Osteoblastoma con presentación atípica en cuboides / Osteoblastoma with atypical presentation in cuboid bone

Resumen: Introducción: El osteoblastoma es un tumor osteoblástico benigno, agresivo y poco frecuente. Su localización más frecuente es en elementos posteriores de la columna vertebral y el sacro. La presentación en cuboides es excepcional. Caso clínico: Masculino de 50 años que inició padecimiento en 2005, con dolor y aumento de volumen en región dorsolateral del mediopié. En las radiografías se observa injerto óseo y una lesión en cuboides, radiotransparente, heterogénea, multilobulada, con bordes irregulares que sobrepasa la cortical lateral. Se realizó angiotomografía donde se observó la lesión hipervascularizada; en la gammagrafía se observó captación del tecnecio 99 y en la resonancia magnética se reporta una lesión con cambios postquirúrgicos, quística, multilobulada. Se tomó biopsia transquirúrgica con abundante tejido fibroconectivo, osteoblastos, nidos de tejido osteoide e hipervascularidad del estroma, aumento de celularidad sin atipias y escasas células gigantes multinucleadas. Se clasificó Enneking 2. Se inició tratamiento con resección y curetaje del tumor, crioterapia y colocación de injerto tricortical en el defecto óseo. Mostró buena evolución postquirúrgica. A los tres años del procedimiento quirúrgico se encuentra sin datos de actividad tumoral y asintomático. A pesar de que el osteoblastoma no se presenta de forma habitual en cuboides, debe tomarse en cuenta como diagnóstico diferencial. Conclusión: Los tumores óseos, a pesar de tener localizaciones habituales, pueden presentarse en zonas poco frecuentes y por lo tanto, el estudio completo clínico radiográfico e histopatológico en cada paciente es fundamental.

Abstract: Introduction: Osteoblastoma is a benign, aggressive and rare osteoblastic tumor. Its most common location is in later elements of the spine and sacrum. The cuboid presentation is exceptional. Case report: A 50-year-old male who began her condition in 2005, with pain and increased volume in the dorsolateral region of the middle foot. X-rays show bone grafting and a cuboid lesion, radiotransparent, heterogeneous, multilobed, with irregular edges that exceeds the lateral cortical. Angiotomography was performed where hypervascularized injury was observed; bone scan showed uptake of technetium 99, and MRI reported an injury with post-surgical, cystic and multilobed changes. Trans surgical biopsy was taken, increased atypia-free cellularity and few multinucleated giant cells were reported and Enneking 2 qualified. Treatment was initiated with resection of the tumor, cryotherapy, and placement of tricortical graft in the bone defect. He exhibited good post-surgical evolution. At three years of the surgical procedure, he`s without tumor and asymptomatic. Although osteoblastoma does not usually occur in cuboid, it should be taken into account as a differential diagnosis. Conclusion: Bone tumors, despite having common locations, can occur in rare areas and therefore the complete radiographic and histopathological clinical study in each patient is critical.

[Osteoblastoma with atypical presentation in cuboid bone]. / Osteoblastoma con presentación atípica en cuboides.

INTRODUCTION: Osteoblastoma is a benign, aggressive and rare osteoblastic tumor. Its most common location is in later elements of the spine and sacrum. The cuboid presentation is exceptional. CASE REPORT: A 50-year-old male who began her condition in 2005, with pain and increased volume in the dorsolateral region of the middle foot. X-rays show bone grafting and a cuboid lesion, radiotransparent, heterogeneous, multilobed, with irregular edges that exceeds the lateral cortical. Angiotomography was performed where hypervascularized injury was observed; bone scan showed uptake of technetium 99, and MRI reported an injury with post-surgical, cystic and multilobed changes. Trans surgical biopsy was taken, increased atypia-free cellularity and few multinucleated giant cells were reported and Enneking 2 qualified. Treatment was initiated with resection of the tumor, cryotherapy, and placement of tricortical graft in the bone defect. He exhibited good post-surgical evolution. At three years of the surgical procedure, he's without tumor and asymptomatic. Although osteoblastoma does not usually occur in cuboid, it should be taken into account as a differential diagnosis. CONCLUSION: Bone tumors, despite having common locations, can occur in rare areas and therefore the complete radiographic and histopathological clinical study in each patient is critical.

INTRODUCCIÓN: El osteoblastoma es un tumor osteoblástico benigno, agresivo y poco frecuente. Su localización más frecuente es en elementos posteriores de la columna vertebral y el sacro. La presentación en cuboides es excepcional. CASO CLÍNICO: Masculino de 50 años que inició padecimiento en 2005, con dolor y aumento de volumen en región dorsolateral del mediopié. En las radiografías se observa injerto óseo y una lesión en cuboides, radiotransparente, heterogénea, multilobulada, con bordes irregulares que sobrepasa la cortical lateral. Se realizó angiotomografía donde se observó la lesión hipervascularizada; en la gammagrafía se observó captación del tecnecio 99 y en la resonancia magnética se reporta una lesión con cambios postquirúrgicos, quística, multilobulada. Se tomó biopsia transquirúrgica con abundante tejido fibroconectivo, osteoblastos, nidos de tejido osteoide e hipervascularidad del estroma, aumento de celularidad sin atipias y escasas células gigantes multinucleadas. Se clasificó Enneking 2. Se inició tratamiento con resección y curetaje del tumor, crioterapia y colocación de injerto tricortical en el defecto óseo. Mostró buena evolución postquirúrgica. A los tres años del procedimiento quirúrgico se encuentra sin datos de actividad tumoral y asintomático. A pesar de que el osteoblastoma no se presenta de forma habitual en cuboides, debe tomarse en cuenta como diagnóstico diferencial. CONCLUSIÓN: Los tumores óseos, a pesar de tener localizaciones habituales, pueden presentarse en zonas poco frecuentes y por lo tanto, el estudio completo clínico radiográfico e histopatológico en cada paciente es fundamental.

Satisfacción del paciente operado de artroplastía primaria de cadera con abordaje anterior, lateral y posterior / Patient satisfaction of primary hip replacement with anterior, lateral and posterior approach

Resumen: Introducción: Hoy en día no se cuenta con evidencia suficiente que determine la mejor opción del abordaje quirúrgico para artroplastía total primaria de cadera. El objetivo de este estudio es comparar los resultados de satisfacción del paciente con la escala de HOOS entre el acceso quirúrgico anterior, lateral y posterior en pacientes tratados mediante reemplazo articular primario de cadera. Material y métodos: Se compararon los resultados de satisfacción con la escala de HOOS entre el abordaje quirúrgico anterior, lateral y posterior a las 48 horas, al mes y a los tres meses; se aplicó la prueba estadística de ANOVA y una prueba post hoc de Tukey a los resultados obtenidos. Resultados: Se obtuvo mayor puntaje en la escala de HOOS con el abordaje anterior en comparación con el abordaje lateral y el posterior a las 48 horas, al mes y a los tres meses del postoperatorio, con un valor p de 0.012 a las 48 horas, de 0.014 al mes y de 0.047 a los tres meses. Conclusiones: Se concluyó que en nuestro grupo de estudio hubo mayor satisfacción de los pacientes postoperados de artroplastía primaria de cadera con abordaje anterior en comparación con los abordajes lateral y posterior; sin embargo, esta diferencia va disminuyendo a lo largo del tiempo, llegando a tener resultados de satisfacción similares a los tres abordajes al cabo de tres meses.

Abstract: Indroduction: Today, there is insufficient evidence, that determines the best option of the surgical approach for primary total hip replacement. The objective of this study is to compare patient satisfaction results with the HOOS scale between anterior, lateral and posterior surgical access in patients treated with primary hip joint replacement. Material and methods: Satisfaction results were compared with the HOOS scale between the surgical approach anterior, lateral and posterior at 48-hour, monthly, and three-month; the ANOVA statistical test and a Tukey post-hoc test were applied to the results obtained. Results: A higher score on the HOOS scale was obtained with the anterior approach compared to the lateral and posterior. At 48 hour, per month and three months after surgery, with a p-value of 0.012 at 48 hours, 0.014 per month and from 0.047 to three months. Conclusions: It was concluded, that in our study group, there was greater satisfaction of the post-operative patients of primary hip replacement with Anterior approach compared to the lateral and posterior approaches, however this difference decreases over the length of the time, reaching similar satisfaction results with all three approaches at three months.

[Patient satisfaction of primary hip replacement with anterior, lateral and posterior approach]. / Satisfacción del paciente operado de artroplastía primaria de cadera con abordaje anterior, lateral y posterior.

INDRODUCTION: Today, there is insufficient evidence, that determines the best option of the surgical approach for primary total hip replacement. The objective of this study is to compare patient satisfaction results with the HOOS scale between anterior, lateral and posterior surgical access in patients treated with primary hip joint replacement. MATERIAL AND METHODS: Satisfaction results were compared with the HOOS scale between the surgical approach anterior, lateral and posterior at 48-hour, monthly, and three-month; the ANOVA statistical test and a Tukey post-hoc test were applied to the results obtained. RESULTS: A higher score on the HOOS scale was obtained with the anterior approach compared to the lateral and posterior. At 48 hour, per month and three months after surgery, with a p-value of 0.012 at 48 hours, 0.014 per month and from 0.047 to three months. CONCLUSIONS: It was concluded, that in our study group, there was greater satisfaction of the post-operative patients of primary hip replacement with Anterior approach compared to the lateral and posterior approaches, however this difference decreases over the length of the time, reaching similar satisfaction results with all three approaches at three months.

INTRODUCCIÓN: Hoy en día no se cuenta con evidencia suficiente que determine la mejor opción del abordaje quirúrgico para artroplastía total primaria de cadera. El objetivo de este estudio es comparar los resultados de satisfacción del paciente con la escala de HOOS entre el acceso quirúrgico anterior, lateral y posterior en pacientes tratados mediante reemplazo articular primario de cadera. MATERIAL Y MÉTODOS: Se compararon los resultados de satisfacción con la escala de HOOS entre el abordaje quirúrgico anterior, lateral y posterior a las 48 horas, al mes y a los tres meses; se aplicó la prueba estadística de ANOVA y una prueba post hoc de Tukey a los resultados obtenidos. RESULTADOS: Se obtuvo mayor puntaje en la escala de HOOS con el abordaje anterior en comparación con el abordaje lateral y el posterior a las 48 horas, al mes y a los tres meses del postoperatorio, con un valor p de 0.012 a las 48 horas, de 0.014 al mes y de 0.047 a los tres meses. CONCLUSIONES: Se concluyó que en nuestro grupo de estudio hubo mayor satisfacción de los pacientes postoperados de artroplastía primaria de cadera con abordaje anterior en comparación con los abordajes lateral y posterior; sin embargo, esta diferencia va disminuyendo a lo largo del tiempo, llegando a tener resultados de satisfacción similares a los tres abordajes al cabo de tres meses.

Translational profiling of stress-induced neuroplasticity in the CA3 pyramidal neurons of BDNF Val66Met mice.

Genetic susceptibility and environmental factors (such as stress) can interact to affect the likelihood of developing a mood disorder. Stress-induced changes in the hippocampus have been implicated in mood disorders, and mutations in several genes have now been associated with increased risk, such as brain-derived neurotrophic factor (BDNF). The hippocampus has important anatomical subdivisions, and pyramidal neurons of the vulnerable CA3 region show significant remodeling after chronic stress, but the mechanisms underlying their unique plasticity remain unknown. This study characterizes stress-induced changes in the in vivo translating mRNA of this cell population using a CA3-specific enhanced green fluorescent protein (EGFP) reporter fused to the L10a large ribosomal subunit (EGFPL10a). RNA-sequencing after isolation of polysome-bound mRNAs allows for cell-type-specific, genome-wide characterization of translational changes after stress. The data demonstrate that acute and chronic stress produce unique translational profiles and that the stress history of the animal can alter future reactivity of CA3 neurons. CA3-specific EGFPL10a mice were then crossed to the stress-susceptible BDNF Val66Met mouse line to characterize how a known genetic susceptibility alters both baseline translational profiles and the reactivity of CA3 neurons to stress. Not only do Met allele carriers exhibit distinct levels of baseline translation in genes implicated in ion channel function and cytoskeletal regulation, but they also activate a stress response profile that is highly dissimilar from wild-type mice. Closer examination of genes implicated in the mechanisms of neuroplasticity, such as the NMDA and AMPA subunits and the BDNF pathway, reveal how wild-type mice upregulate many of these genes in response to stress, but Met allele carriers fail to do so. These profiles provide a roadmap of stress-induced changes in a genetically homogenous population of hippocampal neurons and illustrate the profound effects of gene-environment interactions on the translational profile of these cells.

[Assessment of pain, function and complications after minimelly invasive decompression of morton´s neuroma using a dorsal approach in 16 patients]. / Evaluación del dolor, función y complicaciones posteriores a la descompresión del neuroma de Morton con abordaje dorsal por mínima invasión en 16 pacientes.

BACKGROUND: The purpose of this paper is to assess pain, function and complications after decompression of Mortons neuroma using a minimally invasive dorsal approach. METHOD AND RESULTS: 16 patients who underwent 19 decompressions were followed-up for 18 months. Pain was assessed with the visual analog scale (VAS), and function was assessed with the American Orthopedic Foot and Ankle Society (AOFAS) scale. Data was analyzed with the Student t test for related samples, which yielded a p value 0.05. The possible postoperative complications assessed were: skin problems, infections, wound dehiscence, delayed bone healing and recurrence. CONCLUSION: Minimally invasive decompression of Mortons neuroma is a procedure that provides pain relief and improvement in function, with a low complication rate.

ANTECEDENTES: El objetivo de este trabajo es evaluar el dolor, la función y las complicaciones posteriores a la descompresión del neuroma de Morton con abordaje dorsal por mínima invasión. MÉTODO Y RESULTADOS: Se estudiaron 19 descompresiones en 16 pacientes, en quienes se llevó a cabo un seguimiento de 18 meses. Se evaluó el dolor con la escala visual análoga (EVA) y la función con la escala de la American Orthopaedic Foot and Ankle Society (AOFAS). Los datos fueron aplicados a la prueba de T de Student para muestras relacionadas, con la cual se identificó un valor p 0.05. Se valoraron como posibles complicaciones postquirúrgicas lesiones dérmicas, infecciones, dehiscencia, retardo en la consolidación y recurrencia. CONCLUSIÓN: La descompresión por mínima invasión del neuroma de Morton es un procedimiento que aporta alivio del dolor y mejoría de la función con un porcentaje bajo de complicaciones.

Evaluación del dolor, función y complicaciones posteriores a la descompresión del neuroma de Morton con abordaje dorsal por mínima invasión en 16 pacientes / Minimal invasive Morton's neuroma decompression: assessment of pain, function and complications in 16 patients

Resumen: Antecedentes: El objetivo de este trabajo es evaluar el dolor, la función y las complicaciones posteriores a la descompresión del neuroma de Morton con abordaje dorsal por mínima invasión. Método y resultados: Se estudiaron 19 descompresiones en 16 pacientes, en quienes se llevó a cabo un seguimiento de 18 meses. Se evaluó el dolor con la escala visual análoga (EVA) y la función con la escala de la American Orthopaedic Foot and Ankle Society (AOFAS). Los datos fueron aplicados a la prueba de T de Student para muestras relacionadas, con la cual se identificó un valor p < 0.05. Se valoraron como posibles complicaciones postquirúrgicas lesiones dérmicas, infecciones, dehiscencia, retardo en la consolidación y recurrencia. Conclusión: La descompresión por mínima invasión del neuroma de Morton es un procedimiento que aporta alivio del dolor y mejoría de la función con un porcentaje bajo de complicaciones.

Abstract: Background: The purpose of this paper is to assess pain, function and complications after decompression of Morton's neuroma using a minimally invasive dorsal approach. Method and results: 16 patients who underwent 19 decompressions were followed-up for 18 months. Pain was assessed with the visual analog scale (VAS), and function was assessed with the American Orthopedic Foot and Ankle Society (AOFAS) scale. Data was analyzed with the Student t test for related samples, which yielded a p value < 0.05. The possible postoperative complications assessed were: skin problems, infections, wound dehiscence, delayed bone healing and recurrence. Conclusion: Minimally invasive decompression of Morton's neuroma is a procedure that provides pain relief and improvement in function, with a low complication rate.

A phase I study of PankoMab-GEX, a humanised glyco-optimised monoclonal antibody to a novel tumour-specific MUC1 glycopeptide epitope in patients with advanced carcinomas.

BACKGROUND: A phase I open-label dose-escalation study was conducted to define the safety, tolerability, and pharmacokinetics (PK) of PankoMab-GEX, a glyco-optimised humanised IgG1, with high affinity to a novel tumour-specific glycopeptide epitope of MUC1 (TA-MUC1) with excellent preclinical anti-tumour activity. PATIENTS AND METHODS: Seventy-four patients with advanced TA-MUC1-positive carcinomas received PankoMab-GEX intravenously every 3 (Q3W), 2 (Q2W), or 1 (QW) week in doses of 1-2200 mg in a three-plus-three dose-escalation design until disease progression (NCT01222624). RESULTS: No maximum tolerated dose was reached. Adverse events were mainly mild-to-moderate infusion-related reactions (IRRs) by the first infusion in 45% of patients. Only one dose-limiting toxicity, a grade III IRR, was observed. PankoMab-GEX exhibited linear PK over all doses. Mean terminal half-life was 189 ± 66 h (Q3W), without dose dependency. A target trough level ≥50 µg/mL was reached after one infusion with doses ≥1700 mg Q3W in 80% of patients. Clinical benefit in 60 evaluable patients included one complete response in a patient with ovarian cancer treated 483 d and confirmed disease stabilisation in 19 patients lasting a median (range) of 23 (10-109) weeks. All but two of the patients with clinical benefit had received a compounded total dose ≥700 mg over a 3-week period, including 8 of 12 (67%) patients with ovarian cancer. CONCLUSION: PankoMab-GEX is safe, well tolerated, and showed promising anti-tumour activity in advanced disease. A phase IIb study is ongoing evaluating the efficacy of PankoMab-GEX as a maintenance therapy in advanced ovarian cancer.

Sífilis secundaria en cavidad oral: Reporte de dos casos / Oral secondary syphilis: Two cases report

La sífilis es una enfermedad infecciosa humana causada por una bacteria: el Treponema pallidum. La enfermedad es transmitida por contacto directo a través de lesiones durante el estadio primario y secundario, por vía transplacentaria intrauterina o a través del canal uterino; puede afectar cualquier órgano de la economía causando un número infinito de presentaciones clínicas. La sífilis secundaria cursa con manifestaciones mucocutáneas características y eventual sintomatología general. La presentación clínica de nuestros dos pacientes es singular ya que solo poseían lesiones en la cavidad oral. La respuesta al tratamiento instaurado fue buena.

Syphilis is a human infectious disease caused by the bacterium Treponema pallidum. The disease is transmitted by direct contact with a lesion during the primary or secondary stages, in utero by the transplacental route, or during delivery as the baby passes through an infected canal. The bacterium may infect any organ, causing an infinite number of clinical presentations. Secondary syphilis is characterized by mucocutaneous lesions, a flulike syndrome, and generalized adenopathy. Hepatosplenomegaly may be present. The oral mucosa is the second most frequent site of luetic lesions; the genital areas are the most frequent. In the oral cavity, the most characteristic lesion is a whitish mucosal patch, normally located on the lips, tongue, or palate, which is extremely contagious. The differential diagnosis of this lesion may include oral squamous carcinoma, leukoplakia, candidosis, lichen planus, and hairy oral leukoplakia. Definitive diagnosis is based on clinical information and completed by laboratory examinations even the biopsy can help us. With the diagnosis of secondary syphilis treatment with penicillin G benzathine must be started. We present two cases of secondary syphilis with oral lesions only; the first one, a man with macule covered with a whitish membrane on palate mucosa and a lateral neck adenopathy. The lesion had been present for three months. The second one, a woman with painful whitish mucosal patch since two weeks ago. No fever or flulike syndrome. Luetic serologic tests were positive in both cases and in the first one the biopsy showed a chronic inflammatory infiltrate. The drug of choice in the treatment of our patients was benzathine penicillin G.

Xantomas eruptivos: A propósito de dos casos familiares / Eruptive xanthomas: Two familial clinical cases

Se presentan dos pacientes de sexo masculino, familiares de primer grado, tabaquistas y etilistas severos, sin antecedentes patológicos conocidos. Ambos presentan en forma eruptiva la aparición de xantomas y uno de ellos una pancreatitis necrohemorrágica atribuida a su hipertrigliceridemia, complicación muy grave de este trastorno. Si bien los xantomas eruptivos no son muy frecuentes de observar, deben hacernos sospechar en una dislipidemia severa, confirmándola con una examen de laboratorio que pondrá de manifiesto una elevación significativa de los triglicéridos y frecuentemente alteración de los niveles de glucosa en sangre. Además, el estudio histopatológico de las lesiones mostrará macrófagos cargados de lípidos, de aspecto espumoso e infiltrado polimorfonuclear y mononuclear en dermis.

We report a case of two male patients, first-grade relatives, who are heavy drinkers and smokers but apparently have no pathological records. Both show eruptive xanthomas and one of them presents acute necrotic and hemorrhagic pancreatitis due to hypertriglyceridemia, a serious complication of this disorder. Despite the fact that eruptive xanthomas are not frequently observed, they should make us suspect an instance of severe dyslipidemia. In order to verify it, a laboratory test will show a dramatic raise of serum triglyceride levels and usual changes in the blood glucose levels. Moreover, a histopathologic study of the lesion will reveal macrophages full of lipids (foam cells) with polymorphonuclear and mononuclear infiltrate.

Nevo epidérmico inflamatorio lineal (NEVIL): Presentación en la edad adulta / Inflammatory linear verrucous epidermal nevus (ILVEN): Late onset disease

El NEVIL es la variedad inflamatoria del nevo epidérmico; es un tumor benigno hamartomatoso, que se distribuye siguiendo las líneas de Blaschko. Estas líneas representarían mosaicismos cutáneos del desarrollo embriológico. El NEVIL suele aparecer en la infancia. Son generalmente unilaterales y en ocasiones muy pruriginosos. El diagnóstico diferencial es frecuentemente dificultoso. Presentamos una paciente en la cual la manifestación de esta patología se produce en forma tardía, siendo esto poco frecuente. El tratamiento es un desafío, se han probado múltiples modalidades terapéuticas, con resultados en ocasiones desalentadores. La cirugía, puede utilizarse en lesiones de pequeño tamaño. Los tratamientos con luz láser podrían ser de utilidad.

The ILVEN is the inflammatory variety of epidermal nevi, benign hamartomatous tumor that distributed following Blaschko lines. These lines represent cutaneous mosaicism in embryologic development. The ILVEN usually appear in the infancy. Generally unilateral and occasionally is very pruriginous. The differential diagnosis is often difficult. We present a patient in which the manifestation of her disease is produced in late onset, being this infrequent. Management is a challenge, multiple therapeutic modalities have been tested, with discouraging results. Surgery can be utilized in small size lesions. Laser therapy could be of utility.

Paracoccidioidomicosis perianal asociada a lepra lepromatosa: Presentación de un caso clínico / Perianal paracoccidioidomycosis associated with lepromatous leprosy: A clinical case report

Se presenta el caso de un paciente alcoholista con una ulceración perianal y manifestaciones cutáneas de enfermedad de Hansen. La biopsia de la lesión perianal y otros estudios arribaron al diagnóstico de una forma diseminada de paracoccidioidomicosis, así como también las biopsias cutáneas y los estudios baciloscópicos fueron diagnósticos de lepra lepromatosa. La respuesta a la terapéutica fue satisfactoria con desaparición de las lesiones cutáneas. La disminución de la respuesta inmunológica celular genera un terreno propicio para la infección de estos gérmenes y al compartir área endémica la asociación entre ambas patologías puede ocurrir.

Lepra and Paracoccidioidomycosis are endemic diseases in Argentina. We report a case of a patient with an unusual perianal ulceration and cutaneous manifestations of Hansen's disease. The biopsy of perianal lesion and subsequent studies revealed a disseminated form of paracoccidioidomycosis, as well as skin biopsy and baciloscopic finding diagnostic of Lepromatous Leprosy. The main portal of entry of paracoccidioides is the lung. Hematogenous dissemination of the fungus may occur at this time, with the establishment of metastatic foci in any organ. Anal and perianal lesions are present only in 1.3 to 2.4% of the patients. The pathogenesis of anal lesions remains unclear, it may be secondary from a systemic or a local disease. The patient response to the therapeutic was notable, with disappearance of lesions up to the third month of started itraconazole orally 400 mg/day leading just atrophy scars in perianal areas. The treatment of Hansen's disease was made according to OMS guidelines for multibacillary disease.

Úlcera de lengua como presentación del Histoplasma capsulatum / Tongue ulceration as a presentation of Histoplasma capsulatum infection

La histoplasmosis diseminada progresiva es una enfermedad que se manifiesta como reactivación de una infección latente en pacientes inmunodeprimidos, especialmente en personas con déficit en la inmunidad celular. Existen formas agudas, subagudas y crónicas. Las lesiones focales, en especial úlceras mucocutáneas, predominan en la forma diseminada crónica. Reportamos el caso de una paciente con artritis reumatoidea, que controlaba su patología con fármacos antirreumáticos modificadores de la enfermedad (DMARD), la que consultó por úlcera de lengua como única manifestación de una histoplasmosis diseminada crónica. La histopatología fue compatible y el cultivo positivo para Histoplasma capsulatum. La serología para el HIV fue negativa. Existen pocos casos publicados de pacientes con esta localización atípica en forma aislada, en particular aquellos HIV negativos. El itraconazol y la anfotericina B son las dos drogas más utilizadas para tratar esta enfermedad. Los datos clínicos sobre los nuevos azoles, voriconazol y posaconazol son limitados.

The progressive disseminated histoplasmosis is a disease produced by reactivation of latent infection in immunocompromised host, specially in persons with defective cell-mediated immunity. There are acute, subacute and chronic forms in the progressive illness. Focal lesions, specially mucocutaneous ulcers, are most frequent in the chronic disseminated forms. We reported a patient with rheumatoid arthritis treated with disease modifying antirheumatic drug (DMARD), with an ulcer of the tongue as only clinical manifestation of a chronic disseminated histoplasmosis. The histopathology was compatible, and the culture was positive for Histoplasma capsulatum. The serology for the HIV was negative. There are few published cases of this isolated form, particularly in patients with HIV negative serological test. Itraconazole and amphotericin B are the most frequently drugs used for the treatment in this disease. Clinical data on the new azoles, voriconazole and posaconazole, are limited.

Porfiria cutánea tardía: Reporte de 5 casos / Porphyria cutanea tarda: Five cases report

La PCT es la más común de las porfirias. Es una fotodermatosis que resulta de la deficiencia de la UPD, enzima perteneciente a la vía de síntesis del hemo. Presentamos la evolución de cinco casos de PCT; cuatro de PCT familiar y uno de PCT esporádica. En dos de los pacientes pertenecientes al grupo de PCT tipo II, encontramos como factor de riesgo, el consumo de alcohol, y en la paciente con PCT tipo I se detectó serología positiva para VHC. Todos los pacientes fueron tratados con cloroquina y flebotomías repetidas. Rápidamente se detectó mejoría clínica y bioquímica. Se observó que la porfirinuria continuó en descenso aún luego de suspendida la terapéutica. Tres de los pacientes con PCT familiar persisten en remisión clínica y con ausenciade recaídas tras más de 10 años de seguimiento. Aconsejamos en pacientes que padecen PCT la búsqueda de factores asociados (VHC, HIV, genes de HH) y desencadenantes exógenos (consumo excesivo de alcohol, hierro en la dieta e ingesta de estrógenos) que de ser controlados o evitados, junto con el tratamiento oportuno, contribuyen a un satisfactorio control de la enfermedad.

The porphyria cutanea tarda is the most frequent porphyria, it is a photodermatosis secondary to uroporphyrinogen decarboxylase deficiency; this enzyme belongs to the haem synthesis pathway. We present on this paper the evolution of five cases of PCT, four of them with familiar type and one of them sporadic type. In two patients belonging to PCT type II, we found alcohol addiction as a serious risk, while on the other patients PCT type I we found HCV positive serology. All patients were treated with chloroquine and phlebotomies. We could observe a good response not only clinical but biochemical. We could also see that the porphyrins urinary level continued descending once the drug was withdrew. Three of the patients with familiar PCT remains in clinical remission without any relapses in ten years of control. We advice all the patients that suffer PCT the detection of associated factors such as HCV, HIV, HH genes and the avoidance of the exogenous triggering factors such as excessive intake of alcohol, dietary iron and estrogen intake. Taking these advices into account, together with the correct treatment every patient can control this disease positively or satisfactorily.

Manual method for liquid-based cytology: a demonstration using 1,000 gynecological cytologies collected directly to vial and prepared by a smear-slide technique.

We report on the formulation and use of an alcoholic-agar additive solution generally useful for rapid, inexpensive liquid-based cytology slide preparation. Gynecological cytology specimens were collected from 1,000 women. Two hundred fifty aliquots each of CytoRich, CytoRich Red (Tripath Imaging, Inc., Burlington, NC), Preservcyt (Cytyc Corp., Boxborough, MA), and DINA*TRANS (DINA*CYT Corp., Portland, OR) fixatives were used for this study. Fixed cell suspensions from 1,000 women, seen consecutively by a general obstetrics and gynecology practice, were vortex-mixed and transferred into a premeasured amount of alcoholic-agar in test tubes. Test tubes were conventionally centrifuged, cells were trapped in a spontaneously formed agar-gel, and the supernatant solutions were decanted. Vortex-mixing cell buttons caused a rapid gel-to-sol transition, affording viscous cell suspensions that were applied to slides, smeared, and stained using Papanicolaou stains. Slides showed unclumped, monolayered, uniform, random cell-spreads. All of the fixatives afforded crisp presentation of normal and abnormal cells. There was an about 3-fold increase in HSIL+ (0.7-1.8%) and LSIL diagnoses (1.3-4.4%), and a 45% reduction in ASCUS diagnoses (3.3-1.8%), as compared to our cytology laboratory's previous year's patients' statistics with a concurrent 0.2% unsatisfactory rate, due solely to inadequate sampling. This manual method makes liquid-based cytology inexpensive and does not require specialized preparative devices.

Specialized preparative devices are not needed for liquid-based, thin-layer cytology: an alternate manual method using a metastable alcoholic gel.

The blending and use of a metastable alcoholic gel is described. The gel creates durable, uniform suspensions of cells and small aggregates of cells. It allows the random, uniform transfer of virtually any liquid-fixed cytology specimens to a glass slide without the use of specialized devices, proprietary disposables, or adhesive-coated glass slides. The method is inexpensive and can be performed in a timely fashion, not impacting laboratory turnaround times or requiring the specimen to be processed by other laboratories. It empowers cytology laboratories of any size or level of complexity to make slides from readily available commercial cytology fixatives. It allows the total contents of liquid-based cytology specimen vials to be examined, providing a "cytological method" for quality assuring liquid-based cytology samples.

A novel lipothrixvirus, SIFV, of the extremely thermophilic crenarchaeon Sulfolobus.

We describe a novel lipothrixvirus, SIFV, of the crenarchaeotal archaeon Sulfolobus islandicus. SIFV (S. islandicus filamentous virus) has a linear virion with a linear double-stranded DNA genome. These two features coincide in several crenarchaeotal but not in any other viruses. The SIFV core is formed by a zipper-like array of DNA-associated protein subunits and is covered by a lipid envelope containing host lipids. We sequenced approximately 96% of the virus genome excepting the DNA termini, which were modified in an unusual, yet uncharacterized, manner. Both, the 5' and the 3' DNA termini were insensitive to enzymatic degradation and labelling. Two open reading frames (ORFs) of the SIFV genome are likely to encode helicases and resemble uncharacterized ORFs from other archaea in sequence. Three ORFs showed sequence similarity with each other and each contained a glycosyl transferase motif. Another ORF of the SIFV genome showed significant sequence similarity to the ORF a291 from the well characterized, spindle-shaped Sulfolobus virus SSV1. Due to its structure, SIFV is classified as a lipothrixvirus.

Ag+ labeling: a convenient new tool for the characterization of hydrogen-bonded supramolecular assemblies by MALDI-TOF mass spectrometry.

Herein we describe our results on the characterization of a wide variety of different hydrogen-bonded assemblies by means of a novel matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) technique with Ag+ labeling. The labeling technique with Ag+ ions is extremely mild and provides a nondestructive way to generate charged assemblies that can be detected by mass spectrometry. Up to now more than 25 different single (1(3).2(3)), double (3(3).2(6)), and tetrarosettes (4(3).2(12)) have been successfully characterized by the use of this method. The success of the method entirely depends on the presence of a suitable binding site for the Ag+ ion. A variety of functionalities has been identified that provide strong binding sites for Ag+, either acting in a cooperative way (pi-arene and pi-alkene donor functionalities) or individually (cyano and crown ether functionalities). The method works well for assemblies with molecular weights between 2,000 and 8,000 Da, and most likely far beyond this limit.

Modification of CytoRich Red fixative system for use on bloody Pap and fine-needle aspiration smears.

Recent work has shown CytoRich Red fixative system is effective in lysing red blood cells and reducing background in bloody fluid specimens. The scope of this study was to see whether CytoRich Red can lyse red blood cells in freshly prepared Pap and fine-needle aspiration smears. Paired smears from 20 bloody fine-needle aspirations were prepared. One slide was initially placed in CytoRich Red for up to 30 sec, removed, and then fixed in 95% alcohol. The other slide was placed directly into 95% alcohol. Ten paired Pap smears, one fixed with a commercial fixative and another immersed in a solution of CytoRich Red, were evaluated. All slides were stained with the Papanicolaou stain and analyzed for the amount of red blood cells, background material, and nuclear and cytoplasmic staining. In 100% of all smears utilizing CytoRich Red, red blood cells were significantly reduced without hindering staining. Significant loss of cells from the slides sent in CytoRich Red solution was not observed. CytoRich Red fixative can be effective in reducing red blood cells and background on freshly made smears. In both gynecological and nongynecological cases, diagnostic cells were well preserved and not compromised by blood.

[Endoscopic treatment of vesicorenal reflux in children. Five-year assessment of the use of Macroplastique]. / Traitement endoscopique du reflux vésico-rénal chez l'enfant. Bilan de cinq ans d'utilisation de Macroplastique.

OBJECTIVE: To compare the results of endoscopic treatment of vesicorenal reflux by Macroplastique implantation versus Teflon implantation. MATERIAL AND METHODS: 297 children with 454 refluxing vesicorenal units were treated by endoscopic implantation of Macroplastique (Rplasty)-A.B.S.: 385 cases of primary reflux and 69 cases of secondary or associated reflux. All children were reviewed by ultrasound and cystography 6 weeks and 1 year after implantation. RESULTS: Regardless of the aetiology and the grade, reflux resolved in 91.2% of children (93.3% of ureters). Complications such as ureteric stasis were rare (3 cases). 161 children (253 ureters) were reviewed 1 year after treatment: reflux had recurred in 8.7% of patients. CONCLUSION: Although the mean quantity implanted was lower with Macroplastique, the results appeared to be better than those obtained with Teflon (bases on a previous series of 402 children: cure for 87.1% of ureters and 85.7% of children). The advantages of Macroplastique compared to Teflon include the less liquid consistency, the absence of retraction of the product and the presence of larger microparticles without any local or distant inflammatory reaction.