Multivariate discriminant analysis of normal, intraepithelial neoplasia and human papillomavirus infection of the uterine cervix samples.

The present investigation studies the role of multivariate statistical methods on quantitative histopathological features of cells in uterine cervix epithelium to discriminate between normal and abnormal uterine cervix samples. 143 histological specimens were included in the study involving normal cervix, cervical intraepithelial neoplasia (CIN) lesions and cervical human papillomavirus (HPV) infection with and without CIN (condyloma-CIN and condyloma-NCIN groups, respectively). Deep, middle and superficial regions of the cervical squamous epithelium were morphometrically analyzed. Identification of normal cervix from pathological cases was highly achieved with a specificity of 100%. The application of discriminant statistical method within pathological specimens showed an acceptable percentage of cases correctly classified; thus, an efficiency of 83.0% and 74.6% was obtained in order to discriminate within CIN and condyloma-CIN grades respectively. These percentages increased when differentiation between each grade of CIN versus condyloma-CIN were considered, using only 1-3 morphometrical parameters. Our findings indicate that the combination of nuclear and cytoplasmic quantitative features, specially size parameters, permit a high correct percentage classification of cervix samples. The discrimination process was better when few diagnostic categories were included; however, 100% specificity for normal samples was always reached.

[Candidiasic granuloma associated to hypothyroidism (author's transl)]. / Granuloma candidiásico asociado a hipotiroidismo.

Chronic mucocutaneous candidiasis is a rare cellular immunodeficiency disease, characterized by persistent infections of the mucous membranes, nails, skin and scalp. Candidal granuloma is an uncommon form of mucocutaneous candidiasis of early onset which may ne associated with hypothyroidism. It is difficult to manage as so far no truly effective treatment has been found. We present a 13-year old boy with candidal granuloma associated with primary hypothyroidism who had a favorable response to treatment with thyroid hormone and miconazole. The fungicide was given in tablet form, a single dose per day and patient kept it in his mouth and in contact with his lips for 15 minutes. One and a half year later clinical evolution is good and no side effects related to the miconazole have been observed.

[Gastric tuberculosis: a report of 2 cases]. / Tuberculosis gástrica: presentación de dos casos.

Two patients with gastric tuberculosis are described. The first presented toxic syndrome, multiple abdominal adenopathies, microcytic anemia and a subcardial ulcer with malignant characteristics at endoscopy. Diagnosis was based on the positivity of Ziehl-Neelsen staining and on the growth of Mycobacterium tuberculosis in the culture of the gastric mucosa. The second patient presented toxic syndrome, fever and a miliary pattern on thoracic radiography. Endoscopy demonstrated an ulcerated nodular lesion with granulomas with acid alcohol resistant bacillus being observed on biopsy. Mycobacterium tuberculosis was found in both the sputum and bronchoaspirate. The evolution of both cases was favorable with specific treatment.

[Fatal outcome after severe cerebellar infarction due to spontaneous dissection of the vertebral artery]. / Evolución fatal tras infarto cerebeloso masivo por disección espontánea de arteria vertebral.

Cerebellar infarction due to vertebrobasilar ischemia in spontaneous vertebrobasilar dissection is infrequent in children and adolescents. The commonest pathogenic mechanism of cerebellar infarction is arterial occlusion. Although usually favorable, outcome can be fatal, as in the present case. A previously healthy 4-year-old girl was admitted to the emergency room with sensory failure and trembling. The previous week she had suffered from a transitory ischemic attack that resolved spontaneously. On admission to the emergency department, the Glasgow Coma Scale score was 10/15 and she presented irregular polypneic breathing, anisocoric reactive pupils, enhanced reflexes, lower limb clonus and bilateral pyramidal signs. Cranial computed tomography revealed marked hypodensity in both cerebellar hemispheres and white supratentorial substance with obliteration of the quadrigeminus cisterns. Cerebral angiography showed left vertebral artery dissection with distal pseudoaneurysm and marked basilar occlusion. Despite aggressive antiedemic treatment and early instauration of intravenous continuous sodium heparin infusion, the patient developed a bilateral cerebellar infarction and supratentorial hydrocephalus. Brain death was diagnosed after 48 hours. Postmortem pathologic examination revealed previous thrombus the in superior left cerebellar artery and basilar artery occlusion. We discuss the absence of predisposing factors and the transitory ischemic attack in this patient 1 week before she developed massive cerebellar infarction.

[Testicular teratoma and epididymal adrenal choristoma]. / Teratoma testicular y coristoma adrenal epididimario.

We report a case of mature testicular cystic teratoma in a 28-month old boy. Due to the characteristics of the palpation and its partial transillumination, it may be confused with a hydrocele. They emphasize on the rarity and benign nature of the peculiarities and refer to its prognosis, usually benign, when is diagnosed at about 2 years of age, providing that a very careful examination of the histological sections rules out the presence of anaplastic cells. A left inguinal orchiectomy was performed because it was not possible to establish a line of cleavage between the tumor and the normal tissue. The pathologic examination revealed a benign lesion. An adrenal choristoma in the caput epididymis was also observed. Postoperative course was satisfactory.

[Lymphangioma of the spermatic cord]. / Linfangioma de cordón espermático.

We report a new case of spermatic cord lymphangioma in a infant 2 years old. The initial diagnosis was funicular hydrocele. The treatment was the local excision of tumor and the diagnostic was histological. Postoperative course was excellent. Must be explored the transillumination of the mass which would have led us to think other the diagnosis different from that of the cord hydrocele before the operation since it would have given negative. During the operation, must the assured that the cystic anomaly is limited to spermatic cord, to evite recurrences in the postoperative course.

[Indication of appendectomy in the recurrent abdominal pain]. / Indicación de la apendicectomía en el dolor abdominal recidivante.

INTRODUCTION: The frequency of the recurrent abdominal pain without demonstrable pathology is high and in occasions it takes to the surgeon to practice an appendectomy. In most of the cases the pain disappears. This performance although subjective, it doesn't base on objective data, what takes us to carry out this work. MATERIAL AND METHOD: The study is carried out in 47 patients with recurrent abdominal pain and subjected to appendectomy, 17 were excluded by diverse causes. The vermiform appendixes were studied by morphological and immunohistochemical methods, using the monoclonal antibodies, valuing morphologic sing of a chronic inflammation of the appendix. RESULTS: 100% of the samples studied presented microscopically chronic inflammatory changes microscopically. We observe fibrose in 100%, lympho-plasmocytic inflammatory infiltrate in 60% and a lymphocytes T prevalence has more than enough lymphocytes B. CONCLUSIONS: Our results support the existence of a clinical-pathological condition that can be defined as chronic appendicitis and therefore it justifies the appendectomy in recurrent abdominal pain when another disease has been excluded.

[Immunohistochemical study of hypertrophic pyloric stenosis]. / Estudio inmunohistoquímico en la estenosis hipertrófica del píloro.

INTRODUCTION: In spite of the clinical experience about infantil Hypertrophic Pyloric Stenosis (IHPS), its etiopathology remains unknown. Recent studies have been focussed in immunohistochemistry techniques for valuing the neuronal development in the pyloric muscle. MATERIAL AND METHODS: We took biopsy from 10 babies diagnosed of IHPS and 10 babies with similar age, died because of other causes. Immunohistochemical study was performed using monoclonal antibodies: S100 protein, GFAP, enolasa and neurofilaments NF. The results were showed semi-quantitativement as strong (++), moderate (+) and absent (-). Immunotinction of the myenteric plexus (ganglion cells and satellite) and nervous fibers of the muscle layer, were done. RESULTS: We observed a poor immunoreactivity in the muscle layer (longitudinal and circular) in the 60-70% of specimens of pyloric muscle in babies with IHPS. GFAP were absent in the 80% in the myenteric plexus. This poor innervation may be related to the etiopathogenesis of pyloric stenosis and hypertrophy.

[Experimental testicular torsion: its effect on the contralateral testicle]. / Torsión testicular experimental: efecto en el testículo contralateral.

The purpose of this project is to determine the lesion in contralateral testis after unilateral testicular torsion. For that is reproduced the lesion in an experimental model animal using 35-45 days old Wistar rats. The study of the contralateral testis is performed 30-35 days after lesion, once orchiectomy with histopathological and ultrastructural analysis, was made. We observed zonal tubular atrophy, alteration of spermatogenesis, abnormal formation of spermatozoa and death cellular by apoptosis.

[Solitary intestinal fibromatosis: an unusual cause of neonatal intestinal obstruction]. / Fibromatosis intestinal solitaria: una causa rara de obstrucción intestinal neonatal.

We report a new case of solitary intestinal fibromatosis (SIF) in a neonate with intestinal obstruction in the first day of life. At the laparotomy was found to be due to a solid mass in the jejunum. A segmental jejunal resection with anastomosis was performed. Histologic examination showed a SIF. The postoperative course was excellent in contrast to cases of congenital fibromatosis with multiples lesions, which carries a poor prognosis.

[Appendicular carcinoid tumor in childhood]. / Tumor carcinoide apendicular en la infancia.

Apendicular Carcinoid tumors are very infrequent, being lower than 0.1% of the appendicectomies carried out. We report on the case of a 13 year-old girl, with Acute Appendicitis picture. The appendix was removed and the histological study revealed the presence of the carcinoid tumor with a diameter of a 6 mm. Where non-invasive treatment was decided on, and at present, after two years follow-up, there has been no recurrence.

Minimally invasive endoscopic techniques for treating large, benign processes of the nose, paranasal sinus, and pterygomaxillary and infratemporal fossae: solitary fibrous tumour.

OBJECTIVES: We report an extremely rare case of a large solitary fibroma of the paranasal sinus, which we treated by sinonasal endoscopic surgery. We describe its clinical and histopathological features, and we report the endoscopic technique used to deal with such a large sinonasal mass (penetrating the pterygomaxillary and infratemporal fossae); we also offer a brief survey of the literature. CASE REPORT: A woman presented with an approximately one-year history of nasal obstruction. Nasal endoscopy revealed an irregularly shaped, friable, reddish mass that occupied the whole of the right nasal fossa. Magnetic resonance imaging of the paranasal sinuses revealed a large mass that occupied the anterior and posterior ethmoids and the maxillary and sphenoid sinuses, displacing the septum and penetrating the pterygomaxillary fossa, having destroyed the lateral wall of the right nasal fossa. The tumour was resected by means of sinonasal endoscopic surgery; an endoscopic medial maxillectomy with extension to the pterygomaxillary and infratemporal regions was performed. Histological analysis confirmed the diagnosis of solitary fibrous tumour. During follow up, we performed regular nasal endoscopies, as well as computed tomography scans one and six months post-operatively. CONCLUSIONS: Endoscopic techniques are currently the approach of choice for the treatment of such tumours of the sinonasal cavity and pterygomaxillary and infratemporal regions. The size of the lesion did not contraindicate endoscopic sinonasal surgery as a curative treatment.

Histomorphometry of normal and abnormal cervical samples.

We quantitatively studied the nuclear and cytoplasmic characteristics of cells in the normal cervix, squamous intraepithelial lesions (cervical intraepithelial neoplasia [CIN]) lesions and cervical human papillomavirus (HPV) infection with and without CIN (condyloma-CIN and condyloma-NCIN groups, respectively). The morphometric features of the deep, middle and superficial layers of the cervical epithelium were calculated on 143 cervical samples. The morphometric parameters selected for the analysis were area; perimeter; maximal, minimal and equivalent circle diameters; nuclear/cytoplasmic ratio; and several shape factors. Our quantitative findings support the opinion of other authors that HPV infection is associated with shape and size modifications of the nucleus and cytoplasm in CIN. In relation to cellular size, there were no differences between a normal cell, regardless of its region, and a virus-infected cell. The nuclear differences are predominantly in the deep layer areas. The CIN samples showed changes in both cellular and nuclear form and size but lacked substantial differences in the tumor grades and areas studied. The condyloma-CIN samples revealed more notable differences in both tumor grade differentiation and different cellular layers.

Morphometry and discriminant analysis of the endometrium.

The authors dated 100 normal endometrial biopsies. Only endometrial specimens with histologically confirmed subphases and no evidence of organic disease were accepted for study. The morphometry and stereologic measures of the glands, lumina and endometrial epithelium were assessed. Quantitative assessment of the normal endometrium supported the histologic events that occur in the endometrial cycle (proliferative and secretory phases). There was a progressive increase in morphometric and stereologic values of the glands, epithelium and lumina during the endometrial cycle. Using stepwise discriminant analysis, 94% of the specimens were correctly classified into the categories of proliferative and secretory phase; two quantitative parameters were required, the epithelial volume density and longest luminal diameter. When three subphases within proliferative and secretory endometrium were considered, the overall accuracy was 90% and 78%, respectively.