Inflammatory myofibroblastic tumor of the esophagus treated by endoscopy.

Inflammatory myofibroblastic tumors are rare lesions that have been described in virtually every organ including the gastrointestinal tract. The esophagus is an extremely unusual site for these tumors, with only a few cases described in the literature. Surgery has been the most common therapeutic approach used for the resection of these lesions. In the present case, a patient diagnosed with an inflammatory myofibroblastic tumor of the upper esophagus was reported, and it was successfully removed by endoscopy with no complications.

Hormone sensitive protocol for metastatic prostate cancer, an update.

To review and update last protocols in hormone sensitive metastatic prostate cancer for improving clinical management in routine. Evidence analysis available about recent updates protocols in hormone sensitive metastatic prostate cancer according to expert panel of clinicians about this field. A nominal consensus group for unify and improve the recommendations to the management of sensitive metastatic prostate cancer patients is currently needed. This document unifies and improve the management of patients with hormone sensitive metastatic prostate cancer, with a methodology that combines data quantitative and qualitative and based on the participation of a broad scientific committee appointed by the Spanish Association of Urology.

[Acute abdominal pain and mesenteric cyst: Presentation of a case.]. / Abdomen agudo y quiste de mesenterio: Presentación de un caso.

The cysts of mesentery (QM) are organizations whose embryological origin is multiple and the clinical presentation is not clear, in most of the times it is diagnosed of incidental form or by exclusion of other organizations.At least the third part is diagnosed before the 15 years of age, and tends to be of benign nature, but the recurrence she is high when no parched the surgical treatment the totality of the injury.Little series exist reported in Literature in the last years that try to classify and to know the behavior clinical the organization as well as the surgical findings and the histological types without being able to group series greater to 4 patients.The present work tries to inform on the findings ofa pediatric patient of 4 years of age that enter our hospital by a picture of acute abdomen whose diagnosis of certainty was of a QM and to make are vision of Literature in special in our country.

[Dysphagia: Forestier and Rotes Querol disease]. / Disfagia: enfermedad de Forestier y Rotes Querol.

Inside of the study of Dysphagia, until 38% of the greater patients of 50 years, they present/display cervical Osteophytes like cause of Dysphagia; frequently I diagnose passes for the methods of radiology and endoscopy unnoticed. The disease of Forestier and Rotes better well known Querol or like skeletal hiperostosis diffuse idiophatic it is characterized by the formation of spinal and cervical Osteophytes, ossification of ligaments and muscles for vetebrates of the cervical column. Frequently it produces affectation to medullar that it can pronounce like Dysphagia and crosstalk. We presented/displayed the case of a patient of 78 years with chronic pneumopathy, that presents/displays Dysphagia and progressive crosstalk with pondered loss, in where radiology of the cervical column they show cervical osteofitos with espondilolistesis, rectification of the cervical lordosis and diminution of the intersomatic spaces that they compress the trachea and column of air and an extrinsic compression below the cricopharyngeal is documented by endoscopy.

Relationship between osteopenia, free testosterone, and vitamin D metabolite levels in HIV-infected patients with and without highly active antiretroviral therapy.

The prevalence of osteopenia in HIV-infected patients is high. However, the mechanisms implicated in bone mass loss in HIV infection are unclear. Because of this, we analyzed serum free testosterone and vitamin D3 hydroxylated metabolites in HIV-infected patients, with and without antiretroviral treatment, and the relation between them and osteopenia. Seventy-four HIV-infected patients were selected because they had frozen sera available at a date close to a DEXA evaluation. Free testosterone, 25(OH)D3, and 1,25(OH)2D3 were determined in frozen serum. There were no differences in free testosterone, 25(OH)D3, and 1,25(OH)2D3 levels between patients with and without osteopenia. 25(OH)D3 levels in naive and HAART-treated patients were 26.2 (10.3-32.8) and 33.1 (20.6-46.8) ng/ml, respectively (p = 0.04). 1,25(OH)2D3 levels in naive and HAART treated patients were 60.3 (49.2-80.8) and 85.5 (68-111.6) pmol/liter (p = 0.01). Free testosterone levels in 9 naive men and in 50 HAART-treated men were 42.6 (24.1-67.3) and 69.2 (47.5-112.1) pmol/liter, respectively (p = 0.04). In conclusion, HIV-infected patients with and without osteopenia showed similar levels of vitamin D metabolites and free testosterone. However, antiretroviral drug-naive patients showed lower serum levels of vitamin D metabolites and free testosterone than HAART-treated patients.

Interleukin-1 beta in pleural fluids of different etiologies. Its role as inflammatory mediator in empyema.

STUDY OBJECTIVES: To measure interleukin-1 beta (IL-1 beta) levels in pleural effusions of different etiologies and their relationship with several pleural inflammatory parameters, and to verify whether IL-1 beta can be used as diagnostic marker in the differential diagnosis of pleural diseases. MATERIAL AND METHOD: One hundred two pleural effusions were analyzed using a monoclonal antibody enzyme-linked immunosorbent assay. Pleural fluids were classified as follows: transudates (n = 28), empyema (n = 14), parapneumonic (n = 13), tuberculous (n = 19), neoplastic (n = 17), and miscellaneous effusions (n = 11). RESULTS: IL-1 beta was above 200 pg/mL in all the patients with empyema but only in three patients with other etiologies. Two of those three had parapneumonic effusions and the remaining one had a tuberculous pleurisy with a previous bacterial empyema. No significant relationships were found between pleural effusion IL-1 beta levels and the different inflammatory parameters analyzed. As a diagnostic criterion for empyema, pleural IL-1 beta concentration greater than 200 pg/mL had a sensitivity of 100%, a specificity of 96%, and a positive and negative predictive value of 0.82 and 1, respectively. CONCLUSIONS: Our data suggest that IL-1 beta has a significant role in pyogenic infections of the pleural space but not in effusions of other etiologies. It could be used as a diagnostic marker of empyema.

Interleukin 6 in cerebrospinal fluid of patients with meningitis is not a useful diagnostic marker in the differential diagnosis of meningitis.

We assayed interleukin 6 (IL-6) concentrations in cerebrospinal fluid (CSF) from patients affected by meningitis of different aetiologies, and verified whether IL-6 can be used as a diagnostic marker in the differential diagnosis of meningitis. We used a monoclonal antibody enzyme immunoassay to test 98 CSF samples classified as pyogenic (15), viral (15), self-resolving aseptic meningitis (20), other infectious meningitis (9), neoplastic (4) and normal CSF from patients with (20) and without (15) non-infectious neurological diseases. CSF IL-6 concentrations were increased in pyogenic meningitis (100%) and in more than 50% of viral and other subarachnoid space infections, and rarely in patients without central nervous system infections. Though patients affected by pyogenic meningitis showed the highest levels of CSF IL-6, only a cut-off point > or = 10000 pg/mL was able to discriminate pyogenic meningitis from those of other aetiologies with a specificity > or = 94% and a positive predictive value of > or = 0.75 but the sensitivity was < or = 60%. Therefore, CSF IL-6 concentration is not a good diagnostic marker in the differential diagnosis of meningitis.

[Granulomatous orchitis]. / Orquitis granulomatosa.

Granulomatous orchitis is an inflammatory change of the testis. This is a rare lesion of unknown etiology. Usually are unilateral. The clinical appearance varies, and it is difficult to differentiate from testicular cancer. The diagnosis usually being made on histological examination after orchiectomy. Our paper report one case of granulomatous orchitis in a 27 year old patient. A review of the literature is made on the diagnosis and pathogenesis.

[Renal carcinoma revealed by sternal metastasis and posterior contralateral adrenal metastasis]. / Carcinoma renal descubierto por metastásis esternal y posterior metástasis adrenal contralateral.

We report a exceptional case of renal cell carcinoma whose first manifestation was bone metastases located in the sternum. Three years after radical nephrectomy solitary contralateral adrenal metastasis appeared. Exeresis bone metastasis, radical nephrectomy and adrenalectomy were performed. The patient is alive with no evidence of disease with hormonal substitute treatment 5 years and 2 months after esternal metastasis exeresis and 1 year and 3 months after right adrenalectomy.

[Prostatic leiomyosarcoma. Report of a case a review of the literature]. / Leiomiosarcoma de próstata. Aportación de un caso y revisión de la literatura.

A 48-year-old male with a leiomyosarcoma of the prostate is presented. The clinical presenting features were those of rapidly evolving prostatism and rectal symptoms (rectal bleeding, sense of rectal fullness and perineal pain). Arising from the smooth muscle cells of the prostate gland, this is a rare neoplasm that account for less than 0.1% of prostate malignancies, with a poor prognosis. It is often difficult to determine a definite origin, being necessary the differential diagnosis with pseudosarcoma, inflammatory fibrosarcoma, prostate abscess and other rare tumors. There is no established protocol of treatment. Combined modality therapy including radical surgery, radiation therapy and chemotherapy seems to be the best, although prognosis remains poor.

[Dyslipidemia associated with food]. / La dislipidemia asociada con los alimentos.

The increase of the morbi-mortality due to CHD in México, particularly among the Social Security Institute (IMSS) workers led us to do research on the relative risk and the protection provided by foodstuffs usually consumed by these workers. We found significant evidence of low levels of cholesterol associated with dry alcoholic drinks, skimmed milk and yogurt as well as fresh cheeses. C-LDL was low among people that usually consume sweet alcoholic drinks and fresh cheese. High levels of TG were associated with those people consuming food products containing saturated fat (bacon, pork crackling, fatty red meat, fowl with skin) and viscera, more than three standard cups of alcoholic drinks three times a week, soft drinks and salt. Skimmed milk and yogurt and all vegetables were related to low levels of TG. Products related to high levels of C-HDL were all kinds of vegetables and beans. This study of IMSS worker eating habits could be useful to do research on the food intake of other worker populations, and could help us to design Health Education programs based on scientific knowledge.

Una actualización en el protocolo en cáncer de próstata metastásico hormonosensible / Hormone sensitive protocol for metastatic prostate cancer, an update

Revisar y actualizar los últimos protocolos en cáncer de próstata metastásico hormonosensible para mejorar su manejo clínico en la práctica clínica. Realizar un análisis de los datos y los protocolos más recientes en el cáncer de próstata metastásico hormonosensible según paneles de expertos en este ámbito. Actualmente se necesita un grupo de consenso nominal para unificar y mejorar las recomendaciones para el manejo de pacientes sensibles con cáncer de próstata metastásico. Este documento unifica y mejora el manejo de los pacientes con cáncer de próstata metastásico hormonosensible, con una metodología que combina datos cuantitativos y cualitativos, y basada en la participación de un amplio comité científico designado por la Asociación Española de Urología (AU)

To review and update last protocols in hormone sensitive metastatic prostate cancer for improving clinical management in routine. Evidence analysis available about recent updates protocols in hormone sensitive metastatic prostate cancer according to expert panel of clinicians about this field. A nominal consensus group for unify and improve the recommendations to the management of sensitive metastatic prostate cancer patients is currently needed. This document unifies and improve the management of patients with hormone sensitive metastatic prostate cancer, with a methodology that combines data quantitative and qualitative and based on the participation of a broad scientific committee appointed by the Spanish Association of Urology (AU)

Measurement of levels of tumor necrosis factor-alpha and interleukin-1 beta in the CSF of patients with meningitis of different etiologies: utility in the differential diagnosis.

We assayed tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) concentrations in CSF from patients with meningitis of different etiologies and tested the usefulness of these assays for differentiating between pyogenic meningitis and aseptic meningitis of different etiologies. We used a monoclonal-antibody ELISA to test 125 CSF specimens from patients whose cases were classified as follows: pyogenic meningitis (n = 20), viral meningitis (n = 22), self-resolving aseptic meningitis for which no specific diagnosis was made (n = 25), meningitis due to other infectious agents (n = 11), and neoplastic meningitis (n = 5); we also tested normal CSF from healthy patients (n = 20) and those with neurological diseases (n = 22). Levels of TNF-alpha were above 200 pg/mL in 16 of 20 patients with pyogenic meningitis, but not in patients in the other groups. Levels of IL-1 beta were above 100 pg/mL in 15 of 20 patients with pyogenic meningitis and in one patient with a brain abscess. A positive correlation between levels of these cytokines and different inflammatory parameters was noted, whereas an inverse relationship with the duration of symptoms was observed. With regard to diagnosis, measurement of TNF-alpha and IL-1 beta levels showed sensitivities of 84.2% and 78.9%, respectively; specificities of 100% and 99%, respectively; a positive predictive value of 1 and 0.93, respectively; and a negative predictive value of 0.97 and 0.96, respectively.

Evaluation of AutoDELFIA and access automated immunoassay systems for third generation assays for thyrotropin.

We evaluated the technical performance of two new commercial automated immunoassay systems of third-generation assays for thyrotropin. The interassay CV was 2.8% for AutoDELFIA and 3.25% for Access at thyrotropin concentrations of approximately 1.3 mIU/l. The lower detection limits of the assays were 0.023 mIU/l for AutoDELFIA and 0.0096 mIU/l for Access, and the functional sensitivity for a CV of 20% was 0.027 mIU/l and 0.028 mIU/l, respectively. Sample to sample carry over was negligible (0.0016% for AutoDELFIA and 0.005% for Access). The range of linearity was acceptable for Access (102-115%) but not for low thyrotropin concentrations in AutoDELFIA (143% for a thyrotropin value of 0.48 mIU/l). Correlation between AutoDELFIA and Access was adequate (r = 0.999). We conclude that both automated immunoassays offer good reliability, practicability and performance characteristics.

Interleukin-8 in cerebrospinal fluid from patients with meningitis of different etiologies: its possible role as neutrophil chemotactic factor.

Interleukin (IL)-8 concentrations were analyzed in 70 cerebrospinal fluid (CSF) samples from patients with meningitis of different etiologies and in 34 normal CSF samples. Patient groups included those with pyogenic meningitis, viral meningitis, self-resolving aseptic meningitis without a specific diagnosis, and meningitis of other etiologies and normal CSF from patients with and without neurologic disease. All samples from patients with pyogenic meningitis (18) but only 3 from patients with meningitis of other etiologies and with CSF polymorphonuclear leukocyte (PMNL) counts > or = 80% had IL-8 levels > or = 2.5 ng/mL. IL-8 was above the normal level (< or = 0.5 ng/mL) in samples from 5 of 13 viral and 8 of 23 self-resolving aseptic meningitis patients and in 7 of 13 samples from patients with meningitis caused by other microorganisms. There was a significant relationship between IL-8 levels and CSF PMNL counts in patients with nonpyogenic meningitis. The data suggest a possible role of IL-8 as PMNL chemotactic factor in different infections of the subarachnoid space, not only in pyogenic meningitis.

Adenosine deaminase activity in the CSF of patients with aseptic meningitis: utility in the diagnosis of tuberculous meningitis or neurobrucellosis.

We assayed 229 CSF samples from 180 adults with meningitis of different etiologies for adenosine deaminase activity (ADA) and evaluated the usefulness of this assay in the differential diagnosis of aseptic meningitis. Cases of meningitis were classified as tuberculous meningitis (TBM), pyogenic meningitis, viral meningitis, self-resolving aseptic meningitis without a specific diagnosis, meningitis associated with other infections, and neoplastic meningitis. We also tested 117 CSF specimens for which parameters were normal. We chose a cutoff point of 10 IU/L on the basis of our results and found elevated ADA levels in 50% of the patients with TBM (no differences between patients with AIDS and those who did not have AIDS were observed). Among samples from patients with aseptic meningitis, we observed high ADA levels in only two of five of the patients with neurobrucellosis. Therefore, we concluded that in cases of aseptic meningitis, a CSF ADA level of > or = 10 IU/L has a sensitivity of 48%, a specificity of 100%, a positive predictive value of 1, and a negative predictive value of 0.91 as a diagnostic criterion for TBM or neurobrucellosis. ADA levels were also > 10 IU/L in 30% of the patients with pyogenic meningitis, but this diagnosis was easily excluded on other grounds.

Determination of shelf life and activation energy for tumor necrosis factor-alpha in cerebrospinal fluid samples.

The cytokine rumor necrosis factor-alpha (TNF-alpha) plays a prominent role in the inflammatory response and has been quantified in several kinds of body fluids. A safe method for keeping samples under the best storage conditions for later studies is clearly needed. We estimated TNF-alpha shelf life by using an accelerated stability testing protocol based on the Arrhenius equation. We investigated two kinds of samples: cerebrospinal fluid (CSF) normal pool (from patients without meningitis) and CSF pathological pool (from patients with pyogenic meningitis). Results of the stress protocol indicated that storing both normal and pathological CSF samples at -70 degrees C would maintain sample stability-i.e., retain at least 90% of the original TNF-alpha content-for approximately 5 years. At -20 degrees C and 4 degrees C, the projected stability time at which the same recovery would be obtained was 190 and 90 days, respectively.