Larva migrans cutánea adquirida en Asturias / Cutaneous larva migrans acquired in Asturias, Spain

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Massive bilateral adrenal metastatic melanoma of occult origin: a case report.

BACKGROUND: Adrenal gland involvement by metastatic melanoma can be found in up to 50% of patients with ocular or cutaneous melanomas. Since these tumors are not hormone secreting, they usually present with locally advanced disease. CASE: We report on the presence of a bilateral massive metastatic adrenal melanoma in an 80-year-old, symptomatic woman with the initial clinical diagnosis of adrenal hemorrhage/carcinoma. Histological assessment of the bilateral adrenalectomy showed a massive malignant melanoma in the adrenal glands, consistent with metastasis. Following that diagnosis, thorough studies revealed no ocular, mucocutaneous or primary tumor. The presence of melanoma in both adrenal glands favors metastatic melanoma over a primary adrenal melanoma. CONCLUSION: What makes this case rare is the unusually great size of the symptomatic bilateral malignant melanoma adrenal metastasis of occult primary with wide hemorrhagic and necrotic areas, which was probably responsible for the patient's acute symptoms. The search for the primary tumor may be exigent, and it might not even be present at the time of diagnosis. Confirmation at autopsy is advisable, however this may not always be feasible.

The nipple-areola complex epidermis: a prospective systematic study in adult autopsies.

The prevalence of different types of clear cells and of the mite Demodex in the nipple-areola complex of adult autopsies of both sexes not suffering from breast cancer was studied in a total of 140 nipples. The epidermis of the nipple-areola complex shows squamous cells and 3 types of clear cells: Toker cells, pagetoid dyskeratosis cells, and signet ring-like cells. Toker cells were identified by standard light microscopy in 13 of 140 nipples (9.3%). Reactivity of these cells for CK7 was observed in 35 nipples (25%). They are derived from the lactiferous duct epithelium. Pagetoid dyskeratosis cells were identified in 56 of 140 nipples (40%). In 12 nipples, these cells were conspicuous (8.6%). It is suggested that the proliferation of these cells is induced by friction. Signet ring-like cells were identified in 71 nipples (50.7%). In 2 nipples, these cells were conspicuous (1.4%). They are a consequence of artefact related to formalin fixation. The prevalence of all these clear cells has no relationship with gender. Routine histopathological examination is usually enough to distinguish the characteristic features of the clear cells involving the nipple epidermis and permits differentiation of other entities with epidermal pale cells. Demodex mites were observed in 58 nipple-areola complexes (41.4%). They were more common in male nipple-areola complexes (P < 0.05). The prevalence of these mites was seen to remain steady along the years since the third decade. Demodex mites are common parasites of human nipple and are apparently of no pathologic significance.

Non-compaction of the ventricular myocardium: a cardiomyopathy in search of a pathoanatomical definition.

Ventricular non-compaction is a rare cardiomyopathy characterized by numerous, excessively prominent ventricular trabeculations and deep intertrabecular recesses communicating with the ventricular cavity. The lesion is postulated to result from an intrauterine developmental arrest that stops compaction of the myocardial fiber meshwork. This cardiomyopathy affects the left ventricle, with or without concomitant right ventricular involvement. The disease is now seen with increasing frequency and it is clinically diagnosed by imaging techniques such as echocardiography or cardiac magnetic resonance. Current diagnostic criteria are considered too sensitive, particularly in black individuals. Therefore, this condition has generated considerable controversy and demands a new definition. Non-compaction cardiomyopathy shows variability of hereditary patterns, genetic heterogeneity, diversity in associated phenotypes and a wide spectrum of clinical presentation and pathophysiological findings. Non-compaction can be simply a variant of normal maturation of the ventricular myocardium with only the most severe forms producing a distinct clinical-pathological entity. Ventricular non-compaction most probably is a secondary consequence of an underlying molecular derangement produced by a pathogenetic mutation. It is likely that surgical pathologists will find this entity more frequently due to involvement in transplantation teams.

[Calculation of coronary risk in primary care: which table is more suitable for our patients?]. / Cálculo del riesgo coronario en atención primaria: qué tabla es más adecuada para nuestros pacientes?

OBJECTIVE: To evaluate whether there are differences in the indications for starting lipid lowering treatment when using the different coronary risk tables. DESIGN: Cross-sectional observational study. SETTING: A Health Centre in Department 10, Valencia, Spain. PARTICIPANTS: Three-hundred and fifty-five individuals of both sexes, between 40 and 70 years with no cardiovascular events or lipid lowering treatment who participated in the Adult Health Program between January 1, 2003 and December 31, 2004, of which 192 were lost. MAIN MEASUREMENTS: The variables that are counted in the Framingham-Wilson (F) and REGICOR (R) tables were collected. The total coronary risk was calculated using each table and whether there were differences. It was then evaluated to see if there were differences in the indication for starting lipid lowering treatment according to the ATP-III guides. RESULTS: The risk groups obtained and the indication to treat were compared using contingency tables and the kappa (kappa) level of agreement. With table R, 34.9% of the patients fell into the risk category compared to table F (kappa=0.125). As regards treatment indication the kappa was 0.669. This result is similar when analysed for both sexes and smokers. For diabetics the difference between the risk tables is maximum (kappa=0.006), however the therapeutic action does not vary (kappa=1) since all are considered high risk. CONCLUSIONS: Table F overestimates coronary risk in our environment, which means starting lipid lowering treatment in 6.1% of patients more than with R in all groups except diabetics.

Cálculo del riesgo coronario en atención primaria: ¿qué tabla es más adecuada para nuestros pacientes? / Calculation of coronary risk in primary care: which table is more suitable for our patients?

Objetivo. Evaluar si hay diferencias en la indicación de iniciar tratamiento hipolipidemiante al utilizar 2 tablas de riesgo cardiovascular distintas. Diseño. Observacional, transversal. Emplazamiento. Un centro de salud del departamento 10 de Valencia. Participantes. Se incluyó a 355 individuos de ambos sexos entre 40 y 75 años sin eventos cardiovasculares ni tratamiento hipolipidemiante, que participaron en el Programa de Salud del Adulto entre el 1 de enero de 2003 y el 31 de diciembre de 2004, de los cuales se perdió a 192. Mediciones principales. Se recogieron las variables que computan en las tablas de Framingham-Wilson (F) y REGICOR (R). Se calculó el riesgo coronario total con una y otra y si había diferencias. Después se evaluó si había diferencias en la indicación de iniciar tratamiento hipolipidemiante según las guías del ATP-III. Resultados. Los grupos de riesgo obtenidos y la indicación de tratamiento se compararon mediante tablas de contingencia y la medida de acuerdo kappa (κ). Un 34,9% de los pacientes descendió de categoría de riesgo con R respecto a F (κ = 0,125). En cuanto a la indicación de tratamiento, el valor de kappa fue de 0,699. Este resultado es similar si se analiza por sexos y por fumadores. Para los diabéticos, la discordancia entre las tablas de riesgo es máxima (κ = 0,006); sin embargo, la actitud terapéutica no varía (κ = 1), ya que todos son considerados de alto riesgo. Conclusiones. La tabla de F sobreestima el riesgo coronario en nuestro medio, lo que lleva a iniciar tratamiento hipolipidemiante en un 6,1% de pacientes más que con R en todos los grupos excepto en los diabéticos

Objective. To evaluate whether there are differences in the indications for starting lipid lowering treatment when using the different coronary risk tables. Design. Cross-sectional observational study. Setting. A Health Centre in Department 10, Valencia, Spain. Participants. Three-hundred and fifty-five individuals of both sexes, between 40 and 70 years with no cardiovascular events or lipid lowering treatment who participated in the Adult Health Program between January 1, 2003 and December 31, 2004, of which 192 were lost. Main measurements. The variables that are counted in the Framingham-Wilson (F) and REGICOR (R) tables were collected. The total coronary risk was calculated using each table and whether there were differences. It was then evaluated to see if there were differences in the indication for starting lipid lowering treatment according to the ATP-III guides. Results: The risk groups obtained and the indication to treat were compared using contingency tables and the kappa (κ) level of agreement. With table R, 34.9% of the patients fell into the risk category compared to table F (κ=0.125). As regards treatment indication the kappa was 0.669. This result is similar when analysed for both sexes and smokers. For diabetics the difference between the risk tables is maximum (κ=0.006), however the therapeutic action does not vary (κ=1) since all are considered high risk. Conclusions. Table F overestimates coronary risk in our environment, which means starting lipid lowering treatment in 6.1% of patients more than with R in all groups except diabetics