Angiosarcoma of the of scalp with calvarium involvement in a 50-year-old African-American man

BACKGROUND: Angiosarcoma of the scalp is a rare, aggressive, and deadly cancer that affects mainly elderly Caucasian men. OBJECTIVES: The insidious and masquerading presentation of angiosarcoma poses enormous diagnostic challenges for primary care providers. PATIENTS/METHODS: We present a case of a 50-year-old black man referred for evaluation of a 3.7-cm-x-5.4-cm ulcerated, fluctuant scalp lesion that had failed to respond to different antibiotics and proper wound care. RESULTS: Surgical excision and subsequent histopathology revealed angiosarcoma. CONCLUSIONS: This case report highlights the importance of high index of suspicion for early diagnosis of cancerous lesions in wounds and stresses the need to include angiosarcoma in the differential diagnosis for all face and scalp lesions, as early detection may save lives. A comprehensive literature review is also presented.     

Surgery of large residual mass after chemotherapy in advanced testicular germ cell tumor

Treatment for testicular tumours has progress in such a manner in the last years that high cure percentages can at present be achieved. After chemotherapy, in most cases, residual mass can appear. In this cases surgery is considered a viable therapeutic option although it implies an advanced surgical training since it is a complex technique and implies serious implications. We submit the case of a patient who presented a large residual mass from a testicular germ cell tumour after being treated with orquiectomía and chemotherapy. Surgery was performed resulting in total and radical extirpation of residual mass.     

Identification of gaps in the diagnosis and treatment of childhood asthma using a community-based participatory research approach

The goal of this investigation was to use a community-based participatory research approach to develop, pilot test, and administer an asthma screening questionnaire to identify children with asthma and asthma symptoms in a community setting. This study was conducted as the recruitment effort for Community Action Against Asthma, a randomized trial of a household intervention to reduce exposure to environmental triggers of asthma and was not designed as a classic prevalence study. An asthma screening questionnaire was mailed and/or hand delivered to parents of 9,627 children, aged 5 to 11 years, in two geographic areas of Detroit, Michigan, with predominantly African American and Hispanic populations. Additional questionnaires were distributed via community networking. Measurements included parent report of their child's frequency of respiratory symptoms, presence of physician diagnosis of asthma, and frequency of doctor-prescribed asthma medication usage. Among the 3,067 completed questionnaires, 1,570 (51.2% of returned surveys, 16.3% of eligible population) were consistent with asthma of any severity and 398 (12.9% of returned surveys, 4.1% of eligible population) met criteria, for moderate-to-severe asthma. Among those meeting criteria for moderate-to-severe asthma, over 30% had not been diagnosed by a physician, over one half were not taking daily asthma medication, and one quarter had not taken any physician-prescribed asthma medication in the past year. Screening surveys conducted within the context of a community-based participatory research partnership can identify large numbers of children with undiagnosed and/or undertreated moderate-to-severe asthma. These children are likely to benefit from interventions to reduce morbidity and improve quality of life.     

Argentina, Brazil and Mexico. Biomedical research and the defense of a single standard of attention in developing countries

In the Helsinki Declaration, which established the ethical principles for research with human subjects, article 5 states, "...concern about the well-being of human beings should always come before the interests of science and of society..." Research proposals should include this commitment, both in developed and developing countries. In countries like Argentina, Brazil and Mexico, much of the population experience situations of great injustice, including a lack of equal access to health care. In some cases, sectors of the pharmaceutical industry may see these deficiencies as offering opportunities for carrying out research and achieving economic profits, something which carries the risk of perpetuating and even intensifying the unjust situations and violations of human rights--these population groups already suffer from. This situation implies the need for commitment to and ethical reflection upon human rights related to health. Agreements are needed between the actors involved in health research: sources of funding, researchers, public policy makers, and the study subjects themselves, in order to protect the latter's rights, including continuity of medical treatment for research subjects, when necessary.     

Behavioural and neuroendocrine adaptations to repeated stress during puberty in male golden hamsters

In adult animals, the consequences of stress are often severe and long lasting. Repeated subjugation in adult male golden hamsters inhibits aggression and increases submissive and avoidant behaviours. By contrast, subjugation during puberty enhances offensive aggression. The goals of this study were to characterize behavioural and neuroendocrine responses of naïve and repeatedly subjugated juveniles to social defeat and to assess potential recovery from social stress. From the onset of puberty on postnatal day 28 (P28) to mid puberty (P42), animals were either socially subjugated or placed in a clean and empty cage for 20 min daily. The subjugated and control groups were further divided into subgroups and sacrificed under basal conditions or after social defeat on P28, P35 (early puberty), P45 (mid puberty) and P70 (early adulthood). On P35 and P45, repeatedly subjugated juveniles showed a complete inhibition of olfactory investigation (i.e. risk assessment) towards aggressive adults. Repeatedly subjugated also animals had lower postdefeat cortisol levels than controls on P45. Interestingly, basal cortisol levels increased gradually during puberty but did not differ between treatment groups at any point. Repeated subjugation was also associated with increased tyrosine hydroxylase immunoreactivity (ir‐TH) within the extended medial amygdala. After a 4‐week recovery period, none of these variables differed between subjugated and control groups. In an additional experiment, subjugated adults also had increased ir‐TH in the medial extended amygdala, suggesting that these neurones are particularly responsive to social stress. In conclusion, puberty may be a developmental period characterized by behavioural and neuroendocrine plasticity in stress responsiveness. Furthermore, peri‐pubertal changes in stress hormones may explain why juvenile hamsters are more resilient to social stress than adults.     

A family assessment tool for hospitalized elders

This article describes the development of the FAMILY card, a family assessment instrument used in the Nursing Care Quality Initiative (NCQI) to assess the involvement and needs of family members of hospitalized elders. Through the NCQI project, particular attention has been paid to integrating both clinical expertise in geriatric nursing care and the principles of family-centered care into the nursing care provided by staff on the NCQI study units. Two case studies illustrating use of the SPICES geriatric assessment instrument and the newly developed FAMILY assessment card are included as exemplars.     

Bayesian methodology: an alternative to regular medical practice

The Bayes theorem provides a formula to calculate the probability of an event to occur conditioned by the occurrence of an anterior one (conditioned probability). In medicine it has been applied to calculate the probability of suffering a disease when having a positive result in a given test. This formula emphasizes the importance of prevalence of a disease (or a priori probability of the positive predictive value of a diagnostic test). The novelty of applying the bayesian methodology in clinical practice results from taking into consideration previous external information (or "a priori probability"), and to calculate how it is modified by the evidence (or "verisimilitude") provided by certain empirical tests, to obtain a new probability conditioned by the empirical evidence (or "a posteriori probability"). It also allows to perform sequential analysis (repeated observation of a given event a number of times not fixed in advance) and to incorporate the subjective probabilities to the reasoning. Some authors have proposed the use of bayesian methodology in research studies, such as clinical trials. Nevertheless, this methodology does not adapt well to this kind of reasoning which is hypothetical-deductive.