Clinical and immunohistochemical analysis of orbital metastasis from prostate carcinoma

Orbital tumors can present with different symptoms, especially ophthalmic disturbances. We describe 1 patient with an orbital metastasis from prostate carcinoma presenting with proptosis and give details of his presentation, diagnostic tools, and treatment. This is a rare case. Possible ocular spread of prostate adenocarcinoma and the diagnostic techniques used are discussed. It is stressed that immunohistochemical studies and comparison with primary tumor may be essential for a definitive diagnosis. The treatment of prostate orbital metastases is also reviewed.     

Atypical clinical response patterns to ipilimumab

Patients with advanced melanoma have few treatment options, and survival is poor. However, improved understanding of how the immune system interacts with cancer has led to the development of novel therapies. Ipilimumab is a monoclonal antibody that inhibits cytotoxic T-lymphocyte antigen-4 (CTLA-4), a key negative regulator of host T-cell responses. This article presents cases of patients receiving ipilimumab in clinical trials along with a discussion of their significance and relevance to nursing practice. The patients showed different response patterns to ipilimumab and also had various typical immune-related adverse events (irAEs), which were managed successfully. The atypical response patterns produced by ipilimumab likely reflect its mechanism of action, which requires time for the immune system to mount an effective antitumor response. Meanwhile, lesions may appear to enlarge as a consequence of enhanced T-cell infiltration, although this may not necessarily be true disease progression. Patients receiving ipilimumab may respond very differently compared to how they might react to chemotherapy. Responses can take weeks or months to develop; therefore, clinicians should not terminate treatment prematurely, providing the patient's condition allows for continuation. Early recognition of irAEs combined with prompt management will ensure that events are more likely to resolve without serious consequences.     

First contact with an insulin pump. Clinical case

Insulin pumps are devices that inject insulin continuously into the body in a similar way to the pancreatic secretion, and with endless possibilities to adjust schedules, meals and physical activities, giving diabetics the chance to lead a life with many less restraints due to their illness. Besides giving them this freedom, the therapy allows more precise control of blood glucose, significantly improving the overall self-control and thus the quality of life of the diabetics, reducing the appearance of long-term complications. Although all diabetics receive many guidelines and recommendations for optimal control throughout their illness patients included in this protocol must be especially aware and involved in self-control, since the treatment demands more involvement both when learning to use the device as well as making decisions once they are using it. We present the case of a type 1 diabetic patient, twenty-one years of onset, who while admitted to hospital for a day, had a continuous subcutaneous insulin infusion pump implanted (insulin pump). To this end, we developed a patient care plan of patient following the steps of scientific method and relying on the NANDA taxonomy and on the NOC and NIC to design goals and nursing interventions, respectively.     

Allogeneic hematopoietic transplantation using haploidentical donor vs. unrelated cord blood donor in pediatric patients: a single-center retrospective study

We retrospectively analyzed outcomes in 67 children with acute leukemia who received hematopoietic stem cell transplantation from alternative allogeneic donors: 29 received a haploidentical family donor and 38, an unrelated cord blood donor. All transplantations were performed from 1996 through 2010 in our center. Neutrophil and platelet engraftment were significantly delayed after cord blood transplantation. The median times to neutrophil and platelet recovery were 13 d (7-34) and 11 d (5-70) after haploidentical transplant and 20 d (9-125) and 56 d (12-200) after cord blood (P < 0.001). All supportive care measures included red blood cell, and platelet transfusions were significantly increased in cord blood transplantation group.Transplant-related mortality rates was lower with haplo donors (25 ± 9%) than with cord blood donors (47 ± 9%) (P < 0.05). Acute graft-versus-host disease (GVHD) more than grade II was also lower in haploidentical transplants (19 ± 7%) than in cord blood transplants (44 ± 10%) (P < 0.03). Relapse and chronic GVHD incidence were not significantly different in the two groups. Leukemia-free survival was higher after haploidentical transplants (44 ± 10%) than after cord blood transplants (33 ± 7%) (P < 0.03). Main differences were observed in patients diagnosed with acute lymphoblastic leukemia: haplo, 41 ± 13%; cord blood, 26 ± 9% (P < 0.03) and in advanced phase of disease: haplo, 37 ± 14%; cord blood, 21 ± 8% (P < 0.05). In conclusion, haploidentical transplants are a good and promising alternative option for patients with childhood leukemia who lack an human leukocyte antigen-matched donor (sibling or unrelated donor).     

Validity of a single-factor model underlying the metabolic syndrome in young adults: confirmatory factor analysis

Introduction and objectives

To determine by confirmatory factor analysis whether a model of the metabolic syndrome including waist circumference-to-height ratio, as a measure of adiposity, has better goodness of fit than that based on waist circumference alone and, on the basis of the data of the best-fit model, to develop an index of global cardiometabolic risk in young adults.

Methods

Cross-sectional observational study involving 683 university students aged 18 to 30 years, in their first year at the University of Castilla-La Mancha in Spain, during the 2009-10 academic year. We compared the best fit of 2 models of the metabolic syndrome, both of which included the triglyceride-to-high-density lipoprotein cholesterol ratio, HOMA-IR index, and mean arterial blood pressure, but differed in that one of them used waist circumference, whereas the other used the waist circumference-to-height ratio. A metabolic syndrome index (MSI) was constructed and its association with aerobic capacity, daily physical activity and muscle strength was estimated.

Results

The single-factor model that included waist circumference was a better indicator of goodness of fit. The MSI was inversely associated with aerobic capacity and muscle strength.

Conclusions

This study confirms that a single factor underlies the concept of metabolic syndrome; including the waist circumference-to-height ratio does not result in improvements over the model in which waist circumference alone is considered, and the development of a quantitative MSI may be useful for the quantification of cardiometabolic risk in clinical practice.Full English text available from:www.revespcardiol.org     

Carcinoma ductal in situ, ¿factor de riesgo de mastectomía?

Objective

To determine the histological or immunohistochemical characteristics of ductal carcinomas in situ (DCIS) that could influence margin status at first surgery and at final surgery.

Material and methods

We retrospectively studied the 485 breast carcinomas diagnosed in 2003, 2004 and 2005 at the Doce de Octubre Hospital (Madrid), of which 54 (11.1%) were DCIS and 280 (57.7%) were invasive ductal carcinomas (IDC).

Results

Only 10% of DCIS were palpable. DCIS represented 25% of all carcinomas diagnosed by mammographic wire-guided biopsy. We found positive margins on first breast-conserving surgery in 50% of DCIS and in 34% of IDC. Consequently, a second or even a third intervention (for persistently involved margins) was more frequent in DCIS than in IDC. In DCIS higher histological grades were associated with more frequent margin involvement and a higher rate of re-excision with positive margins and mastectomy. The mastectomy rate in DCIS (43%) was higher than that in IDC diagnosed by mammographic wire-guided biopsy (27%), and was similar to that in IDC overall (41%).

Conclusions

Mammographic screening programs have improved the detection of DCIS, but clear margins are sometimes difficult to achieve in this entity, leading to the paradox that women with palpable IDC are able to undergo breast-conserving surgery without compromising prognosis, whereas a mammographically detected DCIS requires mastectomy.     

Effects of iron deficiency on neonatal behavior at different stages of pregnancy

Animal and human studies have shown that prenatal and postnatal iron deficiency is a risk factor for behavioral, emotional and cognitive development. The aim of this study was to determine the associations between iron status of pregnant women and the behavior of their newborn, taking into account the timing in which the deficit occurs. This study was conducted in Spain (developed country) where: the general population is well-nourished; during pregnancy routine obstetrical checks are carried out; and pregnant women are systematically iron supplemented. A total of 216 healthy and well-nourished pregnant women and their term, normal weight newborn participated in this study. The neonatal behavior was assessed by the Neonatal Behavior Assessment Scale (NBAS). The results showed that in the first and second trimesters of pregnancy, iron deficiency was a weak and significant predictor of the NBAS autonomous nervous system cluster score, and in the third trimester, this condition predicted the NBAS motor and state organization clusters score and the NBAS robustness and endurance supplementary item. In conclusion, iron deficiency during pregnancy is related to the neonate's general autonomous response, motor performance and self regulation capabilities.