type lectin-like protein were only partially immunodepleted, and two PLA(2) molecules were not depleted at all. The antivenom was able to neutralize all toxic and enzymatic activities tested, although neutralization of lethality by A. nummifer venom was achieved when a challenge dose of 3 LD(50)s of venom was used, but was iffective when 4 LD(50)s were used. These results, and previously obtained evidence on the immunoreactivity of this antivenom towards homologous and heterologous venoms, revealed the low immunogenicity of a number of venom components (PLA(2)s, CRISPs, P-I SVMPs, and some serine proteinases), underscoring the need to search for innovative immunization protocols to improve the immune response to these antigens.

Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses.

AIM: To evaluate the diagnostic accuracy of histological evaluation of pancreatic tissue samples obtained by a modified method for recovering and processing the endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) material in the differential diagnosis of pancreatic solid masses. METHODS: Sixty-two consecutive patients with pancreatic masses were prospectively studied. EUS was performed by the linear scanning Pentax FG-38UX echoendoscope. Three FNAs (22G needle) were carried out during each procedure. The materials obtained with first and second punctures were processed for cytological study. Materials of the third puncture were recovered into 10% formol solution by careful injection of saline solution through the needle, and processed for histological study. RESULTS: Length of the core specimen obtained for histological analysis was 6.5 +/- 5.3 mm (range 1-22 mm). Cytological and histological samples were considered as adequate in 51 (82.3%) and 52 cases (83.9%), respectively. Overall sensitivity of both pancreatic cytology and histology for diagnosis of malignancy was 68.4%. Contrary to cytology, histology was able to diagnose tumours other than adenocarcinomas, and all cases of inflammatory masses. Combination of cytology and histology allowed obtaining an adequate sample in 56 cases (90.3%), with a global sensitivity of 84.21%, specificity of 100% and an overall accuracy of 90.32%. The complication rate was 1.6%. CONCLUSION: Adequate pancreatic core specimens for histological examination can be obtained by EUS-guided FNA. This technique is mainly useful for the diagnosis of different types of pancreatic tumours and evaluation of benign diseases.

Vaginal involvement in a woman with Darier's disease: a case report.

BACKGROUND: Involvement of the female genital tract by Darier's disease, an unusual genodermatosis, is uncommon, and the manifestation of the disease in a cervicovaginal smear is exceptionally rare. CASE: A 39-year-old woman had an abnormal Pap smear caused by involvement of the female genital tract by Darier's disease. Cytologic examination showed features consistent with a low grade squamous intraepithelial lesion, but during a biopsy it was found to be vaginal involvement by Darier's disease. CONCLUSION: The correct interpretation of cytologic findings is not possible when the diagnosis of Darier's disease is not known since a low grade squamous intraepithelial lesion cannot be ruled out. This case underlines the importance of knowing the patient's medical histoiy in any moment of medical attention.

Taponamiento cardíaco por sarcoma de Kaposi / Cardiac tamponade through Kaposi's sarcoma

El sarcoma de Kaposi es un tumor angiomatoso, sistémico que, por lo general, afecta a sujetos mayores de 50 años, observándose principalmente en pacientes varones. Se han descrito pocos casos de afectación visceral en su forma clásica. En el presente trabajo, se describe un caso de sarcoma de Kaposi clásico con lesiones cutáneas diseminadas, afectación de numerosos órganos internos y evolución fatal. La causa de la muerte fue un taponamiento cardíaco originado por las lesiones de sarcoma de Kaposi desarrolladas en el epicardio y el pericardio (AU)