Tratamiento multidisciplinario de un sarcoma recurrente de la fosa isquiorrectal / A successful multidisciplinary approach to a recurrent ischiorectal fossa sarcoma

Los tumores de la fosa isquiorrectal son poco frecuentes, habitualmente descritos en reportes o series de casos. Estas lesiones son un reto terapéutico, requiriendo un estudio preoperatorio apropiado, además de discusión y manejo guiado por un comité multidisciplinario, que permiten lograr resultados óptimos tanto oncológicos como funcionales. Presentamos un caso de un hombre de 73 años con antecedentes de resección de un tumor glúteo izquierdo en otro centro 5 años antes. La biopsia fue compatible con un sarcoma epiteloideo (SE) de alto grado, con margen quirúrgico < 0,5 mm que requirió ampliación de los márgenes posteriormente. Además, se realizó radioterapia adyuvante. Al cuarto año de seguimiento el paciente desarrolla dolor e induración con retracción en relación a cicatriz quirúrgica, siendo objetivada una recidiva tumoral local. Luego de una discusión multidisciplinaria, se realizó una desfuncionalización con ileostomía en asa laparoscópica y resección tumoral con preservación del ano y del piso pélvico. El defecto fue cubierto por el equipo de cirugía plástica utilizando un colgajo perforante de la arteria glútea superior. La biopsia confirmó la recidiva tumoral y los márgenes quirúrgicos fueron negativos. El paciente es dado de alta a los 25 días postoperatorios por cuidados del colgajo, sin complicaciones. Al año de seguimiento el paciente no presenta recidiva tumoral, la ileostomía fue cerrada, y sus resultados funcionales en términos defecatorios y de la herida son buenos.

Ischiorectal fossa tumors are rare lesions, mostly described in case reports or case series. These lesions represent a diagnostic and therapeutic challenge. Hence, an appropriate preoperative study and multidisciplinary discussion are essential to achieve good oncologic and functional results. We report a case of a 73-year-old male operated on five years before in another health center due to the diagnosis of a left gluteal tumor. The lesion was excised, and biopsies confirmed a high-grade epithelioid sarcoma with a close margin, requiring a subsequent wider excision of the surgical margins. The patient received adjuvant radiotherapy. After four years of follow-up, the patient developed mild pain with skin retraction around the former incision. A local recurrence was diagnosed by imaging. In a multidisciplinary team meeting, a decision to resect the lesion with preservation of the anus and the pelvic floor was taken. The patient underwent a laparoscopic defunctioning loop ileostomy and a resection of the recurrent tumor in the ischiorectal fossa with preservation of the anal sphincter. The defect was covered utilizing a superior gluteal artery perforator flap and a partial gluteus maximus muscle rotation. The tumor was completely excised with negative margins. The patient was discharged without complications after 25 days due to flap management. After one year of follow-up, the patient is recurrence-free, and the ileostomy was closed.

[A successful multidisciplinary approach to a recurrent ischiorectal fossa sarcoma]. / Tratamiento multidisciplinario de un sarcoma recurrente de la fosa isquiorrectal.

Ischiorectal fossa tumors are rare lesions, mostly described in case reports or case series. These lesions represent a diagnostic and therapeutic challenge. Hence, an appropriate preoperative study and multidisciplinary discussion are essential to achieve good oncologic and functional results. We report a case of a 73-year-old male operated on five years before in another health center due to the diagnosis of a left gluteal tumor. The lesion was excised, and biopsies confirmed a high-grade epithelioid sarcoma with a close margin, requiring a subsequent wider excision of the surgical margins. The patient received adjuvant radiotherapy. After four years of follow-up, the patient developed mild pain with skin retraction around the former incision. A local recurrence was diagnosed by imaging. In a multidisciplinary team meeting, a decision to resect the lesion with preservation of the anus and the pelvic floor was taken. The patient underwent a laparoscopic defunctioning loop ileostomy and a resection of the recurrent tumor in the ischiorectal fossa with preservation of the anal sphincter. The defect was covered utilizing a superior gluteal artery perforator flap and a partial gluteus maximus muscle rotation. The tumor was completely excised with negative margins. The patient was discharged without complications after 25 days due to flap management. After one year of follow-up, the patient is recurrence-free, and the ileostomy was closed.

Raman spectroscopy as a tool to evaluate oxygen effects on the response of polymer gel dosimetry.

Currently, advanced dosimeters like polymer gels are capable of obtaining reliable and accurate 3D dose distributions from correlations with the different polymerization degrees induced by incident radiation. Samples of polymer gel dosimeters are commonly read out using magnetic resonance imaging or optical methods like visible light transmission or laser computed tomography. Alternatively, this work proposes and evaluates the implementation of Raman spectroscopy to provide direct information on the effect of oxygen permeating through the walls of phantoms on the polymerization initiated by irradiation in three types of polymer gel dosimeters, namely NIPAM, ITABIS and PAGAT. The aim of the present study is to provide better and complete interpretations using three different containers, adequate for integral, 2D and 3D dose mapping. Moreover, Raman spectroscopy has been used to analyze the well-known effect of oxygen inhibition on the different polymer gel dosimeters remarking the importance of avoiding air exposition during sample storage and readout. Dose-response curves for different polymer gels were obtained in terms of measurements with a calibrated ionization chamber. Additionally, dedicated Monte Carlo simulations were performed aimed at characterizing dose for different X-ray irradiation setups, providing also suitable information to evaluate oxygen diffusion through the sample wall. The obtained results were contrasted with optical transmission readout as well as Monte Carlo simulations attaining very good agreements for all dosimeter types.

Enfermedad extramamaria de Paget, revisión bibliográfica y reporte de caso / Extramammary Paget's disease, literature review and case report

La enfermedad de Paget es un adenocarcinoma intraepidérmico poco frecuente que se presenta en el complejo areola-pezón o en su forma extramamaria en áreas como las regiones anogenital, perineal y axilar. La enfermedad de Paget extramamaria es un carcinoma epidérmico de diferenciación apocrina que se origina en la epidermis o secundario a la diseminación epidermotropa de neoplasias adyacentes o a distancia. Caracterizado histológicamente por la presencia de células tumorales típicas, denominadas células de Paget...

Removal of triazine herbicides from aqueous systems by a biofilm reactor continuously or intermittently operated.

The impact of pesticide movement via overland flow or tile drainage water on the quality of receiving water bodies has been a serious concern in the last decades; thus, for remediation of water contaminated with herbicides, bioreaction systems designed to retain biomass have been proposed. In this context, the aim of this study was to evaluate the atrazine and terbutryn biodegradation capacity of a microbial consortium, immobilized in a biofilm reactor (PBR), packed with fragments of porous volcanic stone. The microbial consortium, constituted by four predominant bacterial strains, was used to degrade a commercial formulation of atrazine and terbutryn in the biofilm reactor, intermittently or continuously operated at volumetric loading rates ranging from 44 to 306 mg L(-1) d(-1). The complete removal of both herbicides was achieved in both systems; however, higher volumetric removal rates were obtained in the continuous system. It was demonstrated that the adjuvants of the commercial formulation of the herbicide significantly enhanced the removal of atrazine and terbutryn.

Cyanuric acid biodegradation by a mixed bacterial culture of Agrobacterium tumefaciens and Acinetobacter sp. in a packed bed biofilm reactor.

Cyanuric acid (1,3,5-triazine-2,4,6-triol [OOOT]) is a common biodegradation byproduct of triazinic herbicides, frequently accumulated in soils or water when supplementary carbon sources are absent. A binary bacterial culture able to degrade OOOT was selected through a continuous selection process accomplished in a chemostat fed with a mineral salt (MS) medium containing cyanuric acid as the sole carbon and nitrogen source. By sequence comparison of their 16S rDNA amplicons, bacterial strains were identified as Agrobacterium tumefaciens, and Acinetobacter sp. When the binary culture immobilized in a packed bed reactor (PBR) was fed with MS medium containing OOOT (50 mg L(-1)), its removal efficiencies were about 95%; when it was fed with OOOT plus glucose (120 mg L(-1)) as a supplementary carbon source, its removal efficiencies were closer to 100%. From sessile cells, attached to PBR porous support, or free cells present in the outflowing medium, DNA was extracted and used for Random Amplification of Polymorphic DNA analysis. Electrophoretic patterns obtained were compared to those of pure bacterial strains, a clear predominance of A. tumefaciens in PBR was observed. Although in continuous suspended cell culture, a stable binary community could be maintained, the attachment capability of A. tumefaciens represented a selective advantage over Acinetobacter sp. in the biofilm reactor, favoring its predominance in the porous stone support.

Detection of respiratory syncytial virus in nasopharyngeal secretions by 24-well plate precentrifugation assay using a monoclonal antibody against F protein.

BACKGROUND: Respiratory syncytial virus (RSV) is responsible for 50% of all bronchiolitis and 25% of pneumonia cases during the first month of life. Detection of the RSV antigen by immunofluorescence in exfoliated nasal epithelium or by other methods in nasopharyngeal swabs is useful in the potentially infected patient because results are available within a few hours. In contrast, RSV antigen detection in cell culture may require as much as 3 weeks. METHODS: Three methods for detection of respiratory syncytial virus in 131 clinical respiratory specimens from patients with acute respiratory disease and bronchiolitis were compared utilizing the following: a precentrifugation immunofluorescence assay using Hep-2 cells, indirect immunofluorescence assay, and conventional tube cell culture using Hep-2 cells. RESULTS: Respiratory syncytial virus was identified in 36 specimens by the three methods previously described. The virus was recovered in 41 (31.3%) samples by precentrifugation immunofluorescence assay, 40 (30.5%) were identified by the immunofluorescence technique, and 38 (29.0%) cases were positive by conventional cell culture. The sensitivity of the precentrifugation assay in relation to the immunofluorescence technique was 90%, the specificity 94.5%, and the agreement, 96.2%. A positive predictive value of 90.2% was obtained. Sensitivity, specificity, agreement, and positive predictive values obtained by the precentrifugation assay variant compared to the conventional cell were 90.8%, 94.5%, 93.1%, and 87.8%, respectively. CONCLUSIONS: The precentrifugation immunofluorescence assay method was as sensitive as the remainder of the methods used in our study and represents a valid alternative for rapid detection of respiratory syncytial virus in clinical samples.

Low-dose continuous oral fosfestrol is highly active in 'hormone-refractory' prostate cancer.

BACKGROUND: Although not clearly defined, 'hormone refractory' prostate cancer implies disease progression after orchiectomy +/- antiandrogens. Patients in this setting are usually offered chemotherapy protocols which often lead to significant toxicity and expense. In search of a well-tolerated, active, third-line treatment, we have attempted to prolong hormonal maneuvers by using low-dose estrogen therapy. DESIGN: Thirty-eight patients with evidence of disease progression (as indicated by 2 consecutively rising PSA determinations) after > or = 2 hormonal treatments (including surgical or chemical orchiectomy and a median of 3 prior treatment lines) received fosfestrol 100 mg t.i.d. per os in a continuous schedule until the appearance of progressive disease or excessive toxicity. Response was assessed by serial PSA levels. Complete response (CR) was defined as normalisation and partial response (PR) as a > or = 50 decrease of PSA levels for longer than one month. The median duration of prior treatment was 20 months and the median PSA at fosfestrol start was 126 ng/ml (range 8-12,800); symptoms (pain) were present in 73% of patients. RESULTS: CR + PR were observed in 79% (95% confidence interval: 66%-92%). The median time to progression was seven months. Pain remained stable or improved in 34% and 53%, respectively, of symptomatic patients with PSA response. Toxicity included worsening of gynecomastia, peripheral edema, and deep vein thrombosis (8%). No treatment-related deaths occurred. Uni- and multivariate analyses failed to identify predictive factors for response. PSA response was associated with significantly longer survival (13 vs. 7 months, P < 0.05 by Mantel-Haentzel). CONCLUSIONS: FOSF produces high rates of PSA-determined and symptomatic response in 'hormone-refractory' prostate cancer. Toxicity and ease of administration compare favorably with those reported for CHT regimens used in this setting. The role of estrogens in prostate cancer should be redefined.

Antigenic and genetic characterization of twenty-six strains of human respiratory syncytial virus (subgroup A) isolated during three consecutive outbreaks in Havana city, Cuba.

Twenty-six human respiratory syncytial virus strains (subgroup A) isolated from three outbreaks in Havana City during the period 1994/95, 1995/96 and 1996/97 were analyzed to determine their antigenic and genetic relationships. Analyses were performed by monoclonal antibodies and restriction mapping (N gene) following amplification of the select region of the virus genome by polymerase chain reaction. All isolated strains were classified as subgroup A by monoclonal antibodies and they showed a restriction pattern NP4 that belonged to subgroup A. Thus the results obtained in this work, showed a close relation (100%) between antigenic and genetic characterization of the isolated strains in our laboratory. These methods permit the examination of large numbers of isolates by molecular techniques, simplifying the researchs into the molecular epidemiology of the virus.

[Fast detection and characterization of influenza A and B viruses in nasopharyngeal secretions by the immunoperoxidase method]. / Detección y caracterización rápida de los virus de influenza A y B en secreciones nasofaríngeas mediante el método de la inmunoperoxidasa.

One hundred and fourty eight samples from patients with a symptomatology compatible with the influenza virus were studied aimed at identifying in a fast way these viruses. A rapid MDCK-L cell culture was developed on 96 well plates, where nasopharingeal exudates or gargarisms were inoculated and incubated all night long at 37 degrees C. The medium was removed and cells were washed with PBS and fixed with methanol. Viral antigens were detected through the immunoperoxidase staining by using two monoclonal antibody pools for the identification of influenza A and influenza B viruses. The HA1-71 monoclonal antibody, specific for influenza A (H3N2) and the HA2-76, which react with both A (H3N2) and A (H1N1) were used for subtyping. Of all the positive samples (136), 72% corresponded to type A while 34.6% and 37.5% corresponded to subtypes H1 and H3, respectively. Influenza B was detected in 27.9% of the 148 samples studied. Only 12 were negative (8.1%). The use of this technique is recommended as a rapid, convenient and sensitive method that is easy to carry put and to interpretate for the detection and characterization in type and subtype of the influenza viruses starting from the nasopharyngeal exudates or gargarisms.

Molecular characterization of an outbreak of respiratory syncytial virus (subgroup A) in Havana, Cuba, by monoclonal antibodies and restriction mapping (N gene).

Twenty-one respiratory syncytial virus (RSV) strains isolated from one outbreak in Havana, Cuba (1994 to 1995), were analyzed to determine their relatedness. All isolated strains were classified as subgroup A by monoclonal antibodies. Of 21 RSV strains examined, 20 were classified as having restriction pattern NP4 and only 1 was classified as having restriction pattern NP5.

Analysis of respiratory syncytial virus in clinical samples by reverse transcriptase-polymerase chain reaction restriction mapping.

The aim of this study was to develop a polymerase chain reaction (PCR) for the detection of respiratory syncytial virus (RSV) genomes. The primers were designed from published sequences and selected from conserved regions of the genome encoding for the N protein of subgroups A and B of RSV. PCR was applied to 20 specimens from children admitted to the respiratory ward of "William Soler" Pediatric Hospital in Havana City with a clinical diagnosis of bronchiolitis. The PCR was compared with viral isolation and with an indirect immunofluorescence technique that employs monoclonal antibodies of subgroups A and B. Of 20 nasopharyngeal exudates, 10 were found positive by the three assayed methods. In only two cases, samples that yielded positive RNA-PCR were found negative by indirect immunofluorescence and cell culture. Considering viral isolation as the "gold standard" technique, RNA-PCR had 100% sensitivity and 80% specificity. RNA-PCR is a specific and sensitive technique for the detection of the RSV genome. Technical advantages are discussed.

[Application of the polymerase chain reaction for detecting respiratory syncytial virus]. / Aplicación de la reacción en cadena de la polimerasa para la identificación del virus sincitial respiratorio.

The polymerase chain reaction (PCR) was developed in order to identify the respiratory syncytial virus by using the reference strain. The high sensitivity and specificity obtained show the PCR utility for detecting the RSV genoma and its application on the diagnosis.

[Evaluation of a mouse anti-IgG-fluorescein conjugate using indirect immunofluorescence and flow cytometry techniques]. / Evaluación de un conjugado anti-IgG de ratón-fluoresceína mediante técnicas de inmunofluorescencia indirecta y citometría de flujo.

An immunoglobulin G of mouse was purified from sera by affinity chromatography in protein A. The rabbits whose sera were able to recognize the antigen injected by double immunodiffusion were immunized with this preparation. The antibodies were precipitated from the rabbit's serum and purified by ion exchange chromatography. This preparation was conjugated to fluorescin isothiocyanate according to the conventional technique. The conjugated obtained was evaluated with the reference strains of Parainfluenza virus 1, 2, 3; Adenovirus; respiratory syncytial virus; and influenza virus A and B, by an indirect immunofluorescence technique and HIV positive samples by flow citometry. Specific monoclonal antibodies were used in both cases. Clinical specimens of patients with acute respiratory infection were evaluated.

Reproduction and conservation of the leatherback turtle Dermochelys coriacea (Testudines: Dermochelyidae) in Gandoca, Costa Rica.

The leatherback turtle was studied in Gandoca, an important nesting beach on the southeastern Caribbean coast of Costa Rica (82 degrees 37' W; 09 degrees 37' N). In 1994, a total of 530 nests was recorded during the nesting season (February/July) and 160 leatherbacks were tagged; five were remigrants from the 1992 season and 15 carried tags from elsewhere. Eighty eight females only nested once. Mean curve carapace measurements were length 153.8 cm and width 112.0 cm. A hatchery received 82 clutches, with 6277 normal eggs. Their mean incubation period was 62.24 days (range: 56-68 days). Average hatching rate was 55.10% (S.D.: 25.04, range 15-96%). Extensive erosion, beach debris and poaching activity represent the main hazards for nesting in Gandoca.

[Subgroups classification of strains of the respiratory syncytial virus isolated in an outbreak in Ciudad de La Havana]. / Clasificación en subgrupos de cepas del virus sincitial respiratorio aisladas de un brote en Ciudad de La Habana.

A high number of acute respiratory diseases was detected among children under one year admitted in a hospital of Havana City. 25 respiratory syncytial virus strains were obtained from 93 patients studied. Viral isolations were multiplied in HEP-2 cells and after observing a cytopathic effect of 80%, they were classified into subgroups by the indirect immunofluorescence technique, using anti-protein G antibodies from the respiratory syncytial virus. All the samples studied were classified within subgroup A. It is the first time a study like this is conducted in our country, which allowed us to deepen into the viral cause of these diseases and to know that the subgroup A of the respiratory syncytial virus circulated during the outbreak.