Cáncer de pene. Nuestra experiencia en 15 años

ObjectiveTo review and analysis the diagnosis, treatment, evolution, and risk factors of the penis cancer.Material and MethodsWe carried out a retrospective study between 1992 and 2007. We included 47 patients with penis cancer diagnose of treated in our service. We analyzed risk factors, symptoms, diagnosis and treatment. The staging was done according to the TNM classification, taking into account the physical exam, radiology and the surgical findings. The average time of follow-up was 50 months (range 12 to 120 months). For univariate statistical analysis the Chi-square test was used, and for the survival the method of Kaplan Meir.ResultsMean age was 60 years (28-91 years), being 95% older than 50. At the diagnosis 16 patients (34%) had lymphatic nodes, being the most frequent location was unilateral inguinal nodes (62%). Of the 27 cases (57%) who underwent blood calcium check at the time of diagnosis, we found hypercalcaemia in 8 patients (30%). The surgical treatment was the gold standard treatment. The technique more frequently employed was the partial penectomy 25 (53%). 4 patients received radiotherapy as inicial treatment. Lymphadenectomy was performed in 14 patients, mostly bilateral inguinal lymphadenectomy (8 patients). The pathology finding at 100% of the cases was squamous cell carcinoma (80% well differentiated). Regarding to the TNM, most of the patients had a clinical stage located: t1n0m0 23%, t2n0m0 27%. The most significant adverse prognostic factors were the presence of lymph nodes, clinical stage at the diagnosis and the degree of cell differentiation (p = 0001). At the last review 36 (76%) cases were free of disease. There were 11 (24%) cases that presented recurrence and were treated: 3 patients with radiotherapy, surgery was used in 7 patients and 1 patient with chemotherapy. Eleven patients died during follor up, 9 of thes from disease progression.ConclusionsThe carcinoma of the penis remains a rare malignancy in our centre. Hypercalcemia is a common finding when patients have lymph nodes. The most significant adverse prognostic factors were the presence of lymph nodes, clinical stage at the diagnosis and the degree of cell differentiation. The most effective treatment for cancer of the penis is surgery reserving chemotherapy and radiation therapy for the recurrence.     

Estrogen-induced gonadotropin surge in rhesus monkeys is not inhibited by cortisol synthesis inhibition or hypoglycemia

Acute administration of corticotrophin-releasing hormone (CRH) has been shown to inhibit gonadotropin secretion in several species including rodents, sheep, humans, and nonhuman primates. Similarly, a variety of acute stressors have been shown to inhibit tonic gonadotropin secretion and may do so through a CRH mechanism. Stress-induced inhibition of tonic gonadotropin secretion below levels required for follicular maturation would be expected to inhibit ovulation. An additional mechanism whereby acute stressors could interfere with ovulation is through inhibition of the preovulatory gonadotropin surge. In the present study, we determined the effect of acute activation of the hypothalamic-pituitary-adrenal (HPA) axis on phasic gonadotropin secretion in female rhesus monkeys. Activation of the HPA axis was achieved by either a hypoglycemic challenge or blockage of cortisol synthesis with metyrapone, 24h after an estradiol benzoate challenge. Neither metyrapone nor insulin-induced hypoglycemia inhibited gonadotropin secretion. In fact, the initiation of the luteinizing hormone and folliclestimulating hormone surge was advanced by 7.4±0.4 h (p<0.001) and 4.8±1.4 h (p=0.04) respectively, in metyrapone-treated monkeys compared with saline controls. By contrast, hypoglycemia did not affect the gonadotropin surge. The gonadotropin surge was preceded by increased progesterone secretion in metyraponetreated but not insulin-treated monkeys. This difference in progesterone secretion likely explains the advancement of the gonadotropin surge in the metyraponetreated animals.     

Maintaining cosmetics and marginal bone with a dental implant

Inherent concerns for all implant systems exist. These concerns include complex restorative procedures, abutment rotational problems, marginal bone loss, and, in some cases, less than ideal cosmetic results. To overcome or reduce these problems, a new implant has been designed. The implant has been evaluated in this prospective study. Thirty-three new design implants were placed in 11 patients for an average time of 27.25 months. The new implant design proved to be easier to restore, posed no abutment rotational problems, resulted in no marginal bone loss problems (positive bone maintenance), and produced exceptional favorable cosmetic results.     

The evolution of antigen-specific CD8+ T cell responses after natural primary infection of humans with Epstein-Barr virus

Epstein-Barr virus (EBV) is a persistent, gamma-herpes virus that infects 90% of the human population. Primary infection, particularly if it is delayed until adolescence or beyond, may cause acute infectious mononucleosis and persistent infection may be associated with the development of several malignancies. CD8(+) T cells play a critical role in controlling both the primary and persistent phases of infection. This review summarises work that has been done characterising the primary immune responses to EBV. It goes on to describe the down regulation of the primary immune response and to discuss some of the factors that may be involved in determining the death or survival of populations of antigen-specific CD8(+) T cells. Finally it describes features of the populations of memory cells that mediate the long-term control of EBV in healthy seropositive individuals. The studies show differences in the responses to epitopes from lytic cycle versus latent proteins and highlight the complexity of naturally occurring, in vivo, immune responses. A clear understanding of the means by which CD8(+) T cells control EBV is important if we are to successfully develop vaccines and other forms of immunotherapy for the virus and its related malignancies.     

Similarity of university students' and their parents' attitudes toward alcohol

It is proposed that older adolescents become more sensitive to parental norms about alcohol use. Seventy-two father-mother-daughter triads and 30 father-mother-son triads rated structural attitude statements about alcohol and drinking. Factor analyses yielded six dimensions of attitudes toward alcohol. Sons and parents had similar attitudes overall, with perceptions differing more on the sociability factor. There were a larger number of differences in the attitudes of parents and their daughters, especially concerning women drinking, moderate uses of alcohol and social status benefits from drinking. Daughters' attitudes were more likely to be different from both parents' attitudes than were sons' attitudes. The attitudes of daughters toward alcohol were discussed with reference to changes in women's roles and differences in their education and lifestyle.