A Profile and Three-Year Follow-Up of Patients with Basal Cell Carcinoma in the Western Cape, South Africa.

Background: Basal cell carcinoma (BCC) is an important malignancy in sub-Saharan Africa. There is a paucity of data regarding BCC in South Africa. Aims: To describe the clinicopathological features of patients presenting with BCC in a cohort of South African patients. Methods: This retrospective descriptive study reviewed the medical records of 149 patients with BCC who attended the dermatology clinic at Tygerberg Academic Hospital from September 2015 to August 2016. Demographic and clinical data of those patients with histologically proven BCC were retrieved from clinical records. The data included the assessment for BCC recurrence after three years (September 2016-August 2019). Results: Of 390 patients, 155 (39.7%) had histologically confirmed BCCs. Complete medical records were available for 149 of these patients, and most were male (55.7%) and white (85.9%) with a median age of 70 years. Most patients had their BCC lesions for 12 months (43.1%) before diagnosis. BCCs were mostly located on the head and neck area (58.1%). In most patients (72.0%), a diagnostic punch biopsy confirmed BCC. Plastic surgeons subsequently excised the BCC lesions in 74.0% of these patients. The most common histological subtype was nodular BCC (74.0%). The National Comprehensive Cancer Network (NCCN) risk of recurrence was approximately evenly distributed between high- (54.1%) and low-risk groups (45.9%). The major high-risk feature was the location (36.6%). Histologically confirmed BCC recurrence occurred in 9 of the 149 patients (3.7%) over three years. Conclusions: BCC represents a high burden of disease in our setting. Compared to existing studies, the BCCs in this study are clinically and histologically similar to international reports.

Cefalea... ¿y algo más?: Neuroimágenes en el estudio de la cefalea / Headache and something else? Neuroimaging in the study of headaches

Se revisa la iconografía de los hallazgos por tomografía computada (TC) y resonancia magnética (RM) de la cefalea, según nuestra experiencia. De acuerdo con la base MESH, esta entidad se define como un dolor craneano, que puede ser de ocurrencia benigna o la manifestación de una amplia gama de desórdenes. Las cefaleas se clasifican por su evolución temporal (aguda o crónica), presentación (en estallido, gravativa, etc.) o coexistencia de síntomas asociados, como auras, convulsiones o déficits focales. También se dividen en primarias o secundarias, según la existencia o no de una patología subyacente. Las primarias pueden tener manifestaciones clínicas definidas, pero en las secundarias ciertos signos y síntomas deben alertar sobre la presencia de una patología estructural. En este caso, las neuroimágenes tienen un rol esencial al detectar las causantes del cuadro. Nuestros hallazgos correspondieron a cefaleas primarias (p. ej: infarto migrañoso) y a etiologías orgánicas, entre las que se destacaron causas vasculares, como patología venosa (trombosis), vasoespasmo y leucoencefalopatía posterior reversible; hemorragias intraparen-quimatosas y extraaxiales; cefaleas postraumáticas y posquirúrgicas; y causas infecciosas y tumorales (apoplejía hipofisaria e hipertensión endocraneana). Además, hubo malformaciones (Arnold-Chiari, p.ej.) y otras como hipotensión endocraneana. En algunos casos inicialmente se realizó una TC y luego una RM, mientras que en otros la RM fue el método de elección. Las neuroimágenes facilitan el estudio de la cefalea, caracterizando la afección en primaria o secundaria. En el segundo caso permiten, a su vez, clasificar los hallazgos

A review is presented of the radiological findings (computed tomography -CT- and magnetic resonance imaging -MRI-) of headache, according to our experience. According to MESH database this entity is a skull based pain that can have a benign cause or be an expression of a wide spectrum of disorders. Headaches can be classified according to their temporal evolution (acute or chronic), presentation (blow up, aura, rapidly evolutionary, etc.), or according to associated symptoms, such as seizures or focal deficits. They could also be classified into primary or secondary, depending on the presence or absence of demonstrable disease. The primary headaches can have known symptoms (i.e. migraine), but in secondary ones certain symptoms and signs should alert on the existence of structural disease. At this point imaging methods have an outstanding role, as they allow detecting and identifying structural causes in patients with headache. Our findings corresponded to primary headaches (i.e.: migraine infarction) and organic aetiologies, such as vascular causes (venous thrombosis, vasospasm and posterior reversible leukoencephalopathy); intracerebral and extra-axial haemorrhage; post-surgical and post- traumatic headaches; and those due to infections and tumours (pituitary apoplexy or intracranial hypertension). Malformations, such as Arnold-Chiari's, and intracranial hypotension have also been found. In some cases a CT is initially performed and then an MR, whilst in others MR is the method of choice. Neuroimaging facilitates the study of headache, helping to characterise them into primary or secondary. In the latter case, the imaging also enables the findings to be classified

Utilidad de la relación aclaramiento de creatinina-índice de resistencia de la ecografía Doppler renal como predictor de rechazo agudo en riñones trasplantados / Usefulness of the association between doppler ultrasound resistance index and creatinine clearance as a predictor of acute rejection in kidney transplant

Objetivo: Analizar la utilidad de la asociación del índice de resistencia (IR) en las arterias arcuatas renales con el aclaramiento de creatinina (Cl Cr) para predecir el rechazo agudo del riñón trasplantado. Materiales y métodos: Se realizó un estudio prospectivo de una cohorte de 87 pacientes que fueron sometidos a una biopsia renal por alteraciones clínicas de la función renal. Se les midió el IR junto con el Cl Cr mediante el método de modificación de la dieta en la enfermedad renal. Resultados: La sensibilidad de la asociación IR mayor de 0,7 y Cl Cr 0-30 fue del 53,3% (intervalo de confianza [IC] de 95%: 34,3-71,7%) y la especificidad del 98,2% (95% IC: 90,4-100%). El área bajo la curva fue de 0,758 (95% IC: 0,665-0,85), el likelihood ratio positivo de 22,9 (95% IC: 4,16-214), el likelihood ratio negativo de 0,475 (95% IC: 0,324- 0,685), el odds ratio de 62,9, el valor predictivo positivo de 94,1% (95% IC: 71,3- 99,9%) y el valor predictivo negativo de 79,1% (95% IC: 68,3-88,4%). Conclusión: La asociación IR mayor de 0,7 y Cl Cr 0-30 demostró ser útil para confirmar la posibilidad de rechazo renal agudo, al tener una buena especificidad (98,2%) a pesar de su baja sensibilidad (53%).

Objective: To determine the usefulness of the association between the resistance index (RI) values in renal arcuate arteries and creatinine clearance (Cr Cl) levels in order to predict or detect acute rejection in a kidney transplant patient. Materials and methods: A prospective study was conducted on a cohort of 87 patients who were subjected to a kidney biopsy due to clinical changes in renal function. The RI was measured, and Cr Cl levels determined using the modification of diet in renal disease formula. Results: The sensitivity of an RI association higher than 0.7 and a Cr Cl 0-30 was 53.3% (95% confidence interval [CI]: 34.3-71.7%), with a specificity of 98.2% (95% CI: 90.4-100%). The area under the curve was 0.758 (95% CI: 0.665-0.85), the positive and negative likelihood ratio was 22.9 (95% CI: 4.16-214) and 0.475 (95% CI: 0.324-0.685), respectively. The odds ratio was 62.9, and the positive and negative predicted value was 94.1% (95% CI: 71.3-99.9%) and 79.1% (95% CI: 68.3-88.4%), respectively. Conclusion: The RI association higher than 0.7- Cr Cl 0-30 showed to be useful to detect the possibility of acute renal rejection, with its good specificity (98.2%), although with a low sensitivity (53%).

Biopsia prostética randomizada: ¿influye el número de muestras y el valor del PSA para la detección del cáncer prostético? / Randomized prosthetic biopsy: does the number of samples and the value of PSA influence the detection of prostate cancer?

Objetivo: Determinar si la realización de un mayor número de muestras según el valor del antígeno prostático específico (PSA) incrementa la detección del cáncer prostático (CaP). Materiales y métodos: Se estudió transversalmente a 994 pacientes sometidos a una biopsia prostática transrrectal ecodirigida randomizada (BPTE), con sospecha de CaP. Los casos fueron divididos en dos grupos: A (esquema de 8 muestras y ampliado) con protocolo normal (n = 819) y B (esquema de 12 muestras o más) con protocolo extendido (n = 175). Estos se subdividieron de acuerdo con el valor del PSA en tres niveles (< 3,9ng/ml, 4-9,9 ng/ml y > 10ng/ml) y se evaluó la tasa de detección de CaP en cada subgrupo. Los datos clínicos fueron analizados con las pruebas T de student, chi-cuadrado y regresión logística, tomando como estadísticamente significativo un valor inferior a 0,05. Resultados: La tasa de detección de CaP en el grupo A fue mayor que la del B: 43,71%vs. 34,29%; p = 0,022. Al analizar los resultados, teniendo en cuenta la subdivisión de los valores de PSA, no encontramos diferencias estadísticamente significativas para la detección de malignidad entre los dos grupos. Conclusión: Aumentar el número de muestras en la BPTE no incrementó la tasa de detección de CaP de forma independiente ni en cada subgrupo de PSA, así como tampoco en los subgrupos de volumen prostático. Por otro lado, a mayor edad y PSA, hubo más detecciones de CaP.

Objective: To determine whether obtaining a larger number of core specimens, depending on the PSA value, increases the detection of prostate cancer. Materials and methods: A cross-sectional study was conducted on 994 patients with suspected prostate cancer who underwent transrectal ultrasound-guided prostate biopsy. The patients weredivided intogroup Awith a standard protocol (8 core specimens or more scheme) and group B with an extended protocol (12 core specimens or more scheme), and subdivided according to the PSA values into three groups (<3.9ng/ml, 4 to 9.9ng/ml, and > 10ng/ml). The prostate cancer detection rate was evaluated in each subgroup. Clinical data was analysed using the Student t and chisquared tests and logistic regression analysis, taking a P< 0.05 as statistically significant. Results: The detection rate of prostate cancer in the group A was higher than group B: 43.71% vs. 34.29%; P = 0.022. When analysing the results, taking into account the sub-division of PSA results, no significant statistical differences were found in the detection of malignancy in the two groups of patients evaluated. Conclusión: Increasing the number of core specimens in transrectal ultrasound-guided prostate biopsy, does not increase the overall detection rate of prostate cancer in either of the PSA sub-groups, or in either of the of prostate volume sub-groups. On the other hand, the older the patient and the higher the PSA value, the greater the detection of prostate cancer.

Síndrome de la arteria mesentérica superior. Presentación de un caso / Superior mesenteric artery syndrome. A case report

Se presenta un paciente de sexo femenino y 13 de años, sin antecedentes de relevancia, que consultó por episodios de dolor abdominal posprandial. El diagnóstico fue síndrome de la arteria mesentérica superior. La tomografía computada multicorte mostró una disminución del diámetro del compás aortomesentérico y del ángulo de apertura, con atrapamiento de la tercera porción del duodeno. Se desarrollan las características clínicas e imagenológicas del caso, y se realiza una revisión de los hallazgos radiológicos...

Síndrome de la arteria mesentérica superior: Presentación de un caso

Se presenta un paciente de sexo femenino y 13 de años, sin antecedentes de relevancia, que consultó por episodios de dolor abdominal posprandial. El diagnóstico fue síndrome de la arteria mesentérica superior. La tomografía computada multicorte mostró una disminución del diámetro del compás aortomesentérico y del ángulo de apertura, con atrapamiento de la tercera porción del duodeno. Se desarrollan las características clínicas e imagenológicas del caso, y se realiza una revisión de los hallazgos radiológicos.(AU)

We report a case of superior mesenteric artery syndrome in a 13 year-old female patient, with no relevant medical history, who had been having episodes of postprandial abdominal pain. Multislice Computed Tomography showed decrease of the aorta-superior mesenteric artery distance and narrowing of the normal angle between the aorta and the superior mesenteric artery, with obstruction of the duodenum. The clinical and imaging features of the case, as well as a review of the radiological findings of this disease are presented.(AU)

Reemplazo graso total idiopático del páncreas: Reporte de un caso

La lipomatosis pancreática difusa o focal es una entidad que puede ser secundaria a patologías sistémicas (como el síndrome de Shwachman-Diamond, la fi brosis quística u otras) o ser idiopática. Se han reportado algunos casos con ausencia de síntomas clínicos o alteraciones en el laboratorio y otros en los que la funcionalidad del páncreas se encontraba comprometida. Aquí presentamos un caso en el cual el hallazgo de reemplazo graso total fue incidental, debido a que se visualizó en una tomografía computada (TC) solicitada por otras razones.

Fat replacement of pancreas is a condition that may be secondary to systemic diseases (such as Shwachman-Diamond syndrome or cystic fi brosis), or may be idiopathic. There are some reported cases in which there are no clinic symptoms or laboratory changes, and others where the pancreatic function is compromised. We present a case with an incidental finding of fat replacement, after a computed tomography (CT) performed for others reasons.

Bloqueo nervioso lumbar selectivo guiado por tomografía computada. Nuestra experiencia en un hospital universitario / Computed tomography guided selective lumbar nerve block. Our experience in a university hospital

Objetivos: Presentar nuestra experiencia en el tratamiento mínimamente invasivo de la lumbociatalgia con la inyección de corticoides y anestésicos locales bajo control tomográfico. Materiales y métodos: Se realizaron bloqueos selectivos lumbares bajo control tomográfico a 102 pacientes con lumbociatalgia crónica, en un período comprendido entre agosto del 2011 y junio del 2012. Del total de pacientes, se infiltraron 65 a nivel foraminal (64%), 29 a nivel epidural (28%) y 8 a ambos niveles (8%). Los procedimientos se realizaron en forma ambulatoria con anestesia local. Todos los pacientes recibieron tratamiento con antiinflamatorios no esteroides (AINES) vía oral y se utilizó la escala numérica del dolor y el índice de Oswestry (IDO) para medir la discapacidad funcional en cada caso. Resultados: El 100% de los pacientes mostró disminución significativa de la sintomatología apenas finalizó el procedimiento, sin observarse complicaciones inmediatas durante el mismo. Se hizo un seguimiento clínico posterior con las escalas anteriormente mencionadas a los 7 días, 1, 3 y 6 meses. En 95 pacientes (93%) se observó una mejora significativa de los síntomas y se suspendió o se redujo la medicación oral, mientras que en 6 pacientes existió una mejoría parcial de los síntomas al mes, pero hubo una recaída a los 3 meses. En estos casos se debió reiniciar el tratamiento con AINES, manteniéndose a 4 pacientes dentro de la categoría del IDO anterior (aunque con una disminución de al menos 2 puntos en el score numérico del dolor). Sólo un paciente no presentó mejoría de la sintomatología durante el seguimiento y tuvo reaparición de los síntomas habituales a los 7 días, por lo que se debió reprogramar una segunda infiltración. Conclusión: En nuestra experiencia el bloqueo nervioso lumbar selectivo bajo control tomográfico, utilizando esteroides y anestésicos locales, resultó un procedimiento efectivo en el control del dolor con un bajo índice de complicaciones.

Objectives: To present our experience with minimally invasive treatment of low back pain and sciatica with the computed tomography-guided percutaneous injection of steroids and local anaesthetics.Materials and methods: From August 2011 to June 2012, 102 patients underwent selective computed tomography-guided foraminal block for low back pain and sciatica treatment.Sixtyfi ve patients received foraminal infi ltration (64%), 29 epidural infi ltration (28%), and 8 (8%) were subject to combined procedures. All procedures were performed on an outpatient basis with local anaesthetic, with no immediate complications. All patients received oral NSAIDs (non-steroidal anti-infl ammatory drugs) prior to the procedure. A numeric scale of pain and the Oswestry index (IDO) was employed to measure local pain and limb disability. All patients showed at least 7 points in the initial evaluation. Results: All the patients showed a significant reduction in pain by the end of procedure.A clinical follow-up was made after 7 days, 1, 3, and 6 months after the treatment using the previously mentioned scales. Ninety-fi ve patients (93%) showed a signifi cant improvement in their symptoms, with suspension or decrease in oral medication. Six patients showed only a partial reduction of symptoms during the follow-up after one month, with a recurrence of symptoms after 3 months and restarted oral treatment. Four of these patients remained in the same IDO category with at least a 2 point decrease in the pain scale. Only one patient showed no improvement in symptoms during follow-up with a recurrence of symptoms 7 days after procedure, and for whom a second procedure was reprogrammed. Conclusion: In our experience CT-guided percutaneous lumbar selective nerve block using steroids and local anaesthetics, is an effective method of pain control with a very low incidence of complications...

Ecografía y biopsia prostéticas en la detección del carcinoma prostético / Prostate ultrasound and biopsy in the detection of prostate carcinoma

Objetivo: Mostrar nuestra experiencia en ecografía prostática transrectal y biopsia prostática bajo guía ecográfica a lo largo de 10 años, a través de la realización de un análisis retrospectivo, con el fin de evaluar sus beneficios en la detección del adenocarcinoma, identificar la distribución de muestras positivas en la glándula y exponer la utilidad de la punción de imágenes nodulares. prostáticas transrectales seguidas de biopsias prostáticas bajo control ecográfico. En la muestra se incluyó a pacientes que se realizaron más de una biopsia. Los datos obtenidos de estos procedimientos permitieron identificar la presencia de tres grupos etarios de acuerdo a la incidencia de la patología, conocer la localización más frecuente del adenocarcinoma dentro de la próstata y evaluar la utilidad de la biopsia de los nódulos prostáticos en la detección del adenocarcinoma. Resultados: El análisis de la muestra arrojó un porcentaje de detección del adenocarcinoma del 16% en los menores de 50 años, del 36% en aquellos entre los 50 y 60 años, y del 48% en los mayores de 65 años. La base izquierda de la próstata fue la localización con el índice más alto de positividad (15%), seguido por la media izquierda (14%), la base derecha (14%), la media derecha (13%), el ápex izquierdo (12%), el medio lateral izquierdo (12%), el ápex derecho (11%) y el medio lateral derecho (10%). Doscientos noventa y nueve pacientes presentaron imágenes nodulares: 118 (Grupo A) tuvieron alguna muestra positiva y 181 presentaron resultados negativos (Grupo B). A su vez, el Grupo A se dividió en 3 subgrupos: el Subgrupo A, cuyo resultado positivo se registró en la muestra del nódulo, pero fue negativo en el resto de la glándula; Subgrupo B, cuyos resultados fueron positivos en el resto de la glándula y negativos en la muestra del nódulo; y Subgrupo C, cuyo resultado fue positivo tanto en las muestras de la glándula como en las del nódulo (combinación más frecuente de los tres subgrupos). Conclusión: La ecografía y la biopsia prostáticas bajo guía ecográfi ca juegan un rol importante en la evaluación de la próstata ante la sospecha de un adenocarcinoma. Según nuestra experiencia, la biopsia prostática bajo guía ecográfi ca es el método de mayor utilidad para la detección, especialmente en pacientes mayores de 65 años, y debería incluirse la muestra del nódulo (si la hubiese) en el esquema por octantes.

Purpose: To present our experience in prostatic transrectal ultrasound and transrectal ultrasound-guided biopsy over a ten-year period by a retrospective analysis in order to determine the detection rate of adenocarcinoma, identify the distribution of positive samples in the gland, and evaluate the usefulness of biopsy of nodules seen on imaging studies. Materials and methods: A total of 1163 ultrasound and ultrasound-guided transrectal prostate biopsies were performed between March 2001 and November 2011. The population sample included patients who had more than one biopsy performed. Data obtained from these procedures enables us to identify three age groups according to the incidence of pathology, to determine the most frequent location of adenocarcinoma within the prostate, and to evaluate the usefulness of prostate nodules biopsy in the detection of adenocarcinoma. Results: The data analysis showed a 16% detection rate of adenocarcinoma in men under 50 years of age, 36% in patients between 50 and 65 years, and 48% in patients older than 65 years. The left base of the prostate had the highest detection rate (15%), followed by left medium (14%), right base (14%), right medium (13%), left apex (12%), left lateral medium (12%), right apex (11%) and right lateral medium (10%). Nodular images were found in 299 patients: 118 were positive for adenocarcinoma (Group A) and 181 were negative (Group B). Group A was divided into 3 subgroups: Subgroup A, with a positive result only in the nodule sample, and a negative result in the rest of the gland sample; Subgroup B, with a positive result in the gland samples but negative in the nodule sample; and Subgroup C, with results that were positive both in the gland and nodule samples. Conclusion: Ultrasound and ultrasound-guided transrectal prostate biopsy play an important role in the evaluation of the prostate when adenocarcinoma is suspected. Based on our experience, ultrasound-guided prostate biopsy is the most useful method for the detection of adenocarcinoma, especially in patients older than 65 years of age, and the nodule sample (if any) should be included in the eight-biopsy scheme.

Bloqueo nervioso lumbar selectivo guiado por tomografía computada. Nuestra experiencia en un hospital universitario / Computed tomography guided selective lumbar nerve block: Our experience in a university hospital

Objetivos: Presentar nuestra experiencia en el tratamiento mínimamente invasivo de la lumbociatalgia con la inyección de corticoides y anestésicos locales bajo control tomográfico. Materiales y métodos: Se realizaron bloqueos selectivos lumbares bajo control tomográfico a 102 pacientes con lumbociatalgia crónica, en un período comprendido entre agosto del 2011 y junio del 2012. Del total de pacientes, se infiltraron 65 a nivel foraminal (64%), 29 a nivel epidural (28%) y 8 a ambos niveles (8%). Los procedimientos se realizaron en forma ambulatoria con anestesia local. Todos los pacientes recibieron tratamiento con antiinflamatorios no esteroides (AINES) vía oral y se utilizó la escala numérica del dolor y el índice de Oswestry (IDO) para medir la discapacidad funcional en cada caso. Resultados: El 100% de los pacientes mostró disminución significativa de la sintomatología apenas finalizó el procedimiento, sin observarse complicaciones inmediatas durante el mismo. Se hizo un seguimiento clínico posterior con las escalas anteriormente mencionadas a los 7 días, 1, 3 y 6 meses. En 95 pacientes (93%) se observó una mejora significativa de los síntomas y se suspendió o se redujo la medicación oral, mientras que en 6 pacientes existió una mejoría parcial de los síntomas al mes, pero hubo una recaída a los 3 meses. En estos casos se debió reiniciar el tratamiento con AINES, manteniéndose a 4 pacientes dentro de la categoría del IDO anterior (aunque con una disminución de al menos 2 puntos en el score numérico del dolor). Sólo un paciente no presentó mejoría de la sintomatología durante el seguimiento y tuvo reaparición de los síntomas habituales a los 7 días, por lo que se debió reprogramar una segunda infiltración. Conclusión: En nuestra experiencia el bloqueo nervioso lumbar selectivo bajo control tomográfico, utilizando esteroides y anestésicos locales, resultó un procedimiento efectivo en el control del dolor con un bajo índice de complicaciones.(AU)

Objectives: To present our experience with minimally invasive treatment of low back pain and sciatica with the computed tomography-guided percutaneous injection of steroids and local anaesthetics. Materials and methods: From August 2011 to June 2012, 102 patients underwent selective computed tomography-guided foraminal block for low back pain and sciatica treatment. Sixtyfi ve patients received foraminal infi ltration (64%), 29 epidural infi ltration (28%), and 8 (8%) were subject to combined procedures. All procedures were performed on an outpatient basis with local anaesthetic, with no immediate complications. All patients received oral NSAIDs (non-steroidal anti-infl ammatory drugs) prior to the procedure. A numeric scale of pain and the Oswestry index (IDO) was employed to measure local pain and limb disability. All patients showed at least 7 points in the initial evaluation. Results: All the patients showed a significant reduction in pain by the end of procedure. A clinical follow-up was made after 7 days, 1, 3, and 6 months after the treatment using the previously mentioned scales. Ninety-fi ve patients (93%) showed a signifi cant improvement in their symptoms, with suspension or decrease in oral medication. Six patients showed only a partial reduction of symptoms during the follow-up after one month, with a recurrence of symptoms after 3 months and restarted oral treatment. Four of these patients remained in the same IDO category with at least a 2 point decrease in the pain scale. Only one patient showed no improvement in symptoms during follow-up with a recurrence of symptoms 7 days after procedure, and for whom a second procedure was reprogrammed. Conclusion: In our experience CT-guided percutaneous lumbar selective nerve block using steroids and local anaesthetics, is an effective method of pain control with a very low incidence of complications.(AU)

Ecografía y biopsia prostéticas en la detección del carcinoma prostético / Prostate ultrasound and biopsy in the detection of prostate carcinoma

Objetivo: Mostrar nuestra experiencia en ecografía prostática transrectal y biopsia prostática bajo guía ecográfica a lo largo de 10 años, a través de la realización de un análisis retrospectivo, con el fin de evaluar sus beneficios en la detección del adenocarcinoma, identificar la distribución de muestras positivas en la glándula y exponer la utilidad de la punción de imágenes nodulares. prostáticas transrectales seguidas de biopsias prostáticas bajo control ecográfico. En la muestra se incluyó a pacientes que se realizaron más de una biopsia. Los datos obtenidos de estos procedimientos permitieron identificar la presencia de tres grupos etarios de acuerdo a la incidencia de la patología, conocer la localización más frecuente del adenocarcinoma dentro de la próstata y evaluar la utilidad de la biopsia de los nódulos prostáticos en la detección del adenocarcinoma. Resultados: El análisis de la muestra arrojó un porcentaje de detección del adenocarcinoma del 16% en los menores de 50 años, del 36% en aquellos entre los 50 y 60 años, y del 48% en los mayores de 65 años. La base izquierda de la próstata fue la localización con el índice más alto de positividad (15%), seguido por la media izquierda (14%), la base derecha (14%), la media derecha (13%), el ápex izquierdo (12%), el medio lateral izquierdo (12%), el ápex derecho (11%) y el medio lateral derecho (10%). Doscientos noventa y nueve pacientes presentaron imágenes nodulares: 118 (Grupo A) tuvieron alguna muestra positiva y 181 presentaron resultados negativos (Grupo B). A su vez, el Grupo A se dividió en 3 subgrupos: el Subgrupo A, cuyo resultado positivo se registró en la muestra del nódulo, pero fue negativo en el resto de la glándula; Subgrupo B, cuyos resultados fueron positivos en el resto de la glándula y negativos en la muestra del nódulo; y Subgrupo C, cuyo resultado fue positivo tanto en las muestras de la glándula como en las del nódulo (combinación más frecuente de los tres subgrupos). Conclusión: La ecografía y la biopsia prostáticas bajo guía ecográfi ca juegan un rol importante en la evaluación de la próstata ante la sospecha de un adenocarcinoma. Según nuestra experiencia, la biopsia prostática bajo guía ecográfi ca es el método de mayor utilidad para la detección, especialmente en pacientes mayores de 65 años, y debería incluirse la muestra del nódulo (si la hubiese) en el esquema por octantes.(AU)

Purpose: To present our experience in prostatic transrectal ultrasound and transrectal ultrasound-guided biopsy over a ten-year period by a retrospective analysis in order to determine the detection rate of adenocarcinoma, identify the distribution of positive samples in the gland, and evaluate the usefulness of biopsy of nodules seen on imaging studies. Materials and methods: A total of 1163 ultrasound and ultrasound-guided transrectal prostate biopsies were performed between March 2001 and November 2011. The population sample included patients who had more than one biopsy performed. Data obtained from these procedures enables us to identify three age groups according to the incidence of pathology, to determine the most frequent location of adenocarcinoma within the prostate, and to evaluate the usefulness of prostate nodules biopsy in the detection of adenocarcinoma. Results: The data analysis showed a 16% detection rate of adenocarcinoma in men under 50 years of age, 36% in patients between 50 and 65 years, and 48% in patients older than 65 years. The left base of the prostate had the highest detection rate (15%), followed by left medium (14%), right base (14%), right medium (13%), left apex (12%), left lateral medium (12%), right apex (11%) and right lateral medium (10%). Nodular images were found in 299 patients: 118 were positive for adenocarcinoma (Group A) and 181 were negative (Group B). Group A was divided into 3 subgroups: Subgroup A, with a positive result only in the nodule sample, and a negative result in the rest of the gland sample; Subgroup B, with a positive result in the gland samples but negative in the nodule sample; and Subgroup C, with results that were positive both in the gland and nodule samples. Conclusion: Ultrasound and ultrasound-guided transrectal prostate biopsy play an important role in the evaluation of the prostate when adenocarcinoma is suspected. Based on our experience, ultrasound-guided prostate biopsy is the most useful method for the detection of adenocarcinoma, especially in patients older than 65 years of age, and the nodule sample (if any) should be included in the eight-biopsy scheme.(AU)

Effects of subpopulation structure on probability calculations of DNA profiles from forensic PCR analysis.

DNA typing for forensic identification is a two-step process. The first step involves determining the profiles of samples collected at the crime scene and comparing them with the profiles obtained from suspects and the victims. In the case of a match that includes the suspect as the potential source of the material collected at the crime scene, the last step in the process is to answer the question, what is the likelihood that someone in addition to the suspect could match the profile of the sample studied? This likelihood is calculated by determining the frequency of the suspect's profile in the relevant population databases. The design of forensic databases and the criteria for comparison has been addressed by the NRC report of 1996 (National Research Council, 1996). However, the fact that geographical proximity, migrational patterns, and even cultural and social practices have effects on subpopulation structure establishes the grounds for further study into its effects on the calculation of probability of occurrence values. The issue becomes more relevant in the case of discrete polymorphic markers that show higher probability of occurrence in the reference populations, where several orders of magnitude difference between the databases may have an impact on the jury. In this study, we calculated G values for all possible pairwise comparisons of allelic frequencies in the different databases from the races or subpopulations examined. In addition, we analyzed a set of 24 unrelated Caucasian, 37 unrelated African-American, and 96 unrelated Sioux/Chippewa individuals for seven polymorphic loci (DQA1, LDLR, GYPA, HBGG, D7S8, GC, and D1S80). All three sets of individuals where sampled from Minnesota. The probability of occurrence for all seven loci were calculated with respect to nine different databases: Caucasian, Arabic, Korean, Sioux/Chippewa, Navajo, Pueblo, African American, Southeastern Hispanic, and Southwestern Hispanic. Analysis of the results demonstrated marked differences in the probabilities of occurrence when individuals were compared to the different populations and subpopulation databases. The possible genetic and forensic consequences of subpopulation structure on probability calculations are discussed.

Human phylogenetic relationships according to the D1S80 locus.

By analyzing the allelic frequencies at the D1S80 locus in 43 human populations, we show that the locus is polymorphic globally and that it can be used to discriminate between major racial groups and subpopulations through phylogenetic analysis. Although the use of informative multiple loci generally provides more accurate phylogenetic relationships, in instances where time and/or target DNA availability is limited, D1S80 could provide useful data to discriminate between human groups. Also, knowledge of which loci independently provide accurate phylogenetic relationships, such as the D1S80, can be used to design more accurate multi-locus combinations. In addition, allele frequencies at the locus are reported, for the first time, for Bahamian individuals of African origin and for Chimila, Bari, and Navajo (Cañoncito Valley) native Americans. Allelic data was obtained using standard polymerase chain reaction (PCR) techniques. In the four new populations, 65 genotypes and 20 segregating alleles were observed. All populations conformed to Hardy-Weinberg expectations except the Chimila.

A system utilizing Epstein-Barr virus-based expression vectors for the functional cloning of human fibroblast growth regulators.

The acquired ability of adherent mammalian cells to grow in suspension is closely linked to tumorigenic transformation. The anchorage-independence phenotype is likely to result from bypassing an adherence-responsive cell-cycle check-point at the G1/S boundary of the cell cycle. In order to identify genes that are part of or act upon the anchorage signal transduction pathway, we have developed a system which allows functional cloning of regulatory genes by expression of libraries of cDNA inserts either in the sense or antisense direction. The system is comprised of two components: (i) the library expression vectors, CMV-EL and C1E-EL, containing EBoriP for replication in EBN A-1-expressing cells, an expression cassette with a multiple cloning site suitable for directional insertion of cDNA libraries generated by standard protocols, and loxP sites which allow rapid manipulation of recovered vectors without the use of restriction enzymes and (ii) the EBNA-1-producing cell line, BB-5, a derivative of the immortalized, non-tumorigenic and anchorage-dependent human fibroblast cell line, MSU1.1. The growth characteristics of BB-5 cells did not differ from its parental cell line. BB-5 cells supported the episomal replication of CMV-EL and C1E-EL and allowed recovery of the vector from Hirt lysates of transfected BB-5 cells. BB-5 cells transformed to anchorage-independent growth by transfection with a mutant c-Ha-ras gene inserted into CMV-EL could be accurately and efficiently identified in a background of non-transfected BB5 cells by screening for anchorage-independent colonies with the aid of computer-assisted image analysis.

Molecular and genetic analysis of a region of plasmid pCF10 containing positive control genes and structural genes encoding surface proteins involved in pheromone-inducible conjugation in Enterococcus faecalis.

Exposure of Enterococcus faecalis cells carrying the tetracycline resistance plasmid pCF10 to the heptapeptide pheromone cCF10 results in an increase in conjugal transfer frequency by as much as 10(6)-fold. Pheromone-induced donor cells also express at least two plasmid-encoded surface proteins, the 130-kDa Sec 10 protein, which is involved in surface exclusion, and the 150-kDa Asc10 protein, which has been associated with the formation of mating aggregates. Previous subcloning and transposon mutagenesis studies indicated that the adjacent EcoRI c (7.5 kb) and e (4.5 kb) fragments of pCF10 encode the structural genes for these proteins and that the EcoRI c fragment also encodes at least two regulatory genes involved in activation of the expression of the genes encoding Asc10 and Sec10. In this paper, the results of physical and genetic analysis of this region of pCF10, along with the complete DNA sequences of the EcoRI c and e fragments, are reported. The results of the genetic studies indicate the location of the structural genes for the surface proteins and reveal important features of their transcription. In addition, we provide evidence here and in the accompanying paper (S. B. Olmsted, S.-M. Kao, L. J. van Putte, J. C. Gallo, and G. M. Dunny, J. Bacteriol. 173:7665-7672, 1991) for a role of Asc10 in mating aggregate formation. The data also reveal a complex positive control system that acts at distances of at least 3 to 6 kb to activate expression of Asc10. DNA sequence analysis presented here reveals the positions of a number of specific genes, termed prg (pheromone-responsive genes) in this region of pCF10. The genes mapped include prgA (encoding Sec10) and prgB (encoding Asc10), as well as four putative regulatory genes, prgX, -R, -S, and -T. Although the predicted amino acid sequences of Sec10 and Asc10 have some structural features in common with a number of surface proteins of gram-positive cocci, and the Asc10 sequence is highly similar to that of a similar protein encoded by the pheromone-inducible plasmid pAD1 (D. Galli, F. Lottspeich, and R. Wirth, Mol. Microbiol. 4:895-904, 1990), the regulatory genes show relatively little resemblance to any previously sequenced genes from either procaryotes or eucaryotes.

Role of the pheromone-inducible surface protein Asc10 in mating aggregate formation and conjugal transfer of the Enterococcus faecalis plasmid pCF10.

The high transfer frequency of pheromone-inducible conjugative plasmids of Enterococcus faecalis in liquid culture is due in part to the formation of mating aggregates. These aggregates result from the interaction of two surface components, aggregation substance (AS), which is plasmid encoded, and the chromosomally encoded binding substance (BS). In the accompanying paper (S.-M. Kao, S. B. Olmsted, A. S. Viksnins, J.C. Gallo, G. M. Dunny, J. Bacteriol, 173:7650-7664, 1991), the sequence of the prgB gene encoding the AS molecule (Asc10) produced by pheromone-induced cells carrying plasmid pCF10 is presented. Here we report the results of genetic and immunological experiments which define the role of Asc10 in aggregation and plasmid transfer. These data indicate expression of AS on the surface of an E. faecalis cell and its binding to BS expressed on a second cell are required for the formation of a mating pair and the efficient transfer of pCF10 in liquid matings. However, the orientation of the receptors was not critical for transfer; ie., AS expressed on recipient cells could facilitate plasmid transfer via binding to BS on the donor. Our results suggest that additional (as yet unidentified) products are involved in forming the channel that ultimately serves to transfer the DNA, with AS-BS binding serving primarily to generate the initial attachment between cells. The putative prgC gene product, identified by DNA sequencing (data presented in the accompanying paper), could be involved in transfer events occurring subsequent to aggregation.