Tumores virilizantes del ovario: presentación de dos casos manejados mediante cirugía por monopuerto / Virilizing tumors of the ovary: presentation of two cases managed by single-port surgery

Los tumores virilizantes, corresponden al 1% de todos los tumores funcionales del ovario. Estos tipos de tumores virilizantes se originan de las células pluri-potenciales del estroma ovárico, tienen la capacidad de secretar 17-hidroxiprogesterona, testosterona y androstenediona, desencadenando hiperandrogenismo clínico. Son catalogados como de bajo potencial maligno, con un patrón de crecimiento lento, bien diferenciados, diagnosticados en su mayoría en estadío I y II, de buen pronóstico y típicos de mujeres en edad reproductiva. El objetivo de esta comunicación es presentar dos casos clínicos con diagnóstico de tumor virilizante de ovario, tratadas con cirugía laparoscópica por mono puerto.

Virilizing tumors, corresponding to 1% of all functional ovarian tumors. Those type of virilizing tumors originate from pluripotential ovarian stromal cells and have the capacity to secrete 17-hydroxyprogesterone, testosterone and androstenedione, triggering clinical hyperandrogenism. They are classified as low malignant potential, well differentiated, with a pattern of slow growth, mostly diagnosed in stage I and II, with good prognosis and typical of women of reproductive age. The aim of this paper is to present two cases of virilizing ovarian tumor treated by mono port laparoscopic surgery.

Mutaciones del gen RAD51 en el cáncer familiar de ovario: revisión de la literatura / RAD51 gene mutations in familial ovarian cancer: literature review

ANTECEDENTES: En los últimos 15 años, el carcinoma familiar de ovario, ha sido atribuido en su mayoría a mutaciones en BRCA 1 y 2. Sin embargo, aproximadamente el 25% de los nuevos casos se asocian a mutaciones aisladas de genes implicados en el mecanismo de reparación del ADN por recombinación homóloga. Mutaciones monoalélicas de RAD51 han sido identificadas en pacientes con historia de carcinoma mama y ovario, tamizaje negativo para BRCA 1 y 2, y por lo menos con un caso de carcinoma de ovario en el linaje. OBJETIVO: Describir las mutaciones en el complejo RAD51 con el fin de identificar su papel en el cáncer de ovario familiar. MÉTODO: Se realizó una búsqueda de la literatura en bases de datos de los últimos 10 años con los siguientes términos MeSH: "RAD51", "ovarian cancer" "ovarian neoplasm", "family ovarian cancer". RESULTADOS: Se encontró una prevalencia de la mutación en genes del complejo RAD51 que varía entre 0,2% y 2,5%, según la etnia estudiada, siendo una de las causas de tumores serosos de ovario de alto grado en mujeres entre los 57 y 60 años. CONCLUSIÓN: Mutaciones de RAD51 en pacientes negativas para mutaciones de BRCA 1 y 2, se asocian al síndrome familiar mama-ovario, con un aumento del riesgo para carcinoma de ovario, pero sin modificaciones para el carcinoma de mama.

BACKGROUND: In the last fifteen years, familiar ovarian carcinoma has been related to BRCA 1 and 2 mutations. However, 25% of new cases of ovarian neoplasm are explained by isolated genes involved in the mechanism of homologous recombination. Patients with family history of ovarian and breast carcinoma, negative for BRCA mutations and at least with one case of invasive ovarian carcinoma have been identify with monoallelic mutations in RAD51. OBJECTIVE: To describe mutations on RAD51 complex, in order to identify its role in familiar ovarian cancer. METHODOLOGY: A systematic review of the literature of the last ten years involving the main data bases and using the following MeSH terms: "RAD51", "ovarian cancer", "ovarian neoplasm", "family ovarian cancer". RESULTS: Prevalence reported for RAD51 mutation is between 0.2 and 2.5%, associated with the ethnicity of the population involved. Also is considered a cause for high grade serous ovarian carcinoma in women between 57 and 60 years old. RAD51C and RAD51D germ line mutations are related to ovarian-breast hereditary syndrome, in negative population for BRCA 1 and 2 mutations. CONCLUSION: Patients with RAD51 mutations, negative for BRCA mutation are associated with ovarian-breast cancer syndrome increasing the risk just for ovarian cancer.

[Evaluation of Chromalbicans Agar for presumptive identification of Candida albicans]. / Evaluación del medio Chromalbicans Agar para la identificación presuntiva de Candida albicans.

The utility of Chromalbicans Agar (Biolife Italiana, Milano, Italy) was evaluated with 723 clinical isolates and type culture collection strains from different genera including Candida, Cryptococcus, Pichia, Rhodotorula, Saccharomyces, Trichosporon y Zygosaccharomyces. Presumptive identification was confirmed by germ tube test and carbohydrate assimilation on API-ATB ID 32C (bioMerieux, France). Growth on Chromalbicans Agar was very useful for the presumptive identification of C. albicans isolates, and sensitivity and specificity values were significantly high (>97%), since a very low number of isolates were found to be false negative or false positive.

Application of Reductive Samariation to the Synthesis of Small Unnatural Peptides.

Considering that the amide NH groups are neither protected nor deprotonated, reductive samariation in the presence of a carbonyl substrate is a remarkably efficient method for the formation of a C-C bond. This was shown for a series of dipeptides and a tripeptide [Eq. (a)]. For the latter the product was obtained in a good yield of 50 %, despite the presence of three amide protons.

Detection of anti-interferon-gamma autoantibodies in subjects infected by Mycobacterium tuberculosis.

SETTING: Among the cytokines involved in defensive mechanisms against Mycobacterium tuberculosis infection, special attention has been given to interferon-gamma (IFN-gamma); a local synthesis of this cytokine as well as IL-2 (type 1 cytokines) at the site of disease in patients with tuberculous pleuritis has been demonstrated. Moreover, high levels of IgG autoantibodies against IFN-gamma have been shown in several clinical situations. It has been suggested that these antibodies could serve to limit the intensity or duration of the immune response or be able to interfere with the pathophysiological effects of IFN-gamma. OBJECTIVE: To investigate the potential role of anti-IFN-gamma antibodies in the course of M. tuberculosis infection. DESIGN: Investigation of the presence of these antibodies in sera from healthy and ill subjects infected with M. tuberculosis in relation to the extent of the disease and the presence of IFN-gamma in sera by enzyme-linked-immunosorbent assay (ELISA). In order to investigate the presence of these antibodies at the site of infection we included 12 pleural fluids from tuberculosis patients and 9 pleural fluids from other origins. RESULTS: In the course of M. tuberculosis infection the production of anti-IFN-gamma IgG antibodies is induced, being particularly higher in healthy skin test converters. Among tuberculosis patients, the presence of anti-IFN-gamma autoantibodies is significantly associated with detectable levels of the cytokine in sera. Levels of anti-IFN-gamma antibodies in moderately advanced and far advanced tuberculosis patients are significantly greater than in healthy individuals. These antibodies increase at the site of infection. CONCLUSION: Anti-IFN-gamma antibodies must be considered as a new element in the immune response to M. tuberculosis. It would be of great interest to investigate this point especially at the site of infection.

Association between HIV and other DNA viruses in vitro.

To investigate the association of human immunodeficiency virus (HIV) with various DNA viruses, including hepatitis B virus (HBV), cytomegalovirus (CMV) and Epstein-Barr virus, (EBV), simultaneous detection of HIV p24 antigen, HBV surface antigen and DNA, CMV-DNA and EBV-DNA expression was performed in phytohemagglutinin-stimulated peripheral blood mononuclear (PBMC) culture supernatants obtained from 54 individuals at risk for HIV infection. HIV expression in PBMC culture supernatants never occurred alone; expression of other viruses was always detected in the 24 samples expressing HIV antigen in vitro. Furthermore, in 16 patients expression of other viruses was detected without HIV expression, and in 14 patients none of the tested viruses were detected. These results indicate a strong association between the presence of HIV antibody and expression of DNA viruses in vitro (p = 0.0001). The coexpression of these viruses could be related to the evolution of HIV infection and AIDS.

[Detection of the HIV p24 antigen on lymphocyte membranes using flow cytometry]. / Detección de antígeno p24 del VIH en las membranas linfocitarias por citometría de flujo.

The evaluation of the presence of p24 antigen on the membrane of peripheral blood mononuclear cells from 31 HIV infected individuals is presented. The study was performed by indirect immunofluorescence and flow cytometry and the data were analyzed by the Kolmogorov-Smirnov test. Values obtained [D/s(n)] result from the comparison of the fluorescence histograms of each sample with a control one. Cases showing p24 Ag on peripheral blood mononuclear cells also presented percentages of CD3, HLA-DR positive cells significantly higher than p24 negative ones. In addition, D/s(n) values were superior in symptomatic patients than in asymptomatic ones, which indicate the existence of a correlation between flow cytometry results, viral replication and clinical course. Nevertheless in this study, as well and in previous ones, a high degree of cross reactivity between the anti-p24 monoclonal antibody employed and normal lymphocytes has been observed. This reactivity is localized preferentially in the CD4 positive subset.

Correlative detection of human immunodeficiency virus (HIV) antigen p24 and Epstein-Barr virus DNA in vitro: clinical influence on HIV infection.

The existence of molecular transactivations between EBV and HIV-1, as well as reactivations of EBV latent infections in AIDS patients, have been recently documented. In order to shed more light on the putative association between EBV and HIV, and its role in the evolution to AIDS, we have determined simultaneously p24 protein and EBV DNA in culture supernatants of peripheral blood mononuclear cells from 47 individuals suspected of having HIV infection. The results of the in vitro assays were correlated with the clinical stage of the individuals and their serologic status to EBV. Statistical analysis showed a concordance between HIV infection and in vitro detection of EBV DNA (P < 0.002); particularly, a strong correlation between the presence of EBV DNA and p24 in culture was observed (P < 0.001). These results are consistent with the occurrence of viral interactions, manifested in vitro. However, in our series, the appearance of EBV DNA in culture was not concomitant with an elevation of anti-VCA IgG titers, anti-EA titers or the development of symptomatology, suggestive of a reactivation of a latent EBV infection or a progression of HIV infection. Therefore we conclude that, although interaction between both viruses may take place at the molecular level, there is no clear evidence of the repercussion that this event may have on the clinical course of HIV infection.

Induction of cytolytic function in resting peripheral blood CD8+/Leu-7+ T cells through IL2/p 75 IL2-receptor interaction: a study in the allogeneic human bone marrow transplantation model.

CD8+/Leu-7+ T cells which circulate in increased proportions in the blood of long-term surviving BMT patients are for the most part high-density resting lymphocytes lacking IL2R-alpha (p55) expression. We show that they can be induced by IL2 to manifest cytolytic function after 24-48 hr stimulation by using rather high concentrations of IL2 (at least 50 U/ml). This function was much more readily induced in high-density CD8+/Leu-7+ T cells than in high-density CD8+/Leu-7+ T cells and occurred in the presence of minimal cell proliferation. Other cytokines involved in primary CTL differentiation (IFN-gamma, IL4 and IL6) were without effect suggesting that CD8+/Leu-7+ T cells are, in the BMT model, in vivo preactivated CTL ready to differentiate into cytolytic effectors under the sole IL2 stimulus. TU27 Mab directed at IL2R-beta (p75) subunit almost completely prevented IL2-induced cytolytic function of CD8+ T cells while 33B3.1 Mab directed at IL2R-alpha (p55) subunit was ineffective, suggesting that the signal for this function has its origin in IL2R-beta chains constitutively expressed by these cells.

Abnormally expanded CD8+/Leu-7+ lymphocytes persisting in long-term bone marrow-transplanted patients are resting pre-cytotoxic T-lymphocytes.

We analyzed the functional status of the small CD8+/Leu-7+ T-lymphocytes that circulate in increased proportions in the blood of many allogeneic bone marrow transplant (BMT) patients. Purified CD8+/Leu-7+ T cells were tested for their effect on T-cell proliferative responses. In contrast to CD8+/Leu-7-T-lymphocytes, such cells behaved as suppressor cells for lectin-induced mitogenic responses of the donor's peripheral blood lymphocytes. However, they did not interfere with the in vitro responsiveness to specific stimuli such as protein purified derivative (PPD) or alloantigens. We demonstrate that CD8+/Leu-7+ T cells are resting pre-cytotoxic T-lymphocytes (CTL) that can be induced by mitogenic lectins to express their cytolytic program in a non-specific, non-major histocompatibility complex-restricted manner against phytohemagglutinin-treated lymphoblasts or K562 target cells. The lectin-triggered cytotoxicity was achieved within a few days, together with limited cell division. Our results suggest that circulating CD8+/Leu-7+ T cells from BMT recipients are in vivo primed CTL awaiting cellular activation.