Correction to: A practical algorithmic approach to mature aggressive B cell lymphoma diagnosis in the double/triple hit era: selecting cases, matching clinical benefit.

The first and family names of the authors were interchanged and are now presented correctly. The original article has been corrected.

A practical algorithmic approach to mature aggressive B cell lymphoma diagnosis in the double/triple hit era: selecting cases, matching clinical benefit : A position paper from the Italian Group of Haematopathology (G.I.E.).

An accurate diagnosis of clinically distinct subgroups of aggressive mature B cell lymphomas is crucial for the choice of proper treatment. Presently, precise recognition of these disorders relies on the combination of morphological, immunophenotypical, and cytogenetic/molecular features. The diagnostic workup in such situations implies the application of costly and time-consuming analyses, which are not always required, since an intensified treatment option is reasonably reserved to fit patients. The Italian Group of Haematopathology proposes herein a practical algorithm for the diagnosis of aggressive mature B cell lymphomas based on a stepwise approach, aimed to select cases deserving molecular analysis, in order to optimize time and resources still assuring the optimal management for any patient.

El Sistema de Salud de la ciudad de Buenos Aires en el siglo xix en relación a las enfermedades de transmisión sexual / THE HEALTH SYSTEM IN THE CITY OF BUENOS AIRES DURING THE XIXth CENTURY, RELATED TO THE DISEASES OF SEXUAL TRANSMISSION

The health system of the City of Buenos Aires during the XIX century, related to the diseases of sexual transmission, is presented. The "General Hospital for Acute Diseases Dr. Juan A. Fernandez" of universitary character with a well gained prestige in his influencial zone, accumulates the highest technology in this programmatic area, and is today related with the great epidemic disease of sexual transmission from the XXth. Century: AIDS. Not always is well known the fact that, more than a century ago, this Institution was created to confront also to an epidemic of sexual transmission: syphilis. Is then purpose of this revision to introduce to the reader in the behavioral situation at the time of its foundation, the sanitary problems that conducted to its creation and the history of his former years, all of that related to the evolution of the sexually transmitted diseases at the endings of the XIX century.

Open partial horizontal laryngectomies: a proposal for classification by the working committee on nomenclature of the European Laryngological Society.

We present herein the proposal of the European Laryngological Society working committee on nomenclature for a systematic classification of open partial horizontal laryngectomies (OPHL). This is based on the cranio-caudal extent of laryngeal structures resected, instead of a number of different and heterogeneous variables present in existing nomenclatures, usually referring to eponyms, types of pexy, or inferior limit of resection. According to the proposed classification system, we have defined three types of OPHLs: Type I (formerly defined horizontal supraglottic laryngectomy), Type II (previously called supracricoid laryngectomy), and Type III (also named supratracheal laryngectomy). Use of suffixes "a" and "b" in Type II and III OPHLs reflects sparing or not of the suprahyoid epiglottis. Various extensions to one arytenoid, base of tongue, piriform sinus, and crico-arytenoid unit are indicated by abbreviations (ARY, BOT, PIR, and CAU, respectively). Our proposal is not intended to give a comprehensive algorithm of application of different OPHLs to specific clinical situations, but to serve as the basis for obtaining a common language among the head and neck surgical community. We therefore intend to present this classification system as a simple and intuitive teaching instrument, and a tool to be able to compare surgical series with each other and with non-surgical data.

Primary cutaneous diffuse large B-cell lymphoma (PCDLBCL), leg-type and other: an update on morphology and treatment.

Primary cutaneous B-cell lymphoma (PCBCL) is an heterogeneous group of lymphoproliferative disorders, which account for 25-30% of all primary cutaneous lymphoma and include three main histotypes: 1) primary cutaneous marginal zone B-cell lymphoma (PCMZL); 2) primary cutaneous follicular center cell lymphoma (PCFCL); 3) primary cutaneous diffuse large B-cell lymphoma (DLBCL), leg type (PCDLBCL-LT). PCMZL and PCFCL are indolent lymphomas, with an excellent prognosis despite an high rate of cutaneous recurrences; in contrast, PCDLBCL-LT is clinically more aggressive and usually requires to be treated with multi-agent chemotherapy and anti-CD20 monoclonal antibodies. PCDLBCL-LT histologically consists of large round cells (centroblasts and immunoblasts), is characterized by strong bcl-2 expression, in the absence of t(14;18) translocation, and resembles the activated B-cell type of nodal DLBCL. Recently, the term primary cutaneous DLBCL-other (PCDLBCL-O) has been proposed to include diffuse lymphomas composed of large transformed B-cells that lack the typical features of PCDLBCL-LT and do not conform to the definition of PCFCL. Some clinical studies suggested that such cases have an indolent clinical course and may be treated in a conservative manner; however, data regarding the actual prognosis and clinical behaviour of these peculiar cases are still too limited. The spectrum of primary cutaneous DLBCL also encompasses some rare morphological variants, such as anaplastic or plasmablastic subtypes and T-cell rich B-cell lymphoma, and some recently described, exceedingly rare DLBCL subtypes, such as intravascular large B-cell lymphoma and EBV-associated large B-cell lymphoma of the elderly, which often present in the skin.

Dysregulation of global microRNA expression in splenic marginal zone lymphoma and influence of chronic hepatitis C virus infection.

The precise molecular pathogenesis of splenic marginal zone lymphoma (SMZL) is still unknown. Clinical and epidemiological data suggest that chronic hepatitis C virus (HCV) infection may have an etiological role in a subset of cases.We performed a large-scale microRNA (miRNA) expression profiling analysis of 381 miRNAs by quantitative reverse transcription PCR (Q-RT-PCR) of 26 microdissected splenic tissue samples (7 HCV(+) SMZL; 8 HCV(-) SMZL and 11 non-neoplastic splenic controls). Single assay Q-RT-PCR and miRNA in situ hybridization (miRNA-ISH) were used to confirm the results in an independent cohort. Unsupervised hierarchical clustering of miRNA expression profiles demonstrated a distinct signature of SMZL compared with the normal splenic marginal zone. Supervised analysis revealed differentially expressed miRNAs, including miRNAs with previously recognized tumor suppressive or oncogenic potential. Five miRNAs were found significantly overexpressed in SMZL, including miR-21, miR-155 and miR-146a, whereas seven miRNAs showed significantly reduced expression, including miR-139, miR-345, miR-125a and miR-126. Furthermore, we identified miR-26b, a miRNA known to have tumor suppressive properties, as significantly downregulated in SMZL arising in HCV-positive patients (P=0.0016). In conclusion, there is a characteristic dysregulation of miRNA expression in SMZL with a possible implication in its molecular tumorigenesis.

Subtotal laryngectomy: outcomes of 469 patients and proposal of a comprehensive and simplified classification of surgical procedures.

Long-term oncological and functional results from a retrospective study on 469 patients over a 10-year period of subtotal laryngectomies (SL), 399 supracricoid partial laryngectomies (SCL) and 70 supratracheal partial laryngectomies (STL) are presented. The mean follow-up time was 97 months (range 60­165 months). Acute complications, types and rates of late sequelae, functional results, 2-year post-operative scores of laryngeal function and quality of life are reported. The observed long-term results were: SCL, 5-year overall and disease-free survival: 95.6, and 90.9%, respectively; 2-year post-operative laryngeal function preservation: 95.7%; STL, 5-year overall and disease-free survival: 80 and 72.9%, respectively; 2-year post-operative laryngeal function preservation: 80%. The performance status scale for laryngeal function preservation showed very high 2-year scores, with no significant differences depending on the type and extent of surgery. The adopted type of function-sparing surgery provided overall and disease-free survival rates that were somewhat better than those reported in studies based on organ-sparing protocols with chemoradiotherapy. The rate of total laryngectomy of completion in this series was 4.4%. A new classification of the current horizontal partial laryngectomies is also proposed, namely "Horizontal Laryngectomy System" (HOLS), based on the extent of surgical removal of laryngeal structures.

Análisis epidemiológico y gestión sanitaria de la epidemia de gripe A H1N1: experiencia en la ciudad de Buenos Aires (invierno de 2009) / Epidemiological analysis and sanitary management of the influenza a H1N1: experience in the city of Buenos Aires (outbreak in winter 2009)

Las pandemias de influenza son eventos impredecibles pero recurrentes, que suponen consecuencias gravosas para las sociedades en todo el mundo. Desde el siglo XV y XVI, con el famoso sudor anglicus, se han descrito pandemias de influenza con intervalos más o menos regulares, entre 10 y 50 años, cuya gravedad y repercusiones han sido variables destacándose en el siglo XX la "gripe española" de 1918/1919, probablemente una de las mayores y más mortíferas pandemias de la historia humana, la influenza asiática entre 1957/1958 y la de Hong Kong entre 1968/1969. En 2003 surgió preocupación mundial ante una posible pandemia de influenza aviar (H5N1) que era sindicada como la gran favorita para un próximo evento de este tipo; no obstante nunca llegó a sortear la imposibilidd de propagarse de humano a humano. En abril de 2009, la OMS (WHO) comenzó a recibir reportes de personas con un nuevo tipo de virus de influenza A (H1N1) en México y EE.UU. La rápida diseminación internacional ulterior llevó a la propia OMS a declarar el 11 de junio de 2009 la primera pandemia de influenza en 41 años. En Argentina y luego del llamado inicial de alerta de Ministerio de Salud de la Nación, el Gobierno de la Ciudad de Buenos Aires inició procesos destinados al reporte, detección y vigilancia epidemiológica de los casos locales. A principios del mes de mayo se difundieron las noticias de los primeros casos de Gripe A confirmados en el país y el 30 de junio se decretó la emergencia sanitaria en la ciudad profundizándose un proceso de análisis sobre las medidas a tomar. Las acciones específicas tomadas por el GCBA y su MSAL pueden agruparse en acciones sobre el sistema de salud y sus efectores y acciones de estrategia comunicacional. Se concluye de este episodio pandémico que la Gripe A desplazó a la gripe estacional siendo la circulación viral en adultos mayormente virus A H1N1...

Influenza pandemics are unpredictable but recurrent events, involving serious consequences for societies worldwide. From the fifteenth and sixteenth century, with the famous anglicus sweat, there have been described pandemics of influenza within more or less regular intervals, between 10 and 50 years, whose severity and impact has been variale, emphasizing in the twentieth century the "Spanish flu" of 1918/1919, probably one of the largest and most dedly pandemics in human history, between 1957/1958 the Asian flu and the Hong Kong flu from 1968 to 1969. In 2003, concern arose about a possible global pandemic of avian influenza (H5N1), which was syndicated as the most probable cause for an upcoming event of this king, yet it never get around the inability to spread from human to human. In April 2009, WHO began to receive reports of Mexico and the U.S. The rapid internatinal spread further les WHO to declare on June 11 th 2009 the first influenza pandemic in 41 years. In Argentina and after the initial warning call of the Ministry of Health of the Nation, the Government of the City of Buenos Aires initiated processes for the reporting, detection and epidemilogical surveillance of local cases. In early May, the news spread of the first confirmed cases of influenza A in the country and on June 30 was declared a health emergency in the city getting stronger a process of discussion of measures to take. The specific actions taken by the GCBA and The Ministry of Health can be grouped into action on the health system and its effectors, and communications strategies and activities. We conclude from this episode of pandemic Influenza that the A virus H1N1 has replace the seasonal flu virus, because influenza virus circulation among adults was mostly H1N1 virus, that in spite of the fact of being getting trough a pandemic episode, the overall death rate was lower of that of the seasonal flu...

Subcutaneous 'lipoma-like' B-cell lymphoma associated with HCV infection: a new presentation of primary extranodal marginal zone B-cell lymphoma of MALT.

BACKGROUND: Hepatitis C virus (HCV) infection has been linked to lymphoproliferative disorders. Marginal zone B-cell lymphoma (MZL) represents one of the most frequent lymphoma subtypes associated with HCV infection. We describe an unusual subset of HCV-associated MZL characterized by subcutaneous presentation. MATERIALS AND METHODS: A series of 12 HCV-positive patients presenting with subcutaneous nodules that revealed lymphoma infiltration at biopsy. Molecular analysis of immunoglobulin heavy chain (IGH) gene rearrangement and FISH investigations for t(11;18)(q21;q21) and t(14;18)(q32;q21) were carried out in nine patients. RESULTS: The 12 patients (median age 69.5 years), all with positive HCV serology, presented with single or multiple subcutaneous nodules resembling lipomas. Histologically the lesions showed lymphoid infiltrates, consistent with extranodal MZL of mucosa-associated lymphoid tissue (MALT). Functional IGH gene rearrangements were identified in nine tested patients, with somatic mutations in 82%, indicating a histogenesis from germinal center-experienced B cells. The t(11;18) was found in two of nine cases. Staging did not show any other lymphoma localization. In two patients, a response was achieved with antiviral treatment. Extracutaneous spread to MALT sites occurred in a case. CONCLUSIONS: Our observations expand the spectrum of HCV-associated lymphomas to include a subset of extranodal MZL characterized by a novel primary 'lipoma-like' subcutaneous presentation and indolent clinical course.

Bone marrow histology in marginal zone B-cell lymphomas: correlation with clinical parameters and flow cytometry in 120 patients.

BACKGROUND: Among marginal zone lymphomas (MZLs), bone marrow (BM) involvement features are well established in the splenic marginal zone lymphoma (SMZL); few data are available for extranodal marginal zone lymphoma (EMZL) and nodal marginal zone lymphoma (NMZL). PATIENTS AND METHODS: Incidence and patterns of histologic BM involvement are studied in 120 MZL patients (48 SMZL, 59 EMZL, 13 NMZL) at onset and during follow-up; relationships between clinical features, BM histology and flow cytometry (FC) are analyzed. RESULTS: At diagnosis, BM involvement occurs in 90% SMZL, 22% EMZL and 54% NMZL (P<0.0001); at reevaluation, incidence raises to 96% in SMZL and 34% in EMZL. Concordance between histology and FC is found in 87% of cases; most discordant cases have positive histology but negative FC. SMZL and EMZL show a nodular BM infiltration; the interstitial pattern is frequent in NMZL (P<0.0001); sinusoidal localization is typical of SMZL, frequent in NMZL and occasional in EMZL (P=0.0001). Stage, leukemic disease, B symptoms, more than one extranodal involved site, splenomegaly, elevated beta2-microglobulin, serum monoclonal component, International Prognostic Index (IPI) and age-adjusted IPI are directly related to BM infiltration. CONCLUSIONS: The different prevalence of BM involvement in MZL subtypes reflects their heterogeneous dissemination modalities; histology seems more sensible than FC to detect BM infiltration; development of BM involvement during follow-up is typical of EMZL.

Reforma del modelo de atención de la salud mental en la Ciudad Autónoma de Buenos Aires. Ejes conceptuales e instrumentos operativos / Supports for the reformulation of the model for the mental care at the city of buenos Aires

Se presentan las bases operativas del cambio de modelo de atención en salud mental, incluyendo su base de sustentación en la Ley 448, en los documentos nacionales e internacionales en la materia, los cambios programados en infraestructura, equipamiento, recursos humanos y gestión del ingreso a la red de complejidad ascendente.

The aim of this report was to present the supports for the reformulation of the model for the mental health care at the city of Buenos Aires, with conceptual guidelines and the operative instrumentation.

Evaluación de resultados en programas sanitarios: marco conceptual e instrumental oerativo aplicaados en el ámbito del Ministerio de Salud de la Ciudad de Buenos Aires / Evaluation of reults in sanitary programs

Evaluation of results in sanitary programs: conceptual mark and operative instrumentable, applied in the concern of the Ministery of Health from the city of Buenos Aires.

Epidemiología y medicamentos: esenciales, genéricos y el programa Remediar / Epidemiology and pharmaceutical drugs: essential and generics

This report describes the epidemiology and pharmaceutical drugs: essentials and generics.

Análisis epidemiológico georreferencial de la mortalidad infantil en la Ciudad Autónoma de Bs.As. en un período de doce años (19909-2002) / Georeferential epidemiological analysis of the infant mortality rate in Buenos Aires City during a 12-year period (1990-2002)

The objective of this investigation was to determine a georeferential epidemiological analysis of the infant mortality rate in the city of Buenos Aires during a 12 year period (1990-2002). Several facts are evident from this review of the causes of that infant mortality. The overall mortality rate of infants in this city was 9.1 per 1,000, for the 12-years period between 1990 and 2002

Análisis epidemiológico georreferencial de la mortalidad infantil en la Ciudad Autónoma de Bs.As. en un período de doce años (19909-2002) / Georeferential epidemiological analysis of the infant mortality rate in Buenos Aires City during a 12-year period (1990-2002)

The objective of this investigation was to determine a georeferential epidemiological analysis of the infant mortality rate in the city of Buenos Aires during a 12 year period (1990-2002). Several facts are evident from this review of the causes of that infant mortality. The overall mortality rate of infants in this city was 9.1 per 1,000, for the 12-years period between 1990 and 2002

Etica y Salud Pública / Ethics and Public Health

This article describes the concepts of ethics and public health, with special reference to conceptual designs and operative tools

Etica y Salud Pública / Ethics and Public Health

This article describes the concepts of ethics and public health, with special reference to conceptual designs and operative tools

Anßlisis epidemiológico y georreferencial de patrones quiquenales de utilización de servicios médicos en una población cautiva de pacientes / Epidemiological and georeferencial analysis of five year patterns of use medical services in captive patient population

La identificación de problemas de salud en la comunidad y la implementación y monitoreo de estrategias de intervención suelen chocar con la dificultad de presentar datos claro, fiables y sobre todo facilmente aprenhensibles por los tomadores politicos de desiciones y es en este sentido que los sistemas de información geogrßfica pueden ser de utilidad. La tecnología de la georreferencia ya es aceptada como una herramienta esencial para el uso efectivo de la información. Teniendo en cuenta ademas que en cualquier entidad que medie y/o provea servicios de salud la información relativa al uso (y costo) de los mismos, asi como las caracteristicas de los usuarios deberia articularse con la incorporación y desarrollo organizacional de sistemas de información, empleando el raciocinio epidemiológico a la administración de la salud...(AU)