RESUMEN
Motor vehicle accidents are a major public health problem in Jamaica, representing the leading cause of death in adolescents and young adults and consuming a large part of the health care budget, as surviving victims usually require surgical intervention and prolonged hospital stays. Patients with mid-third compound tibial fractures present a particularly difficult surgical challenge due to the difficulty in achieving soft-tissue coverage of the bone in this area, hence the need for extended hospitalization in order to prevent infection. We have used a Hemi-Soleus Muscle Flap to achieve coverage of these difficult wounds, thereby eliminating the risk of osteomyelitis, reducing hospital stays and returning patients to productive lives in a much shorter period.
RESUMEN
Naevus sebaceus (NS), also referred to as NS of Jadassohn, is a rare non-melanocytic congenital cutaneous hamartoma with mainly sebaceous differentiation. NS has pluripotent potential with the possible evolution of benign and/or malignant neoplastic transformation. Literature of clinical audit and retrospective analyses conclude that there is no need for prophylactic excision except for cases in which malignant transformation is suspected. Although malignant transformation is rare, there are psychosocial issues with which to contend. We present a case of a 5 year-old girl with a cerebriform mass to her right parietal scalp, which was present at birth.
RESUMEN
Several potent and broadly neutralizing Abs to HIV-1 have been isolated recently from peripheral blood B cells of infected individuals, based on prescreening of Ab activity in the serum. However, little is known regarding the cells that make the Abs that circulate in the blood. Accordingly, we investigated the most likely source, the bone marrow, of chronically HIV-1-infected individuals who were not receiving antiretroviral therapy. Increased frequencies of plasma cells, as well as B cell precursors, namely preB-I and preB-II, and decreased frequencies of mature B cells were observed in bone marrow aspirates of these individuals compared with HIV-negative counterparts. Increased frequencies of bone marrow plasma cells are consistent with known hallmarks of HIV-1 infection, namely hypergammaglobulinemia and increased frequencies of peripheral blood plasmablasts. Levels of HIV-1 envelope (Env)-binding and HIV-1-neutralizing Abs were measured in serum, and corresponding frequencies of Ab-secreting or Env-binding cells were measured in the blood (plasmablasts and memory B cells) and in the bone marrow (plasma cells). A strong correlation was observed between serum HIV-1-specific Abs and Env-specific bone marrow-derived plasma cells, but not circulating plasmablasts or memory B cells. These findings demonstrate that, despite HIV-1-induced phenotypic and functional B cell dysregulation in the peripheral blood and secondary lymphoid tissues, bone marrow plasma cells remain a primary source for circulating HIV-1-specific Abs in HIV-1-infected individuals.
