[Aphallia associated to urethrorectal fistula: a case report]. / Afalia asociada a fístula recto-uretral: reporte de un caso.

Aphallia had an incidence of 1/30.000.000 newborn. This is a rare genitourinary anomaly derived from a faulty development of the genital tubercles. It usually coexists with series of other anomalies which are incompatible with normal life. This article presents a description of a 2 years old patient.

Efficacy and safety of a salvage regimen based on tipranavir, enfuvirtide and three nucleoside analogues in HIV1 infected patients with clinical progression: 96-week evaluation.

In recent years, novel antiretroviral drugs have become available for multi-experienced HIV-infected patients with limited options. We enrolled seven advanced HIV-patients, failing multiple previous HAART regimens, in virological failure on their current HAART regimen and showing recent clinical and immunological progression. All patients were prescribed a double-boosted tipranavir plus enfuvirtide based regimen, in addition to zidovudine, tenofovir and lamivudine for salvage therapy. To assess susceptibility to tipranavir, the tipranavir genotypic resistance score was calculated and two years later this was re-evaluated on an updated tipranavir genotypic score algorithm. At baseline, CD4 were 139/mcL (more or less 145), HIV-1 RNA was 822,700 cp/mL. All patients achieved HIV-1 RNA levels less than 400 cp/mL between 12 weeks and 24 weeks of observation; two reached less than 50 cp/mL during this period. At 48 weeks three patients had reached less than 50 cp/mL; three other patients had HIV RNA less than 200 cp/mL. At 72 and 96 weeks HIV viraemia was less than 50 cp/mL in six patients; CD4 T-cell counts 285/mcL (more o less 198). No AIDS-defining events were recorded. Adverse events did not need to stop or change HAART. Strong 3 NRTI backbone could help efficacy and durability, and frequent evaluations in complex patients can help to manage toxicity.

A study of risk factors for ruptured tubal ectopic pregnancy.

Ruptured ectopic pregnancy is a leading cause of maternal mortality in the United States. The purpose of this study was to identify predictors of tubal rupture. A retrospective chart review of 236 ectopic pregnancies in 215 patients treated at the Cleveland Clinic Foundation from 1983 through 1996 was performed. Patients were stratified by rupture status of the ectopic pregnancy and compared for the following parameters: age, gravida, parity, aborta, gestational age, preoperative and postoperative hemoglobin level, need for blood transfusion, serum human chorionic gonadotropin (hCG) levels, and findings on ultrasonogram and at surgery. We also compared the two groups in multiple risk factors for ectopic pregnancy. We used the generalized estimating equation (GEE) methodology and unbalanced repeated measures analysis of variance to compare the two groups. Tubal rupture was found in 26.3% of ectopic pregnancies. Tubal rupture occurred with any serum hCG level, even with those under 100 mIU/ml. There was no significant difference between the two groups in gestational age, serum hCG levels, or ultrasound findings except that the frequency of ruptured pregnancies increases as the fluid amount documented on ultrasonography increases (p < 0.001). There was no association between any of the risk factors or the number of risk factors and frequency of tubal rupture. There was no significant decrease in the rupture rate over time (p = 0.34). There was an increased morbidity associated with tubal rupture. Tubal rupture cannot be predicted on the basis of any known risk factor, ultrasonogram findings, or serum hCG levels. Early diagnosis and treatment of ectopic pregnancy are the only modality available to prevent tubal rupture and its associated morbidity.

Gonococcal infection in cerebrospinal fluid and the presence of a ventriculoperitoneal shunt.

BACKGROUND: Neisseria gonorrhoeae is one of the most common organisms associated with pelvic disease in a woman of reproductive age. CASE: We present an unusual case of cerebrospinal fluid infection with N. gonorrhoeae in a woman with a ventriculoperitoneal shunt who complained of abdominal pain. Her shunt was removed and after adequate antibiotic therapy, it was re-inserted. CONCLUSION: Sexually active women, especially those with ventriculoperitoneal shunts, should be encouraged to use a barrier method of contraception, and should have a pelvic examination as part of their evaluation when they present with complaints of abdominal pain.

Desmoide de mama y syndrome de Gardner. / Desmoid breast tumor and Gardner's syndrome

Se presenta un caso de tumor desmoide de mama en una portadora de un sindrome de Gardner. Se senala lo excepcional de esta localizacion y se hace una breve revision sobre la enfermedad de Gardner

Mastectomias profilacticas subcutaneas.Sus indicaciones y tecnica de la reconstruccion inmediata por protesis. / Subcutaneous prophylatic mastectomies. Indications and immediate reconstructive technic using prosthesis

El presente trabajo ha presentado el interes de los autores de la indicacion de la mastectomia subcutanea profilatica y su reconstruccion inmediata con la utilizacion de protesis en aquellas situaciones de mamas con gran actividad celular reflejada en la reiteracion de la cirurgia por nodulos de fibroadenosis, enfermedad fibroquistica, situaciones que hoy se aceptan como factores preneoplasticos.Ello se ve avalado por una amplia literatura mundial. Tambien hemos senalado las indicaciones correspondientes para aquellas pacientes a las cuales ya se le realizo una mastectomia radical de un lado por neoplasma. La tecnica quirurgica y sus complicaciones han sido senaladas con amplios detalles, lo mismo que el numero de casos realizados

Tumor de Wilms con invasion de vena cava. / Wilm's tumor with vena cava invasiveness

Se presenta un caso de trombosis neoplasica de la vena cava inferior, por nefroblastoma derecho en una nina de 2 anos, que fue tratado por nefrectomia ensanchada, extraccion del trombo, quimioterapia y radioterapia, con una buena evolucion a los 22 meses de la nefre

Lipoma del intestino delgado. A proposito de un nuevo caso. / Lipoma of small intestine. Apropos of a case

Se publica un nuevo caso de lipoma de intestino delgado, que se presento como una hemorragia digestiva. Se hace una revision del tema, sus caracteres clinicos y anatomo-patologicos

Colitis ulcerosa de Crohn. Colectomia.Ileostomia. Ileosigmoidostomia. Evaluacion evolutiva. / Crohn's ulcerative colitis. Colectomy. Ileostomy.Ileosigmoidostomy. Evolutionary evaluation

Los autores describen observacion excepcional de colitis de Crohn segmentaria del angulo izquierdo y sus ramas; fistula del sigmoide al psoas, simulando artritis coxofemoral. Se realiza colectomia parcial e ileostomia (Brooke). 4 anos despues anastomosis ileosigmoidea. Han pasado 2 anos y medio del restablecimiento del transito intestinal y la paciente sigue bien. Se hacen consideraciones sobre las posibilidades de este tipo de intervencion

Lymphangiosarcoma of the anterior abdominal wall: a case report.

A rare case of lymphangiosarcoma of the anterior abdominal wall arising in chronic lymphedema following radical vulvectomy with bilateral inguinal lymphadenectomy and postoperative radiotherapy is reported. This is apparently the first description of this association, and the second reported case of lymphangiosarcoma originating in the anterior abdominal wall.

Fasciola hepatica human infection. Histopathological study of sixteen cases.

Sixteen human cases of Fasciola hepatica infection are described. The liver was involved in 13 cases, the gall bladder in 9 cases and the stomach in 2 cases. Lesions containing parasitic remnants or fluke eggs were rarely seen. Surface scarring of the liver, scar tracks and granulomas within organs were the most characteristic changes seen and were the most useful for the histopathological diagnosis of the disease. The associated liver, bile and gastric lesions are briefly discussed.