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The role of vitamin D in mammographic density is still unclear. This study examines the association between serum 25-hydroxyvitamin D (25(OH)D) and mammographic density, overall and by specific women characteristics. DDM-Madrid is a cross-sectional study that recruited 1403 premenopausal women in a breast radiodiagnosis unit of Madrid City Council. Information was collected with a questionnaire and plasma 25(OH)D was measured by solid-phase extraction on-line coupled to liquid chromatography–tandem mass spectrometry. Percent mammographic density was assessed using a semi-automated computer tool (DM-Scan). Multivariable linear regression models were used to quantify the associations, categorizing 25(OH)D levels (nmol/L) into 3 groups according to the cut-offs established by the US Endocrine Society. Models were adjusted for age, education, body mass index, age at menarche, parity, previous breast biopsies, family history of breast cancer, physical activity, energy intake, use of corticoids, hypercholesterolemia and day of sample extraction. Mean serum 25(OH)D level was 49.4 + 18.9 nmol/L. Women with sufficient concentrations of 25(OH)D showed a slight decrease in mammographic density (β >75nmol/L=-3.40; p = 0.037). No differences were observed according to women characteristics except for parity, where the protective effect of 25(OH)D was only seen among nulliparous (β >75nmol/L=-13.00; p-heterogeneity = 0.006). In light of the protective effect of vitamin D on mammographic density and the high prevalence of vitamin D insufficiency in our population, improving these levels could be an effective measure for the prevention of health problems related to the lack of this essential vitamin.

Xanthogranulomatous pyelonephritis (XPN) is an unusual and severe form of chronic inflammatory lesion of the kidney, characterised by the destruction of the renal parenchyma and the presence of multinucleated giant cells and lipid-laden macrophages, inflammatory infiltration and intensive renal fibrosis. There are a few cases in the literature which describe the disease in children. The pathomechanism of XPN is poorly understood. Renal obstruction with concomitant urinary tract infection is the most commonly associated pathological finding. The process is typically unilateral and may be focal or diffuse. In both cases, the perirenal infiltration is possible and can be mistaken for common renal neoplasm or inflammatory process. The symptoms are non-specific. Diagnostic imaging techniques with clinical suspicion have enabled XPN to be diagnosed and differentiated from malignancy with a high degree of confidence. Computed tomography (CT) is the mainstay of diagnostic imaging. The definitive diagnosis of XPN is based on pathological assessment after nephrectomy. We review and illustrate the clinical, radiological, surgical and pathological characteristics of XPN in children. All cases shown are surgically and histopathologically proven. • XPN can present different clinical manifestations. • CT is the mainstay of diagnostic imaging in XPN. • Focal type of XPN should be included in the differential diagnosis of children with a renal mass. • There are no clear guidelines on the management of XPN. • Conservative and surgical treatments should be considered for each individual case. • Histopathological examination confirms the diagnosis and excludes other benign and malign diseases.

OBJETIVO: Evaluar la asociación entre el nivel de conocimientos sobre cáncer cervical y Papanicolaou (Pap) con el miedo, estrés o vergüenza asociados a este tamizaje. DISEÑO: Estudio descriptivo transversal, prospectivo basado en comunidad. MATERIAL Y MÉTODOS: Usando muestreo aleatorio por conglomerados, se entrevistó mujeres de una comunidad pobre de Lima, evaluando su nivel de conocimientos sobre cáncer cervical y Papanicolaou y su percepción sobre este tamizaje. Se usó chi cuadrado, Odds ratios, intervalos de confianza al 95 % y regresión logística para evaluar la asociación en estudio. RESULTADOS: De 300 mujeres entre 18 y 50 años, 20% había tenido su último Pap hacía más de dos años y 20% nunca se lo había realizado; 57 (19%) mujeres refirieron tener mucho miedo, estrés o vergüenza al tamizaje, lo cual estuvo asociado a ser adolescente (OR 5,5, IC95% 1,8-16,9), tener cinco o menos años de vivir en Lima desde haber llgado del interior del país (OR 2,6, IC95% 1,3-5,2), no haber tenido pareja sexual durante el último año (OR 2,1, IC95% 1,1-7,6), no embarazos previos (OR 3,1, IC95% 1,2-8,0), no tener Pap previo (OR4,7, IC9S% 1,9-8,7) y el bajo o regular conocimiento sobre el Papanicolaou o el cáncer de cérvix (OR4,1, IC95% 2,2-7,9). Durante el análisis multivariado, persistieron asociados el ser adolescente y el bajo o regular nivel de conocimiento sobre el Pap y el cáncer de cérvix. CONCLUSIÓN: Se recomiende informar a la comunidad sobre la prueba de Pap y cáncer cervical para mejorar las actitudes negativas asociadas al tamizaje.

La hipotensión intraoperatoria es un efecto secundario común de la anestesia general que puede producir una insuficiente perfusión de órganos. Sin embargo, no está clara la relación entre hipotensión durante cirugía no cardiaca y resultados desfavorables. Métodos: Buscamos en PubMed, Embase, Web of Science y CINAHL, clasificando la calidad de los artículos analizados según los criterios STROBE y CONSORT. Las fuerzas de asociación de los estudios de alta calidad se clasificaron en riesgos de lesiones orgánicas específicas: insuficiencia renal aguda (IRA), lesión miocárdica, accidente cerebrovascular y lesiones orgánicas generales para diferentes umbrales de presión arterial. Resultados: Presentamos una revisión de 42 artículos sobre las asociaciones entre varias definiciones de hipotensión intraoperatoria, y su relación con resultados postoperatorios desfavorables tras cirugía no cardíaca. Se informaron riesgos elevados de lesión orgánica por exposición prolongada (>10 min) a presiones arteriales medias (PAM) 10 min, y que este riesgo aumenta con la disminución progresiva de la presión arterial. Dado el diseño observacional retrospectivo de los estudios revisados, con gran variabilidad en las características del paciente, las definiciones de hipotensión y los resultados, no se pueden obtener conclusiones sólidas sobre qué presión arterial y bajo qué circunstancias son realmente peligrosas. Se ofrecen recomendaciones para el diseño de estudios futuros. ABSTRACT Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Intraoperative hypotension is a common side effect of general anesthesia and might lead to inadequate organ perfusion. However, the relationship between hypotension during non-cardiac surgery and unfavorable results is not clear. Methods: We searched in PubMed, Embase, Web of Science and CINAHL, classified the quality of retrieved articles according to the STROBE and CONSORT criteria. The strengths of association from high-quality studies were classified into end-organ specific injury risks: acute renal failure (ARF), myocardial injury, stroke and overall organ injury risks for various arterial blood pressure thresholds. Results: We present an overview of 42 articles on reported associations between various intraoperative hypotension and their associations with postoperative adverse outcomes after non-cardiac surgery. High risks of end-organ injury were reported for prolonged exposure (> 10 min) to mean blood pressures (MBP) 10 min, and that this risk increases with the progressive decrease in blood pressure. Given the retrospective observational design of the studies reviewed, reflected by large variability in patient characteristics, hypotension definitions and outcomes, solid conclusions cannot be obtained about what blood pressure and under what circumstances are really dangerous. We provide recommendations for the design of future studies.

Background: Established data confirm an increased incidence of skin cancer, mainly squamous cell carcinoma (SCC), in long-term kidney transplant recipients (KTRs). Objective: Our purpose was to investigate prospectively the type and frequency of neoplastic and preneoplastic skin lesions in KTRs during the first 3 years of immunosuppression, as well as the influence of potential risk factors. Methods: Eighty-one consecutive KTRs were examined every 6 months during the first 3 years after transplantation. All survival analyses were performed with the EGRET statistical software package. Results: After a median follow-up of 34 months, 25 skin cancers developed in 12 patients; the basal cell carcinoma (BCC)SCC ratio was 3.1:1. The cumulative risk of skin cancer developing after 3 years of graft survival was 18.1%. Only age at the time of transplantation ( p = 0.005) and occupational sun exposure ( p = 0.048) had statistical significance as risk factors. Conclusion: In carefully supervised KTRs, a high incidence of cutaneous malignancy, mainly BCC, exists in the early posttransplant period. Sun exposure and the patient's age at the time of transplantation seem to be the most important risk factors.

Capillary hemangiomas of the tracheobronchial tree are extremely rare in adults, with hemoptysis being one of the most serious forms of presentation. An operation has been the treatment of choice, although it does involve high rates of morbidity and mortality, especially in emergency situations such as massive hemoptysis, which has led to the search for other therapeutic alternatives. There is no experience with embolization by interventional radiology when the hemoptysis is tracheal in origin, caused partly because the infrequency of this pathology; however, the foundations for it have been laid with the development of embolization for bronchopulmonary pathology. We report a case of a tracheal capillary hemangioma in a 66-year-old woman diagnosed with idiopathic thrombopenic purpura, which began as a massive hemoptysis and was treated successfully with embolization by interventional radiology. There has been no recurrence of the bleeding after 1 year's follow-up, and the patient's control fibrobronchoscopy is normal.

Objective: To evaluate two different approaches used to perform fused fissures in lobectomies in terms of persistent air leak (PAL) and their impact on length of hospital stay. Methods: One hundred and nineteen patients underwent lobectomy or bilobectomy in our unit. We focused on patients with fused fissures (63 patients), all of whom were selected intraoperatively based on predefined criteria. These patients with incomplete fissures were randomly assigned to two groups: Group A patients who underwent a ‘traditional technique’ to approach fused fissures and Group B patients who underwent a ‘fissureless technique’. The latter technique avoids dissecting the lung parenchyma over the pulmonary artery, reducingthe chancesof air leak. Patients in both groupshad shown no significant difference in preoperative variables(p > 0.05).Results: The incidence of PAL was significantly higher among patients with incomplete or fused fissures (0 case vs 8 cases (Groups A and B), p < 0.005). Furthermore, the incidence of PAL was significantly higher in the Group A (traditional technique) (7 vs 1) (p < 0.05, OR = 3.1, CI 0.22—0.51). The probabilityforairleakcessationwassignificantlyhigherinpatientsofGroupB(fissurelesstechnique)(logrankp < 0.0001).Thelengthofhospital stay was higher in Group A (5.76 3.1) compared with Group B (4.9 1.7) (p < 0.05). No other variables were identified as risk factors for PAL in this series. Conclusions: The fissureless technique appears to be a superior approach for fused fissures in terms of both preventing persistent air leak and reducing the length of hospitalisation. This technique can be performed safely at no additional cost and without adverse consequences. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Objective: The non-neoplastic mediastinal cysts (NNMCs) form a group of uncommon benign lesions of a congenital origin. The significant controversy regarding these cysts is whether to manage with observation or surgical resection. The aim of this study is to analyse the utility of thoracic computed axial tomography (CT) in imaging diagnosis of the NNMCs and the results of surgery in these lesions. Patients and methods: Twenty NNMCs underwent surgery between 1980 and 2000. The preoperative study of mediastinal cystic masses includes a complete blood test, chest radiography (CR) and, for the last 15 years, a thoracic CT and/or nuclear magnetic resonance. All the patients underwent surgery in our thoracic surgery department and were reviewed in outpatients at 1 month, 6 months, 1 year and biannually thereafter. The form of manifestation, clinical features, imaging techniques, surgical operation, morbidity, mortality and follow-up are analysed. Results: Ten corresponded to bronchogenic cysts, the most common symptom of which was chest pain. CR showed a mass in the anterior-superior mediastinum in nine cases, and CT (five cases) revealed a cystic tumour in the anterior mediastinum. All were removed surgically, with three patients presenting with mild complications. Seven corresponded to pleuro-pericardial cysts, four being asymptomatic. CR showed a right paracardial mediastinal tumour, which was confirmed by CT (four cases). All were removed surgically, with two patients presenting with mild complications. Three corresponded to enteric cysts. CR showed a tumour in the posterior mediastinum, with CT confirming its cystic nature (two cases). Excision of the cyst was done in all cases, which corresponded to duplication cysts: two oesophageal and one gastric. All the patients are asymptomatic and recurrence-free after a follow-up of 11 ^ 10 years. Conclusions: NNMCs are benign lesions in which the lesions in which the surgery can be done with a low morbidity and mortality rate, enables us to rule out malignancy and offers a definitive cure. Actually the thoracic CT permit a correct diagnosis pre-surgery in function of the radiologic characterisation and topography. q 2002 Elsevier Science B.V. All rights reserved.

Photodynamic therapy (PDT) is widely used to treat non-melanoma skin cancer. However, some patients affected with squamous cell carcinoma (SCC) do not respond adequately to PDT with methyl-δ-aminolevulinic acid (MAL-PDT) and the tumors acquire an infiltrative phenotype and became histologically more aggressive, less differentiated, and more fibroblastic. To search for potential factors implicated in SCC resistance to PDT, we have used the SCC-13 cell line (parental) and resistant SCC-13 cells obtained by repeated MAL-PDT treatments (5th and 10th PDT-resistant generations). Xenografts assays in immunodeficient mice showed that the tumors generated by resistant cells were bigger than those induced by parental cells. Comparative genomic hybridization array (aCGH) showed that the three cell types presented amplicons in 3p12.1 CADM2, 7p11.2 EFGR, and 11q13.3 CCND1 genes. The 5th and 10th PDT-resistant cells showed an amplicon in 5q11.2 MAP3K1, which was not present in parental cells. The changes detected by aCGH on CCND1, EFGR, and MAP3K1 were confirmed in extracts of SCC-13 cells by reverse-transcriptase PCR and by western blot, and by immunohistochemistry in human biopsies from persistent tumors after MAL-PDT. Our data suggest that genomic imbalances related to CCND1, EFGR, and particularly MAP3K1 seem to be involved in the development of the resistance of SCC to PDT. Fil: Gilaberte, Yolanda. Hospital de San Jorge de Huesca. Zaragoza; España Fil: Milla Sanabria, Laura Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas Fisicoquímicas y Naturales. Departamento de Biología Molecular; Argentina Fil: Salazar, Nerea. Universidad Autonoma de Madrid. Facultad de Ciencias. Departamento de Biología.; España Fil: Vera Alvarez, Jesus. Hospital de San Jorge de Huesca. Zaragoza; España Fil: Kourani, Omar. Universidad Autonoma de Madrid. Facultad de Ciencias. Departamento de Biología.; España Fil: Damian, Alejandra. Universidad Autonoma de Madrid. Facultad de Ciencias. Departamento de Biología.; España Fil: Rivarola, Viviana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas Fisicoquímicas y Naturales. Departamento de Biología Molecular; Argentina Fil: Roca, Maria Jose. Hospital de San Jorge de Huesca. Zaragoza; España Fil: Espada, Jesus. Universidad Autonoma de Madrid. Facultad de Ciencias. Departamento de Biología.; España Fil: Gonzalez, Salvador. Memorial Sloan-Kettering Cancer Center. New York; Estados Unidos Fil: Juarranz, Angeles. Universidad Autonoma de Madrid. Facultad de Ciencias. Departamento de Biología.; España

The thymus is a principally lymphoid organ located in the anterosuperior mediastinum and one of the main elements of the immune system. Thymic disease is generally uncommon, and it can be quite varied. The most common thymic tumors are thymomas, but other types of tumors are located in the thymus, and making a differential diagnosis is important because treatment varies greatly from one type of disease to another.1 The fact that the thymus is a lymphoid organ makes it a site for lymphomatous tumor, although primary lymphomas of the thymus are uncommon.1 These lesions make up a heterogeneous group of lymphoproliferative neoplasms, and the distinction between Hodgkin disease and non-Hodgkin lymphoma must be made. Thymic lymphomas must always be considered among the diagnostic options, because the prognosis is strongly dependent on correct early treatment. We report 4 cases of Hodgkin disease of thymic origin and review the literature.