A logistic regression model predicting high axillary tumour burden in early breast cancer patients.

PURPOSE: As elective axillary dissection is loosing ground for early breast cancer (BC) patients both in terms of prognostic and therapeutic power, there is a growing interest in predicting patients with (nodal) high tumour burden (HTB), especially after a positive sentinel node biopsy (SNB) because they would really benefit from further axillary intervention either by complete lymph-node dissection or axillary radiation therapy. METHODS/PATIENTS: Based on an analysis of 1254 BC patients in whom complete axillary clearance was performed, we devised a logistic regression (LR) model to predict those with HTB, as defined by the presence of three or more involved nodes with macrometastasis. This was accomplished through prior selection of every variable associated with HTB at univariate analysis. RESULTS: Only those variables shown as significant at the multivariate analysis were finally considered, namely tumour size, lymphovascular invasion and histological grade. A probability table was then built to calculate the chances of HTB from a cross-correlation of those three variables. As a suggestion, if we were to follow the rationale previously used in the micrometastasis trials, a threshold of about 10% risk of HTB could be considered under which no further axillary treatment is warranted. CONCLUSIONS: Our LR model with its probability table can be used to define a subgroup of early BC patients suitable for axillary conservative procedures, either sparing completion lymph-node dissection or even SNB altogether.

Role of axillary ultrasound, magnetic resonance imaging, and ultrasound-guided fine-needle aspiration biopsy in the preoperative triage of breast cancer patients.

PURPOSE: Roughly two-thirds of early breast cancer cases are associated with negative axillary nodes and do not benefit from axillary surgery at all. Accordingly, there is an ongoing search for non-surgical staging procedures to avoid lymph-node dissection or sentinel node biopsy (SNB). Non-invasive imaging techniques with very high sensitivity (Se) and negative predictive value (NPV) could eventually replace SNB. We aimed to establish the role of axillary US and MRI, alone or in combination, associated with ultrasound-guided fine-needle aspiration biopsy (US-FNAB) in the prediction of axillary node involvement. METHODS/PATIENTS: Between January 2003 and September 2015, we included 1505 of the 1538 breast cancer patients attending our centres. All patients had been referred from a single geographical area. Axillary US, magnetic resonance imaging and ultrasound-guided fine-needle aspiration biopsy (US-FNAB) were performed if required. RESULTS: 1533 axillary US examinations and 1351 axillary MRI studies were analyzed. For axillary US, Se, Specificity (Sp), Positive Predictive Value (PPV), and NPV were 47.5, 93.6, 82.5, and 73.8%, respectively. For axillary MRI, corresponding values were 29.8, 96.6, 84.9, and 68.4%. When both tests were combined, Sp and PPV slightly improved over individual tests alone. US-FNAB showed a 100% Sp and PPV, with a Se of 80%. CONCLUSION: We may confidently state that axillary US and US-FNAB have to be included in the preoperative work-up of breast cancer patients.

Efeito de solo previamente cultivado com plantas aromáticas na germinação e no desenvolvimento inicial de alface / Outcomes of soil previously treated with aromatic plants in the germination and early growth of lettuce

RESUMOO objetivo desse trabalho foi verificar o efeito do solo pré-cultivado com plantas aromáticas na germinação e no desenvolvimento inicial de plântulas de alface cv. Simpson. A pesquisa foi realizada na Embrapa Hortaliças, Brasília, em bandejas mantidas em casa de vegetação. O experimento foi conduzido em delineamento experimental inteiramente casualizado, com três repetições e onze tratamentos: solo pré-cultivado com hortelã-comum (Mentha x villosa), hortelã-brava (Mentha arvensis), hortelã-pimenta (Mentha piperita), Mentha spp., capim-citronela (Cymbopogon winterianus), capim-limão (Cymbopogon citratus), manjericão de folha larga (Ocimum basilicum), manjericão de folha roxa (Ocimum gratissimun), tomilho (Thymus vulgaris), sálvia (Salvia officinalis) e solo da mesma área sem cultivo prévio de planta aromática (controle). Aos 30 dias após o semeio, foram avaliadas: índice de velocidade de emergência (IVE), taxa de sobrevivência (TS), número de folhas (NF), comprimento da raiz principal (CRP) e da parte aérea (CPA), massa fresca da raiz (MFR) e da parte aérea (MFPA) e massa seca da raiz (MSR) e da parte aérea (MSPA). Os dados foram submetidos à análise de variância e teste de Tukey a 5% de probabilidade. Houve diferença significativa em relação ao IVE, sendo que o tratamento com C. citratus afetou negativamente a emergência das plântulas. O tratamento com M. arvensis apresentou uma TS de apenas 16% das plantas aos 30 dias após a semeadura. O NF foi menor no tratamento com M. arvensis, diferentemente de todos os demais, exceto S. officinalis. A MRF e MFF foram estimuladas pelo tratamento com T. vulgaris sendo superior a todos os outros tratamentos. Os resultados obtidos permitem concluir que houve efeito negativo de M. arvensis e positivo de T. vulgaris no desenvolvimento inicial de plântulas de alface.

ABSTRACTThis study aimed to verify the outcomesof the soil previously treated with aromatic plants in the germination and early seedling growth of lettuce var. Simpson under greenhouse conditions. The trial was developed at Embrapa Vegetables, in Brasília, Brazil in a completely randomized design with three replications and composed by eleven treatments as follow: soil cultivated with apple-mint (Mentha x villosa), wild mint (Mentha arvensis), peppermint (Mentha piperita), Mentha spp., citronella (Cymbopogon winterianus), lemon grass (Cymbopogoncitratus), basil (Ocimum basilicum), african basil (Ocimum gratissimun), thyme (Thymus vulgaris), sage (Salvia officinalis) and soil from the same area without prior cultivation of aromatic plant (control). The emergence velocity index (IVE), the survival rate (SR), the number of leaves (NL), the length of the main root (CRP) and the shoot (CPA), the fresh mass of the root (MFR) and the shoot (MFPA) and the dry mass of the root (MSR) and the shoot (MSPA), were evaluated 30 days after the sowing. The data were submitted to analysis of variance and Tukey's test at 5% probability. There was a significant difference regarding the IVE, in which the treatment with C.citratus negatively affected seedlingappearance. The treatment with M. arvensis showeda TS of only 16%at 30 days after the sowing. The NF was lower in the treatment with M. arvensis, differently from all the others, excepting the cultivation withS. officinalis. The MFR and the MFPA were stimulated by the treatment with T. vulgaris, which was higher than all the other cultivations. The obtained results showed that M. arvensis had a negative influence,while T.vulgaris presented a positive outcome in the early development of lettuce seedlings.

[Cardiac perforation as a late complication in a man with an implantable cardioverter-defibrillator]. / Perforación cardiaca como complicación tardía en paciente portador de un Desfibrilador Automático Implantable.

A 55-year-old man with an implantable cardioverter-defibrillator (ICD) placed after diagnosis of Brugada syndrome 4 years earlier was admitted to hospital with dyspnea and a large left pleural effusion. After several episodes of cardiorespiratory arrest and application of advanced cardiac life support measures, an emergency sternotomy was performed. Cardiac and pleural perforation by the ICD lead was observed and the device was removed. Since the ICD was introduced in 1980, it has been effective in the treatment of malignant ventricular arrhythmias and in reducing the incidence of sudden death. Increased use, however, has meant a rise in the number of complications, some of which are potentially fatal. The rare complication we describe should therefore be considered whenever a patient with an ICD develops sudden respiratory failure or massive hemoptysis that cannot be explained by other causes.

[Conservative management of the airway following iatrogenic tracheal rupture]. / Tratamiento conservador en el manejo de la vía aérea tras rotura traqueal iatrogénica.

The trachea of a 39-year-old man ruptured following intubation for fiberoptic bronchoscopy; the complication became evident during surgery as extensive subcutaneous emphysema developed. The emphysema resolved with conservative treatment. Tracheobronchial lesions are generally caused by direct trauma to the chest. Tracheal rupture due to intubation maneuvers is one of the complications anesthetists fear most. Although infrequent, such lesions are potentially fatal. Signs and symptoms can vary widely, from self-limiting asymptomatic subcutaneous emphysema immediately following surgery to severe complications such as tension pneumothorax, acute respiratory failure, pneumomediastinum, or even pneumopericardium. The absence of complications in patients treated conservatively has increased interest in using this approach to management when conditions are favorable, always with fiberoptic assessment to evaluate whether the lesion has resolved completely and without sequelae.

Utilidad de la resonancia magnética en el diagnóstico y seguimiento del síndrome de embolismo graso cerebral / Utility of magnetic resonance imaging in the diagnosis and follow-up of cerebral fat embolism syndrome

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Third-generation cephalosporin resistance in Shigella sonnei, Argentina.

Shigella sonnei resistant to cefotaxime (but not to ceftazidime) was isolated for the first time in stool samples from a pediatric patient with vomiting and bloody diarrhea in northern Argentina. Microbiologic and biochemical tests confirmed the presence of an extended spectrum beta-lactamase displaying an apparent isoelectric point value of 8.2.

[Anatomic and morphological studies on the initiation of somatic embryos obtained from meristematic apexes of Musa sp. / Estudios anatomicos y morfologicos de la iniciacion de embriones somaticos obtenidos a partir de apices meristematicos de Musa sp.

The origin of somatic embryos obtained from meristematic apexes of the Musa (AAA) clone "Gran enano" was analyzed through histological and morphological studies during the various development phases of the process. The research point out that somatic embryos developed directly from perivascular parenchyma cells of the leaves. Histological sections of globular embryos showed a radial disposition to cell and the existence of an epidermal layer that surrounds the embryo completely. When citocinine (Z or BA) was added, some embryos remained in globular stage with mild signs of enlargement but with no later development of invagination. Other's embryos reached the invagination stage; and some reached the enlargement stage with active photosynthetic tissues. However there were no to generation of complete plant regardless of additional treatment, such as "osmotic shock" or the additions of GA3--At present do not have an explanations for this results. Therefore, additional experiment should be in early, intermediate and later stages of somatic embryogenesis, in order to understand the mechanisms underlying the lack of development of plants from somatics embryos.

Characterization of F3II, a sarcomatoid mammary carcinoma cell line originated from a clonal subpopulation of a mouse adenocarcinoma.

We characterized a new mammary tumor cell line, F3II, previously established in vitro from a clonal subpopulation of the BALB/c transplantable mammary adenocarcinoma M3, moderately metastatic to lung. The F3II cell line has been passaged > 50 times. It has grown as elongated cells adherent to the bottom of the flask. Cytogenetic studies showed that F3II cultures were nearly triploid. Tumor cells expressed fibronectin and showed high levels of cell-surface urokinase, a key protease in invasion and metastasis. F3II cells grew as poorly differentiated, spindle-cell carcinoma tumors (sarcomatoid carcinomas) with a prominent local invasiveness, a high angiogenic response, and a 90-100% incidence of lung metastases when inoculated s.c. into syngeneic mice. Ultrastructural and immunocytochemical analysis revealed characteristic features of carcinomas. Our data suggest that F3II is less differentiated and more aggressive than the original tumor line, supporting the notion that mammary carcinomas are heterogeneous neoplasms and contain subpopulations with diverse biologic behavior. The F3II mouse mammary sarcomatoid carcinoma line is a suitable model to examine antiinvasive, antiangiogenic, and antimetastatic agents.

Effect of host-organ environment on the in vivo and in vitro behavior of a murine mammary adenocarcinoma.

We investigated the role that organ environment may play in determining the homing of disseminated cells from a murine mammary adenocarcinoma moderately metastatic to lung (M3). Conditioned medium (CM) from normal lung was able to enhance both local and metastatic growth. It increased the number of lung colonies when inoculated together with tumor cells via intravenous or separately via intraperitoneal route. Several in vitro studies were performed in order to elucidate possible mechanisms. It was shown that lung CM stimulated the in vitro growth and the migration of M3 cells. Normal kidney and liver CM lacked all these capacities.

Altered calcium-binding ability of plasma proteins as the cause of hypocalcemia in lepromatous leprosy.

This paper reports a study performed on 10 lepromatous leprosy outpatients and on the same number of age- and sex-matched contacts. All of the lepromatous patients were hypocalcemic, but plasma levels of ionized calcium and the acid-base status were normal. The average daily food intake assessed through a questionnaire revealed adequate nutrition of patients and controls. Plasma proteins and 1,25-dihydroxyvitamin D3 and intestinal absorption of calcium were discarded as the causes of the hypocalcemia. In vitro experiments designed to investigate the effect of hydrogen ion concentration on the equilibrium between calcium ion and proteins revealed that, at normal pH values, plasma proteins from lepromatous leprosy patients bind a smaller fraction of total plasma calcium than those from controls. This phenomenon produces a normal concentration of ionized calcium that determines a normal parathyroid status as indicated by the normal urinary excretion of hydroxyproline and plasma concentrations of alkaline phosphatase (total and bone isoenzyme) and tartrate-resistant acid phosphatase.

In vivo selection and characterization of a murine mammary tumor subline with high potential for spontaneous lymph node metastasis.

A transplantable mammary adenocarcinoma, grown in Balb/c mice, with a marked enhancement in its draining lymph node metastatic ability (MM3LN), was obtained through an in vivo procedure from a variant tumor moderately metastatic to lymph nodes (MM3). Both MM3 and MM3LN presented a similar latency and tumor growth rate and reached the same tumor mean diameter at death. MM3LN tumor-bearing mice exhibited a larger mean survival time. The new variant showed a 2.5-fold higher incidence of tumor-draining lymph node metastases than MM3 line, with no differences in the incidence of lung metastases. Morphology as well as cytogenetic and in vitro adhesion properties were studied in order to characterize the new subline. This murine tumor model has potential application in the study of the metastatic process in lymphoid tissue.

Characterization of a new murine tumor variant with different in vivo behavior selected by its adhesive properties.

The purpose of the study was to determine whether the selection by adhesion to fibronectin (FN) also selects for cells with different tumorigenic and metastatic abilities. M3 murine mammary adenocarcinoma cells with moderate metastatic potential were seeded on FN-coated plastic substrates. Non-adherent cells were removed at 30 min, and the adherent ones were expanded in monolayer culture. Selected tumor cells were then harvested and inoculated sc into syngeneic mice. The selection procedure was repeated three times. After the third cycle, tumors were further maintained by sc trocar transplantation, and the variant obtained was called M3Ad. Although the in vitro selection was adhesion to FN substrate, the in vitro adhesion behavior of the variant M3Ad was identical to that of the parental tumor M3. However, the cytogenetic profile and the in vivo behavior indicated that M3Ad differed from M3. The distribution of the chromosome number of M3Ad cells revealed a lower mode and mean than of M3 cells. Moreover, the M3Ad variant exhibited a shorter latency, a higher growth rate and a lower incidence of spontaneous lung metastases. However, it produced significantly more and larger lung colonies than M3 after iv injection.

Respiratory alkalosis and reduced plasmatic concentration of ionized calcium in rats treated with 1,25 dihydroxycholecalciferol.

The daily administration of supraphysiological doses of 1,25 dihydroxycholecalciferol (0.1-2.5 micrograms/d/100 g body weight) to rats, produced respiratory alkalosis. With the doses of 0.1-0.2 micrograms/d/100 g and feeding a diet with 0.7% of calcium, calcemias did not exceed 2.75 mM, and significantly reduced plasma ionized calcium levels were measured. The latter phenomenon was found associated with increased urinary excretion of cAMP, soft tissue calcium content, and polyuria with hypostenuria, all known effects of parathyroid hormone. These effects were absent in thyroparathyroidectomized rats treated in the same fashion. Present results suggest that the stimulus of low levels of plasma ionized calcium overcomes the probably inhibitory effect of the steroid on parathyroid hormone secretion.