Sarcoma fibromixoide intracraneal primario de bajo grado: reporte de caso y revisión de la literatura / Low-grade fibro-myxoid sarcoma of intracranial origin: A case report and literature review

Resumen El sarcoma fibromixoide de bajo grado (LGFMS) es un tumor de tejidos blandos de origen mesenquimal. Los sarcomas son un grupo heterogéneo, que representa el 1% de todas las neoplasias. Los sarcomas primarios del sistema nervioso central (SNC) son raros y representan solo el 0,7% del total de sarcomas, con una incidencia estimada de 3 por cada 10 millones de personas por año. En este artículo, se describe el caso de una mujer de 59 años que presentó un sarcoma fibromixoide intracraneal de bajo grado, localizado en la región parietal derecha. Se discute el curso clínico, estudios de imágenes, características histopatológicas y tratamiento de este diagnóstico infrecuente y, por lo mismo, muy poco reportado. El diagnóstico definitivo se obtiene, ciertamente, mediante estudios histo-patológicos.

Summary Low-grade fibromyxoid sarcoma (LGFMS) is a soft tissue tumor of mesenchymal origin. Sarcomas are a heterogeneous group, representing 1% of all neoplasm diagnoses. Primary sarcomas of the central nervous system (CNS) are rare, and represent only 0.7% of all sarcomas, with an estimated incidence of 3 per 10 million people per year. The case of a 59-year-old woman who developed a low-grade intracranial fibromyxoid sarcoma in the right parietal region, is described. The clinical course, imaging studies, histopathological features, and treatment approach of this unusual diagnosis, are discussed. Low-grade intracranial fibromyxoid sarcoma is a rare and probably under- reported condition. The definitive diagnosis is usually made through histo-pathological studies.

Immune-Related Adverse Events and Immune Checkpoint Inhibitor Efficacy in Patients with Gastrointestinal Cancer with Food and Drug Administration-Approved Indications for Immunotherapy.

INTRODUCTION: Immune-related adverse event (IRAE) onset may represent a clinical biomarker for anti-programmed cell death protein 1 (PD-1) antibody response based on emerging evidence from patients with various advanced malignancies. This phenomenon has not been previously reported in a multidisease cohort of patients with gastrointestinal (GI) cancer with Food and Drug Administration (FDA)-approved indications to receive immune checkpoint inhibitor therapy. MATERIALS AND METHODS: The study was a multicenter retrospective cohort analysis of 76 patients with GI cancer who had received anti-PD-1 antibodies for FDA-approved indications. The primary and secondary outcomes of the study were progression-free survival (PFS) and overall survival (OS) in patients based upon IRAE presence, respectively. PFS and OS were estimated by the Kaplan-Meier method; a Cox proportional-hazards model adjusted for IRAE onset, patient age, and enrolling institution was used to analyze outcomes. RESULTS: Median PFS and OS were prolonged in patients who experienced IRAEs compared with those who did not experience them (PFS: not reached [NR] vs. 3.9 months [hazard ratio (HR) 0.13, 95% confidence interval (CI) 0.05-0.3, p < .001]; OS: NR vs. 7.4 months [HR 0.11, 95% CI 0.03-0.36, p < .001]). Among patients who experienced IRAEs, there were no significant differences in PFS and OS by either initial IRAE severity, management, or time to onset. CONCLUSION: Patients with gastrointestinal cancer who experienced IRAEs while on anti-PD-1 antibodies demonstrated significant improvements in PFS and OS compared with their counterparts who did not develop IRAEs. Although these findings add to results from studies in other tumor types, larger prospective studies are needed prior to clinical adoption of IRAE onset as a biomarker for immune checkpoint inhibitor response. IMPLICATIONS FOR PRACTICE: Predictive clinical biomarkers for immune checkpoint inhibitor response have been understudied in the field of immuno-oncology. Immune-related adverse event onset appears to be one such biomarker. Across tumor types, immune-related adverse event onset has been associated with response to anti-programmed cell death protein 1 (PD-1) antibodies. The results of this study demonstrate this for the first time in patients with gastrointestinal cancer receiving anti-PD-1 antibodies. Before immune-related adverse event onset can be adopted clinically as a predictive biomarker for immune checkpoint inhibitor response, however, larger prospective studies are needed to better understand the nuances between immune-related adverse event characteristics (severity, site, management, timing of onset) and immune checkpoint inhibitor effectiveness.

Protección ocular al paciente en estado crítico bajo efectos de sedación / Eye protection for the patient in critical condition under sedation effect", "_i": "

Considerando la tendencia mundial sobre la seguridad del paciente y la calidad del cuidado se hace indispensable diseñar, proponer e implementar procedimientos que lleven a satisfacer tales objetivos. El paciente en estado crítico requiere de cuidados especializados que garanticen la integridad física durante su estancia hospitalaria, a fin de prevenir y/o limitar las complicaciones que en la convalecencia resulten trascendentales para su rehabilitación y reintegración a su rol social. Por lo tanto se propone el procedimiento de protección ocular al paciente en estado crítico bajo efectos de sedación en cuatro etapas que pueden aplicarse de manera universal en toda instancia hospitalaria en la que se proporcione cuidado enfermero a pacientes con deficiencia en la oclusión natural de los ojos.

Considering the world-wide tendency on the security of the patient and the quality of the care it is made indispensable design, propose and implement procedures that take to satisfy such objectives. The patient in critical state requires of specialized cares that guarantee physical integrity during their hospital stay, in order to prevent and/or to limit the complications that in the rehabilitation are transcendental for their rehabilitation and reintegration to their social roll. Therefore the procedure of ocular protection to the patient in critical state under effects of sedation in four stages sets out that can be applied of universal way in all hospitable instance in which well-taken care of nurse to patients with deficiency in the natural occlusion of the eyes provides itself.

Aislamiento de Candida dubliniensis en distintos materiales clínicos: Análisis de métodos fenotípicos de diferenciación con Candida albicans / Isolation of Candida dubliniensis in different clinical samples: Analysis of phenotypical methods to differenciate from Candida albicans

Con el objeto de estimar la frecuencia de aislamientos de Candida dubliniensis en materiales clínicos en el Hospital de Infecciosas F. J. Muñiz, se identificaron 388 levaduras entre setiembre de 2005 y agosto de 2007. Doscientos doce aislamientos presentaban color verde en CHROMagar® y producían tubos germinativos y clamidoconidias en agarleche. Para diferenciar cuales de ellos correspondían a Candida albicans o a C. dubliniensis, se utilizaron distintos métodos fenotípicos y se evaluó la utilidad de cada técnica a fin de proponer un algoritmo de identificación simple, económico y confiable. Se estudió el color en 2 medios con sustratos cromogénicos, la producción de clamidoconidias en medios de Staib, agar tomate-zanahoria y agar-tabaco; en este último medio también se evaluaron las características macromorfológicas de las colonias; se evaluó la presencia de actividad lipolítica (medio-opacidad), capacidad de desarrollo a 45 °C y asimilación de D-xilosa. El 6,1% (13/212 aislamientos) correspondió a C. dubliniensis (3,3% del total de levaduras). No se pudo diferenciar entre ambas especies por el color en los medios cromogénicos usados. Las pruebas que resultaron más sensibles y específicas fueron crecimiento a 45 °C, asimilación de D-xilosa, color y desarrollo en agar-tabaco. C. albicans produjo clamidoconidias en los 3 medios diferenciales, entre 11,6% y 15,1% de los casos. La presencia de lipasas se evidenció en el 95,6% de C. albicans pero 2 de las 13 cepas de C. dubliniensis también presentaron halo de opacidad. Consideramos que se deben usar, al menos, 3 métodos diferentes para discriminar entre estas levaduras ya que ninguna prueba es absolutamente sensible o específica.

In order to estimate the frequence of Candida dubliniensis in clinical samples in F. J. Muñiz Infectious Diseases Hospital, a total of 388 yeasts from September 2005 to August 2007. There were 212 isolates which presented a green color on CHROMagar® Candida medium and produced germ tubes and chlamidoconidiae in milk-agar; so as to distinguish whether they corresponded to Candida albicans or C. dubliniensis, different phenotypical methods were utilized. It was also evaluated the usefulness of each one in order to suggest a simple, economic and reliable identification algorithm. Each isolate was subcultured in two chromogenic media and then, the following determinations were done: chlamidospores production in Staib-agar, tomato-carrot-agar and tobacco-agar, colonies macromorphology was also studied in the last medium; opacity-test in Tween 80-CaCl2 agar (lipase activity), growing capacity at 45 °C, and D-xylose assimilation. Thirteen strains (6.1%) corresponded to C. dubliniensis. The difference in color between both species on chromogenic media was not so stressed as it is pointed out in some works. The more specific and sensitive tests were the ability to grow at 45 °C, D-xylose assimilation, color and macroscopic appearance in tobacco-agar. Between 11.6% and 15.1% of C. albicans strains produced chlamidoconidiae in the 3 differential media tested. The opacity halo (lipase) was evident in 95.6% of C. albicans isolates but 2 out of 13 C. dubliniensis also presented precipitation halo. We consider that at least 3 different phenotypical methods should be used to distinguish properly these two species since none of the tests is absolutely sensitive or specific.

[Isolation of Candida dubliniensis in different clinical samples. Analysis of phenotypical methods to differentiate it from Candida albicans]. / Aislamiento de Candida dubliniensis en distintos materiales clínicos. Análisis de métodos fenotípicos de diferenciación con Candida albicans.

In order to estimate the frequence of Candida dubliniensis in clinical samples in F. J. Muñiz Infectious Diseases Hospital, a total of 388 yeasts from September 2005 to August 2007. There were 212 isolates which presented a green color on CHROMagar Candida medium and produced germ tubes and chlamidoconidiae in milk-agar; so as to distinguish whether they corresponded to Candida albicans or C. dubliniensis, different phenotypical methods were utilized. It was also evaluated the usefulness of each one in order to suggest a simple, economic and reliable identification algorithm. Each isolate was subcultured in two chromogenic media and then, the following determinations were done: chlamidospores production in Staib-agar, tomato-carrot-agar and tobacco-agar, colonies macromorphology was also studied in the last medium; opacity-test in Tween 80-CaCl2 agar (lipase activity), growing capacity at 45 degrees C, and D-xylose assimilation. Thirteen strains (6.1%) corresponded to C. dubliniensis. The difference in color between both species on chromogenic media was not so stressed as it is pointed out in some works. The more specific and sensitive tests were the ability to grow at 45 degrees C, D-xylose assimilation, color and macroscopic appearance in tobacco-agar. Between 11.6% and 15.1% of C. albicans strains produced chlamidoconidiae in the 3 differential media tested. The opacity halo (lipase) was evident in 95.6% of C. albicans isolates but 2 out of 13 C. dubliniensis also presented precipitation halo. We consider that at least 3 different phenotypical methods should be used to distinguish properly these two species since none of the tests is absolutely sensitive or specific.

Percepciones, actitudes y prácticas en malaria en el Amazonas Colombiano / Perceptions, practice and attitudes concerning malaria in the Colombian Amazon region

OBJETIVO: El objetivo del estudio fue obtener información sobre las percepciones, actitudes y las prácticas que las personas del Amazonas Colombiano tienen sobre la etiología de la malaria, el diagnóstico, la profilaxis, la terapéutica, la prevención, y la percepción del riesgo para contraer la malaria. MÉTODOS: Se realizó un estudio cualitativo y se utilizó como técnica de investigación grupos focales, en total se realizaron 23, cada uno contó con la participación de 6 a 10 personas clasificadas de acuerdo a unas variables de inclusión pertinentes para el estudio. RESULTADOS: El estudio encontró que las personas que mejor conocen las medidas preventivas y de control son quienes tienen un riesgo alto para adquirir malaria, pero sin embargo no las ponen en práctica. Existen dificultades de acceso al diagnóstico y tratamiento de la malaria y problemas de automedicación en poblaciones de alto riesgo. CONCLUSIONES: Los factores comportamentales de las poblaciones expuesta a la malaria, pueden facilitar u obstaculizar las intervenciones de control en el Departamento del Amazonas Colombiano.

Impaired temporo-occipital blood flow in an atypical CLN1 case with late infantile onset and granular osmiophilic deposits.

A 5-year-old boy presented with frequent absences. Speech began to regress. He became ataxic, barely able to walk. Studies with Xe-133 and hexamethylpropylene amine oxime single-photon emission computed tomography revealed sharply decreased cerebral blood flow, especially in the occipital area. Landau-Kleffner syndrome was suspected but a sleep electroencephalogram showed few abnormalities. He was started on clorazepate and diltiazem. A skin biopsy to rule out possible CLN2 revealed, instead of the predicted curvilinear profiles, granular osmiophilic deposits, consistent with infantile neuronal ceroid lipofuscinosis (CLN1). The family reported increased seizure frequency and consulted with a colleague, who advised them to resume valproate and discontinue diltiazem. The boy died shortly thereafter. Decreased cerebral blood flow is a new finding in CLN1 with delayed onset. Calcium-channel blockers improve cerebral blood flow and perhaps delay clinical regression.

[Multiple endocrine neoplasia: a clinical model for applying molecular genetic techniques]. / Neoplasias endocrinas múltiples: un modelo clínico para aplicar técnicas de genética molecular.

Multiple endocrine neoplasias (MEN) are syndromes inherited as autosomal dominant. The application of the techniques of molecular biology has made possible the identification of the genes causing MEN 1 and 2. The gene responsible for MEN 1 belongs to the family of tumor suppressor genes and encodes for a protein named MENIN whose function remains to be elucidated. The identification of mutant MEN 1 gene carriers who are at risk of developing this syndrome requires frequent biochemical screening for the development of endocrine tumors. MEN 2 is a consequence of mutations in the Ret proto-oncogene (c-Ret). This gene encodes for a tyrosine kinase receptor thought to play a role in the development of neural crest-derived tissue. Members of kindred with either MEN 2A or MEN 2B should be screened by direct DNA testing early in life for mutations in c-Ret. Those with the mutation should be advised to have thyroidectomy at five years of age in children with MEN 2A and earlier in children with MEN 2B. Some cases of sporadic MTC are actually MEN 2A or Familial MTC after c-Ret testing is done, therefore routine application of this test is recommended in all cases of apparent sporadic MTC.

[Treatment of diffuse hyperthyroid goiter with radioiodine: influence of propylthiouracil pretreatment]. / Tratamiento con radioyodo del bocio difuso hipertiroideo: influencia del pretratamiento con propiltiuracilo.

BACKGROUND: To stabilize Graves disease and deplete the preformed hormone, the use of antithyroid drugs prior 131I therapy has been suggested, specially in those patients with severe thyrotoxicosis and in the elderly. However, PTU may reduce the effectiveness of 131I. AIM: To study the effects of PTU pretreatment before 131I administration. SUBJETS AND METHODS: A retrospective analysis of the medical records of patients with Graves disease treated with 131I from 1989 to 1997 was made. Of 244 patients with adequate follow-up for at least 12 months after 131I treatment, 142 had not been pretreated and 102 had received PTU prior to 131I therapy. Pretreated patients were distributed according to the number of days that PTU was discontinued before receiving 131I, forming four groups (a = 5 d, b = 6-14 d, c = 15-30 d and d = 31-60 d). Radioiodine was delivered according to our protocol of 120 microCi per gram of thyroid tissue, as estimated by clinical examination. Therapy was considered successful when laboratory evidence of euthyroidism or hypothyroidism after one year of treatment was obtained and as a failure when undetectable TSH values persisted after 12 months of treatment with 131I. RESULTS: All groups were comparable as to age, gender, goiter size, and 24 h radioiodine uptake. Control of hyperthyroidism was achieved in 76% of the non pretreated group. A similar percentage was observed in groups (b), (c) and (d). However, the disease was controlled in only 50% of group (a) patients (p < 0.003). CONCLUSIONS: The therapeutic efficacy of 131I is significantly reduced when the PTU is stopped for only a few days prior to the use of radioiodine. We postulate that PTU has to be discontinued for at least 10 days before radioiodine administration.

Ritmos anuales escolar: vacaciones-estudio y de menarquia / Annual menarche and scholar rhythms

Background: It has been hypothesized that the yearly menarche rhythm could be caused by the seasonal variation of photoperiod and temperature or by the annual distribution of the scholar vacation and study periods. Aim: To test the hypothesis that the distribution of study vacation periods is a condition that modifies the annual menarche rhythm. Subjects and methods: Two thousand ninety four school girls from Chile, 2.356 girls from Madras, India, 3.454 girls from Medellin, Colombia and 2.627 girls from Debrecen, Hungary, were studied. They were asked about the month of their menarche. Vacation months were considered those with more than 6 days of leave from school. Results: The seasonal hypothesis was refuted because there were contradictions with the expected antithetical behavior in both hemispheres, there was a significant heterogeneity of the yearly menarche among girls from the same region, the expected cline of the menarche frequency variance from equator to poles was not observed, finding an antithetical cline instead and there was a significant heterogeneity among months of the same season. On the other hand, months with vacation periods coincided significantly with peaks of menarche, while study months had lower proportion of menarche (total binomial probability <10-6). Girls whose month of menarche was the same as their month of birth, did not agree completely with the vacation-study hypothesis as the rest of the sample. Conclusions: Vacation periods influenced menarche rhythm. However, these periods coincide with most cultural events and this strong association needs further study to be considered causal. It is not possible to assume school stress as the main explanatory variable. Ontogenetic factors such as birth imprinting also can influence the menarche rhythm, as shown in girls whose month of menarche coincided with their month of birth

Lingual thyroid: report of three cases.

Lingual thyroid is a rare developmental disorder and is more frequent in women. The pathogenesis is unclear but may be related to the presence of maternal blocking autoantibodies against the thyroid. Treatment of this disorder includes the use of levothyroxine in order to correct the hypothyroidism, which is very frequent and to induce the shrinkage of the gland. When symptoms of obstruction or bleeding appear, ablative therapy by means of surgery or radioiodine is warranted. We report three cases and discuss the approach to diagnosis and a strategy for management.

[Treatment of Basedow-Graves' hyperthyroidism: retrospective analysis after 30 years]. / Tratamiento del hipertiroidismo por enfermedad de Basedow-Graves: visión retrospectiva al cabo de 30 años.

BACKGROUND: It is still debated which is the best treatment for Basedow-Graves' hyperthyroidism (BGH). We reviewed 195 patients treated and followed-up during the past 30 years: 88 treated with propylthiouracil (PTU), 70 with 131I and 37 thyroidectomized. AIM: to analyze the efficacy of each therapy in terms of achieving euthyroidism and the search of possible indexes for success. Surgery attained euthyroidism in 70.2% but has disadvantages; 131I accounted for the highest hypothyroid rate (72.1%) irrespective of the dose administered; PTU alone was successful in only 26.4% but combined with T4, success rose to 62.5% (p < 0.025). Suppression test and/or TRAb measurements after 6 mo PTU therapy were used to decide if therapy continued or was changed to other form of treatment. Using this criteria, 87.5% of pts with positive results achieved longstanding euthyroidism. Pretreatment predictive indexes were goiter size, T4 levels and 24 h/RAI uptake. CONCLUSIONS: As 131I induces hypothyroidism in over 2/3 of pts and surgery besides its cost is not devoid of serious complications, we advocate for the use of PTU as first line therapy; combined treatment (PTU + T4) seems promising. If after 6 mo on PTU, TRAb or Suppression test do not improve, we recommend 131I or surgery.

Assessment of the functional capacity for intracellular death and phagocytosis of polymorphonuclear cells in healthy neonates.

The objective of this study was to assess the functional capacity for intracellular death (ID) and/or phagocytic index (PI) of polymorphonuclear cells of 24-h-old healthy newborns with respect to the PMN cells of adults using the same standard exogenous source of opsonins. The ID and PI techniques were standardized and 2-3 ml of blood were used. No differences were found in the percentages of ID, P, PI among the PMNs of the newborns and those of the adults: 43.95 +/- 15.70 vs. 44.56 +/- 8.43 for ID; 38.96 +/- 14.34 vs. 39.00 +/- 14.54 for P; 1.71 +/- 0.54 vs. 1.73 0.45 for PI, respectively. It was concluded that the PMNs of 24-h newborns have an ID, P, PI functionality comparable to adult PMNs; differences observed in PMN function in newborns may be due to humoral deficiencies (opsonins).

[Subacute thyroiditis and concurrent suppurative thyroiditis in one case]. / Tiroiditis subaguda y supuración tiroidea concomitante en 1 caso.

We report a 41 years old man admitted with a tender goiter, fever, thyrotoxic manifestations and atrial fibrillation. Laboratory confirmed the diagnosis of subacute thyroiditis and treatment with aspirin and propranolol was started, obtaining a rapid relief of symptoms and normalization of heart rate. On the tenth day after admission, severe dysphagia, dysphonia, irritative cough and further enlargement of the neck mass developed. Fine needle aspiration of the mass and thyroid ultrasound lead to the diagnosis of a thyroidal abscess, which was surgically excised, draining 250 ml of purulent material. Cultures were positive for Staphylococcus aureus. Patient was treated during 21 with cloxacilyn and discharged with normal thyroid function. Long term follow up has been uneventful.