Large-Scale Interlaboratory DI-FT-ICR MS Comparability Study Employing Various Systems.

Ultrahigh resolution mass spectrometry (UHR-MS) coupled with direct infusion (DI) electrospray ionization offers a fast solution for accurate untargeted profiling. Fourier transform ion cyclotron resonance (FT-ICR) mass spectrometers have been shown to produce a wealth of insights into complex chemical systems because they enable unambiguous molecular formula assignment even if the vast majority of signals is of unknown identity. Interlaboratory comparisons are required to apply this type of instrumentation in quality control (for food industry or pharmaceuticals), large-scale environmental studies, or clinical diagnostics. Extended comparisons employing different FT-ICR MS instruments with qualitative direct infusion analysis are scarce since the majority of detected compounds cannot be quantified. The extent to which observations can be reproduced by different laboratories remains unknown. We set up a preliminary study which encompassed a set of 17 laboratories around the globe, diverse in instrumental characteristics and applications, to analyze the same sets of extracts from commercially available standard human blood plasma and Standard Reference Material (SRM) for blood plasma (SRM1950), which were delivered at different dilutions or spiked with different concentrations of pesticides. The aim of this study was to assess the extent to which the outputs of differently tuned FT-ICR mass spectrometers, with different technical specifications, are comparable for setting the frames of a future DI-FT-ICR MS ring trial. We concluded that a cluster of five laboratories, with diverse instrumental characteristics, showed comparable and representative performance across all experiments, setting a reference to be used in a future ring trial on blood plasma.

Spatially Resolved Neuropeptide Characterization from Neuropathological Formalin-Fixed, Paraffin-Embedded Tissue Sections by a Combination of Imaging MALDI FT-ICR Mass Spectrometry Histochemistry and Liquid Extraction Surface Analysis-Trapped Ion Mobility Spectrometry-Tandem Mass Spectrometry.

To make the vast collections of well-documented human clinical samples archived in biobanks accessible for mass spectrometry imaging (MSI), recent developments have focused on the label-free top-down MS analysis of neuropeptides in sections of formalin-fixed, paraffin-embedded (FFPE) tissues. In analogy to immunohistochemistry (IHC), this variant of MSI has been designated MSHC (mass spectrometry histochemistry). Besides the detection and localization of neuropeptide and other biomolecular MS signals in these FFPE samples, there is great interest in their molecular identification and full characterization. We here used matrix assisted laser desorption ionization (MALDI) MSI employing ultrahigh-resolution FT-ICR MS on 2,5-dihydroxybenzoic acid (DHB) coated five-micron sections of human FFPE pituitary to demonstrate clear isotope patterns and elemental composition assignment of neuropeptides (with ∼1 ppm mass accuracy). Besides tandem MS fragmentation pattern analysis to deduce or confirm amino acid sequence information (Arg-vasopressin for the case presented here), there is a need for orthogonal primary structure characterization of the peptide-like MS signals of biomolecules desorbed directly off FFPE tissue sections. In the present work, we performed liquid extraction surface analysis (LESA) extractions on consecutive (uncoated) tissue slices. This enables the successful characterization by ion mobility MS of vasopressin present in FFPE material. Differences in sequence coverage are discussed on the basis of the mobility selected collision induced dissociation (CID), electron capture dissociation (ECD), and UV photodissociation (UVPD) MS/MS. Using Arg-vasopressin as model case (a peptide with a disulfide bridged ring structure), we illustrate the use of LESA in combination with a reduction agent for effective sequencing using mobility selected CID, ECD, and UVPD MS/MS.

Exploring structural signatures of the lanthipeptide prochlorosin 2.8 using tandem mass spectrometry and trapped ion mobility-mass spectrometry.

Lanthipeptides are a family of ribosomally synthesized and post-translationally modified peptides (RiPPs) characterized by intramolecular thioether cross-links formed between a dehydrated serine/threonine (dSer/dThr) and a cysteine residue. Prochlorosin 2.8 (Pcn2.8) is a class II lanthipeptide that exhibits a non-overlapping thioether ring pattern, for which no biological activity has been reported yet. The variant Pcn2.8[16RGD] has been shown to bind tightly to the αvß3 integrin receptor. In the present work, tandem mass spectrometry, using collision-induced dissociation (CID) and electron capture dissociation (ECD), and trapped ion mobility spectrometry-mass spectrometry (TIMS-MS) were used to investigate structural signatures for the non-overlapping thioether ring pattern of Pcn2.8. CID experiments on Pcn2.8 yielded bi and yj fragments between the thioether cross-links, evidencing the presence of a non-overlapping thioether ring pattern. ECD experiments of Pcn2.8 showed a significant increase of hydrogen migration events near the residues involved in the thioether rings with a more pronounced effect at the dehydrated residues as compared to the cysteine residues. The high-resolution mobility analysis, aided by site-directed mutagenesis ([P8A], [P11A], [P12A], [P8A/P11A], [P8A/P12A], [P11A/P12A], and [P8A/P11A/P12A] variants), demonstrated that Pcn2.8 adopts cis/trans-conformations at Pro8, Pro11, and Pro12 residues. These observations were complementary to recent NMR findings, for which only the Pro8 residue was evidenced to adopt cis/trans-orientations. This study highlights the analytical power of the TIMS-MS/MS workflow for the structural characterization of lanthipeptides and could be a useful tool in our understanding of the biologically important structural elements that drive the thioether cyclization process.

Physiologically Relevant Fluid-Induced Oscillatory Shear Stress Stimulation of Mesenchymal Stem Cells Enhances the Engineered Valve Matrix Phenotype.

Support of somatic growth is a fundamental requirement of tissue-engineered valves. However, efforts thus far have been unable to maintain this support long term. A key event that will determine the valve's long-term success is the extent to which healthy host tissue remodeling can occur on the valve soon after implantation. The construct's phenotypic-status plays a critical role in accelerating tissue remodeling and engineered valve integration with the host via chemotaxis. In the current study, human bone-marrow-derived mesenchymal stem cells were utilized to seed synthetic, biodegradable scaffolds for a period of 8 days in rotisserie culture. Subsequently, cell-seeded scaffolds were exposed to physiologically relevant oscillatory shear stresses (overall mean, time-averaged shear stress, ~7.9 dynes/cm2; overall mean, oscillatory shear index, ~0.18) for an additional 2 weeks. The constructs were found to exhibit relatively augmented endothelial cell expression (CD31; compared to static controls) but concomitantly served to restrict the level of the activated smooth muscle phenotype (α-SMA) and also produced very low stem cell secretion levels of fibronectin (p < 0.05 compared to static and rotisserie controls). These findings suggest that fluid-induced oscillatory shear stresses alone are important in regulating a healthy valve phenotype of the engineered tissue matrix. Moreover, as solid stresses could lead to increased α-SMA levels, they should be excluded from conditioning during the culture process owing to their associated potential risks with pathological tissue remodeling. In conclusion, engineered valve tissues derived from mesenchymal stem cells revealed both a relatively robust valvular phenotype after exposure to physiologically relevant scales of oscillatory shear stress and may thereby serve to accelerate healthy valve tissue remodeling in the host post-implantation.

Biochemical Basis of E. coli Topoisomerase I Relaxation Activity Reduction by Nonenzymatic Lysine Acetylation.

The relaxation activity of E. coli topoisomerase I is required for regulation of global and local DNA supercoiling. The in vivo topoisomerase I enzyme activity is sensitive to lysine acetylation⁻deacetylation and can affect DNA supercoiling and growth as a result. Nonenzymatic lysine acetylation by acetyl phosphate has been shown to reduce the relaxation activity of E. coli topoisomerase I. In this work, the biochemical consequence of topoisomerase I modification by acetyl phosphate with enzymatic assays was studied. Results showed that noncovalent binding to DNA and DNA cleavage by the enzyme were reduced as a result of the acetylation, with greater effect on DNA cleavage. Four lysine acetylation sites were identified using bottom-up proteomics: Lys13, Lys45, Lys346, and Lys488. The Lys13 residue modified by acetyl phosphate has not been reported previously as a lysine acetylation site for E. coli topoisomerase I. We discuss the potential biochemical consequence of lysine acetylation at this strictly conserved lysine and other lysine residues on the enzyme based on available genetic and structural information.

Publisher Correction: Novel detection of post-translational modifications in human monocyte-derived dendritic cells after chronic alcohol exposure: Role of inflammation regulator H4K12ac.

A correction to this article has been published and is linked from the HTML version of this paper. The error has not been fixed in the paper.

Novel detection of post-translational modifications in human monocyte-derived dendritic cells after chronic alcohol exposure: Role of inflammation regulator H4K12ac.

Previous reports on epigenetic mechanisms involved in alcohol abuse have focus on hepatic and neuronal regions, leaving the immune system and specifically monocyte-derived dendritic cells (MDDCs) understudied. Our lab has previously shown histone deacetylases are modulated in cells derived from alcohol users and after in vitro acute alcohol treatment of human MDDCs. In the current study, we developed a novel screening tool using matrix assisted laser desorption ionization-fourier transform-ion cyclotron resonance mass spectrometry (MALDI-FT-ICR MS) and single cell imaging flow cytometry to detect post-translational modifications (PTMs) in human MDDCs due to chronic alcohol exposure. Our results demonstrate, for the first time, in vitro chronic alcohol exposure of MDDCs modulates H3 and H4 and induces a significant increase in acetylation at H4K12 (H4K12ac). Moreover, the Tip60/HAT inhibitor, NU9056, was able to block EtOH-induced H4K12ac, enhancing the effect of EtOH on IL-15, RANTES, TGF-ß1, and TNF-α cytokines while restoring MCP-2 levels, suggesting that H4K12ac may be playing a major role during inflammation and may serve as an inflammation regulator or a cellular stress response mechanism under chronic alcohol conditions.

OH-Initiated Oxidation of m-Xylene on Black Carbon Aging.

Laboratory experiments are conducted to investigate aging of size-classified black carbon (BC) particles from OH-initiated oxidation of m-xylene. The variations in the particle size, mass, effective density, morphology, optical properties, hygroscopicity, and activation as cloud condensation nuclei (CCN) are simultaneously measured by a suite of aerosol instruments, when BC particles are exposed to the oxidation products of the OH-m-xylene reactions. The BC aging is governed by the coating thickness (Δrve), which is correlated to the reaction time and initial concentrations of m-xylene and NOx. For an initial diameter of 100 nm and Δrve = 44 nm, the particle size and mass increase by a factor of 1.5 and 10.4, respectively, and the effective density increases from 0.43 to 1.45 g cm(-3) due to organic coating and collapsing of the BC core. The BC particles are fully converted from a highly fractal to nearly spherical morphology for Δrve = 30 nm. The scattering, absorption, and single scattering albedo of BC particles are enhanced accordingly with organic coating. The critical supersaturation for CCN activation is reduced to 0.1% with Δrve = 44 nm. The results imply that the oxidation of m-xylene exhibits larger impacts in modifying the BC particle properties than those for the OH-initiated oxidation of isoprene and toluene.

Hygroscopic Characteristics of Alkylaminium Carboxylate Aerosols.

The hygroscopic growth factor (HGF) and cloud condensation nuclei (CCN) activity for a series of alkylaminium carboxylate aerosols have been measured using a hygroscopicity tandem differential mobility analyzer coupled to a condensation particle counter and a CCN counter. The particles, consisting of the mixtures of mono- (acetic, propanoic, p-toluic, and cis-pinonic acid) and dicarboxylic (oxalic, succinic, malic, adipic, and azelaic acid) acid with alkylamine (mono-, di-, and trimethylamines), represent those commonly found under diverse environmental conditions. The hygroscopicity parameter (κ) of the alkylaminium carboxylate aerosols was derived from the HGF and CCN results and theoretically calculated. The HGF at 90% RH is in the range of 1.3 to 1.8 for alkylaminium monocarboxylates and 1.1 to 2.2 for alkylaminium dicarboxylates, dependent on the molecular functionality (i.e., the carboxylic or OH functional group in organic acids and methyl substitution in alkylamines). The κ value for all alkylaminium carboxylates is in the range of 0.06-1.37 derived from the HGF measurements at 90% RH, 0.05-0.49 derived from the CCN measurements, and 0.22-0.66 theoretically calculated. The measured hygroscopicity of the alkylaminium carboxylates increases with decreasing acid to base ratio. The deliquescence point is apparent for several of the alkylaminium dicarboxylates but not for the alkylaminium monocarboxylates. Our results reveal that alkylaminium carboxylate aerosols exhibit distinct hygroscopic and deliquescent characteristics that are dependent on their molecular functionality, hence regulating their impacts on human health, air quality, and direct and indirect radiative forcing on climate.

Volatility of atmospherically relevant alkylaminium carboxylate salts.

Heterogeneous neutralization reactions of ammonia and alkylamines with sulfuric acid play an important role in aerosol formation and particle growth. However, little is known about the physical and chemical properties of alkylaminium salts of organic acids. In this work we studied the thermal stability and volatility of alkylaminium carboxylate salts of short aliphatic alkylamines with monocarboxylic and dicarboxylic acids. The enthalpy of vaporization and saturation vapor pressure at 298 K were derived using the kinetic model of evaporation and the Clausius-Clapeyron relation. The vapor pressure of alkylaminium dicarboxylate salts is ∼10(-6) Pa, and the vaporization enthalpy ranges from 73 to 134 kJ mol(-1). Alkylaminium monocarboxylate salts show high thermal stability, and their thermograms do not follow our evaporation model. Hence, we inferred their vapor pressure from their thermograms as comparable to that of ammonium sulfate (∼10(-9) Pa). Further characterization showed that alkylaminium monocarboxylates are room temperature protic ionic liquids (RTPILs) that are more hygroscopic than ammonium sulfate (AS). We suggest that the irregular thermograms result from an incomplete neutralization reaction leading to a mixture of ionic and nonionic compounds. We conclude that these salts are expected to contribute to new particle formation and particle growth under ambient conditions and can significantly enhance the CCN activity of mixed particles in areas where SO2 emissions are regulated.

Acid-catalyzed reactions of epoxides for atmospheric nanoparticle growth.

Although new particle formation accounts for about 50% of the global aerosol production in the troposphere, the chemical species and mechanism responsible for the growth of freshly nucleated nanoparticles remain largely uncertain. Here we show large size growth when sulfuric acid nanoparticles of 4-20 nm are exposed to epoxide vapors, dependent on the particle size and relative humidity. Composition analysis of the nanoparticles after epoxide exposure reveals the presence of high molecular weight organosulfates and polymers, indicating the occurrence of acid-catalyzed reactions of epoxides. Our results suggest that epoxides play an important role in the growth of atmospheric newly nucleated nanoparticles, considering their large formation yields from photochemical oxidation of biogenic volatile organic compounds.

Cánceres mamarios de buen pronóstico: presentación de una serie de 80 casos / Breast cancers of good prognosis: presentation of a series of 80 cases

INTRODUCCIÓN. Se conoce que el tipo histológico del cáncer de mama influye fuertemente en el pronóstico de la enfermedad y que existe una correlación directa entre este y los índices de supervivencia. El objetivo de este estudio fue evaluar las variedades histopatológicas que están asociadas a un buen pronóstico de la enfermedad. MÉTODOS. Se realizó un estudio descriptivo, longitudinal y retrospectivo de la influencia de las variedades histológicas sobre el pronóstico del cáncer mamario en pacientes operadas entre enero de 1976 y diciembre de 2007. De un total de 597 cánceres de mama atendidos en ese período, fueron tomados 80 casos con tipos histológicos de buen pronóstico. RESULTADOS. Se encontraron 23 cánceres de mama no invasivos, todos con un índice de supervivencia elevado. Se presentaron 14 carcinomas mucinosos con un 57 por ciento de metástasis ganglionar, que se evidenció en los tumores con más de 4 cm de diámetro. Se registraron 10 casos de carcinomas tubulares y cribiformes (1,8 por ciento), con un pronóstico excelente. Se estudiaron 16 carcinomas papilares invasores, donde a pesar del gran tamaño no se encontraron ganglios metastáticos en las 168 adenopatías analizadas. Fueron evaluados 17 carcinomas medulares mamarios, para una incidencia del 2,85 por ciento y un pronóstico relativamente favorable. CONCLUSIONES. Todas estas variedades histopatológicas, exceptuando las no invasivas, tuvieron caracteres invasores comunes, márgenes bien delimitados y un excelente pronóstico luego del tratamiento quirúrgico(AU)

INTRODUCTION. It is known that the histopathological type of breast cancer exerts a strong influence on the prognosis of the disease and that there exists a direct correlation between this and the survival rates. The objective of this study was to evaluate the histopathological varieties associated with a good prognosis of the disease. METHODS. A retrospective, longitudinal, and descriptive study on the influence of the histological varieties on the good prognosis of breast cancer in patients operated on at Dr. Mario Muñoz Monroy University Hospital of Colón, Matanzas Province, from January 1976 to December 2007, was conducted. Of a total of 597 breast cancers attended in that period, 80 cases with histological types of good prognosis were taken. RESULTS. We found 23 non-invasive breast cancers, all of them with an elevated survival rate. 14 mucinous carcinomas were detected with 57 percent of ganglionic metastasis, which was evidenced in the tumors over 4 cm of diameter. Ten cases of tubular and cribriform carcinomas (1.8 percent) with an excellent prognosis were reported. 16 invasive papillary carcinomas were studied. In spite of their great size, no metastatic ganglia were found in the 168 analyzed.adenopathies. 17 medullary breast carcinomas were evaluated for an incidence of 2.85 percent and a relatively favorable prognosis. CONCLUSIONS. All these histopathological varieties, excepting the non-invasive, had common invasive characters, well delimited margins and an excellent prognosis after the surgical treatment(AU)

Cánceres mamarios de buen pronóstico: presentación de una serie de 80 casos / Breast cancers of good prognosis: presentation of a series of 80 cases

Se conoce que el tipo histológico del cáncer de mama influye fuertemente en el pronóstico de la enfermedad y que existe una correlación directa entre este y los índices de supervivencia. El objetivo de este estudio fue evaluar las variedades histopatológicas que están asociadas a un buen pronóstico de la enfermedad. Se realizó un estudio descriptivo, longitudinal y retrospectivo de la influencia de las variedades histológicas sobre el pronóstico del cáncer mamario en pacientes operadas entre enero de 1976 y diciembre de 2007. De un total de 597 cánceres de mama atendidos en ese período, fueron tomados 80 casos con tipos histológicos de buen pronóstico. Se encontraron 23 cánceres de mama no invasivos, todos con un índice de supervivencia elevado. Se presentaron 14 carcinomas mucinosos con un 57 por ciento de metástasis ganglionar, que se evidenció en los tumores con más de 4 cm de diámetro. Se registraron 10 casos de carcinomas tubulares y cribiformes (1,8 por ciento), con un pronóstico excelente. Se estudiaron 16 carcinomas papilares invasores, donde a pesar del gran tamaño no se encontraron ganglios metastáticos en las 168 adenopatías analizadas. Fueron evaluados 17 carcinomas medulares mamarios, para una incidencia del 2,85 por ciento y un pronóstico relativamente favorable. Todas estas variedades histopatológicas, exceptuando las no invasivas, tuvieron caracteres invasores comunes, márgenes bien delimitados y un excelente pronóstico luego del tratamiento quirúrgico(AU)

It is known that the histopathological type of breast cancer exerts a strong influence on the prognosis of the disease and that there exists a direct correlation between this and the survival rates. The objective of this study was to evaluate the histopathological varieties associated with a good prognosis of the disease. A retrospective, longitudinal, and descriptive study on the influence of the histological varieties on the good prognosis of breast cancer in patients operated on at Dr Mario Muñoz Monroy University Hospital of Colón, Matanzas Province, from January 1976 to December 2007, was conducted. Of a total of 597 breast cancers attended in that period, 80 cases with histological types of good prognosis were taken. We found 23 non-invasive breast cancers, all of them with an elevated survival rate. 14 mucinous carcinomas were detected with 57 percent of ganglionic metastasis, which was evidenced in the tumors over 4 cm of diameter. Ten cases of tubular and cribriform carcinomas (1,8 percent) with an excellent prognosis were reported. 16 invasive papillary carcinomas were studied. In spite of their great size, no metastatic ganglia were found in the 168 analyzed.adenopathies. 17 medullary breast carcinomas were evaluated for an incidence of 2,85 percent and a relatively favorable prognosis. All these histopathological varieties, excepting the non-invasive, had common invasive characters, well delimited margins and an excellent prognosis after the surgical treatment(AU)

Impacto psicológico y social de la Mastectomía en pacientes operadas de cáncer de mama / Mastectomy's social and psychological impact in patients operated of mamma cancer

Las mamas son uno de los elementos más importantes de la belleza femenina, siendo las enfermedades que en ellas se desarrollan un factor de mucha preocupación para la mujer. La aparición de un cáncer de mama es un elemento de impacto sobre la calidad de vida de dichas pacientes, constituyendo un grave problema de salud aun en países desarrollados. Estudiamos la influencia que tuvo el diagnóstico de carcinoma mamario sobre la calidad de vida de las pacientes afectas. Realizamos un estudio longitudinal retrospectivo de 23 pacientes dispensarizadas por cáncer de mama en el área comunitaria del policlínico Dr. Carlos J. Finlay, en Colón, durante el período comprendido entre enero/2000 a diciembre/2005. A la muestra se le aplicó diferentes tests y encuestas para evaluar calidad de vida, datos demográficos, etc. El 65.3 por ciento de la muestra eran amas de casa, el 74 por ciento le atribuyen a la enfermedad algún rol causal de dificultades económicas. Al evaluar su capacidad de enfrentamiento a esta situación se encontró que el 60.9 por ciento lo hacía con algún nivel de dificultad, lo cual puede estar condicionado a que el 78.2 ciento quedó con alguna limitación funcional postcirugía. El tratamiento Quimioterápico causó el mayor por ciento de molestias en la vida de relación de las enfermas. En el 47.9 por ciento apareció algún grado de afectación psicológica, siendo las más frecuentes la depresión, la ansiedad y el desinterés por la sexualidad. El 43.5 por ciento de las familias se volvieron disfuncionales al diagnosticársele a un miembro de ellas un cáncer de mama, siendo afectadas la participación social y comunitaria. Es un reto para las ciencias médicas establecer una estrategia que eleve no sólo la cantidad, sino la calidad de vida de estas pacientes y puedan reinsertarse armónicamente en su medio social y familiar...(AU)

Mammas are one of the most important elements of women beauty, being diseases developed in them a factor of a high preoccupation for women. Apparition of a mamma cancer is an element of impact on the life quality of those patients, being a serious health problem even in developed countries. We studied the influence the diagnosis of mamma cancer had on the life quality of affected patients. We carried out a longitudinal, retrospective study of 23 patients attended for mamma cancer in the Communitarian Area of the policlinic Dr. Carlos J. Finlay, in Colon, during the period January 2000-December 2005. Different tests and inquiries were applied to evaluate the life quality, demographic data, etc. 65.3 percent of the sample were housewives; 74 percent of them attributed the disease some role in generating economic difficulties. When we evaluated their capacity of affronting this situation, we found that 60.9 porciento of them made it with some level of difficulty, which may be conditioned by the reason that the 78.2 percent of them presented some post-surgery functional limitations. Chemotherapeutic treatment caused the biggest percent of disturbances in the patients´ social life. 47.9 percent of them presented some level of psychological affectation, being depression, anxiety and disinterest in sexuality the most frequent of them. 43.5 percent of the families became dysfunctional when a mamma cancer was diagnosed to one of their members, being affected the communitarian and social participation. It is a challenge for the medical sciences to establish a strategy to raise not only the life quantity, but also the life quality of these patients, to harmonically reinsert them in their social and familiar environment...(AU)

Lesiones torácicas graves y el enfoque del control de daños / Severe thoracic lesions and the damage control approach

En los últimos años se han desarrollado nuevas estrategias para el tratamiento del trauma grave con lesiones exanguinantes o sin ellas, pero son estas últimas las que más requieren un cambio de la forma de actuar en aras de mejorar la supervivencia. Tales estrategias quirúrgicas se han denominado cirugía de control de daños, que en esencia evita complicaciones como la tríada letal de acidosis, hipotermia y coagulopatía. A diferencia del control de daños en el abdomen, existen lesiones torácicas que requieren una reparación inicial durante el acto quirúrgico, pero pueden hallarse otras cuya reparación puede ser secundaria. El método de control de daños en las lesiones torácicas debe llevarse a cabo con procedimientos que sean técnicamente rápidos y simples, para postergar el tratamiento definitivo de las lesiones que no requieran una reparación inmediata en pacientes in extremis(AU)

New strategies have been developed in the last years to treat severe trauma with exsanguinating lesions or without them. The latter demand more changes in the way of acting in order to improve survival. Such surgical strategies have been called damage control surgery that in essence prevent complications such as the lethal triad of acidosis, hypothermia and coagulopathy. Unlike the control of abdomen damage, there are thoracic lesions requiring an initial repair during surgery, but there may be found others, whose repair is secondary. The damage control method in the thoracic lesions should be conducted with technically fast and simple procedures to postpone the definitive treatment of the lesions that do not require an immediate repair in patients in extremis(AU)

Lesiones torácicas graves y el enfoque del control de daños / Severe thoracic lesions and the damage control approach

En los últimos años se han desarrollado nuevas estrategias para el tratamiento del trauma grave con lesiones exanguinantes o sin ellas, pero son estas últimas las que más requieren un cambio de la forma de actuar en aras de mejorar la supervivencia. Tales estrategias quirúrgicas se han denominado cirugía de control de daños, que en esencia evita complicaciones como la tríada letal de acidosis, hipotermia y coagulopatía. A diferencia del control de daños en el abdomen, existen lesiones torácicas que requieren una reparación inicial durante el acto quirúrgico, pero pueden hallarse otras cuya reparación puede ser secundaria. El método de control de daños en las lesiones torácicas debe llevarse a cabo con procedimientos que sean técnicamente rápidos y simples, para postergar el tratamiento definitivo de las lesiones que no requieran una reparación inmediata en pacientes in extremis(AU)

New strategies have been developed in the last years to treat severe trauma with exsanguinating lesions or without them. The latter demand more changes in the way of acting in order to improve survival. Such surgical strategies have been called damage control surgery that in essence prevent complications such as the lethal triad of acidosis, hypothermia and coagulopathy. Unlike the control of abdomen damage, there are thoracic lesions requiring an initial repair during surgery, but there may be found others, whose repair is secondary. The damage control method in the thoracic lesions should be conducted with technically fast and simple procedures to postpone the definitive treatment of the lesions that do not require an immediate repair in patients in extremis(AU)

Un nuevo diagnóstico en la cirugía de la glándula mamaria: Ganglio linfático centinela en el cáncer de mama / A new diagnosis of the mammary gland: sentinel lymphatic ganglia in mammary cancer

A lo largo de la historia, el tratamiento quirúrgico del cáncer mamario ha comprendido la exéresis del tumor mamario complementado con uno de los mayores pilares que es la exéresis completa de los ganglios linfáticos de la axila, comúnmente denominada Disección Radical Axilar (DRA). La tendencia actual respecto a la resección del tumor ha tenido una inclinación conservadora que ha ido desde la cuadrantectomía hasta incluso simples tumorectomías, en casos específicos. En cuanto a la axila está ocurriendo lo mismo, existen corrientes de realizar linfadenectomías cada vez más selectivas y conservadoras, entrando en juego la Biopsia del Ganglio Centinela como eslabón fundamental que determina si es necesaria o no la disección ganglionar axilar, en los casos en que está indicado. En la presente revisión se realiza un estudio de los orígenes, particularidades técnicas, indicaciones, contraindicaciones, resultados, etc., de la Biopsia del Ganglio Centinela con el objetivo de brindar una actualización del estado del arte referente al tema...(AU)

Throughout the history, mammary cancer surgical treatment has included the extraction of the mammary tumor complemented with one of the biggest pillars, i.e., the complete extraction of the axillar lymphatic ganglia, commonly named Radical Axillar Dissection. The current tendency with respect to the tumor resection has had a conservative inclination going from quadrantectomy to even simple tumorectomies, in some specific cases. As for the axilla, the same process is taking place; there are many forms of making limphadenectomies more and more selective and conservative, being used the Sentinel Ganglia Biopsy as main stage to determine if it is necessary or not to make the axillar ganglia dissection, in cases it is indicated. In this review we carried out an study of the origins, technical particularities, indications, counterindications, results, etc. of the Sentinel Ganglia Biopsy, with the objective of giving an actualization of the art status of the theme...(AU)

Lesiones papilares de la mama. Presentación de una serie y revisión del tema / Papillary lesions of the mamma. Presentation of a series and review on the theme

Las lesiones papilares de la mama representan un grupo heterogéneo de tumores que crecen en el interior de los conductos galactóforos y que varían desde lesiones benignas como los Papilomas Ductales Benignos hasta entidades malignas. Se realizó un estudio retrospectivo, de corte transversal, sobre las lesiones papilares de la mama, en el Servicio de Cirugía General del Hospital Universitario Dr. Mario Muñoz Monroy del municipio de Colón, provincia de Matanzas, en el período comprendido entre enero de 1980 y diciembre de 2005 (26 años), encontrando 36 lesiones papilares mamarias, identificando en ellas a 18 casos con Papilomas Intracanaliculares Benignos de la Mama, 4 Carcinomas Ductales In Situ Papilares y 14 Carcinomas Papilares Invasivos. Encontramos que los Papilomas Intracanaliculares Benignos de la mama tuvieron una incidencia del 0.56 por ciento entre toda la patología quirúrgica de la mama, teniendo las neoplasias papilares malignas una incidencia del 3.3 por ciento entre las neoplasias malignas mamarias operadas (18/530). La edad promedio de aparición de los Papilomas Intracanaliculares fue de 49 años, mientras que en las lesiones papilares malignas fue de 55 años. El 100 por ciento de los Papilomas Intracanaliculares se presentaron por una Telorragia, mientras que las lesiones malignas papilares la gran mayoría se manifestó por una tumoración palpable. Con relación al tratamiento para las afecciones benignas es suficiente la resección en bloque que comprende el conducto afectado, para las lesiones malignas las modalidades van desde la cirugía preservadora de la mama hasta la Mastectomía Radical Modificada de Mérola-Patey...(AU)

The papillary lesions of the mamma are a group of heterogeneous tumors growing inside lactiferous ducts, varying from benign lesions as the benign ductal papillomas, to malign entities. We made a transversal, retrospective study on the papillary lesions of the mamma in the General Surgery Service of the University Hospital Dr Mario Muñoz Monroy, of the municipality of Colon, in the province of Matanzas, during the period from January 1980 to December 2005 (26 years), finding 36 papillary lesions of the mamma; 18 of them were identified as benign intracanal papillomas, 4 as in situ papillary ductal carcinomas and 14 as invasive papillary carcinomas. We found that benign intracanal papillomas of the mamma had an incidence of 0.56 per cent of all the mamma's surgical pathologies, having malign papillary neoplasias an incidence of 3.3 por ciento among the operated mammary malign neoplasias (188/530). The average age when intracanal papillomas appear was 49 years old, while malign papillary lesions appear at the age of 55. 100 per cent of the intracanal papillomas began by a hemorrhagic secretion through the nipple (telorragia), while most of the malign papillary lesions were discovered as a palpable tumor. In relation with the treatment, a block resection including the affected conduct is enough for the benign affections; for the malign lesions, the modalities cover from a surgery preserving the mamma to a Merola- Patey's Modified Radical Mastectomy...(AU)

La Tríada de la Muerte: acidosis, hipotermia y coagulopatías en pacientes con traumas / The Death Triad: acidosis, hypothermia and coagulopathies in traumatized patients

Las consecuencias fisiopatológicas y terapéuticas de los pacientes con trauma y con shock hemorrágico grave son causas de la alta mortalidad que muchas veces se escapan de nuestro control. Son la acidosis, la hipotermia y la coagulopatía las complicaciones que irremediablemente llevan a la muerte a los pacientes cuando no son previstas o prevenidas adecuadamente, y nos obligan a postergar el tratamiento quirúrgico definitivo con el objetivo de lograr una mayor supervivencia, mediante pasos consecutivos y ordenados basados en la tolerancia fisiológica del paciente, elemento este que hasta hace alrededor de una década no se tenía en cuenta en la reanimación del paciente con trauma grave. Estas estrategias han sido denominadas "cirugía de control de daños". En este trabajo nos propusimos realizar una revisión de las causas, consecuencias y tratamiento de los componentes de la tríada mortal para un mejor manejo del paciente traumatizado grave...

La Tríada de la Muerte: acidosis, hipotermia y coagulopatías en pacientes con traumas / The Death Triad: acidosis, hypothermia and coagulopathies in traumatized patients

Las consecuencias fisiopatológicas y terapéuticas de los pacientes con trauma y con shock hemorrágico grave son causas de la alta mortalidad que muchas veces se escapan de nuestro control. Son la acidosis, la hipotermia y la coagulopatía las complicaciones que irremediablemente llevan a la muerte a los pacientes cuando no son previstas o prevenidas adecuadamente, y nos obligan a postergar el tratamiento quirúrgico definitivo con el objetivo de lograr una mayor supervivencia, mediante pasos consecutivos y ordenados basados en la tolerancia fisiológica del paciente, elemento este que hasta hace alrededor de una década no se tenía en cuenta en la reanimación del paciente con trauma grave. Estas estrategias han sido denominadas "cirugía de control de daños". En este trabajo nos propusimos realizar una revisión de las causas, consecuencias y tratamiento de los componentes de la tríada mortal para un mejor manejo del paciente traumatizado grave...(AU)