Mammography and ultrasound in the evaluation of male breast disease

Objective  

To assess clinical variables that may be useful in differentiating gynaecomastia from carcinoma and to analyse the contribution of mammography and ultrasound to the evaluation of male breast disease.     

Rotura espontánea de la vena renal izquierda materna durante la gestación

Retroperitoneal hemorrhage is a very rare event, especially during pregnancy, and is associated with high morbimortality for both the mother and fetus. The cause is usually traumatic, but these hemorrhages can occur spontaneously, which further hampers their diagnosis. Presenting symptoms are abdominal pain and maternal hypovolemic shock, with rapid fetal compromise. We present a case of maternal retroperitoneal hemorrhage, which occurred at week 35 of pregnancy due to spontaneous rupture of the left renal vein, although the first manifestation was placental abruption.     

Efficacy of low-dose interferon with antiretroviral therapy in Kaposi's sarcoma: a randomized phase II AIDS clinical trials group study.

We wished to evaluate the efficacy and safety of a low and an intermediate daily dose of interferon-alpha2b (IFN-alpha2b) with didanosine in patients with acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma (KS). HIV-seropositive subjects with biopsy-confirmed cutaneous KS were randomized to receive either a low (1 million IU) or an intermediate (10 million IU) dose of IFN-alpha2b once daily with twice daily doses of didanosine. Treatment assignment was stratified by CD4 count. Response, toxicity, changes in CD4 counts, and survival were evaluated. Sixty-eight eligible subjects were accrued, 35 to low-dose and 33 to intermediate-dose IFN-alpha2b. The response rate was 40% in the low-dose group (95% CI, 24-58) and 55% in the intermediate-dose group (95% CI, 36-72) (p = 0.338). The median response duration was approximately 110 weeks in both groups. Intermediate-dose IFN induced grade 3/4 neutropenia more often (21% vs. 3%, p = 0.048) and grade 3/4 toxicity faster (p = 0.0231) and necessitated treatment discontinuation earlier for drug-related toxicities (p = 0.0416) than low-dose IFN. There were no significant differences in survival between the treatment groups. Baseline CD4 count was the only significant factor predicting response. Once-daily low-dose and intermediate-dose IFN-alpha2b induced similar response rates, which were achieved without optimal antiretroviral therapy. The slightly higher response rate in the intermediate-dose group was offset by its significantly poorer tolerance. These findings justify the use of lower, well-tolerated IFN doses for treatment of KS with currently used antiretroviral regimens.     

Sexual and olfactory preference in noncopulating male rats

In some species including rats, mice, gerbils, and rams, apparently normal males fail to copulate when repeatedly tested with receptive females. These animals are called "noncopulators (NC)," and the cause of this behavioral deficit is unknown. It has been shown that NC rats do not have hormonal alterations or deficits in the mechanisms that control penile function. The present study was designed to examine (Experiment 1) whether NC male rats prefer receptive females to sexually active males. In addition, the olfactory preference for bedding soiled from estrous or for anestrous bedding was investigated. These tests were performed in NC and copulating (C) male rats when the subjects were intact, gonadectomized (GDX), or GDX and treated with high doses of testosterone propionate (TP). Our results demonstrate that NC rats do not display sexual behavior even after high TP treatment. While C male rats have a clear preference for receptive females as opposed to a sexually active male, NC rats do not. In all hormonal conditions, the preference shown by NC rats for estrous bedding was significantly reduced in comparison to that seen in C rats. TP treatment in NC rats did not modify either partner or odor preference. In Experiment 2, we evaluated if NC rats are feminized and if it could be easier to induce feminine-like behavior by hormone treatment with estradiol benzoate (EB) or with EB plus progesterone (P) (EB+P). Odor preference for estrous or male bedding under these hormonal conditions was also compared. No differences between NC and C rats were found in feminine sexual behavior. In the olfactory test, we found that NC rats prefer odors from receptive females as opposed to male odors, but this preference is reduced compared to that of C rats. Males treated with EB or EB+P show no preference for female odors. These results demonstrate that treatment with EB or EB+P does not increase feminine sexual behavior in NC rats.     

Laparoscopic Resection of a Symptomatic Parasitic Leiomyoma of Paravesical and Obturator Fossa

Study ObjectiveTo show laparoscopic management of a symptomatic parasitic leiomyoma of paravesical and obturator fossa.DesignEdited video demonstrating a step-by-step explanation of the surgical technique of this case.SettingUniversity hospital.InterventionsUterine leiomyomas are the most common benign pelvic tumors in women. They occur in approximately 25% of women of reproductive age. Parasitic leiomyomas are rare, with few cases reported in the literature [1,2]. They are classified according to their location in relation to the myometrium. Parasitic leiomyomas are in group 8 of the International Federation of Gynecology and Obstetrics classification [3].It is not clear why they are produced; it is thought that they could derive from subserous leiomyomas that achieved a blood supply from neighboring structures outside the uterus [1,3].They can also have iatrogenic origin in patients who have undergone previous surgery such as myomectomy with power morcellation use [4].We present the case of a 32-year-old women, gravida 1 para 1, without previous pelvic surgery. She complained of lower back and sacrum pain and nonspecific discomfort in her inner thigh. Her physical examination showed a 6- to 7-cm solid right paravaginal tumor. Ultrasonography and nuclear magnetic resonance confirmed the presence of a 7 × 5-cm solid tumor in the right paravesical and obturator fossa. The diagnosis of a probable parasitic myoma was proposed, and a laparoscopic resection was scheduled. The video demonstrates the surgical technique with special emphasis on the anatomy of the surgical site. The patient was discharged 24 hours after surgery without complications. The final pathology confirmed uterine leiomyoma.Written informed consent was requested according to the regulations of our institution.ConclusionA successful laparoscopic resection of a symptomatic parasitic leiomyoma of the paravesical and obturator fossa was achieved. The importance of knowledge of the pelvic anatomy for the management of this type of case is underlined.     

Cardiac tamponade due to tuberculous mediastinal lymphadenitis

Pneumopericardium is rare in tuberculous mediastinal lymphadenitis. Much rarer is the association of pneumopericardium with cardiac tamponade. The case is reported of a 29-year-old patient in whom tuberculous mediastinal lymphadenitis resulted in a fatal tension pneumopericardium.     

Correlation between theoretical anatomical patterns of lymphatic drainage and lymphoscintigraphy findings during sentinel node detection in head and neck melanomas

Purpose

In the diagnosis of head and neck melanoma, lymphatic drainage is complex and highly variable. As regional lymph node metastasis is one of the most important prognostic factors, lymphoscintigraphy can help map individual drainage patterns. The aim of this study was to compare the results of lymphoscintigraphy and sentinel lymph node (SLN) detection with theoretical anatomical patterns of lymphatic drainage based on the location of the primary tumour lesion in patients with head and neck melanoma. We also determined the percentage of discrepancies between our lymphoscintigraphy and the theoretical location of nodal drainage predicted by a large lymphoscintigraphic database, in order to explain recurrence and false-negative SLN biopsies.

Methods

In this retrospective study of 152 patients with head and neck melanoma, the locations of the SLNs on lymphoscintigraphy and detected intraoperatively were compared with the lymphatic drainage predicted by on-line software based on a large melanoma database.

Results

All patients showed lymphatic drainage and in all patients at least one SLN was identified by lymphoscintigraphy. Of the 152 patients, 4 had a primary lesion in areas that were not described in the Sydney Melanoma Unit database, so agreement could only be evaluated in 148 patients. Agreement between lymphoscintigraphic findings and the theoretical lymphatic drainage predicted by the software was completely concordant in 119 of the 148 patients (80.4 %, 95 % CI 73.3 – 86 %). However, this concordance was partial (some concordant nodes and others not) in 18 patients (12.2 %, 95 % CI 7.8 – 18.4 %). Discordance was complete in 11 patients (7.4 %, 95 % CI 4.2 – 12.8 %).

Conclusion

In melanoma of the head and neck there is a high correlation between lymphatic drainage found by lymphoscintigraphy and the predicted drainage pattern and basins provided by a large reference database. Due to unpredictable drainage, preoperative lymphoscintigraphy is essential to accurately detect the SLNs in head and neck melanoma.

     

Exosomes in Pancreatic Cancer: from Early Detection to Treatment

Background

Pancreatic cancer (PC) remains one of the most fatal forms of cancer worldwide with incidence nearly equal to mortality. This is often attributed to the fact that diagnosis is often not made until later disease stages when treatment proves difficult. Efforts have been made to reduce the mortality of PC through improvements in early screening techniques and treatments of late-stage disease. Exosomes, small extracellular vesicles involved in cellular communication, have shown promise in helping understand PC disease biology.

Methods

In this review, we discuss current studies of the role of exosomes in PC physiology, and their potential use as diagnostic and treatment tools.

Results

Exosomes have a role in diagnosing pancreatic cancer and in understanding tumor biology including migration, proliferation, chemoresistance, immunosuppression, cachexia and diabetes, and have a potential role in therapy for pancreatic cancer.

Conclusions

Exosomal analysis is beneficial in demonstrating mechanisms behind PC growth and metastasis, immunosuppression, drug resistance, and paraneoplastic conditions. Furthermore, the use of exosomes can be beneficial in detecting early-stage PC and exosomes have potential applications as therapeutic targets.