Treatment of COVID-19 pneumonia with low-dose radiotherapy plus standard of care versus standard of care alone in frail patients : The SEOR-GICOR IPACOVID comparative cohort trial.

PURPOSE: To assess the efficacy of lung low-dose radiotherapy (LD-RT) in the treatment of patients with COVID-19 pneumonia. MATERIALS AND METHODS: Ambispective study with two cohorts to compare treatment with standard of care (SoC) plus a single dose of 0.5 Gy to the whole thorax (experimental prospective cohort) with SoC alone (control retrospective cohort) for patients with COVID-19 pneumonia not candidates for admission to the intensive care unit (ICU) for mechanical ventilation. RESULTS: Fifty patients treated with LD-RT were compared with 50 matched controls. Mean age was 85 years in both groups. An increase in arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (PAFI) in the experimental LD-RT-treated group compared to the control group could not be found at 48 h after LD-RT, which was the primary endpoint of the study. However, PAFI values significantly improved after 1 month (473 vs. 302 mm Hg; p < 0.0001). Pulse oxymetric saturation/fraction of inspired oxygen (SAFI) values were also significantly higher in LD-RT-treated patients than in control patients at 1 week (405 vs. 334 mm Hg; p = 0.0157) and 1 month after LD-RT (462 vs. 326 mm Hg; p < 0.0001). All other timepoint measurements of the respiratory parameters were similar across groups. Patients in the experimental group were discharged from the hospital significantly earlier (23 vs. 31 days; p = 0.047). Fifteen and 26 patients died due to COVID-19 pneumonia in the experimental and control cohorts, respectively (30% vs. 48%; p = 0.1). LD-RT was associated with a decreased odds ratio (OR) for 1­month COVID-19 mortality (OR = 0.302 [0.106-0.859]; p = 0.025) when adjusted for potentially confounding factors. Overall survival was significantly prolonged in the LD-RT group compared to the control group (log-rank p = 0.027). No adverse events related to radiation treatment were observed. CONCLUSION: Treatment of frail patients with COVID-19 pneumonia with SoC plus single-dose LD-RT of 0.5 Gy improved respiratory parameters, reduced the period of hospitalization, decreased the rate of 1­month mortality, and prolonged actuarial overall survival compared to SoC alone.

Quantitative and Topographic Analysis by Immunohistochemical Expression of Ghrelin Gastric Cells in Patients with Morbid Obesity.

PURPOSE: The cellular distribution of ghrelin positive cells is not well defined. The aim of the study is to quantify and determine the distribution of ghrelin cells in gastric mucosa in patients with morbid obesity and relate this finding to gender, comorbidities, gastritis, and plasmatic levels of acyl and desacylghrelin before and after laparoscopic sleeve gastrectomy. PATIENT AND METHODS: We performed a study on 61 patients with BMI≥50 kg/m2 operated by laparoscopic sleeve gastrectomy. Three gastric regions were analyzed by histopathology and immunohistology. Blood sample was taken before surgery, and at 6 and 12 months post-surgery, to study the plasma levels of ghrelin isoforms. RESULTS: Ghrelin cells are present in all regions of the gastric mucosa, with a greater number in the body and the fundus. Difference was found in the antrum between male and female patients (p=0.018). Patients with arterial hypertension also showed a lower level of cells in antrum (p<0.05). Acylghrelin levels after surgery were significantly lower (32.83+5.6 pg/mL to 10.09+11.8 pg/mL, p<0.05). Values of desacylghrelin tended to decrease but no significant variation was observed (207.4+39.3 pg/mL to 188.84+52.3 pg/mL). CONCLUSION: Our patients show ghrelin cells in all areas of the stomach. Gender, comorbidities, and gastritis are determinant on gastric ghrelin-producing cells distribution.

Enfermedad celíaca y el nuevo Coronavirus SARS-CoV-2 / Celiac disease and the novel Coronavirus SARS-CoV-2

To date, it has not been described that celiac disease (CD) increases the risk of contagion by the new coronavirus SARS-CoV-2 nor the severity of the disease. The main risk factors for severe disease for this coronavirus are old male patients (> 65 years) with hypertension, diabetes, obesity, smoking, lung, cardiovascular and kidney diseases. The only treatment for CD is a gluten-free diet that improves the intestinal immune response. Adherence to treatment and follow-up of recommendations by experts during the COVID-19 period, would ensure celiac patients are better prepared for this pandemic.

Hasta la fecha no se ha descrito que la enfermedad celíaca (EC) incremente el riesgo de contagio por el nuevo coronavirus SARS-CoV-2 ni la gravedad de la enfermedad. Los principales factores de riego de enfermedad grave para este coronavirus son pacientes mayores de 65 años de sexo masculino con hipertensión, diabetes, obesidad, tabaquismo, y enfermedades pulmonar, cardiovascular y renal. El único tratamiento de la EC es la dieta libre de gluten que mejora la respuesta inmune intestinal. La adherencia al tratamiento y el seguimiento de recomendaciones dadas por expertos durante el período COVID-19, aseguraría a los enfermos celíacos, estar mejor preparados para esta pandemia.

Evaluation of MR imaging-targeted biopsies of the prostate in biopsy-naïve patients. A single centre study.

PURPOSE: To evaluate the differences in prostate cancer detection rate and biopsy effectiveness between magnetic resonance imaging (MRI) target biopsy (TB) and transperineal standard biopsy (SB) in biopsy-naïve patients. MATERIAL AND METHODS: Between October 2014 and April 2016, 60 men with a mean age of 64.1±6.7 (SD) years (range: 53-82 years) were prospectively enrolled. All patients underwent a prostate MRI study, evaluated by two radiologists, before undergoing the biopsy. A transperineal 12-core SB was carried out before TB, without the information from the MRI. The detection rate for all tumors and for clinically significant tumors (CS) was recorded. Sampling variables such as the proportion of cores positive for CS cancer (PCP-CS) and the maximum cancer core length (MCCL) were also calculated. The ability of MRI to predict the presence of a CS tumor at biopsy was studied using a sector analysis. Patients with negative biopsies were followed during a minimum of 12 months. RESULTS: The detection rate for SB and TB was 53.3% (32/60) and 46.7% (28/60) respectively for all tumors (P=0.289) and 45% (27/60) in both techniques for CS tumors. TB obtained a larger PCP-CS (P<0.001) and MCCL (P=0.018). The sensitivity, specificity, positive predictive value, negative predictive value and cancer prevalence was 83.3%, 92.9%, 83.3%, 92.9% and 30% for peripheral zone sectors and 43.8%, 97.1%, 70.0%, 91.8% and 13,3% for transitional zone sectors. The proportion of patients that showed an increase of PSA faster than 0.75ng/mL/year after a negative biopsy was 26.1%. CONCLUSION: Detection rate of prostate cancer did not show significant differences between a TB and a SB technique in biopsy-naïve patients. However, targeted prostate biopsies demonstrated a better sampling effectiveness thus reducing the cores needed to diagnose clinically significant tumors.

Absceso del psoas como presentación de tuberculosis vertebral: reporte de un caso / Psoas abscess as spinal tuberculosis presentation: case report

Introducción: El absceso del psoas es un cuadro infrecuente cuyo principal agente etiológico es el Staphyloccocus aureus, y que con baja frecuencia puede ser de etiología tuberculosa como complicación de una afección vertebral por Mycobacterium tuberculosis. Presentación del caso: Mujer de 58 años, mapuche, con antecedentes de enfermedad pulmonar obstructiva crónica y alcoholismo crónico, consultó por cuadro de dos meses de evolución de dolor lumbar, baja de peso y paresia de extremidad inferior derecha que impedía la marcha. Tomografía computada (TC) de columna evidenció espondilodiscitis y absceso del psoas derecho, iniciándose tratamiento antibiótico cubriendo Staphyloccocus aureus. Los hemocultivos y los cultivos de la colección resultaron negativos por lo que se decidió mantener tratamiento ambulatorio. Paciente consultó cuatro meses después por exacerbación de su disnea basal de dos semanas de evolución, radiografía de tórax y TC de tórax de alta resolución compatibles con tuberculosis pulmonar con diseminación miliar bilateral, por lo cual, se inició tratamiento antituberculoso, realizándose baciloscopías que resultaron negativas. Además, se solicitó identificación del bacilo de Koch mediante reacción de polimerasa en cadena que resultó positiva, con lo que se confirmó el diagnóstico de tuberculosis miliar y mal de Pott. Se decidió reevaluar con TC de columna una vez finalizado el tratamiento antituberculoso para decidir conducta quirúrgica. Discusión: Es importante la sospecha activa de etiología tuberculosa ante una espondilodiscitis y un absceso del psoas, pese a su baja frecuencia. El inicio del tratamiento en forma precoz puede modificar la progresión de una infección que puede ser invalidante e incluso mortal.

Introduction: The Psoas abscess is an infrecuent condition which main ethiology is the Staphyloccocus aureus and with less frequency can be a vertebral tuberculosis complication caused by Mycobacterium tuberculosis. Case Report: a 58 years old female, Mapuche, with Chronic Obstructive Pulmonar Disease and chronic alcoholism antecedents, was admitted in the emergency room with a two month old lumbar pain, loss of weight and right inferior extremity paresia which didn't allowed her to walk. The column's Computed Tomography (CT) showed spondylodiscitis and a right psoas abscess, the antibiotherapy, covering Staphyloccocus aureus, was started. The hemoculives and abscess' cultives were negative, so it was decided to continue with ambulatory treatment. The patient was admitted four month later because of two weeks of exacerbation of her basal dysnea. The thorax Radiography and high resolution CT were compatibles with pulmonary tuberculosis with bilateral miliar disemination. Antituberculosis treatment was started, bacilloscopies were negative, also, a Polymerase Chain Reaction identification of Koch's bacillus was performed, resulting positive, confirming the diagnosis of miliar tuberculosis and Pott's disease. Once antituberculosis treatment was finished, a new column's CT was requested to decided surgical conduct. Discussion: Is important to actively suspect of tuberculosis ethiology in presence of spondylodiscitis and psoas abscess, despite it's low frequency. The early treatment start may modify the progresion of an infección that can be invalidating and even mortal.

Calidad del sueño y consumo de inhibidores del sueño en estudiantes de medicina / Sleep quality and sleep inhibitors consumption in medical students

Introducción: Los desórdenes del sueño son un problema creciente en las sociedades occi-dentales afectando el rendimiento diurno, tanto en el ámbito académico como laboral. Ade-más en los últimos años, el consumo de inhibidores del sueño por estudiantes universita-rios ha ido en aumento. El objetivo de este estudio es conocer la calidad del sueño en los estudiantes de medicina de Universidad San Sebastián, junto con determinar la prevalencia de trastornos del sueño y consumo de psicoestimulantes en esta población. Material y Métodos: Estudio de corte transversal en 65 estudiantes de medicina de tercer año durante el año 2012. Se midió el índice de calidad del sueño de Pittsburgh, junto con las horas de sueño y la frecuencia consumo de sustancias psicoactivas en el último mes. Resultados: Un 83% de los sujetos fueron definidos como malos dormidores, con disfunción leve del sueño. Un 53,8% de los estudiantes duermen menos de 6 horas diarias en promedio. Se consignó que un 41,5% consumió fármacos psicoestimulantes y/o bebidas energéticas en el último mes y su prevalencia de consumo fue mayor en malos dormidores. Un 64,6% consumió al menos una taza de café diaria, este consumo prevalece más en los malos dormidores que en los buenos dormidores. Un 27,7% de los sujetos refirió consumir al menos un cigarrillo al día. Discusión: Se observó una alta prevalencia de mala calidad del sueño y también en el consumo de psicoestimulantes que podrían afectar el buen dormir, teniendo consecuencias para el desempeño diario y la salud de estos estudiantes.

Introduction: Sleep disorders are an increasing health problem in occidental societies, affecting daytime functioning both the academic area such as labor. The consumption of Sleep inhibitors by university students has increased. The objective is to know about sleep quality in medical students of San Sebastian's University and determine the prevalence of sleep disorders and psychostimulant use in this population. Material and method: Cross-sectional study. Study group: 65 third year medical students 2012 of San Sebastian's University. It was measured Pittsburgh ́s Sleep Quality Index, sleeping hours, psychoactive substances consumption in the last month. Results: 83% of the subjects were defined as poor sleepers, with mild sleep dysfunction. 53.8% of the students sleep less than 6 hours per day on average. 41.5% consumed psychostimulants and/or energy drinks and the consumption prevalence was higher in poor sleepers. 64.6% consumed at least one cup of coffee a day, consumption is more prevalent in poor sleepers than in good sleepers. 27.7% of subjects reported consuming at least one cigarette a day. Discussion: A very high prevalence of poor sleep quality and consumption of psychoestimulants was observed, this could affect the sleep quality, having consequences for daily performance and health of these students.

Utilidad de la biopsia guiada cognitivamente por resonancia magnética multiparamétrica para diagnosticar la lesión dominante del cáncer de próstata / Usefulness of cognitive targeting in multiparametric MRI-guided biopsy to diagnose the dominant lesion in prostate cancer

Objetivo. Evaluar la seguridad y eficacia de la biopsia guiada cognitivamente (BGC) con la resonancia magnética multiparamétrica (RMmp) para obtener muestras del nódulo dominante del cáncer de próstata. Material y métodos. Realizamos una BGC en 53 pacientes por elevación progresiva del PSA tras hacer una RMmp. Todos los pacientes firmaron el consentimiento informado. Las biopsias se realizaron por vía transperineal con control ecográfico. Las 3 primeras muestras se obtuvieron de la lesión diana determinada por la RMmp, utilizando criterios PIRADS (corresponden a las BGC). Posteriormente se obtuvieron 9 cilindros del resto de los segmentos de la próstata (biopsias sistemáticas). El anatomopatólogo valoró los 12 cilindros sin saber cuáles correspondían a las BGC y cuáles a las biopsias sistemáticas. Definimos como lesión dominante la de mayor valor Gleason y volumen tumoral en lesiones multifocales y a la única lesión detectada en tumores unifocales. Resultados. Diagnosticamos 29 tumores de próstata. En el 89,7% (26/29), el nódulo dominante fue diagnosticado por las BGC. De haber realizado únicamente las BGC no se hubieran diagnosticado 2 pacientes (3,8%, 2/53) y se hubiera infraestadificado solo uno (1,8%, 1/53) en el que no se obtuvo muestra de la lesión con mayor valor Gleason. La tasa de positividad de la BGC fue del 50,9% (27/53), y en los pacientes con biopsias previas negativas del 46,3% (19/41). No observamos complicaciones significativas inmediatas ni tardías. Conclusión. La BGC es una técnica segura y eficaz para detectar la lesión dominante del cáncer de próstata (AU)

Objective. To evaluate the safety and efficacy of cognitive targeting in multiparametric MRI-guided biopsy to obtain samples of the dominant nodule in prostate cancer. Material and methods. We performed cognitive-targeted biopsy after multiparametric MRI in 53 patients with progressive elevation of PSA. All patients provided written informed consent. Biopsies were done via a transperineal route under ultrasound guidance. The first three samples were obtained by cognitive targeting, with the target lesion determined by multiparametric MRI according to the PI-RADS (prostate imaging, reporting, and data system) criteria. Then 9 cylinders were obtained from the remaining segments of the prostate (systematic biopsies). The pathologist evaluated the 12 cylinders without knowing which ones were obtained by cognitive targeting. In patients with multifocal lesions, we defined the dominant lesion as the one with the highest Gleason score and tumor volume; in patients with unifocal lesions, we defined the dominant lesion as the lesion identified. Results. We diagnosed 29 prostate tumors. In 89.7% (26/29), the dominant nodule was diagnosed by the cognitive-targeted biopsy. If only cognitive-targeted biopsy had been done, the dominant nodule would not have been diagnosed in two (3.8%, 2/53) patients and only one (1.8%, 1/53) patient, in whom no sample was obtained from the lesion with the highest Gleason score, would have been understaged. The rate of positivity of cognitive-targeted biopsy was 50.9% (27/53) in the entire group of patients and 46.3% (19/41) in the group of patients with previous negative biopsies. No significant immediate or late complications were observed. Conclusion. Cognitive targeting is safe and efficacious for detecting the dominant lesion in prostate cancer (AU)

Usefulness of cognitive targeting in multiparametric MRI-guided biopsy to diagnose the dominant lesion in prostate cancer.

OBJECTIVE: To evaluate the safety and efficacy of cognitive targeting in multiparametric MRI-guided biopsy to obtain samples of the dominant nodule in prostate cancer. MATERIAL AND METHODS: We performed cognitive-targeted biopsy after multiparametric MRI in 53 patients with progressive elevation of PSA. All patients provided written informed consent. Biopsies were done via a transperineal route under ultrasound guidance. The first three samples were obtained by cognitive targeting, with the target lesion determined by multiparametric MRI according to the PI-RADS (prostate imaging, reporting, and data system) criteria. Then 9 cylinders were obtained from the remaining segments of the prostate (systematic biopsies). The pathologist evaluated the 12 cylinders without knowing which ones were obtained by cognitive targeting. In patients with multifocal lesions, we defined the dominant lesion as the one with the highest Gleason score and tumor volume; in patients with unifocal lesions, we defined the dominant lesion as the lesion identified. RESULTS: We diagnosed 29 prostate tumors. In 89.7% (26/29), the dominant nodule was diagnosed by the cognitive-targeted biopsy. If only cognitive-targeted biopsy had been done, the dominant nodule would not have been diagnosed in two (3.8%, 2/53) patients and only one (1.8%, 1/53) patient, in whom no sample was obtained from the lesion with the highest Gleason score, would have been understaged. The rate of positivity of cognitive-targeted biopsy was 50.9% (27/53) in the entire group of patients and 46.3% (19/41) in the group of patients with previous negative biopsies. No significant immediate or late complications were observed. CONCLUSION: Cognitive targeting is safe and efficacious for detecting the dominant lesion in prostate cancer.

Carcinoma renal con translocación XP11.2: informe de un caso con énfasis en los diagnósticos diferenciales / Renal carcinoma with translocation XP11.2: a case report with emphases in differential diagnostic

En adultos el carcinoma de células renales con translocación Xp11.2 es una neoplasia poco frecuente representando menos del 1% de todas las neoplasias renales. Analizar las características morfológicas de un carcinoma con translocación Xp11.2 y establecer los posibles diagnósticos diferenciales de este tumor renal. Paciente femenina de 45 años de edad, quien en mayo de 2008 acudió a emergencia por dolor en flanco izquierdo. Un ecosonograma abdominal evidenció litiasis renal izquierda y lesión sólida en polo inferior, la cual fue confirmada por tomografía abdominal. Se realizó nefrectomía laparoscópica izquierda, sin complicaciones. El espécimen quirúrgico fue enviado al departamento de patología fijado en formol tamponado al 10% y procesado para histología e inmunohistoquímica. Macroscópicamente, se evidenció en el polo inferior renal una lesión tumoral de 45 mm x 40 mm x 35 mm, amarillenta-anaranjada, con áreas de necrosis. Las secciones histopatológicas mostraron una lesión epitelial con patrón predominante papilar. Las células tumorales mostraban bordes citoplasmáticos discretos, con citoplasma eosinófilo granular y zonas vacuoladas. Se evidenció variabilidad de la forma y contorno nuclear. La inmunohistoquímica mostró reactividad nuclear para el TFE3. La correcta clasificación de estos carcinomas es importante por los factores pronósticos y predictivos, ya que estas neoplasias pueden ser sensibles a agentes quimioterapéuticos que afectan los micro túbulos.

In adult life, the kidney carcinomas associated with Xp11.2 translocations are an infrequent neoplasia representing less than the 1% of all kidneys neoplasias. To analyze the morphologic characteristics of a carcinoma with Xp11.2 translocation and to establish the probable differential diagnostics of this kidney tumour. A 45 years-old female patient, who at May 2008 was admitted to emergency by left flank pain. An abdominal ultrasound showed a left renal lithiasis and a solid lesion at the inferior pole, which was confirmed by the abdominal tomography. A left laparoscopic nephrectomy was performed without complications. The surgical specimen was send to the pathology department in 10% buffered formalin and processed to histology and immunohistochemestry. Macroscopically was observed at the inferior kidney pole a yellow orange tumor lesion with necrosis and 45 mm x 40 mm x 35 mm in size. The histopathologic sections showed an epithelial lesion with papillary pattern. The tumour cells showed discrete cytoplasmatic borders, with granular eosinophil to vacuolated appearance. Nuclei showed variability in form and size. The immunohistochemical study showed a nuclear positivity to TFE3. The correct classification of these carcinomas is important due to the prognostic and the predictive factors, since these neoplasias could be sensible to the chemotherapeutics agents that affect the micro tubules.

Poniendo al día la enfermedad celíaca / Celiac disease: up to date

El conocimiento en Enfermedad Celíaca (EC) ha mejorado sustancialmente en las últimas décadas, cambiando muchos de los conceptos históricamente aceptados sobre este tema. Las novedades se están incorporando lentamente a algunos sectores de nuestro país, a pesar de que gozamos de una situación de privilegio en comparación a otros países, contando con un Servicio Nacional de Salud formado por profesionales y que mantiene alta cobertura de la población. Es urgente mejorar las capacidades del equipo de salud en el tema de enfermedad celíaca; aun existe un sub diagnóstico importante, con pacientes en los que el diagnóstico no se buscó activamente, a menudo no se siguieron los criterios actualmente aceptados para llegar a él, el tratamiento está mal indicado y finalmente, el paciente es mal manejado. En este artículo revisamos qué entendemos hoy por EC, cómo ha cambiado la epidemiología debido a la mejor capacidad de búsqueda, en qué consisten las presentaciones clínicas típicas y atípicas, cómo hacer el diagnóstico, cuándo indicar dieta sin gluten y los requerimientos que hay para mantener un adecuado seguimiento.

Knowledge on celiac disease has greatly improved in the last decades, changing many of the concepts historically accepted. New developments are being incorporated rather slowly in some areas in our country, despite the existence of a National Health Service formed by professionally trained people that covers a large proportion of the population. It is urgent to update the capacities of our professionals on celiac disease; under diagnosis is still prevalent, cases are not actively searched for, diagnosis often does not follow current accepted criteria, treatment is inadequately indicated and as a result the patient is poorly managed. In this paper we review what we understand by celiac disease today, how epidemiology has changed derived from the new screening methods, what are the typical and atypical clinical presentations, how we reach diagnosis, when to indicate gluten free diet and the requirements to maintain a adequate follow up.

Linfangioma mesentérico multiquístico como causa de vólvulo intestinal / Mesenteric lymphangioma causing volvulus: report of one case

Lymphangiomas are rare benign lesions, most commonly seen in children and adolescents. Their intra-abdominal presentation is uncommon. We report a 19 years old male, presenting to the emergency room with abdominal pain associated with fever, vomiting and abdominal distension. There was a history of multiple previous consultations for abdominal pain. A plain abdominal X-ray examination suggested a bowel obstruction. At surgery a volvulus and dilation of the small bowel in relation to a vascular malformation was found, excising 40 cm of jejunum with an end-to-end intestinal anastomosis. The pathology report showed a Mesenteric Multicystic Lymphangioma. Presently, the patient is in good conditions.

Los linfangiomas son lesiones benignas, de baja incidencia, más comunes en niños y adolescentes. Con muy baja frecuencia son intraabdominales y poseen presentación clínica variable, yendo desde el hallazgo clínico hasta pacientes con riesgo vital por abdomen agudo. Presentamos el caso de un paciente de 19 años, sin antecedentes mórbidos que acude a urgencias por dolor abdominal asociado a fiebre, vómitos y distensión abdominal; la radiografía simple es sugerente de obstrucción intestinal. En laparotomía exploradora se encuentra un vólvulo y dilatación del intestino delgado en relación a una malformación vascular y lesiones multilobuladas en mesenterio. Se resecan 40 cm de yeyuno y realiza anastomosis término-terminal. La histología reveló un Linfangioma Multiquístico Mesentérico. El paciente evoluciona en buenas condiciones generales y se mantiene control clínico e imagenológico seriado. Aunque infrecuente, es uno de los diagnósticos diferenciales de abdomen agudo. A pesar de su naturaleza benigna puede llegar a comprometer el pronóstico vital del paciente.

Estudio inmunohistoquímico del carcinoma de glándula mamaria: en el Hospital Vargas de Caracas / Immunohistochemical study of mammary gland carcinoma: in Hospital Vargas de Caracas

Estudiar la asociación entre diferentes elementos morfológicos con aspectos inmunohistoquímicos y su posible utilidad pronóstica. Estudio descriptivo-retrospectivo, de 651 casos de carcinoma mamario con marcaje inmunohistoquímico en el Hospital Vargas de Caracas desde mayo 2001 a julio 2004. Se analizaron características morfológicas de los diferentes tipos tumorales, aplicando la clasificación de Scarff-Bloom-Richardson modificada, relacionándolos con la expresión de diferentes marcadores inmunohistoquímicos: receptores de estrógeno, receptores de progesterona, c-erbB-2 y Ki-67, realizados mediante la técnica de biotina-estreptavidina. La edad promedio fue 51,72 años. El tumor más frecuente fue el carcinoma ductal infiltrante (88,7 por ciento), seguido del carcinoma lobulillar infiltrante (4,6 por ciento). El 5,5 por ciento de los carcinomas ductales eran bien diferenciados, 42,3 por ciento moderadamente diferenciados, 52,2 por ciento poco diferenciados; de estos, el 77 por ciento tenían receptores de estrógeno y de progesterona ≤ 10 por ciento; los carcinomas bien diferenciados mostraron positividad variable. Los tumores poco diferenciados presentaron c-erbB-2 positivo en 51,36 por ciento, entre los bien diferenciados el 81,84 por ciento fueron negativos, el carcinoma intraductal fue positivo en un 42,86 por ciento, generalmente asociado a comedocarcinoma. El 94,37 por ciento de los tumores poco diferenciados fueron Ki-67 positivos. El carcinoma ductal infiltrante de tipo clásico es el tumor maligno más frecuente de la glándula mamaria, con una edad promedio de 51,5 años, generalmente es poco diferenciado, implicando posiblemente tumores con conducta biológica agresiva. Esto se evidencia por la negatividad para receptores hormonales y la expresión aumentada de c-erbB-2 y Ki-67.

To study and assess the association between different morfhological and pathologic features and immunohistochemistry as a prognostic factor. A retrospective-descriptive study of 651 cases of breast cancer by immunohistochemistry markers was analyzed in the Vargas Hospital of Caracas since may 2001 until july 2004. We evaluate the pathologic features of the different tumor subtypes, and relation this with the expression of immunohistochemistry markers: the estrogen receptor, progesterone receptor, c-erbB-2 and Ki-67, made by the biotin-streptavidin technique. The median patient age was 51.72 years. The most frequent type of tumor was the invasive duct carcinoma (88.7 %), follow by the invasive lobular carcinoma (4.6 %). The 5.5 % of the duct carcinomas were well differentiated tumors, 42.3 % moderate differentiated, and 52.2 % poorly differentiated; in which 77 % had estrogen receptor and progesterone receptor ≤ 10 %, well differentiated tumors show a variable positivity. The poorly differentiated tumors show positive c-erbB-2 in 51.36 %, in the well-differentiated group 81.84 % were negative; the c-erbB-2 on intraductal carcinoma was positive in 42.86 %, generally associated with the comedocarcinoma; the 94.7 % of the poorly differentiated tumors were Ki-67 positives. Classic invasive duct carcinoma is the most frequent malignant tumor, with a median age of 51.5 years, and the poorly differentiated tumors generally show an aggressive biologic conduct, associated to patients with estrogen receptors and progesterone receptors negative tumors and a high expression of the c-erbB-2 y Ki-67.

Carcinoma urotelial primario de uretrabulbo membranosa. Estudio histológico e inmunohistoquímico de un caso / Primary urothelial carcinoma of the bulbar-membranous urethra: case report with histological and immunohistochemical studies

OBJETIVO: Describir el caso de un carcinoma urotelial primario de uretra bulbomembranosa, haciendo especial énfasis en los hallazgos histopatológicos e inmunohistoquímicos. MÉTODO/RESULTADOS: Paciente masculino de 63 años de edad, con síntomas de obstrucción urinaria. Se le practicó falectomía radical, evidenciándose tumor de 4,5 x 4 cm ubicado en la uretra bulbomembranosa. El diagnóstico patológico fue de carcinoma urotelial, con expresión de citoqueratina AE1/AE3, citoqueratina 7, antígeno carcinoembrionario y antígeno de membrana epitelial. El paciente recibió radioterapia y quimioterapia adyuvante, encontrándose libre de enfermedad. CONCLUSIONES: Los carcinomas uroteliales de la uretra posterior masculina son neoplasias poco frecuentes, presentándose generalmente de forma similar a lesiones benignas uretrales. Generalmente, su diagnóstico se realiza cuando la lesión se encuentra en estados avanzados lo cual limita la respuesta terapéutica (AU)

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Intususcepción colocolónica por pólipo / Colonic intussusception by polyp

Presentamos caso clínico, en el que hubo desarrollo de intususcepción de ángulo esplénico de colon, en cuya génesis participó un pólipo colónico gigante, de tipo hiperplástico y que clínicamente se manifestó como obstrucción intestinal. La intusescepción intestinal en el adulto es un cuadro altamente infrecuente, aún más si la localización es colocolónica, siendo realizado el diagnóstico con mayor frecuencia en el intraoperatorio. En este caso, a pesar de contar con los exámenes de elección en que podría haberse identificado el mecanismo de la obstrucción intestinal, el paciente fue intervenido sin ser sospechada la intusescepción

Variables nutricionales en enfermos dializados / Nutritional variables in dialized patients

El enfermo hemodializado sufre constantemente variaciones de peso interdiálisis con desequilibrios orgánicos. El objetivo de esta investigación fue identificar las variables explicativas de las fluctuaciones de peso, siendo la ingesta de sodio, agua y calorías, la hipótesis de tal fenómeno, lo que se estudió en un grupo de pacientes hemodializados. Aplicando encuestas alimentarias, se evaluó el estado nutricional antropométrica y bioquímicamente. Además, se analizó el nivel de diureris, las patologías asociadas, el uso de diuréticos y el tiempo de la sesión de diálisis. Se obtuvieron resultados a nivel global e individual del grupo estudiado. En el primer caso las ingestas de sodio, agua y calorías explicaron las variaciones de peso. Individualmente, son más importantes la variables características de cada paciente y que en la investigación están representadas por los errores estadísticos. Esto permite concluir que para los pacientes estudiados en el tratamiento de hemodiálisis debe dársele mucha importancia a las características individuales de cada paciente

[Morphometric analysis of nuclear variations in normal and neoplastic mammary ductal cells]. / Análisis morfométrico de variables en núcleos de células ductales normales y neoplásicas de la glándula mamaria. Informe preliminar.

Morphometry is a method to detect changes in a variety of tissues through quantitative elements. The purpose of this study was to examine several nuclear morphologic characteristics in normal and neoplastic mammary ductal cells using a multivariable method and expression of estrogen receptors by immunohistochemical techniques. A total of 1879 nuclei were examined by a computerized program, following the detection of estrogen receptors. Nuclear area, perimeter, diameter, maximal and minimal radio were obtained in 439 normal ductal nuclei. The mean nuclear area was 14.45 with a range between 10.88 and 17.90. Variables showed adequate statistical correlation (r > 0.5). A total of 1440 neoplastic nuclei were classified as grades I, II and III, and a statistical significative difference was found between these three groups. We conclude that the nuclear area is a reliable variable for statistical correlation being the ductal nuclei anisotropic objects.

[Ultrastructural aspects of lesions caused by Mycobacterium spp in AIDS]. / Aspectos ultraestructurales de las lesiones producidas por Mycobacterium spp en el SIDA.

Samples from necrotizing lesions in eight autopsy cases of AIDS were examined with transmission electron microscopy. They were selected among 35 autopsies of Mycobacterium spp infection and AIDS, and were part of a series of 230 autopsy cases of AIDS performed from 1984 to 1995 in the Anatomopathologic Institute at Central University of Venezuela. Ultrastructural aspects of micobacteriae, their relationship with macrophages and tissue alterations are discussed and related to the immune defcit observed in AIDS patients.

[An ultrastructural evaluation of Pneumocystis carinii]. / Evaluación ultraestructural del Pneumocystis carinii.

The pneumocystis carinii (PNC) is a challenge, because its taxonomy has not been completely explained. PNC seems to be a chimera with fungal and parasitic characteristics. The objective of the present study is to analyze the different stages observed in PNC using transmission electron microscopy in order to correlate them with bibliographic reports regarding a possible taxonomic classification. The trophic stage was the form most frequently encountered in alveolar spaces and their organisms varying in size and shape from 6 to 20 microns. Cyst were round or oval, with diameters ranging between 4 and 12 microns, showing four intracystic bodies were individually limited by a membrane. Connections between the membrane of intracystic bodies and junctions between them and the inner cell membrane of the cyst wall were also observed. Our ultrastructural findings appear to be in agreement with several reports which considered PNC among the fungi, most likely related them to the non-gemating Ascomycetes.

[Importance of transmission electron microscopy in the diagnosis of a Venezuelan equine encephalitis outbreak in 1995 in the Venezuelan Guajira]. / Importancia de la microscopía electrónica de transmisión en el diagnóstico de la epidemia de encefalitis equina venezolana de 1995 en la Guajira Venezolana.

Transmission electron microscopy of the brain in 25 newborn mice was performed. Mice were intracerebrally inoculated with cultured VERO cells infected with VEE to be used as positive control, with samples of serum of cerebrospinal fluid from patients with clinical symptoms and signs of encephalitis, with serum from healthy patients or with serum from sick equines. Borate bovine albumin serum was also inoculated in some mice to be used as negative control. All samples were obtained during the epizootic and epidemic outbreak in the Venezuelan Guajira area, northern of Zulia State during October 1995. The ultrastructural study was blindly performed, however the presence of Togavirus particles were detected in 100% of the virologically positive cases. The usefulness, accuracy and speed of the employed methodology is stressed.

[Pulmonary alveolar proteinosis: ultrastructural study of 4 cases]. / Proteinosis alveolar pulmonar: estudio ultraestructural de cuatro casos.

Pulmonary Alveolar Proteinosis (PAP) is a rare and diffuse lung disease characterized by the abnormal deposition of PAS positive, lipoproteinaceous material in the alveolar spaces. It has been related, mainly, to alterations in the immune state and to secondary infections. We studied four cases of PAP diagnosed by light microscopy. In two cases we were able to demonstrate disseminated Histoplasmosis related to immunodeficiency states (AIDS and malnutrition), one case with Pneumocystis carinii infection and AIDS, and one case with no related pathology. Granular and electron dense material, concentric myelin figures, and variable-sized osmiophilic bodies were observed by electron microscopy. We found yeast-like structures, trophozoites and cysts in the alveolar spaces, in the Histoplasmosis and Pneumocystic carinii infection cases, respectively. In one of our cases, the circulating neutrophils showed crystalloid inclusions in the nucleus. PAP should be considered in the differential diagnoses of patients with pulmonary infiltrates.