[Penoscrotal aggressive angiomyxoma]. / Angiomixoma agresivo penoescrotal.

Aggressive angiomyxoma denotes an extremely infrequent mesenchymal tumour. In virtually every case it involves genital, pelvic or perineal female structures. Cases involving male patients are extremely rare. It is a distinctive tumour with a characteristic clinical course and specific and well characterized microscopic features. The authors report an additional clinical case in a young male patient with massive scrotal and penile involvement, necessitating exeresis followed by complex reconstructive procedure implying flap and graft use. A review of the available literature concerning etiopathogenic, clinical, imagiologic, histological and differential diagnosis, therapeutic and prognostic aspects is also presented.

[Primary mucinous adenocarcinoma of the renal pelvis--adicional case report]. / Adenocarcinoma mucinoso primário de pélvis renal--caso adicional.

Mucinous adenocarcinoma of the renal pelvis may be classified as among the rarest neoplasms of the genitourinary tract. Until the present moment just a few dozen cases have been reported previously. Despite the known association with chronic inflammatory conditions of the upper urinary tract, the exact pathogenesis remains unknown. The authors report an adicional clinical case with particular aspects in what concerns differential diagnosis. A review of the available literature concerning clinical, imagiologic, therapeutic and prognostic aspects is also presented.

Angiomixoma agresivo penoescrotal / Penoscrotal agressive angiomyxoma

Angiomixoma agresivo designa una neoplasia mesenquimatosa extremadamente rara. Afecta casi exclusivamente estructuras genitales, pélvicas o perineales de pacientes de sexo femenino, siendo muy raros los casos que envuelven el sexo masculino. Se trata de neo formaciones bien caracterizadas desde el punto de vista histológico y de comportamiento benigno. Los autores presentan un caso clínico de un tumor de este tipo en un adulto joven de sexo masculino con envolvimiento penoescrotalde grandes dimensiones implicando exéresis y reconstrucción compleja, con recurso a colgajos e injertos cutáneos. Es igualmente realizada una revisión bibliográfica exhaustiva sobre el tema englobando aspectos etiopatogénicos, clínicos, de imagen, anatomo-patológicos y de diagnóstico diferencial, así como terapéuticos y de pronóstico (AU)

Aggressive angiomyxoma denotes an extremely infrequent mesenchymal tumour. In virtually every case it involves genital, pelvic or perineal female structures. Cases involving male patients are extremely rare. It is a distinctive tumour with a characteristic clinical course and specific and well characterized microscopic features. The authors report an additional clinical case in a young male patient with massive scrotal and penile involvement, necessitating exeresis followed by complex reconstructive procedure implying flap and graft use. A review of the available literature concerning etiopathogenic, clinical, imagiologic, histological and differential diagnosis, therapeutic and prognostic aspects is also presented (AU)

Adenocarcinoma mucinoso primário de pélvis renal-caso adicional / Primary mucinous adenocarcinoma of the renal pelvis–adicional case report

Los adenocarcinomas mucinosos de la pelvis renal se encuentran entre las neoplasias genitourinarias más raras, encontrándose descritas apenas algunas decenas de casos hasta el presente momento. Aunque esten asociados a alteraciones inflamatorias crónicas persistentes del aparato escretor alto, la etiopatogenia subyacente exacta permanece por esclarecer. Los autores presentan un caso adicional de este tipo de tumores, revestido de aspectos de diagnóstico diferencial particulares, así como una revisión de los aspectos clínicos, de imagen, terapeúticos y pronósticos (AU)

Mucinous adenocarcinoma of the renal pelvis may be classified as among the rarest neoplasms of the genitourinary tract. Until the present moment just a few dozen cases have been reported previously. Despite the known association with chronic inflamatory conditions of the upper urinary tract, the exact pathogenesis remains unknown. The authors report an adicional clinical case with particular aspects in what concerns diferencial diagnosis. A review of the available literature concerning clinical, imagiologic, therapeutic and prognostic aspects is also presented (AU)

Colonoscopy completion in a large safety net health care system.

BACKGROUND & AIMS: Anecdotally, patients in safety net health care systems have difficulty completing screening and diagnostic colonoscopies, but this is poorly characterized. It is important to understand this phenomenon to improve low rates of colorectal cancer screening in vulnerable populations and to ensure that patients with signs and symptoms complete medically indicated colonoscopic evaluations. METHODS: We performed a 6-month retrospective review of outpatient endoscopy laboratory scheduling and procedure logs and electronic medical records at Denver Health Medical Center (DHMC), a large safety net health care system, to describe rates and sociodemographic predictors of colonoscopy nonattendance and inadequate (fair/poor) bowel preparation. Predictor variables included patient age, gender, race/ethnicity, procedure indication, and insurance type. RESULTS: The nonattendance rate was 41.7% for all scheduled outpatient colonoscopies without difference between screening and diagnostic procedures. Consistent with non-safety net systems, the rate of inadequate bowel preparation was 30.2%; however, the rate of poor bowel preparation that absolutely precluded an exam was 9.9%. Correctional care patients had markedly higher rates of nonattendance and inadequate bowel preparation compared with other groups. CONCLUSIONS: A very large proportion of patients scheduled for colonoscopy in a large safety net health care system do not attend their procedures, and among those who do, there is a high rate of inadequate bowel preparation leading to incomplete and aborted evaluations. Interventions are needed to promote the more efficient use of a limited and expensive resource and to achieve higher rates of screening and medically indicated diagnostic colonoscopies in vulnerable patient populations.

Inhibiting myosin light chain kinase induces apoptosis in vitro and in vivo.

Previous short-term studies have correlated an increase in the phosphorylation of the 20-kDa light chain of myosin II (MLC20) with blebbing in apoptotic cells. We have found that this increase in MLC20 phosphorylation is rapidly followed by MLC20 dephosphorylation when cells are stimulated with various apoptotic agents. MLC20 dephosphorylation is not a consequence of apoptosis because MLC20 dephosphorylation precedes caspase activation when cells are stimulated with a proapoptotic agent or when myosin light chain kinase (MLCK) is inhibited pharmacologically or by microinjecting an inhibitory antibody to MLCK. Moreover, blocking caspase activation increased cell survival when MLCK is inhibited or when cells are treated with tumor necrosis factor alpha. Depolymerizing actin filaments or detaching cells, processes that destabilize the cytoskeleton, or inhibiting myosin ATPase activity also resulted in MLC20 dephosphorylation and cell death. In vivo experiments showed that inhibiting MLCK increased the number of apoptotic cells and retarded the growth of mammary cancer cells in mice. Thus, MLC20 dephosphorylation occurs during physiological cell death and prolonged MLC20 dephosphorylation can trigger apoptosis.