Analysis of invasive diagnostic techniques for pathological confirmation of pleural mesothelioma.

BACKGROUND AND OBJECTIVES: Mesothelioma is an infrequent neoplasm with a poor prognosis that is related to exposure to asbestos and whose peak incidence in Europe is estimated from 2020. Its diagnosis is complex; imaging techniques and the performance of invasive pleural techniques being essential for pathological confirmation. The different diagnostic yields of these invasive techniques are collected in the medical literature. The present work consisted of reviewing how the definitive diagnosis of mesothelioma cases in our centre was reached to check if there was concordance with the data in the bibliography. MATERIALS AND METHODS: Retrospective review of patients with a diagnosis of pleural mesothelioma in the period 2019-2021, analysing demographic data and exposure to asbestos, the semiology of the radiological findings and the invasive techniques performed to reach the diagnosis. RESULTS: Twenty-six mesothelioma cases were reviewed. 22 men and 4 women. Median age 74 years. 9 patients had a history of asbestos exposure. Moderate-severe pleural effusion was the most frequent radiological finding (23/26). The sensitivity of the invasive techniques was as follows: Cytology 13%, biopsy without image guidance 11%, image-guided biopsy 93%, surgical biopsy 67%. CONCLUSIONS: In our review, pleural biopsy performed with image guidance was the test that had the highest diagnostic yield, so it should be considered as the initial invasive test for the study of mesothelioma.

Hematoma epidural secundario a catéter epidural para analgesia en un paciente politraumatizado / Epidural hematoma secondary to epidural catheter for analgesia in a polytraumatized patient

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[Relation between clinical symptoms and the results of a computerized dynamic posturography]. / Asociación entre síntomas clínicos y resultados de la posturografía computarizada dinámica.

The computerized dynamic posturography (CDP) is a quantitative method for the evaluation of balance function under different conditions that simulates the ones found in normal life. Its applications are centered in the diagnosis and rehabilitation of balance dysfunction. We report a descriptive study on 96 patients with balance disorders who underwent a CDP, stablishing a relation between their main symptoms and the results in the test. A high percentage of patients with symptoms that suggested peripheral vestibular pathology did not present alterations at this level by means of the CDP. However a considerable number of patients who referred symptoms classically related to a non vestibular origin did show an alteration at this level.

Asociación entre síntomas clínicos y resultados de la posturografía computarizada dinámica / Relation between clinical symptoms and the results of a computerized dynamic posturography

La posturografía computarizada dinámica (PCD) es un método cuantitativo para la valoración de la función del equilibrio en diversas condiciones que simulan las encontradas en la vida diaria. Sus aplicaciones se centran en el diagnóstico y rehabilitación de los trastornos del equilibrio. Presentamos un estudio descriptivo sobre 96 pacientes con alteraciones del equilibrio a los que se les ha realizado una PCD relacionando su sintomatología principal con los resultados obtenidos en la prueba. Un alto porcentaje de pacientes con sintomatología sugestiva de patología vestibular periférica no presentaban alteraciones a este nivel evaluadas mediante la PCD. En cambio un número considerable de pacientes que referían clínica clásicamente relacionada con un origen no vestibular evidenciaban un trastorno vestibular en la PCD. (AU)

The computerized dynamic posturography (CDP) is a quantitative method for the evaluation of balance function under different conditions that simulates the ones found in normal life. Its applications are centered in the diagnosis and rehabilitation of balance dysfunction. We report a descriptive study on 96 patients with balance disorders who underwent a CDP, stablishing a relation between their main symptoms and the results in the test. A high percentage of patients with symptoms that suggested peripheral vestibular pathology did not present alterations at this level by means of the CDP. However a considerable number of patients who referred symptoms classically related to a non vestibular origin did show an alteration at this level (AU)

[Presentation of multiple oncocytic type laryngeal cysts. Clinical and histopathological findings]. / Presentación múltiple de quistes laríngeos de tipo oncocítico. Hallazgos clínicos e histopatológicos.

Oncocytic cysts are a histologically well-defined subgroup of cystic lesions of the larynx. Oncocytic cysts of the larynx are rare, clinically similar to simple laryngeal cysts, and occur as a casual finding of pathology studies. Multiple oncocytic cysts have rarely been described. Microscopic examination of laryngeal biopsies showed cysts within the lamina propria lined by oncocytic epithelium. The differential diagnosis and pathogenesis of oncocytic cysts is discussed and other laryngeal cystic lesions are reviewed.

Presentación múltiple de quistes laríngeos de tipo oncocítico. Hallazgos clínicos e histopatológicos / Presentation of multiple oncocytic type laryngeal cysts. Clinical and histopathological findings

Los quistes oncocíticos son un subgrupo patológico bien definido de lesiones quísticas de la laringe. Clínicamente similares al quiste laríngeo simple, los quistes oncocíticos laríngeos son un raro hallazgo histopatológico. La presentación múltiple de quistes oncocíticos ha sido raramente descrita. El examen microscópico de las biopsias laríngeas demuestra quistes en relación con la lámina propia, revestidos por un epitelio oncocítico. Discutimos el diagnóstico diferencial y la patogénesis de los quistes oncocíticos y revisamos otras lesiones quísticas laríngeas (AU)

Oncocytic cysts are a histologically well-defined subgroup of cystic lesions of the larynx. Oncocytic cysts of the larynx are rare, clinically similar to simple laryngeal cysts, and occur as a casual finding of pathology studies. Multiple oncocytic cysts have rarely been described. Microscopic examination of laryngeal biopsies showed cysts within the lamina propria lined by oncocytic epithelium. The differential diagnosis and pathogenesis of oncocytic cysts is discussed and other laryngeal cystic lesions are reviewed (AU)

Quantitative reverse transcriptase-polymerase chain reaction for prostate-specific antigen mRNA.

OBJECTIVE: To develop a quantitative reverse transcriptase-polymerase chain reaction assay for monitoring the prostate-specific antigen (PSA) mRNA. METHODS: PSA mRNA is amplified, in parallel, with the mRNA of beta-actin, a housekeeping gene. The ratio of the amplification products obtained reflects the relative amount of PSA mRNA with respect to actin mRNA. During PCR, digoxigenin-dUTP is incorporated in the amplified sequences. The PCR products are analyzed separately by time-resolved immunofluorometric hybridization assays, using specific probes immobilized in microtiter wells. The hybrids are reacted with alkaline phosphatase-labeled anti-digoxigenin antibody. The phosphate ester of fluorosalicylate is used as a substrate. The fluorosalicylate produced forms a fluorescent complex with Tb(3+)-EDTA which is measured by time-resolved fluorometry. RESULTS: The hybridization assays for both PSA and actin amplification products show linearity in the range of 1.4-110 pmol/L. The exponential phase of PCR amplification extends up to 200,000 and 100,000 PSA and actin cDNA molecules, respectively. We prepared mixtures containing various numbers of LNCaP cells in one million cells that do not express PSA and used them as samples in the proposed assay. The ratio of the fluorescence values obtained after analysis of PSA and actin amplification products is linearly related to the number of LNCaP cells in the range of 20 to 3000 cells. Reproducibility studies demonstrate %CVs for the fluorescence ratios of 14.7, 11.8, and 12.2 when samples containing 150, 300 and 1600 LNCaP cells were analyzed (n = 4). CONCLUSIONS: A quantitative analytical methodology is provided for monitoring PSA mRNA. The assay is expected to be beneficial in the study of prostate cancer spread.

Bioluminescence hybridization assays using recombinant aequorin. Application to the detection of prostate-specific antigen mRNA.

We developed microtiter well-based bioluminescence hybridization assays using the photoprotein aequorin as a reporter molecule. The target DNA was hybridized simultaneously with a capture probe and a detection probe. The capture probe was immobilized on the wells through digoxigenin/anti-digoxigenin interaction. The detection probe was biotinylated. The hybrids were determined by using aequorin covalently attached to streptavidin or complexes of biotinylated aequorin with streptavidin. The luminescence was then measured in the presence of excess Ca2+. The optimized protocols showed linearity in the range from 5 amol to 10 fmol of target DNA. In combination with reverse transcriptase polymerase chain reaction, the proposed assay was applied to the detection of the mRNA for prostate-specific antigen (PSA). PSA mRNA from a single cell, in the presence of one million cells that do not express PSA, was detected with a signal-to-background ratio of 2.5. Typical CVs obtained were 6%.

Fluorometric and time-resolved immunofluorometric assays for protein-tyrosine phosphatase activity.

OBJECTIVE: To develop sensitive nonisotopic assays for protein-tyrosine phosphatase (PTP) activity. METHODS: The fluorometric assay is based on the fact that phosphotyrosine but not tyrosine forms highly fluorescent complexes with Tb3+. Thus, PTP activity can be followed by measuring the decrease of fluorescence due to hydrolysis of phosphotyrosine. The time-resolved immunofluorometric assay employs tyrosine-phosphorylated substrates, immobilized on microtitre wells. After incubation with PTP, the remaining phosphotyrosine residues are reacted with an antiphosphotyrosine antibody. The immunocomplexes formed are detected with an alkaline phosphatase (ALP)-labeled second antibody. The phosphate ester of 5' fluorosalicylate (FSAP) is used as substrate. The fluorosalicylate produced forms highly fluorescent complexes with Tb3+ - EDTA in alkaline solution. The fluorescence is measured with a time-resolved fluorometer. RESULTS: The truncated form of the T-cell protein tyrosine phosphatase (TCdeltaC11 PTP) was determined in the range 1100-36,500 U/L by the fluorometric assay and 36-7100 U/L by the time-resolved immunofluorometric assay. CONCLUSIONS: The two nonisotopic assays should prove beneficial for the determination and study of various PTP.

Detection of prostate-specific antigen mRNA by reverse transcription polymerase chain reaction and time-resolved fluorometry.

We have developed a time-resolved fluorometric hybridization assay for detecting prostate-specific antigen (PSA) mRNA amplified by reverse transcription polymerase chain reaction. During PCR, digoxigenin-11-dUTP is incorporated into the amplified product. An oligonucleotide internal to the primers is used as a specific probe, being biotinylated and captured on streptavidin-coated microtiter wells. Denatured PCR product hybridizes with the probe, and the hybrids are detected with an alkaline phosphatase-labeled antidigoxigenin antibody. We used the phosphate ester of fluorosalicylic acid as the substrate. The fluorosalicylate produced forms a highly fluorescent ternary complex with Tb(3+)-EDTA, which we can measure by time-resolved fluorometry. A signal-to-background ratio of 10 was obtained when 160 PSA cDNA molecules were present in the preamplification sample. Also, mRNA corresponding to one LNCaP cell in the presence of 10(6) PSA-negative cells can be detected (signal-to-background ratio of 3.1). Samples containing 100, 1000, and 50,000 LNCaP cells gave CVs of 12.4%, 4.9%, and 6.8%, respectively (n = 10).

Using amnioinfusion for the relief of repetitive variable decelerations during labor.

Amnioinfusion is a method of replacing intrauterine amniotic fluid volume through intrauterine infusion of a saline solution using a pressure catheter. This method simply and effectively relieves variable decelerations not alleviated by the conventional measures of maternal position change and oxygen administration. The mechanisms underlying variable decelerations, the technique for amnioinfusion administration, and two case studies are reported. Nursing responsibilities regarding amnioinfusion include pattern recognition, assisting with or initiation of amnioinfusion, and maintenance and evaluation of this intervention.

Obstetric vacuum extraction.

A brief historical review of vacuum extraction, indications for use, safety considerations, mode of action, delivery technique, and discussion of nursing implications is presented. Safety and effectiveness of vacuum extraction are supported by the results of a comparative study done at Mount Sinai Medical Center in which 256 vacuum extractions and 300 randomly selected forceps deliveries were performed. Indications for use, clinical status before application, maternal complications, and immediate neonatal complications are analyzed and discussed.