Tumor infiltrating lymphocytes in acral lentiginous melanoma: a study of a large cohort of cases from Latin America

Purpose. Acral lentiginous melanoma (ALM) is a poor prognosis subtype and is the most prevalent in non-Caucasian populations. The presence of tumor infiltrating lymphocytes (TILs) has been associated with poor prognosis in melanoma. A large cohort of ALM cases was studied to determine status of TIL and its association with outcome. Methods. All patients with cutaneous melanoma presenting from 2005 to 2012 at Instituto Nacional de Enfermedades Neoplasicas in Peru were retrospectively identified. Clinicopathological information was obtained from the medical charts. A prospective evaluation of TIL was performed. Analysis of association between ALM and clinicopathological features including TIL as well as survival analysis compared the outcome of ALM to whole group and extremity NALM was performed. Results. 537 ALM from a total of 824 cutaneous melanoma cases were studied. Older age (p = 0.022), higher Breslow (p = 0.008) and ulceration (p < 0.001) were found to be more frequent in ALM. Acral had worse overall survival (OS) compared with the whole group (p = 0.04). Clinical stage (CS) I-II patients had a median OS of 5.3 (95% CI 4.3-6.2) for ALM and 9.2 (95% CI 5.0-7.0) for extremity NALM (p = 0.016). Grade 0 (absence of TIL), I, II and III were found in 7.5, 34.5, 32.1, and 25.9%, respectively. Lower TIL grade was associated with larger tumor size (p = 0.003), higher Breslow (p = 0.001), higher Clark level (p = 0.007), higher CS (p = 0.002), extremity location (p = 0.048), histological subtype ALM (p = 0.024) and better OS (p = 0.001). Conclusions. ALM is highly prevalent in Peru and carries poor outcome. Lower TIL levels were associated with poor outcome and ALM (AU)

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Expansión cutánea externa con endermología. Un método alternativo complementario en reconstrucción mamaria diferida / External cutaneous expansión with endermologie. An alternative complementary method in delayed breast reconstruction

Con el objetivo de mejorar las técnicas de reconstrucción mamaria diferida, incorporamos la técnica de endermología como método de expansión cutánea externa para eliminar el plano cicatricial inextensible que se forma entre la fascia del pectoral y el tejido celular subcutáneo tras la cirugía radical. Se trata de un procedimiento sencillo, de bajo coste y de aplicación universal, que en estos casos enfocamos a evitar nuevas cicatrices, complicaciones de zonas donantes, ingresos hospitalarios prolongados y los riesgos quirúrgicos elevados propios de las técnicas de reconstrucción mamaria con colgajos libres o pediculados, así como los frecuentes resultados insatisfactorios de la reconstrucción con expansor y prótesis en pacientes radiadas. Cuando la piel presenta un grosor insuficiente o la paciente ha sido sometida a radioterapia previa, complementamos el tratamiento con lipotransferencia de grasa abdominal. Todos los tratamientos de expansión cutánea externa se realizan en consulta mediante un equipo Cellu m6 (LPG(R) endermologia, Francia).Tras la expansión, realizamos la reconstrucción como un aumento mamario simple con prótesis anatómica. Medimos la ganancia de elasticidad cutánea tras masaje y el grosor dermograso mediante test de pellizco. Realizamos la simetrización de la mama contralateral ptósica o hipertrófica en el momento de la colocación del implante o de la mastectomía subcutánea contralateral profiláctica en pacientes de riesgo. Incluimos en el estudio mujeres sin distinción de edad, tipo o tamaño de tumor, o si han recibido radio o quimioterapia. Con esta técnica, obtenemos resultados homogéneamente satisfactorios sin añadir nuevas cicatrices y mejorando la calidad dela piel y de la cicatriz de mastectomía (AU)

In order to find an easy, low cost and universal breast reconstruction technique in deferred mastectomies, we have performed an external skin expansion technique treating the skin and scar removing there for the inextensible scary tissue present between the Pectoralis Mayor fascia and the subcutaneous tissue after radical surgery. This technique is focused in avoiding new scars, complication sat donors sites, delayed hospital staying and mayor risks of free or pedicle flaps, and/or improving the poor results of traditional expansion plus prosthesis mammary reconstruction. Cases with insufficient skin thickness or post radiation were treated with abdominal fat lipotransference. All external expansion treatments had been performed at our office facilities through endermologie LPG Cellu m6(R) equipment. After expansion, breast reconstruction has therefor been treatedas a simple augmentation with anatomical implants. We measured skin elasticity gain after expansion and thickness(pinch test) after lipotransference. Contralateral ptotic or hypertrophic breast has been symmetrized at implant reconstruction stage. Mastectomyzed women have been included in the study regardless of age, size or type of tumor, or if they have received radiation or chemotherapy. With this painless technique we have obtained homogeneously good results without adding new scars and improving the quality of the skin and mastectomy scar (AU)

Respuesta al Comentario del Dr Haddad: Comentario al artículo «Expansión cutánea esterna con endermología. Un método alternativo complementario en reconstrucción mamaria diferida» / No disponible

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Clinical and immunological features of common variable immunodeficiency in Mexican patients

BACKGROUND: Common variable immunodeficiency (CVID) is characterised by hypogammaglobulinaemia and a broad clinical spectrum, mainly showing recurrent bacterial infections accompanied sometimes by increased susceptibility to chronic lung disease, autoimmunity, and neoplastic diseases. OBJECTIVES: To evaluate the clinical and immunological characteristics of patients with CVID in Mexico. METHODS: This is a retrospective analysis of 43 patients with CVID from the Immunology Division of seven different reference centres in Mexico. Patients were diagnosed according to the diagnostic criteria of the European Society for Immunodeficiency Diseases. We collected demographics, clinical and immunological data from each patient and a statistical analysis was performed. RESULTS: There were 23 (53.5%) male and 20 (46.5%) female patients. Median age at onset of disease was 13.7 years, and median age at diagnosis was 19 years. Average delay in diagnosis was 12.5 years. The median total serum levels of IgG, IgM, and IgA at diagnosis were 175, 18, and 17.8 mg/dL, respectively. The mean percentage of CD19+ B cells was 8.15%. Sinusitis (83%), pneumonia (83%), gastrointestinal infection (70%), and acute otitis media (49%) were the most common manifestations. Bronchiectasis was present in 51% of the patients, 44% manifested non-infectious chronic diarrhoea, and 70% experienced weight loss. Autoimmunity was present in 23% of the patients; haemolytic anaemia and autoimmune thrombocytopenic purpura were the most common presentations. Allergy was present in 30.2% of patients, with allergic rhinitis and asthma being the most frequent types. Two patients developed malignancy. All the patients received Intravenous immunoglobulin (IVIG) as a fundamental part of the treatment at a mean dose of 408 mg/kg. CONCLUSION: This is the first cohort of CVID reported in Mexico We found that infection diseases were the most frequent presentations at onset. Moreover, patients had an average diagnosis delay of twelve years and thus a major prevalence of bronchiectasis. We suggest performing an extended analysis of patients with CVID patients in other Latin American countries

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Aportación a la farmacología del alprazolam / Contribution to pharmacology of alprazolam

Se estudia el efecto de alprazolam sobre el consumo de oxígeno, y la actividad ATPasa de cerebro de rata "in vitro" y la interacción con diversos neurotransmisores en preparaciones de órgano aislado de cobaya y de rata "in vitro". El consumo de oxígeno en cortes y homogeneizados de cerebro de rata "in vitro" se determinó mediante técnica manométrica. La actividad ATPasa se determinó estimando el fosfato inorgánico liberado a partir de adenosín-trifosfato en ausencia y en presencia de ouabaína. Para el estudio de las interacciones con los neurotransmisores se recurrió a la técnica de órgano aislado. Se determinó el valor de pA2 cuando el antagonismo era de tipo competitivo. El alprazolam a concentraciones elevadas disminuye el consumo de oxígeno en cortes de cerebro de rata "in vitro" e inhibe la actividad ATPasa de membrana sodio-potasio dependiente. En la preparación de ileon aislado de cobaya se comporta como antagonista competitivo de histamina y de acetilcolina, mientras que se comporta como antagonista no competitivo de histamina en la preparación de útero aislado de rata depolarizado con potasio. El efecto anticolinérgico pudiera explicar algunos efectos adversos de esta sustancia. Los otros hallazgos son completamente inespecíficos (AU)