Volar dislocation of the metacarpophalangeal joint of the thumb: open reduction and repair of the ulnar collateral ligament. A case report.

INTRODUCTION: metacarpophalangeal dislocations of the thumb are not very frequent injuries, it is necessary to know the anatomy of the region to know possible causes of interposition that prevent a closed reduction of this pathology. CASE PRESENTATION: we present the case of a 75-year-old woman with a post-traumatic metacarpophalangeal dislocation of the thumb that required open reduction and surgical repair. In this procedure, we performed reduction of the dislocation, mobilization of the interposed structures, repair of the capsule and reinsertion of the ulnar collateral ligament. The early mobilization protocol helped to obtain very good results. CONCLUSION: it is imperative to consider possible associated injuries during the acute phase to achieve optimal short, medium, and long-term outcomes for our patients. A comprehensive and proactive approach to diagnosis and treatment is vital in effectively addressing this pathology and minimizing its potential sequelae.

INTRODUCCIÓN: las luxaciones metacarpofalángicas del pulgar no son lesiones muy frecuentes, es necesario conocer la anatomía de la región para conocer posibles causas de interposición que impidan una reducción cerrada de esta patología. PRESENTACIÓN DEL CASO: presentamos el caso de una mujer de 75 años con luxación metacarpofalángica postraumática del pulgar que requirió reducción abierta y reparación quirúrgica. En este procedimiento realizamos reducción de la luxación, movilización de las estructuras interpuestas, reparación de la cápsula y reinserción del ligamento colateral cubital. El protocolo de movilización temprana ayudó a obtener muy buenos resultados. CONCLUSIÓN: es imperativo considerar posibles lesiones asociadas durante la fase aguda para lograr resultados óptimos a corto, mediano y largo plazo para nuestros pacientes. Un enfoque integral y proactivo del diagnóstico y tratamiento es vital para abordar eficazmente esta patología y minimizar sus posibles secuelas.

First Radiological Study of a Complete Dental Ontogeny Sequence of an Extinct Equid: Implications for Equidae Life History and Taphonomy.

The sequence of cheek teeth mineralization, eruption, and replacement of an extinct horse species is here documented with radiological techniques for the first time thanks to the exceptional preservation of Hipparion sp. mandibles from Cerro de los Batallones (Madrid Basin, Spain). The sequence of dental ontogeny in mammals provides valuable insights about life history traits, such as the pace of growth, and about the mode of formation of fossiliferous assemblages. We have determined that the order of permanent cheek teeth mineralization and eruption of hipparionine horses is m1, m2, (p2, p3), p4, m3. Cheek teeth mineralization timing of hipparionine horses coincides with the one observed in modern equids. In turn, there are differences in the eruption timing of the p4 and m3 between horses belonging to the Anchitheriinae and Hipparionini compared to equids of the Equus genus that might be related to the shorter durability of the deciduous tooth dp4 in anchitheriine and hipparionine horses and, more broadly, to an increased durability of equid teeth through their evolutionary history. Based on the dental eruption sequence, hipparionine horses are slow-growing, long-living mammals. The Hipparion sp. assemblage from Batallones-10 conforms to an attritional model, as individuals more vulnerable to natural mortality predominate.

Decoupled ecomorphological evolution and diversification in Neogene-Quaternary horses.

Evolutionary theory has long proposed a connection between trait evolution and diversification rates. In this work, we used phylogenetic methods to evaluate the relationship of lineage-specific speciation rates and the mode of evolution of body size and tooth morphology in the Neogene and Quaternary radiation of horses (7 living and 131 extinct species). We show that diversification pulses are a recurrent feature of equid evolution but that these pulses are not correlated with rapid bursts in phenotypic evolution. Instead, rapid cladogenesis seems repeatedly associated with extrinsic factors that relaxed diversity bounds, such as increasing productivity and geographic dispersals into the Old World. This evidence suggests that diversity dynamics in Equinae were controlled mainly by ecological limits under diversity dependence rather than rapid ecomorphological differentiation.

Proteomic analysis of Lawsonia intracellularis reveals expression of outer membrane proteins during infection.

Lawsonia intracellularis is the aetiological agent of the commercially significant porcine disease, proliferative enteropathy. Current understanding of host-pathogen interaction is limited due to the fastidious microaerophilic obligate intracellular nature of the bacterium. In the present study, expression of bacterial proteins during infection was investigated using a mass spectrometry approach. LC-ESI-MS/MS analysis of two isolates of L. intracellularis from heavily-infected epithelial cell cultures and database mining using fully annotated L. intracellularis genome sequences identified 19 proteins. According to the Clusters of Orthologous Groups (COG) functional classification, proteins were identified with roles in cell metabolism, protein synthesis and oxidative stress protection; seven proteins with putative or unknown function were also identified. Detailed bioinformatic analyses of five uncharacterised proteins, which were expressed by both isolates, identified domains and motifs common to other outer membrane-associated proteins with important roles in pathogenesis including adherence and invasion. Analysis of recombinant proteins on Western blots using immune sera from L. intracellularis-infected pigs identified two proteins, LI0841 and LI0902 as antigenic. The detection of five outer membrane proteins expressed during infection, including two antigenic proteins, demonstrates the potential of this approach to interrogate L. intracellularis host-pathogen interactions and identify novel targets which may be exploited in disease control.

Coinfection of tick cell lines has variable effects on replication of intracellular bacterial and viral pathogens.

Ticks transmit various human and animal microbial pathogens and may harbour more than one pathogen simultaneously. Both viruses and bacteria can trigger, and may subsequently suppress, vertebrate host and arthropod vector anti-microbial responses. Microbial coinfection of ticks could lead to an advantage or disadvantage for one or more of the microorganisms. In this preliminary study, cell lines derived from the ticks Ixodes scapularis and Ixodes ricinus were infected sequentially with 2 arthropod-borne pathogens, Borrelia burgdorferi s.s., Ehrlichia ruminantium, or Semliki Forest virus (SFV), and the effect of coinfection on the replication of these pathogens was measured. Prior infection of tick cell cultures with the spirochaete B. burgdorferi enhanced subsequent replication of the rickettsial pathogen E. ruminantium whereas addition of spirochaetes to cells infected with E. ruminantium had no effect on growth of the latter. Both prior and subsequent presence of B. burgdorferi also had a positive effect on SFV replication. Presence of E. ruminantium or SFV had no measurable effect on B. burgdorferi growth. In tick cells infected first with E. ruminantium and then with SFV, virus replication was significantly higher across all time points measured (24, 48, 72h post infection), while presence of the virus had no detectable effect on bacterial growth. When cells were infected first with SFV and then with E. ruminantium, there was no effect on replication of either pathogen. The results of this preliminary study indicate that interplay does occur between different pathogens during infection of tick cells. Further study is needed to determine if this results from direct pathogen-pathogen interaction or from effects on host cell defences, and to determine if these observations also apply in vivo in ticks. If presence of one pathogen in the tick vector results in increased replication of another, this could have implications for disease transmission and incidence.

Origin of an assemblage massively dominated by carnivorans from the miocene of Spain.

Carnivoran-dominated fossil sites provide precious insights into the diversity and ecology of species rarely recovered in the fossil record. The lower level assemblage of Batallones-1 fossil site (Late Miocene; Madrid Basin, Spain) has yielded one of the most abundant and diversified carnivoran assemblage ever known from the Cenozoic record of mammals. A comprehensive taphonomic study is carried out here in order to constrain the concentration mode of this remarkable assemblage. Another distinctive feature of Batallones-1 is that the accumulation of carnivoran remains took place in the context of a geomorphological landform (cavity formation through a piping process) practically unknown in the generation of fossil sites. Two characteristics of the assemblage highly restrict the probable causes for the accumulation of the remains: (1) the overwhelming number of carnivorans individuals; and (2) the mortality profiles estimated for the four most abundant taxa do not correspond to the classic mortality types but rather were the consequence of the behavior of the taxa. This evidence together with other taphonomic data supports the hypothesis that carnivoran individuals actively entered the cavity searching for resources (food or water) and were unable to exit. The scarcity of herbivores implies that the shaft was well visible and avoided by these taxa. Fossil bones exhibit a very good preservation state as a consequence of their deposition in the restricted and protective environment of the chamber. Batallones-1 had another assemblage (upper level assemblage) that was dominated by herbivore remains and that potentially corresponded to the final stages of the cavity filling.

Molecular characterisation of a calmodulin gene, VcCaM1, that is differentially expressed under aluminium stress in highbush blueberry.

Calmodulin (CaM), a small acidic protein, is one of the best characterised Ca(2+) sensors in eukaryotes. This Ca(2+) -regulated protein plays a critical role in decoding and transducing environmental stress signals by activating specific targets. Many environmental stresses elicit changes in intracellular Ca(2+) activity that could initiate adaptive responses under adverse conditions. We report the first molecular cloning and characterisation of a calmodulin gene, VcCaM1 (Vaccinium corymbosum Calmodulin 1), in the woody shrub, highbush blueberry. VcCaM1 was first identified as VCAL19, a gene induced by aluminium stress in V. corymbosum L. A full-length cDNA of VcCaM1 containing a 766-bp open reading frame (ORF) encoding 149 amino acids was cloned from root RNA. The sequence encodes four Ca(2+) -binding motifs (EF-hands) and shows high similarity (99%) with the isoform CaM 201 of Daucus carota. Expression analyses showed that following Al treatment, VcCaM1 message level decreased in roots of Brigitta, an Al-resistant cultivar, and after 48 h, was lower than in Bluegold, an Al-sensitive cultivar. VcCAM1 message also decreased in leaves of both cultivars within 2 h of treatment. Message levels in leaves then increased by 24 h to control levels in Brigitta, but not in Bluegold, but then decreased again by 48 h. In conclusion, VcCaM1 does not appear to be directly involved in Al resistance, but may be involved in improved plant performance under Al toxicity conditions through regulation of Ca(2+) homeostasis and antioxidant systems in leaves.

Excess manganese differentially inhibits photosystem I versus II in Arabidopsis thaliana.

The effects of exposure to increasing manganese concentrations (50-1500 µM) from the start of the experiment on the functional performance of photosystem II (PSII) and photosystem I (PSI) and photosynthetic apparatus composition of Arabidopsis thaliana were compared. In agreement with earlier studies, excess Mn caused minimal changes in the PSII photochemical efficiency measured as F(v)/F(m), although the characteristic peak temperature of the S(2/3)Q(B) (-) charge recombinations was shifted to lower temperatures at the highest Mn concentration. SDS-PAGE and immunoblot analyses also did not exhibit any significant change in the relative abundance of PSII-associated polypeptides: PSII reaction centre protein D1, Lhcb1 (major light-harvesting protein of LHCII complex), and PsbO (OEC33, a 33 kDa protein of the oxygen-evolving complex). In addition, the abundance of Rubisco also did not change with Mn treatments. However, plants grown under excess Mn exhibited increased susceptibility to PSII photoinhibition. In contrast, in vivo measurements of the redox transients of PSI reaction centre (P700) showed a considerable gradual decrease in the extent of P700 photooxidation (P700(+)) under increased Mn concentrations compared to control. This was accompanied by a slower rate of P700(+) re-reduction indicating a downregulation of the PSI-dependent cyclic electron flow. The abundance of PSI reaction centre polypeptides (PsaA and PsaB) in plants under the highest Mn concentration was also significantly lower compared to the control. The results demonstrate for the first time that PSI is the major target of Mn toxicity within the photosynthetic apparatus of Arabidopsis plants. The possible involvement mechanisms of Mn toxicity targeting specifically PSI are discussed.

Tick cell culture isolation and growth of Rickettsia raoultii from Dutch Dermacentor reticulatus ticks.

Tick cell lines play an important role in research on ticks and tick-borne pathogenic and symbiotic microorganisms. In an attempt to derive continuous Dermacentor reticulatus cell lines, embryo-derived primary cell cultures were set up from eggs laid by field ticks originally collected as unfed adults in The Netherlands and maintained for up to 16 months. After several months, it became evident that cells in the primary cultures were infected with a Rickettsia-like intracellular organism. Supernatant medium containing some D. reticulatus cells was inoculated into cultures of 2 Rhipicephalus (Boophilus) microplus cell lines, BME/CTVM2 and BME/CTVM23, where abundant growth of the bacteria occurred intracellularly on transfer to both cell lines. Bacterial growth was monitored by light (live, inverted microscope, Giemsa-stained cytocentrifuge smears) and transmission electron microscopy revealing heavy infection with typical intracytoplasmic Rickettsia-like bacteria, not present in uninfected cultures. DNA was extracted from bacteria-infected and uninfected control cultures, and primers specific for Rickettsia 16S rRNA, ompB, and sca4 genes were used to generate PCR products that were subsequently sequenced. D. reticulatus primary cultures and both infected tick cell lines were positive for all 3 Rickettsia genes. Sequencing of PCR products revealed 99-100% identity with published Rickettsia raoultii sequences. The R. raoultii also grew abundantly in the D. nitens cell line ANE58, poorly in the D. albipictus cell line DALBE3, and not at all in the D. andersoni cell line DAE15. In conclusion, primary tick cell cultures and cell lines are useful systems for isolation and propagation of fastidious tick-borne microorganisms. In vitro isolation of R. raoultii from Dutch D. reticulatus confirms previous PCR-based detection in field ticks, and presence of the bacteria in the tick eggs used to initiate the primary cultures confirms that transovarial transmission of this Rickettsia occurs.

Detection and identification of putative bacterial endosymbionts and endogenous viruses in tick cell lines.

As well as being vectors of many viral, bacterial, and protozoan pathogens of medical and veterinary importance, ticks harbour a variety of microorganisms which are not known to be pathogenic for vertebrate hosts. Continuous cell lines established from ixodid and argasid ticks could be infected with such endosymbiotic bacteria and endogenous viruses, but to date very few cell lines have been examined for their presence. DNA and RNA extracted from over 50 tick cell lines deposited in the Roslin Wellcome Trust Tick Cell Biobank (http://tickcells.roslin.ac.uk) were screened for presence of bacteria and RNA viruses, respectively. Sequencing of PCR products amplified using pan-16S rRNA primers revealed the presence of DNA sequences from bacterial endosymbionts in several cell lines derived from Amblyomma and Dermacentor spp. ticks. Identification to species level was attempted using Rickettsia- and Francisella-specific primers. Pan-Nairovirus primers amplified PCR products of uncertain specificity in cell lines derived from Rhipicephalus, Hyalomma, Ixodes, Carios, and Ornithodoros spp. ticks. Further characterisation attempted with primers specific for Crimean-Congo haemorrhagic fever virus segments confirmed the absence of this arbovirus in the cells. A set of pan-Flavivirus primers did not detect endogenous viruses in any of the cell lines. Transmission electron microscopy revealed the presence of endogenous reovirus-like viruses in many of the cell lines; only 4 of these lines gave positive results with primers specific for the tick Orbivirus St Croix River virus, indicating that there may be additional, as yet undescribed 'tick-only' viruses inhabiting tick cell lines.

Sox2 expression in breast tumours and activation in breast cancer stem cells.

The cancer stem cell (CSC) model does not imply that tumours are generated from transformed tissue stem cells. The target of transformation could be a tissue stem cell, a progenitor cell, or a differentiated cell that acquires self-renewal ability. The observation that induced pluripotency reprogramming and cancer are related has lead to the speculation that CSCs may arise through a reprogramming-like mechanism. Expression of pluripotency genes (Oct4, Nanog and Sox2) was tested in breast tumours by immunohistochemistry and it was found that Sox2 is expressed in early stage breast tumours. However, expression of Oct4 or Nanog was not found. Mammosphere formation in culture was used to reveal stem cell properties, where expression of Sox2, but not Oct4 or Nanog, was induced. Over-expression of Sox2 increased mammosphere formation, effect dependent on continuous Sox2 expression; furthermore, Sox2 knockdown prevented mammosphere formation and delayed tumour formation in xenograft tumour initiation models. Induction of Sox2 expression was achieved through activation of the distal enhancer of Sox2 promoter upon sphere formation, the same element that controls Sox2 transcription in pluripotent stem cells. These findings suggest that reactivation of Sox2 represents an early step in breast tumour initiation, explaining tumour heterogeneity by placing the tumour-initiating event in any cell along the axis of mammary differentiation.

A novel Lawsonia intracellularis autotransporter protein is a prominent antigen.

Investigation of antigenic determinants of the microaerophilic obligate intracellular bacterium Lawsonia intracellularis using a mass spectrometry approach identified a novel bacterial protein present in an extract of cell culture medium aspirated from heavily infected in vitro cell cultures. Western immunoblotting analysis of SDS-PAGE-resolved proteins using immune sera pooled from L. intracellularis-infected pigs revealed the presence of a strongly immunoreactive band of ∼ 72 kDa. Liquid chromatography-electrospray ionization-tandem mass spectrometry analysis of this component and database mining using a fully annotated L. intracellularis genome sequence and the comprehensive GenBank prokaryotic genomic database highlighted the presence of a protein that shares little sequence similarity with other prokaryotic proteins and appears to be highly species specific. Detailed bioinformatic analyses identified the protein as member of the autotransporter protein family of surface-exposed proteins, and the designation LatA (Lawsonia autotransporter protein A) is suggested. Recognition of recombinant LatA on Western blots by a panel of sera from infected and control pigs corresponded 100% with a commercial serodiagnostic that relies on in vitro culture of this fastidious organism. LatA therefore represents a potential candidate for the development of a rapid and species-specific serodiagnostic reagent.

Expression by Lawsonia intracellularis of type III secretion system components during infection.

Contact-dependent secretion systems, such as the type III secretion system (T3SS), have been shown to play significant roles in the pathogenicity of many gram-negative bacterial pathogens. Lawsonia intracellularis is a novel, obligate intracellular gram-negative bacterium, which has been identified as the etiological agent of proliferative enteropathies in numerous animal species. Analysis of the genome sequence of the L. intracellularis strain PHE/MN1-00 has revealed the presence of a T3SS secretion system in this bacterium. In this study we aimed to determine whether this important virulence mechanism is also present in L. intracellularis strain LR189/5/83. Using a PCR-based approach, we verified the presence of a genomic region encoding a T3SS. Specifically, a gene highly homologous to the yscN energiser component of the prototypic T3SS of Yersinia spp. was identified and termed lscN. Two further open reading frames (ORFs) contiguous with lscN were also identified: lscO and lscQ, which are also homologues of ORFs within the T3SS of Yersinia spp. To establish whether this T3SS may be functional, expression was monitored directly by RT-PCR and indirectly by detection of serological responses in vaccinated and infected animals. Transcripts for lscN and lscQ were detected and purified rLscQ was recognized by antiserum from infected pigs, indicating expression in vivo during infection. By analogy to other bacteria, this T3SS may be crucial for intracellular development and is likely to play a significant role in the virulence of this unusual pathogen.

Perspectivas futuras para la autopsia clínica en los pacientes procedentes de la unidad de cuidados críticos y urgencias / Future perspectives for clinical autopsy in patients from critic and urgent care units

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Paleoenvironmental conditions in the Spanish Miocene-Pliocene boundary: isotopic analyses of Hipparion dental enamel.

Expansion of C(4) grasses during Late Miocene and Early Pliocene constitutes one of the most remarkable biotic events of the Cenozoic era. The Teruel-Alfambra region (northeastern Spain) contains one of the most complete Miocene-Pliocene sequences of mammalian fossil sites in the world. In this study, stable isotope (delta (13)C and delta (18)O) analyses have been performed on the tooth enamel from the equid Hipparion from 19 localities spanning a time interval from approximately 10.9 to 2.7 Ma. This time range starts with the first appearance of this genus in Spain and ends at its extinction. An increase in delta (13)C at about 4.2 Ma has been observed, indicative of a shift toward a more open habitat. This shift may be related to a large scale vegetation change which occurred across the Miocene-Pliocene boundary when C(4) grasses expanded. This expansion might in turn be linked to global tectonic events such as the uplift of the Himalaya and/or the closure of the Panama Isthmus. However, other more regional factors may have ultimately enhanced the trend toward more open habitats in the Western Mediterranean Basin. The Messinian Salinity Crisis was a major environmental event that may have been responsible for the isotopic changes seen in the equid Hipparion from the Iberian Peninsula along with an increase in the aridity detected approximately 4.6 Ma ago in the Sahara. Even though the exact factor triggering the isotopic change observed in the Hipparion enamel remains mostly unknown, this study demonstrates that the global environmental changes detected across the Miocene-Pliocene boundary are also recorded in the realm of the Iberian Peninsula.

[Value of autopsy in a neonatal intensive care unit]. / Valor de la autopsia en una unidad de cuidados intensivos neonatológicos.

OBJECTIVES: 1) To identify the profile of the cases requested for autopsy; 2) to analyze the clinocopathological discordance; 3) to investigate predictive factors for unsuspected clinically relevant diagnoses. PATIENTS AND METHOD: All autopsies performed between January 1999 and December 2005 in a tertiary neonatal intensive care unit, were retrospectively reviewed. Clinicopathological concordance was assessed independently by two neonatologists and two pathologists, according to a modification of the Goldman classification. A comparison was made between newborns who had an autopsy performed and those who did not and predictive factors for unsuspected findings were investigated. RESULTS: During the study period, there were 309 deaths, and autopsies were performed in 128 (41.4 %) of these cases. Autopsies were more common in newborns who had gestational age > 36 weeks (p < 0.001), birthweight > 1500 g (p < 0.001) and congenital defects (p < 0.007). However, the probability that the autopsy was granted decreased with increasing death age (p < 0.016). Unsuspected diagnoses were observed in 49.2 % of the autopsies, being a major finding in 21.1 % of the cases. A clinicopathological discordance involving the prognosis was found in four cases (3.1 %). Relevant unsuspected findings could not be predicted from the ante-mortem clinical diagnosis, gestational age, birthweight, sex, and death age. CONCLUSION: The autopsy remains the "gold standard" method to reveal major and unsuspected diagnoses and there is no substitute for it. Postmortem examination should be requested systematically in every neonatal death. However, several factors such as gestational age, birthweight, presence of congenital defects and death age, influence the likelihood of autopsy being granted.

Valor de la autopsia en una unidad de cuidados intensivos neonatológicos / Value of autopsy in a neonatal intensive care unit

Objetivos: Conocer el perfil de los casos sometidos a autopsia, analizar la discrepancia clinicopatológica e investigar los factores predictivos de un rendimiento alto. Pacientes y método: Se estudiaron retrospectivamente todas las autopsias practicadas en una unidad de cuidados intensivos neonatológicos de tercer nivel entre enero de 1999 y diciembre de 2005. De manera independiente, dos patólogos y dos neonatólogos establecieron la concordancia clinicopatológica según la clasificación de Goldman modificada. Se compararon los neonatos sometidos a autopsia con los que no lo fueron, y se investigaron los factores predictivos de hallazgos insospechados. Resultados: Se practicaron 128 autopsias (41,4 %) en 309 fallecimientos ocurridos durante el período de estudio. Las necropsias se realizaron con más frecuencia en los recién nacidos mayores de 36 semanas de edad gestacional (p < 0,001), peso superior a 1.500 g (p < 0,001) y con malformación (p < 0,007). Sin embargo, la probabilidad de que se concediera la autopsia decreció cuanto mayor era la edad del paciente fallecido (p < 0,016). Se observaron diagnósticos insospechados en el 49,2 % de las necropsias, siendo relevantes en el 21,1 %. En 4 casos (3,1 %) existió una discrepancia clinicopatológica con implicaciones en el pronóstico. No fue posible predecir los hallazgos insospechados relevantes en función del diagnóstico clínico ante mortem, la edad gestacional, el peso al nacer, el sexo y la edad en el momento del fallecimiento. Conclusión: La autopsia continúa siendo el método de referencia e insustituible para demostrar diagnósticos insospechados y relevantes. La necropsia debe solicitarse de manera sistemática ante toda muerte neonatal. Sin embargo, factores como la edad gestacional, el peso de nacimiento, la presencia de malformaciones y la edad de fallecimiento influyen en la probabilidad de ser concedida

Objectives: 1) To identify the profile of the cases requested for autopsy; 2) to analyze the clinocopathological discordance; 3) to investigate predictive factors for unsuspected clinically relevant diagnoses. Patients and method: All autopsies performed between January 1999 and December 2005 in a tertiary neonatal intensive care unit, were retrospectively reviewed. Clinicopathological concordance was assessed independently by two neonatologists and two pathologists, according to a modification of the Goldman classification. A comparison was made between newborns who had an autopsy performed and those who did not and predictive factors for unsuspected findings were investigated. Results: During the study period, there were 309 deaths, and autopsies were performed in 128 (41.4 %) of these cases. Autopsies were more common in newborns who had gestational age > 36 weeks (p < 0.001), birthweight > 1500 g (p < 0.001) and congenital defects (p < 0.007). However, the probability that the autopsy was granted decreased with increasing death age (p < 0.016). Unsuspected diagnoses were observed in 49.2 % of the autopsies, being a major finding in 21.1 % of the cases. A clinicopathological discordance involving the prognosis was found in four cases (3.1 %). Relevant unsuspected findings could not be predicted from the ante-mortem clinical diagnosis, gestational age, birthweight, sex, and death age. Conclusion: The autopsy remains the "gold standard" method to reveal major and unsuspected diagnoses and there is no substitute for it. Postmortem examination should be requested systematically in every neonatal death. However, several factors such as gestational age, birthweight, presence of congenital defects and death age, influence the likelihood of autopsy being granted

Patología de la mama en niños y adolescentes / Breast disease in children and adolescents

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