Inter- and Intra-Operator Variability of Regularized Backscatter Quantitative Ultrasound for the Characterization of Breast Masses.

OBJECTIVES: Here we report on the intra- and inter-operator variability of the backscatter coefficient (BSC) estimated with a new low-variance quantitative ultrasound (QUS) approach applied to breast lesions in vivo. METHODS: Radiofrequency (RF) echo signals were acquired from 29 BIRADS 4 and 5 breast lesions in 2 sequential cohorts following 2 imaging protocols: cohort 1) radial and antiradial views, and cohort 2) short- and long-axis views. Protocol 2 was implemented after retraining and discussion on how to improve reproducibility. Each patient was scanned by at least 2 of 3 radiologists; each performed 3 acquisitions with transducer and patient repositioning in between acquisitions. BSC was estimated using a low-variance QUS approach based on regularization. Intra- and inter-operator variability of the intra-lesion median BSC was evaluated with a multifactorial ANOVA test (P-values) and the intraclass correlation coefficient (ICC). RESULTS: Inter-operator variability was only significant in the first protocol (P < .007); ICCinter = .77 (95% CI .71-.82), indicating good inter-operator agreement. In the second protocol, the inter-operator variability was not significant (P > .05) and agreement was excellent (ICCinter = .92 [.89-.94]). In both protocols, the intra-operator variability was not significant. CONCLUSIONS: Our findings demonstrate the need for standardizing image acquisition protocols for backscatter-based QUS to reduce inter-operator variability and ensure its successful translation to the characterization of suspicious breast masses.

An Uncommon Case of Bilateral Breast Enlargement Diagnosed as Tumoral Pseudoangiomatous Stromal Hyperplasia: Imaging and Pathological Findings.

The incidence of reported pseudoangiomatous stromal hyperplasia (PASH), as well as the variability and severity of clinical presentations, is increasing in the literature. In parallel, several authors posit the need for an improved classification of PASH to avoid possible variables associated with this diagnosis. Here, we present a 25-year-old woman with PASH accompanied by severe bilateral and symmetrical breasts enlargement, highlighting an uncommon clinical presentation of PASH as much as the careful interdisciplinary review and correlation of histology and all available imaging studies to confirm the definitive diagnosis.

Complementary role of magnetic resonance imaging in the study of the fetal urinary system.

Urinary system birth defects represent the abnormality most often detected in prenatal studies, accounting for 30% to 50% of all structural anomalies present at birth. The most common disorders are urinary tract dilation, developmental variants, cystic kidney diseases, kidney tumors, and bladder defects. These anomalies can present in isolation or in association with various syndromes. They are normally evaluated with sonography, and the use of magnetic resonance imaging (MRI) is considered only in inconclusive cases. In this article, we show the potential of fetal MRI as a technique to complement sonography in the study of fetal urinary system anomalies. We show the additional information that MRI can provide in each entity, especially in the evaluation of kidney function through diffusion-weighted sequences.

Preoperative cow-side lactatemia measurement predicts negative outcome in Holstein dairy cattle with right abomasal disorders.

The objectives of the current study were (1) to determine the gain in prognostic accuracy of preoperative l-lactate concentration (LAC) measured on farm on cows with right displaced abomasum (RDA) or abomasal volvulus (AV) for predicting negative outcome; and (2) to suggest clinically relevant thresholds for such use. A cohort of 102 cows with on-farm surgical diagnostic of RDA or AV was obtained from June 2009 through December 2011. Blood was drawn from coccygeal vessels before surgery and plasma LAC was immediately measured by using a portable clinical analyzer. Dairy producers were interviewed by phone 30 d following surgery and the outcome was determined: a positive outcome if the owner was satisfied of the overall evolution 30 d postoperatively, and a negative outcome if the cow was culled, died, or if the owner reported being unsatisfied 30 d postoperatively. The area under the curve of the receiver operating characteristic curve for LAC was 0.92 and was significantly greater than the area under the curve of the receiver operating characteristic curve of heart rate (HR; 0.77), indicating that LAC, in general, performed better than HR to predict a negative outcome. Furthermore, the ability to predict a negative outcome was significantly improved when LAC measurement was considered in addition to the already available HR data (area under the curve: 0.93 and 95% confidence interval: 0.87, 0.99). Important inflection points of the misclassification cost term function were noted at thresholds of 2 and 6 mmol/L, suggesting the potential utility of these cut-points. The 2 and 6 mmol/L thresholds had a sensitivity, specificity, positive predictive value, and negative predictive value for predicting a negative outcome of 76.2, 82.7, 53.3, and 93.1%, and of 28.6, 97.5, 75, and 84%, respectively. In terms of clinical interpretation, LAC ≤2 mmol/L appeared to be a good indicator of positive outcome and could be used to support a surgical treatment decision. The treatment decision for cows with LAC between 2 and 6 mmol/L, however, would depend on the economic context and the owner's attitude to risk in regard to potential return on its investment. Finally, performing a surgical correction on commercial cows with RDA or AV and a LAC ≥6 mmol/L appeared to be unjustified and these animals should be culled based on their high probability of negative outcome.

Depression, Anxiety and Somatic Complaints in Colombian Children Living in Rural Communities / Depresión, ansiedad y síntomas somáticos en niños que viven en comunidades rurales colombianas

Introduction: In Colombia, children are frequently exposed to traumatic events; however, there are no data regarding the impact on depression, anxiety and somatic correlates of such exposure in children living in rural communities. Objective: To investigate the somatic complaints and symptoms of depression and anxiety among children exposed to traumatic events in a rural community of Colombia. Methods: Design: Cross-Sectional study. Participants: Two hundred and ninety-three Colombian children aged eight to 18 years. Main Outcome Measures: Standardized measures were administered to assess children's depression, anxiety, physical symptoms and exposure to traumatic events. Depression: CDI (Children's Depression Inventory); anxiety: SCARED (The Screen for Child Anxiety Related Emotional Disorders); somatic complaints: CBCL (Child Behavior Checklist, Somatic Complaints scale) and reporting traumatic events during the K-SADS-PL (Diagnostic Interview for Children and Adolescents). Results: Ninety-one of the 293 children (31.1%) reported somatic complaints. The most common somatic complaint was in the gastrointestinal category (35/91). One hundred and seventy eight children (60.5%) had observed traumatic events, including homicides during the last month. Two hundred five (69.9%) of the children showed depressive symptom profiles above established norms, and 239 (81.6%) exhibited anxiety symptoms according to their own reports. The correlation between depression and traumatic events, anxiety and somatic complaints, and between anxiety and depression were statistically significant (p<0.005). Conclusions: As the first study of its kind in children living in rural communities in Colombia, it demonstrates a clear impact of traumatic events on mental health. Information that somatic complaints are commonly an expression of underlying depression and anxiety may facilitate the treatment and thereby help avoid unnecessary medical workups and sequelae from traumatized children. It is important for physicians to probe for "hidden" symptoms in traumatized children.

Introducción: En Colombia, los niños están expuestos con frecuencia a eventos traumáticos, sin embargo, no hay datos sobre el impacto de la depresión, la ansiedad y la correlación somática de dicha exposición en niños que viven en comunidades rurales. Objetivo: investigar las alteraciones somáticas, síntomas de depresión y ansiedad en los niños expuestos a eventos traumáticos en una comunidad rural de Colombia. Metodología: Diseño: Estudio transversal; Participantes: Doscientos noventa y tres niños colombianos de ocho a 18 años. Principales medidas de resultado: se aplicaron medidas estandarizadas para evaluar la depresión infantil, ansiedad, síntomas físicos y la exposición a eventos traumáticos. Depresión:CDI (Children's Depression Inventory)). Ansiedad: SCARED (The Screen for Child Anxiety Related Emotional Disorders), Enfermedades somáticas: CBCL (Child Behavior Checklist, Somatic Complaints scale) e informar los eventos traumáticos durante el K -SADS -PL (Diagnostic Interview for Children and Adolescents). Resultados: Noventa y uno de los 293 niños ( 31,1 % ) informaron de síntomas somáticos. La queja somática más común estuvo en la categoría gastrointestinal (35/ 91). Ciento setenta y ocho niños ( 60,5 % ) habían observado los acontecimientos traumáticos, incluyendo homicidios durante el último mes. Doscientos cinco ( 69,9 % ) de los niños mostraron perfiles de síntomas depresivos por encima de las normas establecidas, y 239 ( 81,6 % ) presentaban síntomas de ansiedad según sus propios informes. La correlación entre la depresión y los eventos traumáticos, la ansiedad y quejas somáticas, y entre la ansiedad y la depresión fueron estadísticamente significativas ( p < 0,005 ). Conclusiones: como el primer estudio de su tipo en los niños que viven en comunidades rurales de Colombia , demuestra un claro impacto de eventos traumáticos en la salud mental. La afirmación que las quejas somáticas son comúnmente una expresión de la depresión y la ansiedad subyacente puede facilitar el tratamiento y de ese modo ayudar a evitar abordajes médicos innecesarios y secuelas en los niños traumatizados . Es importante para los médicos explorar los síntomas "ocultos" en los niños traumatizados.

Oral lenalidomide with rituximab in relapsed or refractory diffuse large cell, follicular and transformed lymphoma: a phase II clinical trial.

Lenalidomide-rituximab therapy is effective in grade 1-2 follicular and mantle cell lymphoma, but its efficacy in diffuse large B-cell lymphoma (DLBCL), transformed large cell lymphoma (TL) and grade 3 follicular lymphoma (FLG3) is unknown. In this phase II trial, 45 patients with relapsed or refractory DLBCL (n=32), TL (n=9) or FLG3 (n=4) who had received 1-4 prior lines of treatment were given 20 mg oral lenalidomide on days 1-21 of each 28-day cycle, and intravenous rituximab (375 mg/m(2)) weekly during cycle 1. Grade 3/4 hematological toxicities included neutropenia (53%), lymphopenia (40%), thrombocytopenia (33%), leukopenia (27%) and anemia (18%), with a median follow-up time of 29.1 months (range 14.7-52.0 months). Overall response (OR) rate was 33%; median response duration was 10.2 months. Median progression-free survival (PFS) and overall survival (OS) were 3.7 and 10.7 months, respectively. Nine of the 15 responding patients (three partial response (PR), six complete response (CR)) proceeded with stem cell transplantation (SCT) and were censored at the time of transplantation. When data were analyzed without censoring, median PFS remained 3.7 months and response duration increased to 30.9 months. Rituximab plus oral lenalidomide is well tolerated and effective for patients with relapsed/refractory DLBCL and TL. SCT after lenalidomide-rituximab is associated with prolonged response duration.

Diagnóstico prenatal de teratomainmaduro intracraneal / Prenatal diagnosis of intracranial immature

Los tumores intracraneales fetales tienen una baja incidencia.La variedad anatomopatológica más frecuente la constituyeel teratoma. En la mayoría de los casos el pronósticoes malo ya que supera la línea media, suele presentar un rápidocrecimiento y la mayoría de los fetos mueren intraúteroo poco después de su nacimiento.Presentamos una gestante de 27 semanas que consultapor brusco aumento de la altura uterina y distensión abdominal.En la valoración ecográfica se aprecia una circunferenciacefálica muy aumentada a expensas de una masa heterogéneaque ocupa todo el cráneo, no visualizándose estructurascerebrales indemnes y que produce exoftalmos derecho. Dadoel mal pronóstico fetal, se induce el parto por interés maternoy finalmente éste se produce mediante cesárea de un fetomujer fallecido intraparto. El estudio anatomopatológico informade teratoma inmaduro intracraneal (AU)

Intracranial fetal tumors have a low incidence. Mostof the cases are teratomas in the histology. The prognosisis poor because they normally override the middle line ofthe brain, present a rapid growth and almost all the fetusesdie intrauterus or short after birth.We present a 27 weeks pregnant woman that cameto the emergency casualty because of a sudden increasedof the abdominal height. In the ultrasound we could seea very large cephalic circumference at expense of a heterogeneous mass that occupied all the fetal head and producedextrusion of the facial structures. There were notany recognizable anatomical parts of the normal fetalbrain remaining. In view of the fatal prognosis, the labourwas induced and terminated by a cesarean sectioneven after trying to reduce the head volume by intrapartumaspiration of the tumoral mass. The histology wasreported as immature teratoma (AU)

Influencia de la analgesia epidural en la saturación arterial fetal de oxígeno durante el período de dilatación / Influence of epidural analgesia on fetal oxygen saturation during labor

Objetivo: Valorar la influencia de la analgesia vía epidural en la saturación de oxígeno fetal (SpO2) intraparto y los patrones de frecuencia cardíaca fetal. Material y métodos: Se realizó un estudio prospectivo con 50 gestantes a las que, durante el período de dilatación, se les administró analgesia por vía epidural, y que fueron monitorizadas mediante cardiotocografía y pulsioximetría fetal a través de una sonda Nellcor FS-14®. Resultados: El valor de SpO2 preepidural fue del 48,5 ± 7,8%. Durante los primeros 15 min postepidural se obtuvo la cifra de 47,4 ± 9,7 (p = NS), y la significación estadística se alcanzó a partir de los 30min posteriores a su instauración. En un 76% de los casos aparecieron alteraciones del registro cardiotocográfico en los primeros 120 min tras la perfusión analgésica. Conclusiones: La disminución de la saturación arterial de oxígeno a partir de los 30 min postepidural puede estar relacionada con la administración de analgésicos por vía epidural (AU)

Objective: To evaluate the influence of maternalepidural analgesia on fetal oxygen saturation (SpO2) and fetal heart rate (FHR) patterns during labor. Material and methods: We performed a prospective study in 50 pregnant women. During labor, epidural analgesia was administered and the women were monitored by means of cardiotocography (CTG) and fetal pulse oximetry, using a Nellcor FS-14® sensor. Results: The mean SpO2 value before analgesia administration was 48.5 ± 7.8%. During the first 15 minutes after administration, this value was 47.4 ± 9.7 (p: NS). A statistically significant decrease in SpO2 was found 30 minutes after initiation of epidural analgesia in 76 % of the patients, alterations in the CTG appeared during the first 120 minutes after maternal epidural analgesia. Conclusions: The decrease in SpO2 30 minutes after administration of epidural analgesia could be influenced by the use of epidural analgesic drugs (AU)

La calidad de la atención de Enfermería a los pacientes de un Hospital Regional del ISSSTE, en México D. F: Un estudio basado en el grado de satisfacción de los usuarios / The quality of nursing care patients of a Regional Hospital ISSSTE in Mexico D. F: A study based on the degree of user satisfaction

El objeto de esta investigación es conocer cual es la calidad de la atención que proporciona Enfermería en el Hospital Regional 1º de Octubre del ISSSTE, en México, D.F con base en el grado de satisfacción de los usuarios. La variable medida fue la calidad de la atención. El tipo de investigación fue descriptivo, diagnóstico, analítico, transversal y observacional. La población estuvo constituida por 445 pacientes del Hospital Regional 1º de Octubre del ISSSTE, internados en los cuatro servicios básicos como son: Cirugía, Pediatría, Gineco - Obstetricia y Medicina Interna. La muestra total es de 198 pacientes. La investigación fue realizada en el año 1999. Se midió la variable Calidad de Atención de Enfermería con base en la teoría de Avedis Donabedian de clasificar las modalidades de: estructuras, proceso y resultados. De cada modalidad se establecieron indicadores. Se comprobó la hipótesis de trabajo que califica de alta calidad, la atención que Enfermería proporciona a los pacientes. Se disprueba la hipótesis nula al considerar que los usuarios se sienten satisfechos con la atención que Enfermería les proporciona y la calidad de atención que reciben.

This research aims to know what the attention quality delivered by Nursing in the Regional ISSSTE Hospital 1o. de Octubre in Mexico City is, based on the users satisfaction level. The measured variable was attention quality. The research type was descriptive, diagnostic, analytical, transversal, and observational. Population consisted of 445 patients from the Regional ISSSTE Hospital 1o. de Octubre, who were interned in the four basic services: Surgery, Pediatrics, Gyneco-Obstetrics, and Internal Medicine. The total sample had 198 patients. The research was carried out during 1999. Nursing attention quality variable was measured based on the Avedis Donabedian's theory, which classifies the structures, process, and result modalities. Indicators were set for each modality. The work hypothesis that qualifies the high quality of attention delivered by nursing to the patients was checked. The null hypothesis was proven off when considering that users feel satisfied with the attention nursing is providing then and with the attention quality they are receiving.

[Trophic range of tilapia Oreochromis aureus (Perciformes: Cichlidae) in Infiernillo dam, Michoacán-Guerrero, Mexico]. / Espectro trófico de la tilapia Oreochromis aureus (Perciformes: Cichlidae) en la presa Infiernillo, Michoacán-Guerrero, México.

The trophic spectrum of tilapia Oreochromis aureus (Steindachner 1864), was determined by stomach content analysis in 153 organisms collected during 1993 in Michoacán-Guerrero, México. The feeding status of the fish at the time of observation was evaluated by the examination of fat surrounding the gut, gastric replection and the condition coefficient. The quantitative evaluation of the food items was carried out by the combination of the following analysis: Frequency of Occurrence, Volumetric Method, Volumetric Mean Index and Relative Importance Index. Diet consisted of: detritus and vascular plant residues as a primary food; unicellular algae as secondary food; and remains of insects and fish, graminean seeds, filamentous algae, cladocerans, ostracods, rotifers and copepods as occasional food. We detected a difference in food preferences between juveniles and adults and a variation in the consumption proportions of some food items during the rainy and dry seasons. Thus, we concluded that O. aureus is an omnivorous species with preference for detritus and vascular plant remain. Feeding seems to be determined by the abundance of food items found in the habitat and adults showed a trend to eat only detritus. Feeding does not seem to be a limiting factor in the development of the tilapia in Infiernillo dam.