Subungual Melanoma: A Descriptive Study of 34 Patients. / Melanoma subungueal: estudio descriptivo de 34 pacientes.

INTRODUCTION AND OBJECTIVES: Subungual melanoma constitutes a diagnostic challenge because it often has an atypical clinical presentation. The aims of this study were to revise the clinical and pathologic characteristics of patients with subungual melanoma diagnosed at a tertiary care university hospital and analyze the factors potentially associated with a delayed diagnosis. MATERIAL AND METHODS: We analyzed data for 34 patients diagnosed with subungual melanoma at our hospital over a period of 20 years. RESULTS: The study population comprised 18 women and 16 men with a median age at diagnosis of 66 years. Only 5 of the patients had longitudinal melanonychia when examined at the dermatology department. At the time of diagnosis, 19 of the 34 patients had invasive melanoma (median Breslow thickness, 3.70mm); 16 had ulceration and 8 had regional lymph node involvement. Five patients had subungual melanoma in situ at diagnosis. The median time from appearance of the lesions to consultation at a primary care center was 15 months; the corresponding time from primary care consultation to diagnosis at our hospital was 5.5 months. Lesions located on the toes were more likely to be ulcerated (P=.017) and to be accompanied by regional lymph node involvement at diagnosis (P=.012). CONCLUSIONS: The factors associated with a longer diagnostic delay in patients with subungual melanoma were absence of melanonychia as a presenting feature and involvement of the toes.

[Cross-Cultural Adaptaton and Validation of the Attitudes Towards Men in Nursing Scale (ATMINS)]. / Adaptación y validación de un cuestionario para medir las actitudes y percepciones hacia los hombres enfermeros.

Introduction: Aiming at detecting possible causes for the lack of male nursing professionals, Bartfay et al. developed a questionnaire named Attitudes Towards Men in Nursing Scale (ATMINS), which they tested a university in Ontario, Canada. Objective: Achieve a cross-cultural adaptation and validation of the Attitudes Towards Men in Nursing Scale (ATMINS), in order to evaluate if results achieved using a Spanish sample are comparable with the Canadian study's results. Participantsm, Materials, and Method: Participants were recruited in universities of Alicante and Donostia (Basque Country). To assure voluntary participation in the study, all candidates were informed about the objective of the study and giving enough time to read the questionnaire. The questionnaire used was the Attitudes Toward Men in Nursing Scale (ATMINS), translated to Spanish. The Spanish version of the ARMINS scale was handed over to a total of 142 students from the Nursing Universities of Alicante and Donostia. Time needed to fill the questionnaires didn't exceed 5 minutes in any case, and no difficulty was observed during implementation. After testing the scale, an internal consistency analysis was performed using Cronbach's Alpha with correction by eliminating items. Validation of construct was done via Exploratory Factorial analysis with Varimax rotation. Results: The results show a reliability which does not reach a moderate degree. Eliminating item 6 in all subsamples, as well as the total sample suppressing any of the other 5 items, increases internal consistency. The exploratory factorial analysis supports a bi-factorial structure of the questionnaire with very high saturation on each factor and a negative charge inside factor 2 for item 6. The negative charge of item 6 keeps the saturation (0.717) after its inversion. By performing an internal consistency analysis taking only into account items of factor 1, the scale's consistency improves with results close to 0.70. Conclusion: The revised scale is a tool which enables easy and fast application. It is valid for the Spanish sample and provides an acceptable internal consistency. The results obtained in both universities in Spain and in Canada are comparable.

Behavioral Interventions for Preventing Sexually Transmitted Infections and Unintended Pregnancies: An Overview of Systematic Reviews. / Intervenciones conductuales para la prevención de infecciones de transmisión sexual y embarazo no deseado: revisión de revisiones sistemáticas.

BACKGROUND: Countless sex education programs have been implemented worldwide in recent decades, but epidemiological data show no improvement in rates of sexually transmitted infections or unintended pregnancies. OBJECTIVE: To summarize the evidence from higher-quality systematic reviews on the efficacy of behavioral interventions for the prevention of sexually transmitted infections and unintended pregnancies. METHODS: We conducted an overview of reviews by selecting systematic reviews that met minimum quality criteria in terms of the design of the studies reviewed. We compared the results obtained when the effects of interventions were assessed on the basis of objective criteria (biological data) to those obtained when outcomes were assessed on the basis of subjective criteria (self-reports). The results of Cochrane and non-Cochrane reviews were also compared. RESULTS: We identified 55 systematic reviews. No overall effect on the sexual behavior of program participants was observed in 72.5% of the reviews that used objective criteria and in 48.1% of the reviews based on subjective criteria. In the Cochrane reviews, no evidence of an overall effect was observed in 86% of reviews based on objective variables and in 70.5% of those based on subjective variables. CONCLUSIONS: There is no evidence that behavioral interventions modify rates of sexually transmitted infections (including human immunodeficiency virus infections) or unintended pregnancies, particularly when effects are assessed using objective, biological data. Primary prevention strategies for sexually transmitted infections and unintended pregnancies need to be re-evaluated.

Enfermedad de Paget extramamaria / Extramammary Paget's disease

La enfermedad de Paget extramamaria es un carcinoma epidérmico de diferenciación apocrina que se origina en la epidermis o secundario a la diseminación epidermotropa de neoplasias adyacentes o a distancia. Suele presentarse como una lesión eccematiforme, de límites bien definidos, en zonas ricas en glándulas apocrinas como axilas, zona genital y anal. Su pronóstico depende de 2 factores: la profundidad de la invasión del tumor primario y de la presencia o no de tumor asociado. Su sintomatología inespecífica y la lenta evolución de las lesiones a menudo provoca un retraso en el diagnóstico que conlleva un empeoramiento del pronóstico. El diagnóstico de enfermedad de Paget es histológico precisando en ocasiones un estudio inmunohistoquímico. La inmunohistoquímica permite orientar hacia la naturaleza primaria o secundaria de la enfermedad, pero precisará de un estudio de extensión (AU)

Extramammary Paget disease is an epidermal carcinoma with apocrine differentiation originating in the epidermis o secondary to epidermotropic dissemination from a near or distant neoplasm. It usually shows as an eczematiform lesion with well defined margins in areas rich in apocrine glands, such as the axilla, genital and anal areas. Prognosis is defined by two factors: depth of invasion of primary tumour and whether there is an associated tumour. Its non specific clinical signs and slow evolution of the lesions, often delay the diagnosis, which leads to a poor prognosis. The diagnosis of Paget's disease is histological, sometimes requiring an immunohistochemical study. This can orient towards the primary or secondary nature of the disease, but will still need an extension study (AU)

Enfermedad pulmonar y afectación ungueal / Lung disease and nail-bed involvement

El síndrome de las uñas amarillas es una entidad poco frecuente caracterizada por la tríada de uñas amarillas, afectación pleuropulmonar y linfedema primario. Su origen aún no está aclarado pero se sugiere una alteración del retorno linfático como causa de todas sus manifestaciones. Presentamos este caso por la importancia que puede tener diagnosticar este síndrome y descartar posibles procesos patológicos asociados (neoplasias, VIH, tuberculosis, enfermedad tiroidea, artritis reumatoide), ya que es fácil llegar al diagnóstico si se conocen los signos cardinales, sobre todo la típica afectación ungueal (uñas amarillas y detención del crecimiento ungueal). En el tratamiento de este síndrome se han propuesto muchas alternativas, incluido el itraconazol oral, la vitamina E o los suplementos de cinc, pero la baja prevalencia de la enfermedad y la posibilidad de curación espontánea hacen que sea difícil evaluar la verdadera eficacia de las diferentes medidas terapéuticas (AU)

Yellow nails syndrome is a rare disease characterised by a triad of, yellow nails, pleural and lung involvement and primary lymphoedema. Its origin still remains unclear, but lymphatic return disturbance has been suggested as the reason of all its signs. We present this case because of the importance of diagnosing this syndrome and to rule out other associated diseases (malignancies, HIV, tuberculosis, thyroid disease, rheumatoid arthritis) as the diagnosis of the disease is easy if cardinal signs are known, particularly the condition of the nails (yellow nails and halted nail growth). Many possibilities have been proposed on the treatment of this syndrome,including, oral itraconazole, oral vitamin E, and zinc supplements, but the low prevalence of the disease and the possibility of spontaneous healing makes it difficult to evaluate the real effectiveness of the different treatments (AU)

Registros de enfermería. ¿cuestión de tiempo?

La importancia de los registros de actividad como herramienta de gestión es indiscutible, pero suele suceder que su cumplimiento no refleja, a juicio de los profesionales, la actividad real que éstos desarrollan. La falta de tiempo, la inconcreción de los indicadores utilizados, la ausencia de indicadores específicos, entre otros, son algunos de los argumentos utilizados para justificar la deficiente calidad de los registros y su consecuente mala utilización como herramienta para la adecuada gestión de los recursos. Ante esta situación, desde la Dirección de Enfermería de AP del Área 17 se elabora consensuada un modelo de registro de actividades de enfermería en el que se recogen aquellos indicadores que los profesionales consideran necesarios para conocer su verdadera actividad (tiempo fuera de jornada laboral, altas y bajas en consultas de enfermería, causas de las bajas en programas, etc.).Durante 6 meses (de noviembre de 2000 a abril de 2001) se recogen los nuevos registros y se procede a su procesamiento y valoración. De los datos obtenidos se puede concluir que se registra poco y mal, una asignatura pendiente para las enfermeras que demuestra que no depende de la implantación de nuevos instrumentos, sino de la implicación de los profesionales en su cumplimentación. Por otra parte, si se tuviese que realizar una valoración objetiva de los datos, ésta sería la de que se trabaja poco y mal, lo que no coincide con la percepción, subjetiva, de los profesionales, lleva en sentido contrario. En cualquier caso, cabe destacar la inquietud mostrada por los profesionales para mejorar lo que sin duda resulta una herramienta imprescindible de la gestión, como son los registros de actividad, que deben conducir a plantear nuevas estrategias (AU)

Discrepancias y correlaciones en los resultado entre la inmunohistoquímica y la biología celular / Discrepancies and correlations between immunohisstochemical and molecular biological results

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Quantitative immunohistochemical analyses of the expression of E-cadherin, thrombomodulin, CD44H and CD44v6 in primary tumours of pharynx/larynx squamous cell carcinoma and their lymph node metastases.

The quantitative expression of E-cadherin, thrombomodulin, CD44H and CD44v6 in 32 specimens of primary tumours of pharynx/larynx squamous cell carcinoma and their lymph node metastases was studied by immunohistochemistry. With the aim of obtaining comparative and objective data, image acquisition conditions were kept unaltered for all the measurements and the immunostaining intensity was quantified by applying an image processing system. On the one hand, correlations were only observed between CD44H and CD44v6, both in primary tumours and metastases, and between E-cadherin and TM in metastases. On the other hand, statistical analyses of paired data did not show significant differences in the expression of these markers between the two tumour sites. In agreement with previous reports, E-cadherin expression was rather low or negative in primary tumours and metastases of the three poorly differentiated specimens we studied, as well as that of TM, but otherwise some of these samples showed intermediate immunostaining levels of CD44H/CD44v6. It may be concluded from the present study that the quantitative expression of these adhesion molecules in well established lymph node metastases of pharynx/larynx squamous cell carcinoma is essentially unaltered in relation to their primary sites.

[Report to nurses about a patient admission. A specific method of coordination]. / Informe de enfermería al ingreso (I.E.I.). Instrumento específico de interrelación.

The need to have an adequate and efficient continuity regarding each patient's treatment is not questioned at present; however, this need, in many situations, continues to be a pending subject for the health care system in general and for different professional associations in particular. Nursing is not exempt from this problem and in fact there already have been instances of coordination which attempt to alleviate this problem such as through the emission of documents like the Nurses' Report for the Medical Release Certificate which allows professionals at both levels of attention, primary care and specialized, to maintain a set level of communication and information among themselves. Nevertheless, there still are no known instances about the establishment of a Report to Nurses Upon Admission of a Patient to a Unit; thus, we can state that an efficient two-way communication circuit has not yet been completed. The Report to Nurses Upon Admission of a Patient to a Unit is designed to be the method through which Specialized Care nurses obtain information about a patient who is admitted to their unit directly from the professional who has been caring for this patient until that moment, in other words, the Primary Health Care Unit nurse. As part of a ten year-old project to coordinate different health sections, this Report of Nurses Upon Admission of a Patient to a Unit is described in this article. This project has been implemented in Health Area Number 17 in the Valencia Autonomous Region. It is one of the methods which have been used to coordinate the relationship among nurses in primary health care centers and specialized units.

The immunohistochemical diagnostic panel for epithelial mesothelioma: a reevaluation after heat-induced epitope retrieval.

The immunohistochemical diagnosis between epithelial mesothelioma and adenocarcinoma is currently based on the use of a panel of antibodies to adenocarcinoma-associated antigens and a few antibodies to mesothelial-associated antigens. Since the introduction of epitope retrieval methods, the sensitivity of many antibodies has been enhanced. Thus, a reevaluation of the mesothelioma/adenocarcinoma diagnostic panel becomes necessary. We studied 268 paraffin-embedded formalin-fixed tumor samples that included 57 epithelial mesotheliomas and 211 adenocarcinomas of various origins, comparing an extensive antibody panel with and without heat-induced epitope retrieval (HIER). Marked increase in the sensitivity of several antibodies, with no loss of specificity, was found when HIER was used. After statistical analysis, the antibodies to the epithelial glycoproteins carcinoembryonic antigen, BerEp4, and Bg8 emerged as the best discriminators between adenocarcinoma and epithelial mesothelioma within the entire panel. The mesothelium-associated antibodies, HBME-1, calretinin, and thrombomodulin were less sensitive and less specific than the former, although they were found to be useful on certain cases. Antibodies to cytokeratins and vimentin, although of minor diagnostic value in this context, may be helpful to evaluate the quality of antigen preservation. This study confirms the value of immunohistochemistry to accurately distinguish mesothelioma from adenocarcinoma when an antibody panel approach is used. The addition of heat-induced epitope retrieval methods increases the effectiveness of the procedure and is recommended for most of the antibody panel members.

Fine needle aspiration of breast masses. An analysis of 1,398 patients in a community hospital.

OBJECTIVE: To determine the diagnostic efficacy of breast fine needle aspiration (FNA) in the routine practice of a community hospital. STUDY DESIGN: The study group consisted of 1,398 consecutive FNA biopsies of the female breast performed at our institution during a five-year period; 450 (32%) had histologic follow-up. Both FNA and the histologic diagnosis were compared in order to establish the accuracy, efficiency and safety of the FNA breast technique. RESULTS: The sensitivity of the FNA procedure was 93.49% and specificity 95.73%, with a predictive value for a positive diagnosis of 93.49% and for a negative diagnosis, 95.73%. The overall diagnostic accuracy was 94.84%, and the sensitivity of cytologic diagnosis was 98.75%. The false negative and false positive rates were 2.5%, including 10 cases with suspicious diagnoses and only 1 false positive diagnosis (0.23%). The false positive and false negative cases were recorded as having no effect or a minimal effect on patient management, and no mastectomy was performed because of this FNA diagnosis. CONCLUSION: FNA breast biopsy is an efficient tool for diagnosis when performed by surgical pathologists with cytologic training but not exclusively dedicated to cytopathology.

Detection of p53 protein in oropharyngeal carcinoma. Prognostic implications.

OBJECTIVE: To demonstrate how the detection of p53 protein in formaldehyde-fixed, paraffin-embedded oropharyngeal carcinoma may be used as a factor in estimating prognosis. SETTING: University medical centers. DESIGN: Validation cohort. Formaldehyde-fixed, paraffin-embedded squamous cell carcinoma of the oropharynx tissues from 106 patients who underwent surgical therapy between 1975 and 1988 were immunostained by using M-7001 antibody (IgG class). RESULTS: Overexpression of p53 was observed in 46 tumors (43.4%). The detection of nuclear p53 was significantly associated with an increased risk of recurrence of oropharyngeal carcinoma (P = .05). Similar results were obtained when the presence or absence of p53 in the nuclei of the tumor cells was studied in relation to overall survival (P < .001). In a multivariate analysis stratified according to grade, pathological stage, and lymph node status, nuclear p53 status was an independent predictor of overall survival (P < .001). CONCLUSIONS: In patients with squamous cell carcinoma of the oropharynx, an accumulation of p53 in the tumor cell nuclei detected by immunohistochemical methods predicts a significantly increased risk of death, independent of tumor grade, stage, and lymph node status. The p53 overexpression appears to be a useful prognostic factor.

[Generalized lymphadenopathy with morphologic findings of multicentric angiofollicular ganglionic hyperplasia in a patient with AIDS]. / Linfadenopatía generalizada con hallazgos morfológicos de hiperplasia ganglionar angiofolicular multicéntrica en un paciente con síndrome de inmunodeficiencia adquirida.

We report a case of a 33-year-old man, intravenous drugs abuser, HIV-positive, with peripheral lymphadenopathy, hepato-splenomegaly and fever, in which a ganglionic biopsy showed a histology with morphologic features of multicentric Castleman's-like disease, and minute foci of Kaposi's sarcoma ganglion, without cutaneous lesions. Given the interrelationships between this morphology of angiofollicular lymph node hyperplasia, the development of Kaposi's Sarcoma, and the aggressive clinical course seen in our patient and those in the literature, the use of lymph node biopsy may be an important prognostic tool for the patients with the acquired immunodeficiency syndrome.

Secretory carcinoma of the breast. Report of a case with diagnosis by fine needle aspiration.

We report a case of secretory carcinoma of the breast in a 63-year-old woman studied by fine needle aspiration (FNA). The cytologic features included solid nests, cohesive sheets and isolated tumor cells with intracytoplasmic vacuolization and signet-ring-like forms. Although secretory carcinoma is an unusual breast tumor, especially in adults, the cellular morphology was distinctive on FNA. This could permit the preoperative diagnosis of secretory carcinoma and the planning of optimal surgical therapy prior to an intervention.

Portal hypertension in acute liver failure.

Twenty five patients with acute liver failure were measured for hepatic venous pressure gradient as an index of portal pressure during the course of a transjugular liver biopsy. Hepatic venous pressure gradient ranged from 4 to 24.5 mm Hg with a mean of 12.8 (5.3) mm Hg (normal values less than 5 mm Hg). All patients but one had increased portal pressure gradient. Portal hypertension correlated with the degree of architectural distortion of the liver, as suggested by a direct correlation between hepatic venous pressure gradient and the area of reticulin collapse, evaluated by means of a morphometric analysis on Sirius red stained liver slides (r = 0.43, p less than 0.05). Hepatic venous pressure gradient was significantly higher in patients with ascites (15.1 (5) mm Hg, n = 15) or renal failure (14.4 (5.3) mm Hg, n = 16) than in those without (9.3 (3.4) mm Hg and 10.1 (4) mm Hg, respectively; p less than 0.05). Portal hypertension was associated with systemic vasodilation and a hyperkinetic circulatory state, with decreased arterial pressure, and peripheral resistance and increased cardiac output.

[The association of hypernephroma and dysfunction of the pyeloureteral junction. Apropos of a case]. / Asociación de hipernefroma y disfunción de la unión pieloureteral. A propósito de un caso.

We report on a patient with a tumor coexisting with a congenital condition. The foregoing conditions are discussed separately and their clinical and radiological features are described and compared with the findings commonly reported elsewhere. Finally, the conclusions relative to this uncommon case and its atypical mode of presentation are put forward.

Goodpasture's syndrome in a patient receiving penicillamine and carbimazole.

A 51-year-old woman with advanced rheumatoid arthritis developed a Goodpasture's syndrome during treatment with penicillamine and carbimazole. Circulating antiglomerular basement membrane antibodies (anti-GBM) were present. Renal biopsy showed focal necrotizing glomerulonephritis with crescents, and HLA typing showed the presence of DR3 and DR4. The patient responded dramatically to pulse methylprednisolone and cyclophosphamide, with both clinical remission and disappearance of anti-GBM antibodies.

Steroid-responsive relapsing nephrotic syndrome associated with early diabetic glomerulopathy in a child.

A child developed steroid-responsive nephrotic syndrome at the age of 3 years. 6 years later, he developed insulin-dependent diabetes mellitus. At this time renal biopsy disclosed minimal-change disease. After multiple relapses requiring cyclophosphamide or repeated courses of steroid therapy, a second renal biopsy, 5 years after the first, revealed early diabetic changes with associated exudative lesions. The nephrotic syndrome remains responsive to steroids and cyclophosphamide, and the patient maintains an increased glomerular filtration rate and normal blood pressure 3.5 years afterwards. His HLA typing showed DR4 and DR7. Since DR4 and DR7 are associated with diabetes and minimal-change disease, respectively, we speculate that he could carry the genetic predisposition for the development of both diseases.