Neumatosis quística intestinal: presentación de tres casos y revisión de la literatura / Three cases of cystic intestinal pneumatosis and review of the literature

La neumatosis quística intestinal es una entidad rara que se caracteriza por la presencia de gas en la pared intestinal a modo de quistes aéreos sin revestimiento epitelial, rodeados o no por un infiltrado granulomatoso con células gigantes multinucleadas. Los autores describen tres casos de la forma secundaria de esta entidad, dos asociados a adenocarcinoma de colon y uno a enfermedad de Crohn. Los casos se corresponden muy bien con lo descrito en la literatura, con la peculiaridad de que uno de ellos presenta algunos quistes rellenos de un líquido transparente, proteináceo, algo que no hemos encontrado descrito en la bibliografía consultada. Como conclusión, podemos decir que la neumatosis quística intestinal es una entidad rara o poco frecuente, generalmente asintomática y usualmente asociada a otra patología subyacente. Ante la presencia de quistes con contenido aéreo en el espesor de la pared intestinal tenemos que pensar y descartar esta patología(AU)

Pneumatosis cystoides instestinalis is a rare condition characterized by the presence of air in the bowel wall in the form of gas-filled non-epithelial cysts, which may or may not be surrounded by a granulomatous infiltrate with multinucleate giant cells. Three cases of the secondary form of pneumatosis cystoides instestinalis are described, two associated with colon adenocarcinoma and the other with Crohn's disease. Whilst their general appearance was characteristic, one case had cysts filled with a transparent, proteinaceus liquid. To our knowledge this unusual feature has not been previously reported. In conclusion, pneumatosis cystoides intestinalis is infrequent, generally non-symptomatic and usually associated with other subjacent pathology. It should be considered in the differential diagnosis when gas-filled cysts in the bowel wall are found(AU)

Phrynoderma: a rare dermatologic complication of bariatric surgery.

Biliopancreatic diversion is a predominantly malabsorptive bariatric procedure that can lead to the development of several nutrition complications, including fat-soluble vitamin deficiencies. Routine supplementation with vitamins and trace elements and a strict medical follow-up are essential to prevent these nutrition risks. Vitamin A deficiency is common after bariatric surgery but rarely causes clinical symptoms. Case reports have described ophthalmological and fetal complications associated with vitamin A deficiency after malabsorptive bariatric surgery. Phrynoderma is a type of follicular hyperkeratosis located on the extensor surfaces of the extremities whose main cause is vitamin A deficiency. The simultaneous occurrence of phrynoderma and ocular symptoms secondary to hypovitaminosis A after bariatric surgery is exceptional. The authors describe a man who presented follicular hyperkeratosis with nyctalopia and xerophthalmia that had appeared 1 year after biliopancreatic diversion. He admitted poor compliance with diet and daily supplementation of vitamins and oligoelements. Serum vitamin A levels were decreased. Treatment with high doses of vitamin A was associated with a clear improvement of cutaneous and ocular lesions with complete resolution after 2 months. The patient was readmitted 2 years later because of the reappearance of cutaneous lesions and micronutrient deficiency. Revisional bariatric surgery was performed. The authors review and discuss the relationship between phrynoderma, malnutrition, and vitamin A deficiency.

Single instrument for hemostatic control in laparoscopic partial nephrectomy in a porcine model without renal vascular clamping.

PURPOSE: To test the viability of a new device to obtain hemostasis during laparoscopic partial nephrectomy (LPN) without vascular clamping. MATERIALS AND METHODS: We performed a comparative experimental study between a new radiofrequency (RF)-assisted device consisting of a handheld instrument that simultaneously conducts coagulation and cutting tasks without hilar clamping vs a standard technique with hilar clamping. A porcine model was used (10 animals per group) with survival of 17 days. RESULTS: The estimated blood loss with the new device was significantly lower than with the standard technique (15.5±23.7 vs 79.4±76.3 mL). Although transection time was longer with the new device (10.7±13.7 vs 2.1±1.2 min), the total operative time was significantly shorter (35.3±13.7 vs 60.2±10.5 min). Evidence of localized urinary extravasation (urinoma) was identical in both groups (five cases). The group subjected to the new device, however, showed a significantly higher number of cases of leakage after conducting the methylene-blue test: eight (80%) cases vs only one (11%) with the standard technique. Necrosis depth was significantly greater with the new device (6.6±0.9 vs <1 mm). CONCLUSIONS: The experimental results suggest that the proposed RF-assisted device provides adequate hemostatic control during transection of the renal parenchyma without additional instruments or surgical maneuvers and could therefore be a valuable adjunct for LPN without vascular clamping. The device was unsuccessful in effectively sealing the collecting system.

[Detection of specific T cells for 264-272 and 149-157 peptides of p53 protein in peripheral blood of patients with breast cancer]. / Detección de linfocitos T citotóxicos contra los epítopos 264-272 y 149-157 de la proteína p53 en sangre periférica de pacientes con cáncer de mama.

BACKGROUND AND OBJECTIVE: p53 protein is overexpressed in nearly half of all human tumours. An HLA-A2.1-restricted immunological response mediated by anti-p53 CD8+ T cells directed against the wild type p53 264-272 epitope has been demonstrated in patients with head and neck squamous carcinomas. The existence of such a response in patients with other cancer types could be determinant for the development of specific antitumour vaccines targeting the p53 protein. We aimed to determine the presence of anti-p53 specific CD8+ T cells in peripheral blood of breast cancer patients in vivo. PATIENTS AND METHOD: p53 264-272-specific CD8+ T cells were directly enumerated in the peripheral circulation of patients with breast cancer using tetrameric p53 264-272/HLA-A2.1 complexes by multicolor flow cytometry. The same procedure was used to enumerate T cells specific for another HLA-A2.1 restricted wild type p53 epitope, p53 (149-157). RESULTS: The 99th percentile of the concentration of anti-p53 cells in 6 HLA A2- breast cancer patients was 1/5634 (cut-off point). The median counts of anti-p53264-272 and anti-p53149-157 lymphocytes in 14 HLA A2.1+ patients were 1/2383 and 1/2335 respectively. All of the HLA A2+ patients had concentrations of anti-p53 lymphocytes above the cut-off point for at least one of the epitopes: 13/14 (93%) for p53(264-272) and 11/12 (92%) for p53(149-157). CONCLUSIONS: A specific immunological response mediated by anti-p53 CD8+ T cells has been detected in patients with breast carcinoma. More studies are needed to confirm these results and to determine its usefulness for the development of p53-based vaccines.

Detección de linfocitos T citotóxicos contra los epítopos 264-272 y 149-157 de la proteína p53 en sangre periférica de pacientes con cáncer de mama / Detection of specific T cells for 264-272 and 149-157 peptides of p53 protein in peripheral blood of patients with breast cancer

FUNDAMENTO Y OBJETIVO: La proteína p53 está sobreexpresada en la mitad de los tumores humanos.Se ha descrito que se produce una respuesta inmunológica específica mediada por linfocitosT citotóxicos dirigidos contra el epítopo 264-272 de p53 en pacientes con cáncer de cabezay cuello. Demostrar que se produce ese tipo de respuesta en otros tumores podría serdeterminante para el desarrollo de vacunas antitumorales específicas anti-p53. El objetivo deeste estudio fue demostrar in vivo la existencia de linfocitos T citotóxicos específicos anti-p53en sangre periférica de pacientes con cáncer de mama.PACIENTES Y MÉTODO: Se realizó la determinación mediante citometría de flujo del recuento delinfocitos T citotóxicos específicos dirigidos contra los epítopos HLA A2 restringidos 264-272 y149-147 de la proteína p53 en sangre periférica de pacientes con cáncer de mama.RESULTADOS: El percentil 99 de la concentración de células T anti-p53 en los pacientes conHLA A2.1 negativo fue 1/5.634 (punto de corte). En los pacientes con HLA A2 positivo, la medianade linfocitos anti-p53264-272 fue de 1/2.383 y la de linfocitos anti-p53149-157, de 1/2.335.Todos los pacientes con HLA A2 positivo presentaron recuentos de linfocitos anti-p53 por encimadel punto de corte para al menos uno de los 2 epítopos: 13/14 (93%) para p53264-272 y11/12 (92%) para p53149-157.CONCLUSIONES: Ha sido posible demostrar in vivo que hay una respuesta inmunológica específicamediada por linfocitos T citotóxicos anti-p53 en pacientes con cáncer de mama. Son necesariosfuturos estudios para confirmar estos resultados y determinar su utilidad para el diseño y eldesarrollo de vacunas dirigidas contra la proteína p53

BACKGROUND AND OBJECTIVE: p53 protein is overexpresed in nearly half of all human tumours. AnHLA-A2.1-restricted immunological response mediated by anti-p53 CD8+ T cells directedagainst the wild type p53 264-272 epitope has been demonstrated in patients with head andneck squamous carcinomas. The existence of such a response in patients with other cancer typescould be determinant for the development of specific antitumour vaccines targeting thep53 protein. We aimed to determine the presence of anti-p53 specific CD8+ T cells in peripheralblood of breast cancer patients in vivo.PATIENTS AND METHOD: p53 264-272-specific CD8+ T cells were directly enumerated in the peripheralcirculation of patients with breast cancer using tetrameric p53 264-272/HLA-A2.1complexes by multicolor flow cytometry. The same procedure was used to enumerate T cellsspecific for another HLA-A2.1 restricted wild type p53 epitope, p53 (149-157).RESULTS: The 99th percentile of the concentration of anti-p53 cells in 6 HLA A2– breast cancerpatients was 1/5634 (cut-off point). The median counts of anti-p53264-272 and anti-p53149-157lymphocytes in 14 HLA A2.1+ patients were 1/2383 and 1/2335 respectively. All of the HLAA2+ patients had concentrations of anti-p53 lymphocytes above the cut-off point for at leastone of the epitopes: 13/14 (93%) for p53264-272 and 11/12 (92%) for p53149-157.CONCLUSIONS: A specific immunological response mediated by anti-p53 CD8+ T cells has beendetected in patients with breast carcinoma. More studies are needed to confirm these resultsand to determine its usefulness for the development of p53-based vaccines

Human papillomavirus (HPV) infection and intraepithelial neoplasia and invasive cancer of the uterine cervix: a case-control study in Zaragoza, Spain.

INTRODUCTION: The raw incidence of cancer of the uterine cervix is Spain is 7,8 per 100.000 inhabitants (adjusted incidence is 5.6). The incidence of this tumor is still low, but a steady increase has been seen, probably related to increasing risk factors. AIM: To determine the frequency of infection by different types of human papillomavirus (HPV) in Papanicolau smears from women with and without cancer of the uterine cervix in Spain. PATIENTS AND METHODS: A case-control study was performed in women with and without cervical cancer from Zaragoza, Spain. Pap smears from 600 cases (540 women with cervical intraepithelial neoplasms (CIN) and 60 with invasive cancer) and 1200 controls (women without those lesions) were tested by polymerase chain reaction (PCR) and typed by oligonucleotide microarray-based detection. RESULTS: HPV was detected in 93.3% of all samples with invasive cancer versus 17.5% of controls. OR for invasive cancer was 55 (95% CI 21.5-140,5). Statistically significant associations were also found for different grades of cervical dysplasia. CONCLUSION: The strong association found between HPV infection, specifically types 16 and 18 and cancer of the uterine cervix in Zaragoza, Spain, stresses the importance of ongoing efforts to institute a vaccine program with recently approved HPV vaccines in order to prevent cervical cancer in this population.

Aspectos técnicos y resultados de la mastectomía profiláctica en pacientes con elevado riesgo de cáncer de mama / Technical features and results in 65 prophylactic mastectomies in patients at high risk of breast cancer

Objetivo. Analizar la técnica quirúrgica y los hallazgos histopatológicos en una serie de pacientes a los que se practicó una mastectomía profiláctica. Pacientes y métodos. Se estudió retrospectivamente a 65 mujeres con un riesgo elevado de cáncer de mama a las que se practicó una mastectomía profiláctica uni o bilateral, seguida de reconstrucción. Las pacientes fueron intervenidas por el mismo equipo quirúrgico y el mismo anatomopatólogo analizó las piezas extirpadas. La técnica quirúrgica consistió en una mastectomía con conservación de la piel y reconstrucción con prótesis o en una mastectomía simple, seguida de reconstrucción con colgajo del gran dorsal. Resultados. Se intervino (1996-2001) a 65 pacientes con un elevado riesgo de cáncer mamario (56 mastectomías bilaterales y 9 unilaterales). El 58 por ciento de las pacientes presentó lesiones preneoplásicas en las piezas extirpadas. Conclusiones. La mastectomía profiláctica debe ser una opción para la población con un elevado riesgo de cáncer mamario. La mastectomía con conservación de piel supone una agresión quirúrgica menor y permite una reconstrucción durante la intervención. El hallazgo de un gran número de lesiones, consideradas de riesgo, en las piezas extirpadas puede favorecer el concepto de cirugía profiláctica (AU)

Role of ribavirin in membranoproliferative glomerulonephritis associated with hepatitis C virus infection refractory to alpha-interferon.

Chronic hepatitis C virus (HCV) has been associated with several extrahepatic diseases, such as membranoproliferative glomerulonephritis (MPGN). alpha-Interferon is currently the treatment of choice for this association. When this therapy fails clinicians face a difficult challenge due to the lack of useful information in these particularly difficult patients. We report the case of a severe nephrotic syndrome due to MPGN associated HCV infection, in which a triple association--interferon plus ribavirin and cyclophosphamide--was needed to control the disease.

Leiomiosarcoma del esófago. Presentación de un caso y revisión de la literatura

Se presenta un caso de leiomiosarcoma esofágico en una mujer tratada quirúrgicamente. Se revisa la literatura sobre las neoplasias del esófago enfatizando en los sarcomas