[Non-Hodgkin's lymphoma primary in breast. Literature review in relation to a case report]. / Linfoma no Hodgkin primario en la mama: reporte de un caso.

BACKGROUND: Extranodal lymphoma are rare, in particular, breast non-Hodgkin's lymphoma has an impact of lower 0.5%. It is difficult to diagnose during the pre-operative period, since it can be confused with breast carcinoma. CASE REPORT: A 52 years old female patient was sent due to a lump in her left breast identified in a mammogram. A study was conducted with supplementary tests, being eventually diagnosed as low-grade B-cell follicular lymphoma. She was subjected to a mammary and axillary radioguided occult lesion localisation (ROLL). After, radiation therapy was delivered. CONCLUSIONS: It is a very rare pathology, therefore, there is not relevant research to show effective treatment or diagnosis.

In leukapheresis products from non-Hodgkin's lymphoma patients, the immature hematopoietic progenitors show higher CD90 and CD34 antigenic expression.

Damage to the stem cell progenitors caused by the chemotherapy received in patients diagnosed with non-Hodgkin's lymphoma (NHL) may be an important factor limiting progenitor cell mobilization. The aim of the present analysis was to evaluate the effect of the chemotherapy on the different progenitor cell subpopulations obtained in the leukapheresis. For this purpose, a combination of immunophenotype and functional assays has been performed in 26 mobilized peripheral blood (PB) samples from NHL patients and 36 healthy donors. The different progenitor subpopulations analyzed by flow cytometry significantly correlated with the corresponding populations assessed by functional assays in both healthy donors and NHL patients (p<0.05, r>0.5). The number of committed CFU-GM was similar in both groups (p=0.246), but we found significant decrease in the number of BFU-E and more immature progenitors in PB from NHL patients as compared to donors (p<0.05). Moreover, the number of total CFU was significantly lower in NHL patients (p=0.007). Accordingly, CD34+ cells (p=0.018) and CD34+ subpopulations was decreased in NHL patients. Nevertheless, CD90 and CD34 intensity was significantly higher within CD34+ cells from NHL patients as compared to donors. However, although numerically reduced non-committed CD34+ cells are more immature in chemotherapy mobilized NHL patients. In summary, our results show that all NHL hematopoietic progenitors, analyzed by both immunophenotypical and functional approaches, are impaired in leukapheresis products.

Left atrium myxosarcoma: an exceptional cardiac malignant primary tumor.

We report the case of a 32-year-old patient with a left atrium myxosarcoma, presenting with congestive heart failure. It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. These tumors present local recidives and distance metastasis, so the mean survival is about 1 year, independent of any therapeutical option.

[Cardiac resynchronization in heart failure: well-established therapy or new approach with unanswered questions?]. / Resincronización ventricular en la insuficiencia cardíaca: ¿un método bien establecido o una línea de progreso con muchos interrogantes?

Biventricular pacing is a new development in the treatment of ventricular failure associated with intraventricular conduction delays, and the term ventricular resynchronization has been coined, implying for many authors that synchronous right and left ventricular activation and contraction are the goal of therapy. However, there is ample evidence that isolated left ventricular stimulation may be at least as efficacious as biventricular stimulation, and the mechanisms of functional improvement remain speculative. The role of mitral regurgitation and its modification with resynchronization has not been fully evaluated. Long-term prognosis, effect on mortality and predictors of a positive response are important unanswered questions. It is clear that a narrow-based QRS complex is not a good indicator of a favorable response. We need to better understand the effect of the activation sequence on left ventricular contraction dynamics, including mitral valve function, to refine the technique and indications for resynchronization therapy.

[The progression of a postinfarct interventricular communication: an echocardiographic follow-up]. / Progresión de una comunicación interventricular postinfarto: seguimiento ecocardiográfico.

An 80-year-old female patient presented rupture of the interventricular septum as complication of acute anteroseptal myocardial infarction. Serial echocardiographic studies documented progressive increase in size of the apical defect over 16 hours. This observation highlights a potential hazard if surgical repair is deferred to "stabilize" hemodynamically the patient before the intervention.

[Accuracy and clinical applicability of the echocardiographic automated endocardial boundary detection system: correlation and bias analysis]. / Precisión y aplicabilidad clínica del sistema ecocardiográfico de detección automática de bordes endocárdicos: análisis de correlación y de sesgo.

INTRODUCTION AND OBJECTIVES: Automated edge detection of endocardial borders is a new echo system that permits on-line delineation and tracking of blood-tissue interface and offers promise for measuring cyclic changes in cavity area and the assessment of left ventricular function on-line. Its accuracy has only been analyzed by linear regression and its applicability in unselected patients is not clearly established. METHODS: We analyzed the accuracy and clinical applicability of the system in 150 patients. Its accuracy was assessed not only by linear regression but also by bias analysis by comparing the results of the system with those obtained by manual tracing from parasternal short-axis and apical 4 chamber views. RESULTS: We obtained satisfactory studies with this system in at least one of the two echo views in 66% of patients: 47% from 4-chambers view, 43% from parasternal short-axis view and 24.6% from both echo views. A visual semiquantitative assessment of left ventricular function could be performed in 88.6% of patients (p < 0.001). On-line and hand-traced left ventricular areas there well correlated, but fractional area change values from both methods correlated less closely. 95% limits of agreement between both methods were: 2.8 +/- 5.5 cm2 (end-diastolic area), 1 +/- 4.4 cm2 (end-systolic area) and 1.2 +/- 23% (fractional area change) in short-axis parasternal view; in apical 4-chambers view these limits were: 1.16 +/- 6.4 cm2,--1.1 +/- 6 cm2 and 7.3 +/- 16%, respectively. CONCLUSIONS: Although the correlations between left ventricular areas from both methods were close the limits of agreement exceeded our acceptable range of reproducibility. Fractional area change showed only moderate correlations and a lack of agreement with off-line method. Poor image quality of the conventional echo still limits the clinical applicability of the current automated edge detection system.

Short-term endothelial progenitor cell colonies are composed of monocytes and do not acquire endothelial markers.

BACKGROUND: The aim of this study was to identify circulating endothelial progenitor cells (EPC) with colony-forming capacity and compare them with the monocytic-macrophage lineage. METHODS: Forty-two healthy donors were analyzed. EPC were cultured with VEGF and b-FGF. Sequential studies were performed on days +7 (colonies) +21 and +35. Monocytic cells were cultured using the same conditions as EPC until day +21 or alternatively by adding IGF. RESULTS: The number of EPC colonies was higher in BM than in mobilized or steady-state PB. Using EPC medium, monocytic cells formed cord-like structures but no colonies. However, colonies grew when IGF was added to the medium. By immunocytochemistry, colonies showed CD45, CD31 and lysozyme but no vWF. Colonies were CD4+, CD13+dim, CD14+, CD15++, CD16-/+dim, CD31+dim, CD33+dim, CD45+, CD105-/+dim, lysozyme+ and VE-cadherin+, and constantly negative for CD34, CD133 and KDR, when flow cytometry was used. The immunophenotype of pre-cultured and cultured monocytes was similar to that described for EPC. DISCUSSION: Our results suggest that the so-called 'EPC' obtained at 7 days of culture belong to the monocyte-macrophage lineage, as they share immunophenotypic and molecular features.

Right ventricular systolic time intervals determined by means of a pulmonary artery catheter.

OBJECTIVES: To evaluate the right ventricular systolic time interval as an index of right ventricular function and also to ascertain whether the right ventricular ejection fraction may be determined by means of a conventional pulmonary artery catheter. DESIGN: Prospective study. SETTING: Intensive care unit. PATIENTS: Eight, consecutive critically ill adult patients. METHODS: Simultaneous blind measurements, performed by two investigators, of the right ventricular systolic time interval and right ventricular ejection fraction, determined by means of a pulmonary artery catheter. Two studies, separated by an interval of 24 hrs, per patient. Linear regression analysis. Multiple regression test. RESULTS: Of the 16 studies performed, two determinations of right ventricular systolic time intervals were technically inadequate. In the remaining 14 valid studies, we found one close linear correlation between the right ventricular ejection fraction and the preejection period/ejection time quotient measured using the simultaneous display of the electrocardiogram (EKG) and pulmonary arterial pressure curve (r2 = .90, p < .001, right ventricular ejection fraction = 68.96-60.59 x [right ventricular preejection period/right ventricular ejection time]). The method proved to be simple, very accurate, with little interobserver variation (8.09 +/- 10.6% interobserver variation for right ventricular preejection period/right ventricular ejection time) and provided adequate information regarding situations in which the performance of the right ventricle is modified in a given patient. The right ventricular preejection period/right ventricular ejection time quotient was the only variable that displayed a significant relationship with the right ventricular ejection fraction in the multivariate analysis (p < .001). CONCLUSIONS: Right ventricular systolic time intervals, measured using the simultaneous display of the pulmonary artery catheter curve and EKG, provide adequate information regarding right ventricle performance in critically ill patients. The close linear correlation between the right ventricular preejection period/right ventricular ejection time quotient and the right ventricular ejection fraction enables the investigator to estimate, with a high degree of accuracy, the right ventricular ejection fraction and the values derived from the preload of the right ventricle, without the need for a modified pulmonary artery catheter.

"Resincronización ventricular" en la insuficiencia cardíaca: ¿un método bien establecido o una línea de progreso con muchos interrogantes? / "Cardiac resychronization" in heart failure: well-established therapy or new approach with unanswered questions?

La estimulación biventricular ha supuesto una línea nueva de desarrollo para el tratamiento de los pacientes con insuficiencia cardíaca asociada a retrasos de la conducción intraventricular, y el término "resincronización ventricular", acuñado por muchos autores, implica que la sincronía entre la activación y contracción del ventrículo izquierdo y derecho es el objetivo de esta terapia. Sin embargo, existen amplias evidencias de que la estimulación aislada del ventrículo izquierdo puede ser, al menos,tan efectiva como la estimulación biventricular, haciendo que los mecanismos de mejoría citados sean especulativos. El papel de la insuficiencia mitral y sus cambios con la "resincronización" no han sido completamente evaluados. El pronóstico a largo plazo, el efecto en la mortalidad y los predictores de respuesta positiva son cuestiones importantes todavía no resueltas. Está bastante claro que perseguir un complejo QRS estrecho con la estimulación no es un buen indicador de una respuesta favorable,y que necesitamos comprender mejor el efecto que supone la secuencia de activación ventricular izquierda sobre la contracción, incluyendo el efecto sobre la función de la válvula mitral para, con ello, poder mejorar la técnica y las indicaciones de la terapia de "resincronización" (AU)