Myocardial torsion and cardiac fulcrum.

OBJECTIVE: The development of the myocardial band shows that it starts and ends at the origin of the great vessels and that the myocardium joins to these rings but does not inserted into them. We always considered that there should be a fixed end of the muscle band that would allow it a helical rotation to fulfill its fundamental movements of shortening-torsion (systole) and elongation-distortion (suction). MATERIAL AND METHODS: Seven young-bovine hearts (800-1000g) and seven human hearts (one embryo, 4g; one 10 years, 250g and five adult, 300g/average) were used for a detailed macrocoscopic and microscopic study. RESULTS: We have found in all the bovine and human hearts studied a nucleus underlying the right trigone, whose osseus, chondroid or tendinous histological structure depends on the specimen analyzed. The microscopic analysis revealed in the hearts a trabecular osteochondral matrix (fulcrum) with segmental lines in bovines and in the ten-year-old human. In the fetus, it was found pre-chondroid areas in a myxoid stroma. In the adult human hearts, the histological analysis revealed a matrix similar to that of a tendon. All the hearts studied presented myocardial attachment to the rigid structure of the fulcrum. Myocardiocytes were not found neither at the left or rigth trigonous nor at the base of the valves. CONCLUSIONS: The finding of the fulcrum gives support to the spiral myocardial band being the point of fixation that allows the helicoidal torsion.

[Diagnostics and treatment of sex offenders : In psychiatric forensic committment according to § 63 StGB and in outpatient prevention]. / Diagnostik und Behandlung sexueller Missbrauchstäter : Im Maßregelvollzug nach § 63 StGB und in der Präventionsambulanz.

In the following article similarities and differences concerning the treatment of sex offenders in the psychiatric forensic commitment (§ 63 German penal code) and of persons with a self-reported sexual interest in children, who were diagnosed and treated in the outpatient prevention of sexual abuse (PSM) in Göttingen are demonstrated. Diagnostic and therapeutic characteristics of outpatient prevention as well as the initial results of the evaluation of the Göttingen therapy manual are presented and differentiated from the normal treatment program in psychiatric forensic commitment.

Carcinoma ductal in situ da mama / Breast ductal in situ carcinoma

Neste trabalho é apresentada a casuística de carcinoma ductal in situ de mama do Hospital Italiano de Buenos Aires. Sao discutidos aspectos de diagnóstico e comentados os resultados em funçao das diferentes opçoes terapêuticas.

Averaging evoked potentials with an improved weighting algorithm.

The procedure of averaging generally applied for noise reduction of evoked potentials can probably be improved by weighting the sweeps in dependence on their noise energy, which fluctuates considerably. This article demonstrates that weighting factors must be free of the signal part in the sweeps if underestimation and distortion of the reconstructed evoked potential are to be avoided. This can be achieved by pairing the sweeps and weighting the sum of a pair by the reciprocal sample variance from its difference. In order to enhance precision in variance determination, pre-whitening the data has been suggested (Wernicke, 1992). In a feasibility study, this technique is compared with several other algorithms known from the literature.

The diagnosis and prognosis of the 2nd clinical stage of the endometrial carcinoma.

The clinical and histopathological findings of 35 patients with endometrial carcinoma, 2nd Clinical Stage, allow us to conclude: the exclusive cervical involvement does not signify an important impoverishment of the prognosis. As in the 1st Clinical Stage, the outer myometrial infiltration and histologic differentiation are reliable prognostic parameters. The cervical participation in the endometrial carcinoma as is observed in the diagnostic D & C was only corroborated in 61% of the operated cases.

Host defense factors, tumor aggressiveness, and prognosis associated with carcinomas of the breast.

Analysis of disease-free survival rates in 405 women with operable breast cancers was undertaken in a five-year retrospective study; tumor aggressiveness and host defense factors ( HDF ) were evaluated by a histologic method. Tumors were classified as slightly, moderately, or highly aggressive carcinomas by a scoring method that takes into account several histologic features. The presence of absence of HDF was determined by nodal sinus histiocytosis in the regional axillary lymph nodes and by stromal mononuclear reaction in the primary tumor. Overall, women with positive HDF had better cumulative five-year survival rates (76 per cent) than women with negative HDF (49 per cent). The combination of highly aggressive tumors, metastatic lymph nodes, and negative HDF was associated with extremely poor five-year survival rates (1 per cent) compared with those observed for women with aggressive tumors, nodal metastases, and positive HDF (30 percent), P less than 0.001. In this group, patients with four or fewer metastatic nodes showed a recurrence rate of 28 per cent; however, if five or more nodes were involved, the recurrence rate was 93 per cent. This pattern in disease-free survival rates related to HDF was not found in slightly or moderately aggressive tumors with or without metastases or in aggressive tumors without metastases. In addition, there was no relation between the number of metastatic nodes and survival in patients with slightly or moderately aggressive tumors or with aggressive tumors and negative HDF . It is concluded that HDF influence survival only in aggressive tumors with metastases and that the inherent aggressiveness of the tumor is the main factor that determines prognosis.

Evaluation of tumor aggressiveness in breast carcinoma according to a scoring method.

A scoring system was used to classify 310 patients with breast carcinoma. Tumors were divided and scored according to their architectural patterns and histological features of known prognostic significance such as tumor volume, nuclear grade, mitosis, etc. According to the scoring value, tumors were classified as aggressive (A), moderately aggressive (M), and low aggressive (L). Results showed a higher rate of metastasis in patients with A tumors (72%) and M tumors (63%) when compared with L tumors (22%). There were 175 patients with axillary lymph node metastasis. Of these, 101 had A tumors, 91 had recurrences (90%), and 81 died (80%); of the 56 patients with M tumors, 26 had recurrences (46%) and 9 died (16%) (P less than 0.001). None of the 18 cases classified as L recurred (P less than 0.001). There were 135 patients with no nodal metastasis: 39 had A tumors (21 recurrences [54%] and 19 deaths [49%] and 96 had M and L tumors (1 recurrence [1%] and no deaths) (P less than 0.001).

Differences in regional immunoreactivity during the premenopausal and postmenopausal periods in patients with carcinoma of the breast.

Quantitative morphologic assessment of immunoreactivity in regional lymph nodes in 82 patients with carcinoma of the breast without axillary node metastasis showed a significant decrease of the hyperplasia index with age. These differences were particularly noteworthy when premenopausal and postmenopausal women were compared, p less than 0.05. This finding might be an indication of a direct link between ovarian hormones, probably progesterone, and immunity, and it would challenge the concept of oophorectomy performed as a prophylactic measure in patients in the premenopausal period.

Quantitative morphologic assessment of immunoreactivity in regional lymph nodes of patients with carcinoma of the breast.

The main quantitative problem in the pathologic evaluation of carcinoma of the breast is how to appraise host resistance. To study this in 107 patients with radically excised carcinoma of the breast, the axillary lymph nodes were weighed, the average sinus histiocytosis was estimated, and the plasma cells in the medullary cords were counted and expressed as a plasma cell index. The product of the lymphoid weight, the average sinus histiocytosis and the plasma cell index multiplied by 0.1 is called the hyperplasia index, which expresses quantitatively the cell mediated immunity and the humoral immunity in the axillary lymph nodes. The hyperplasia index was correlated with the metastatic tumor weight in the primary tumor with blood vessel invasion, lymphoid infiltration and volume of the tumor. There was a significant inverse relationship, p smaller than 0.001, between the hyperplasia index and the ratio of metastatic tumor weight to lymphoid weight. A significant direct relationship was found in the women with blood vessel invasion and low hyperplasia index values with increased metastatic tumor weight ratio to lymphoid weight, p smaller than 0.01. In patients without metastatic lymph nodes, there was a direct relationship between high hyperplasia indexes and lymphoid infiltration of the frank tumor, p smaller than 0.05. The hyperplasia index is considered a quantitative morphologic evaluation of the regional host defense reaction in the axillary lymph nodes, reflecting the antigenic strength of the tumor and the immune response to it.