Biomedical subjects
Publications and source records attributed to A Piñero.
Juvenile papillomatosis of the breast (JPB) was first described in 1980 and is occasionally associated with breast cancer. The literature reports only four cases of JPB in males; none of them associated simultaneously with breast cancer. We present a case of a male with JPB associated with a ductal carcinoma in the same gland.
OBJECTIVE: To report our experience in patients with anaplastic thyroid carcinoma and try to establish differences between cases in which the histological study showed that there was an associated thyroid carcinoma and those that were strictly anaplastic or pure. DESIGN: Retrospective study. SETTING: University hospital, Spain. SUBJECTS: 14 patients with anaplastic thyroid cancer treated over a period of 26 years; 7 presented with associated thyroid tumours and 7 were pure. MEAN OUTCOME MEASURES: Clinical data (age, sex, symptoms), treatment, histological study (associated thyroid disease, spread, involved lymph nodes) and follow-up. RESULTS: 13 of the 14 tumours had spread locally. 5 patients were treated by total thyroidectomy, 3 subtotal thyroidectomy, 5 excision of the tumour, and 1 patient had a biopsy alone. There were associated thyroid tumours in 7 cases: 2 follicular, 2 tall cell papillary, 1 solid papillary, 1 medullary and 1 Hurthle cell tumour. 12 patients died. Another 2 are still alive having survived 61 and 70 months respectively, both with associated anaplastic cancers (follicular and solid). The mean survival was 14 months (24 for associated anaplastic carcinoma and 4 for pure anaplastic carcinoma). CONCLUSION: There is a subgroup of anaplastic cancers in which a better differentiated thyroid carcinoma coexists with the anaplastic carcinoma. The prognosis in this subgroup is better than that for primary pure anaplastic carcinoma.
PURPOSE: Retinitis pigmentosa (RP) is the most prevalent inherited degeneration in the retina. The clinical manifestations are variable in terms of severity, age of onset and progression. The clinical variation is paralleled by genetic heterogeneity (more than 20 different loci have been described to date). The aim of this work was to identify mutations in rhodopsin gene and to determine the frequencies of the different genetic forms of RP in the Galician population. METHODS: 47 previously diagnosed RP patients and their relatives were studied. Genetic forms of RP were identified by recording full family history and clinical examination. DNA samples from patients with RP and control individuals were screened for point mutations in the rhodopsin gene by using PCR SSCPs (Single Strand Conformation Polymorphisms) and direct sequencing in 36 unrelated nonsyndromic RP patients. RESULTS: We report the frequency distribution of the different genetic RP forms. In the SSCPs analysis of rhodopsin gene we found different mobility shifts: one variant in the 5'-untranslated region of the gen and one variant in the third intron. Direct sequencing revealed an A269-->G and an C3982-->T transitions, respectively. Additionally, we observed a single base change in codon 160 (C-->A) of this gene. CONCLUSIONS: Polymorphisms are commom findings in the exon 1 and 3 of rhodopsin gene. They are neutral variations and do not represent a change in the protein. No significant differences in the frecuencies of A269-->G and C3982-->T polymorphisms among the three groups of RP patients (ADRP, ARRP, Esporadic RP) and normal individuals were found. There was no significant deviation from Hardy-Weinberg's equilibrium in each genotype in any group.
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The aim of this work was to study the clinical management and surgical approach of substernal goiters. We studied the clinical data, preoperative evaluation, surgical treatment, histopathologic data, complications, and follow-up of 72 patients found to have substernal goiter over a period of 15 years, from a total of 780 patients with goiter who underwent surgery. In this group, 83% were women, and the mean age was 61 years. The most common symptoms were the existence of a palpable cervical mass (93% of cases) and dyspnea (40%). The most successful study to diagnose substernal goiter was computed tomography (100%), followed by chest radiography (75%), gammagraphy (19%), and ultrasound (15%). All but 7 patients received a Kocher cervicotomy, and 49% of the cases underwent a total thyroidectomy. The histologic study revealed 3 carcinomas (4%). There was 1 permanent unilateral recurrent laryngeal nerve injury (1.4%) and 1 instance of permanent hypoparathyroidism (1.4%). We regard surgery as the most successful treatment for patients with substernal goiter, even in those without compressive symptoms. We base our choice on the low morbidity and zero mortality obtained.
PURPOSE: Whether primary anastomosis should be performed after segmental resection with intraoperative colonic irrigation or subtotal colectomy is not yet established in the surgical treatment of obstructive left colon carcinoma. In this prospective, nonrandomized study, we present the results of 66 patients undergoing one-stage surgery for obstructed left colon carcinoma. PATIENTS AND METHODS: We compared two techniques, subtotal colectomy (35 patients) and intraoperative colonic irrigation with segmental resection and immediate anastomosis (31 patients). RESULTS: The mortality rate was similar in both groups, 8.5 percent in the subtotal colectomy group and 3.2 percent in the intraoperative colonic irrigation group. The surgical complication rate was significantly higher in the intraoperative colonic irrigation group (41.9 percent) than in the subtotal colectomy group (14.2 percent; P < 0.05). Mean operating time was significantly lower in the subtotal colectomy group than in the intraoperative colonic irrigation group (P < 0.05). Both groups had a similar mean duration of hospital stay. Ten patients who underwent subtotal colectomy (31.2 percent) presented with diarrhea in the immediate postoperative period, which disappeared spontaneously or with antidiarrheal medication; a disabling diarrhea persisted in two patients only (6.2 percent). CONCLUSION: We believe that subtotal colectomy is the treatment of choice for obstructed left-sided colonic carcinoma. Segmental resection with intraoperative colonic irrigation is more appropriate than subtotal colectomy only in patients with carcinomas of the rectosigmoid junction or with previous anal incontinence to avoid the appearance of postoperative diarrhea.
OBJECTIVE: To present our experience with the treatment of primary gastrointestinal (GI) non-Hodgkin's lymphoma, evaluate prognostic factors, and give our recommendations for treatment. DESIGN: Retrospective study. SETTING: Teaching hospital, Spain. SUBJECTS: 76 patients (47 men and 29 women, mean age 51 years) treated over the 15 years 1980-1994. INTERVENTIONS: 52 patients had radical resections, 19 palliative resections, and 5 biopsy alone. 42 (55%) also had adjuvant chemotherapy and 20 (26%) radiotherapy. RESULTS: Patients with primary intestinal lymphoma were slightly but not significantly younger than those with gastric lymphoma (43 compared with 56 years). 43 Patients (57%) had tumours in the stomach, 26 (34%) in the small bowel, and 7 (9%) in the colon. At presentation 34 had stage I disease, 25 stage IIE1 disease, and the remaining 17 stage IIE2; 14 were classified as low grade, 41 as intermediate, and 21 as high grade. 60 (79%) had a B-cell phenotype. Overall 5-year survival was 53%. Of the 11 variables tested by univariate analysis for their prognostic effect only abdominal mass (p < 0.001), clinical stage (p < 0.001), type of operation (p < 0.001), tumour size (p < 0.05), and histological grade (p < 0.05) achieved significance, but when Cox's multivariate analysis was applied only clinical stage was significant (p < 0.01). CONCLUSION: Operation is the treatment of choice, but chemotherapy and radiotherapy may have a role though as yet there are no standard guidelines for their use.
INTRODUCTION: Digital treatment of electrical signals coming from the central nervous system on stimulation of the optic nerve path offers an objective method for evaluation of visual evoked potentials (VEP) shown graphically on a cerebral map. OBJECTIVE: To evaluate the topographical distribution of VEP in cases of optic neuropathy adding this parameter to the usual parameters of latency and amplitude. MATERIAL AND METHODS: We studied 35 patients with suspected optic neuropathy and normal findings on basic ophthalmological examination, in whom VEP and VEP mapping (VEPM) was done. RESULTS: In 26% of the cases there was no response for evaluation with the usual VEP recording techniques, whilst in those with VEPM this percentage was reduced to 11.5%. In the other cases there was a potential with characteristic distribution in the occipital areas and a maximally positive dipole posteriorly. CONCLUSION: VEPM is an objective method for evaluation of the visual pathway offering better discrimination than the usual VEP in more severe cases of neuropathy.
BACKGROUND: An effort was made to present our experience with thoracoscopy in the diagnosis and management of pericardial effusions. METHODS: Twenty-two partial pericardiectomies were performed with the thoracoscopic approach in patients with pericardial effusions, the etiology of which was uremic (n = 7), neoplastic (n = 8), idiopathic (n = 5), septicemia (n = 1), and postpericardiotomy (n = 1). All cases had grade III-IV/IV radiological cardiomegaly and ultrasonographic confirmation of the effusion. We found hemodynamic compromise in 17 patients. The operation, requiring the insertion of three trocars, enabled us to remove a large part (approximately 6 x 10 cm) of the left anterolateral side of the pericardium and aspirate the effusion contents for diagnostic and therapeutic purposes. RESULTS: In five cases we found coexisting pleural effusions. The pericardial effusion had a mean volume of 817 ml, which was serous in 11 cases, hematic in six, serohematic in four, and purulent in one. Cytology of the pericardial effusion was positive for neoplasia in four cases (one pulmonary neoplasia, two breast carcinomas, and one lymphoma). We observed conversion to grade I/IV cardiomegaly in 16 cases and a return to normality in the other six, with the absence of ultrasonographic effusion in all cases. There was no recurrence during the mean follow-up period of 20.5 months (range: 2-47). CONCLUSIONS: The thoracoscopic management of pericardial effusions is a simple and effective technique that allows us to create a large pericardial window that drains the effusion definitively, determines its etiology, and explores and treats coexisting pleural lesions, all without recurrences.
The kinetics of 99mTc-Trimethyl-Br-IDA blood clearance was analysed in the rat 24 h after warm ischaemia and reperfusion of the liver. There were changes in the elimination of 99mTc-Trimethyl-Br-IDA depending on the length of the ischaemic period and the dose given. Statistically significant differences were found between the various periods of ischaemia when higher doses of the radionuclide were utilised. At lower doses, the clearance was not capable to discriminate between control rats and rats submitted to 45 min of ischaemia, but it did discriminate more severe degrees of ischaemic liver injury. Instead, galactose elimination capacity discriminated between ischaemic and control rats, but not between 45 and 90 min or between 90 and 120 min of ischaemia. Alanine aminotransferase was able to discriminate between control and ischaemic rats and between 45 and 90 min of ischaemia, but not between 90 and 120 min of ischaemia. The response of 99mTc-Trimethyl-Br-IDA clearance under extreme conditions of ischaemia and reperfusion is consistent and opens a possible window for the application of this test in the quantification of liver function in severely damaged livers and in decision making and prognosis in liver disease.
We report a patient with intestinal pseudo-obstruction in which both the histopathological findings and the clinical history strongly suggest a visceral myopathy of familial type. Reviewing the clinicopathological descriptions of the different families appearing in the literature, is evident that both the presentation (severity, distribution of lesions, etc) and the inheritance pattern seem not to be clearly delimitated, and it has been recently suggested that it may be related to the mitochondrial myopathies. The useless of conventional biopsy procedures (due to the almost exclusive affectation of the external muscle layer of the intestinal wall); the frequently patchy distribution of the lesions (which might be overlooked in a routine histological handling of a resection specimen) and the extensive range of symptoms of the disease, support the paramount importance of a high index of suspicion (obviously, the clinical history plays a fundamental role). In this setting, it is also interesting to emphasize the utility of manometric studies for the correct diagnosis and management of these patients; as well their possible application to identify asymptomatic heterozygotes.
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This report refers to the manifestation of an infrequent skin blastoma, with: Carcinoid papillomatosis developing on a zona-like verrucous nevus. An endeavor is made to determine the nosologic, etiologic, evolutionary and therapeutic aspects of both conditions.
Rotaviruses were identified by electron microscopy in 19 of 26 (73%) Venezuelan children with gastroenteritis. Noncultivable adenoviruses and small (29-30 nm), spherical viruses were also observed in a few cases. Bacterial pathogens were isolated from five children (19%), all of whom were also carrying rotaviruses.