Use of echocardiography in percutaneous closure of patent ductus arteriosus at the Instituto Nacional de Salud del Niño, San Borja, Lima - Peru.

Objetive: Percutaneous occlusion of patent ductus arteriosus (PDA) has classically been performed entirely by fluoroscopy, however in recent years, transthoracic echocardiography (TE) has been used as an aid to fluoroscopy or entirely by echocardiography, which avoids access of femoral artery, use of contrast and decrease in time and dose of radiation exposure. The objective of this study was to evaluate the success rate with the use of TE in percutaneous PDA closure. Material and method: Descriptive, comparative, retrospective study between patients in whom PDA closure was performed with fluoroscopy plus angiography (group 1) and fluoroscopy plus ET (group 2), between January 2018 and December 2022. The data were obtained from the clinical history electronic and procedure report. Results: One hundred eight patients were analyzed, fluoroscopy group (n: 57) and TE (n: 51). The success rate in PDA occlusion using TE was 100% and 98% for the fluoroscopy group, with no statistically significant difference The average age of group 2 was 2.9 years, while the average age of group 1 was 5 years (p=0.001), the average fluoroscopy time in group 1 was 16.9 min and 4.71 min in group 2 (p < 0.001); the fluoroscopy dose in group 1 was 68.98 mGy and 5.17 mGy in group 2 (p<0.001). Krichenko, but without significant difference in both groups. Conclusions: The success rate of percutaneous PDA closure using echocardiography and fluoroscopy is appropiate, with a success rate similar to the classic technique. In addition, it makes it possible to reduce the dose and time of fluoroscopy, avoid the use of contrast, and access the femoral artery.

Objetivo: La oclusión percutánea del ductus arterioso persistente (DAP) clásicamente se ha realizado por fluoroscopía y angiografía; sin embargo, en los últimos años se está utilizando la ecocardiografía transtorácica (ETT) como ayuda a la fluoroscopía o íntegramente por ETT, lo que evita el acceso de arteria femoral, uso de contraste y disminución de tiempo y dosis exposición a la radiación. El objetivo del estudio fue evaluar la tasa de éxito con la utilización de la ETT en el cierre percutáneo del DAP. Materiales y métodos: Estudio descriptivo de tipo comparativo, retrospectivo, entre pacientes en quienes se realizó el cierre del DAP con fluoroscopía más angiografía (grupo 1) y fluoroscopía más ETT (grupo 2), entre enero 2018 y diciembre 2022. Los datos fueron obtenidos de la historia clínica electrónica y del informe del procedimiento. Resultados: Se analizaron 108 pacientes, de los cuales 57 pertenecen al grupo de fluoroscopía más angiografía y 51 al grupo de fluoroscopía más ETT. La tasa de éxito en la oclusión del DAP utilizando fluoroscopía más ETT fue del 100% y 98% para el grupo de fluoroscopía más angiografía, sin diferencia estadísticamente significativa. La edad promedio del grupo 2 fue de 2,9 años, mientras que la edad promedio del grupo 1 fue 5 años (p< 0,001), el tiempo promedio de fluoroscopía en el grupo 1 fue de 16,9 min y 4,7 min en el grupo 2 (p < 0,001); la dosis de fluoroscopía en el grupo 1 fue de 68,98 mGy y 5,17 mGy en el grupo 2 (p< 0,001). Se encontró que el tipo de DAP predominante fue el tipo A de Krichenko, pero sin diferencia significativa en ambos grupos. Conclusión: La tasa de éxito del cierre percutáneo del DAP con el uso de la ecocardiografía y fluoroscopia es adecuada, con un nivel de éxito similar a la técnica clásica, esto permite, además, disminuir la dosis y tiempo de fluoroscopia, evitar el uso de contraste y el acceso de la arteria femoral.

Complex karyotype including ring chromosome 11 in a patient with acute myeloid leukemia: case report

ABSTRACT CONTEXT: Complex karyotypes in acute myeloid leukemia (AML) are characterized by an overall low response rate with frequent relapses after clinical treatment. CASE REPORT: Here, we describe the case of a 61-year-old obese female with clinically diagnosed AML who presented a complex karyotype involving an uncommon abnormality: ring chromosome 11. Immunophenotypic analysis confirmed the diagnosis. Classical and molecular cytogenetic analyses, using GTG banding and FISH (fluorescence in situ hybridization), revealed the presence of complex structural rearrangement involving r(11), add(12)(p13), der(5) and der(13). CONCLUSIONS: Molecular cytogenetic analysis is suitable for better identification and characterization of chromosomal rearrangements in AML. Case reports like this, as well as population-based studies, are necessary for understanding the karyotypic changes that occur in humans.

Complex karyotype including ring chromosome 11 in a patient with acute myeloid leukemia: case report.

CONTEXT: Complex karyotypes in acute myeloid leukemia (AML) are characterized by an overall low response rate with frequent relapses after clinical treatment. CASE REPORT: Here, we describe the case of a 61-year-old obese female with clinically diagnosed AML who presented a complex karyotype involving an uncommon abnormality: ring chromosome 11. Immunophenotypic analysis confirmed the diagnosis. Classical and molecular cytogenetic analyses, using GTG banding and FISH (fluorescence in situ hybridization), revealed the presence of complex structural rearrangement involving r(11), add(12)(p13), der(5) and der(13). CONCLUSIONS: Molecular cytogenetic analysis is suitable for better identification and characterization of chromosomal rearrangements in AML. Case reports like this, as well as population-based studies, are necessary for understanding the karyotypic changes that occur in humans.

Howell-Jolly bodies and liver-spleen scanning for assessment of splenic filtrative function yields discordant results in renal transplant recipients.

Given discrepancies between methods for diagnosing hyposplenism, the purpose of this study was to evaluate the effect of the spleen size on the correlation between the methods, and to propose a model for improving the interpretation. Patients with renal allografts were included, in whom the spleen was assessed using Doppler ultrasound, scintiscan, and the presence of Howell-Jolly bodies (HJBs) in peripheral smears. In 35 subjects, scintiscan and HJBs were normal (Group 0); 20 had an abnormal result in both methods (Group 1); 34 had discordant results with HJBs present (Group 2); and 14 had discordant results with decreased spleen uptake (Group 3). There was no association between HJBs and scintiscan. The patients of Groups 1 and 2 had smaller spleens. The patients with smaller spleen had more hematological evidence of hyposplenism and exhibit smaller discrepancies between the methods than patients with larger spleen. The spleen can tip the balance from a normal to impaired function provided that the spleen size is below the critical mass required to maintain splenic function. A mild impairment of phagocytic function and slight dyserythropoiesis along with a small spleen would result in decreased take up of radiocolloid or the appearance of HJBs in blood smears.

Trisomy 11 as an additional chromosome alteration in a child with acute promyelocytic leukemia with poor prognosis.

The prognostic significance of the additional abnormalities to the t(15; 17) remains controversial. We report a case of promyelocytic leukemia (APL) in a ten-year-old boy. Classical and molecular cytogenetic (FISH) studies of a bone marrow sample obtained at diagnosis revealed the presence of trisomy of chromosome 11 as an additional chromosomal abnormality to the t(15; 17). The presence of the translocation t(15; 17), the cytogenetic marker of APL, is usually associated with good response to treatment with ATRA. In this case, although the patient had risk factors associated with good prognosis, he evolved and died quickly. So it seems that the presence of the trisomy 11 may be associated with disease progression and the poor outcome. To our knowledge, this is the first reported case of t(15; 17) associated with trisomy of chromosome 11 in a child with APL.

Análise imunofenotípica e avaliação nutricional na leucemia linfoblástica aguda da criança: [carta ao editor] / Immunophenotypic analysis and evaluation of nutritional status in childhood acute lymphoblastic leukemia: [letter to editor]

The cure rate for childhood acute lymphoblastic leukemia (ALL) differs between developed and developing countries. In developing countries there is a high prevalence of malnutrition thus it is important to evaluate the association between factors of nutritionand ALL prognosis, as well as to identify the prevalence of immunophenotypes and their association with nutritional status. Eighty-six children with acute lymphoblastic leukemia diagnosedin two universities in Rio de Janeiro were studied. The frequencies of each immunological subtype were: common ALL 57%, pre-B 9.3%; pro-B 8.1%; T-ALL 18% and biphenotypic ALL 7.0%. Itwas noticed that the typical incidence peak of common ALL is between 1 and 6 years old. The small number of malnourished children did not allow statistical analysis to compare data between the immunophenotype and nutritional status. For the same reason,a statistical approach comparing malnutrition status with complete remission and relapse rates was impaired. The relative incidence of each immunological subtype was similar to those found in developed countriess.

Aspectos da tomografia computadorizada no linfoma em pacientes abaixo de 20 anos de idade / Computed tomography findings in patients less than 20 years old with lymphoma

OBJETIVO: Descrever os achados gerais do linfoma em pacientes abaixo de 20 anos de idade e por subtipo histológico. MATERIAIS E MÉTODOS: Estudo retrospectivo do arquivo digital de tomografia computadorizada do Centro de Controle do Câncer do Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro, no período de março de 2003 a julho de 2005. Dos 22 casos - 16 do sexo masculino e 6 do sexo feminino, com média de idade de 11,5 anos -, 12 eram do subtipo Hodgkin e 10 eram não-Hodgkin. RESULTADOS: Dos achados gerais, verificamos as linfonodomegalias mediastinais como o mais freqüente (59 por cento), com predomínio no grupo Hodgkin (75 por cento), seguido por hepatoesplenomegalia (50 por cento) e linfonodomegalias cervicais e retroperitoneais (27,3 por cento). No subtipo Hodgkin houve predomínio do acometimento linfonodal, em sucessivas cadeias, seguido pela hepatoesplenomegalia (50 por cento). Verificamos um caso de massa tonsilar unilateral, opacidade pulmonar em "vidro-fosco" e nódulos renais. No subtipo não-Hodgkin houve predomínio extranodal caracterizado por hepatoesplenomegalia (50 por cento), espessamento de alça intestinal (40 por cento), derrame pleural (30 por cento), nódulo pulmonar (20 por cento), ascite (10 por cento), derrame pericárdico (10 por cento) e lesões ósseas mistas (10 por cento). CONCLUSÃO: A tomografia computadorizada é de grande valia no diagnóstico, estadiamento e seguimento do linfoma, com achados de alerta como massa linfonodal, notadamente mediastinal, hepatoesplenomegalia, massa unilateral na tonsila e espessamento parietal de alça intestinal.

OBJECTIVE: To describe the general findings of lymphoma and their histological patterns in patients less than 20 years old. MATERIALS AND METHODS: Twenty-two cases (16 male and 6 female, mean age 11.5 years) from the digital archive of computed tomography at the Cancer Control Center of "Hospital Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro", Rio de Janeiro, RJ, Brazil, were retrospectively analyzed in the period between March 2003 and July 2005. Of these 22 cases, 12 were Hodgkin's and 10 were non-Hodgkin's. RESULTS: Overall, mediastinal lymphadenomegaly was the most frequent finding (59 percent), with predominance in the Hodgkin's subgroup (75 percent), followed by hepatosplenomegaly (50 percent) and cervical and retroperitoneal lymphadenomegaly (27.3 percent). The Hodgkin's subgroup presented a prevalence of lymphadenopathy, in many lymph node chains, followed by hepatosplenomegaly (50 percent). One case was found with unilateral tonsillar mass, pulmonary ground-glass opacities, and renal nodules. In the non-Hodgkin's subgroup, the disease was predominantly extranodal, characterized by hepatosplenomegaly (50 percent), thickening of the intestinal wall (40 percent), pleural effusion (30 percent), pulmonary nodule (20 percent), ascites (10 percent), pericardial effusion (10 percent) and mixed bone lesions (10 percent). CONCLUSION: Computed tomography is an extremely useful method for detection, staging and follow-up of lymphomas, with alert findings like mediastinal lymphadenopathy, hepatosplenomegaly, unilateral tonsillar mass and thickening of intestinal wall.

Linfoma pulmonar / Pulmonary lymphoma

Linfomas não-Hodgkin constituem um grupo de doenças linfoproliferativas malignas com diferentes padrões de comportamento, tratamento e prognóstico. Podem acometer as estruturas intratorácicas, particularmente os linfonodos mediastinais e o parênquima pulmonar, em alguma fase docurso da doença. Os autores descrevem um caso de linfoma não-Hodgkin com manifestação atípica nos pulmões e discutem o diagnóstico diferencial.

Miomatose uterina; fator eritrocitose: relato de um caso / Uterine myomatosis: erythrocytosis factor; report of a case

Os autores apresentam o caso de uma paciente de 42 anos portadora de mioma uterino e quadro hematológico secundário de eritrocitose com níveis de hamatócrito e hemoglobina de 62% e 19,29%, respectivamente. Foi observada correlaçäo das cifras hematimétricas com a ablaçäo do tumor, conforme atestam o seguimento clínico e laboratorial no período de dois anos

Bernard-Soulier: relato de um caso / Bernard-Soulier syndrome: report of a case

Os autores descrevem um caso raro com quase duas décadas de evoluçäo, antes que o diagnóstico de Bernard-Soulier fosse firmado. Säo discutidos as características clínicas e laboratoriais da síndrome, a abordagem terapêutica e o diagnóstico diferencial com a púrpura trombocitopênica idiopática