Hemivulvectomía radical por gangrena de fournier en mujer con antecedente de radioterapia pélvica / Radical hemivulvectomy due to Fournier's gangrene in a woman with a history of pelvic radiotherapy

RESUMEN La Gangrena de Fournier es una infección necrotizante que afecta al área genitourinaria, perineal y perianal. Se trata de una infección muy grave con una rápida evolución a estadios avanzados y una elevada tasa de morbimortalidad asociada. Sin embargo, con frecuencia tiende a ser infradiagnosticada. Es vital en su manejo un diagnóstico basado en la sospecha clínica e inicio del tratamiento quirúrgico precoz con desbridamiento y exéresis de los tejidos afectos. Además, es crucial la asociación de antibioterapia de amplio espectro y el apoyo nutricional de soporte en el pronóstico de dicha entidad. En este artículo se revisa un caso clínico de Gangrena de Fournier, en una paciente con antecedentes de osteítis púbica y cistitis derivadas del tratamiento mediante radioterapia pélvica, diagnosticado y tratado con una hemivulvectomía radical, antibioterapia y lavados quirúrgicos en nuestro Hospital.

ABSTRACT The Fournier's Gangrene is a necrotizing infection which is located in the perineal area. It´s a severe infection, which involves a quick evolution to advanced stages where a high morbimortality rate is associated. However, it often tends to be underdiagnosed in early stages. The most important in the diagnosis is a high clinical suspicion and subsequent surgical treatment which is base on a desbridalment and exeresis of the affected tissues. In addition, the association of broad-spectrum antibiotic therapy and nutritional support are crucial. This report reviews a clinical case of Fournier's Gangrene, in a patient with a history of radiation induced cystitis and pubic osteitis after pelvic radiotherapy, diagnosed and treated with a radical hemivulvectomy, antibiotic therapy and lavages in our Hospital.

Dermatofibrosarcoma protuberans vulvar: tres casos clínicos de localización inusual / Dermatofibrosarcoma protuberans vulvar: three clinical cases of localization unusual

RESUMEN El dermatofibrosarcoma protuberans (DFSP) es un sarcoma fusocelular de grado intermedio de malignidad con máxima incidencia en adultos entre 20 y 40 años y de localización habitualmente troncular (cabeza, cuello extremidades superiores). Se presentan tres casos de DFSP de localización excepcional a nivel vulvar. Las pacientes fueron tratadas con vulvectomía respetando márgenes de seguridad pero, debido a la idiosincrasia del tumor, presentaron recidivas locales que precisaron de una nueva cirugía. En su posterior seguimiento no presentaron recaídas y se encuentran libres de enfermedad.

ABSTRACT Dermatofibrosarcoma protuberans (DFSP) is an intermediate grade spindle-cell sarcoma with a highest incidence in adults between 20 and 40 years old and a trunk location (head, neck and arms). We introduce three case reports of vulvar DFSP considered unusual because of their location. The patients were conducted a free-margin vulvectomy but, due to the nature of the tumor, local reappearances required a second surgery. In the subsequent follow-up they did not suffer from any tumor relapse and they are currently disease-free.

A 50-gene signature is a novel scoring system for tumor-infiltrating immune cells with strong correlation with clinical outcome of stage I/II non-small cell lung cancer.

PURPOSE: To identify a novel system for scoring intratumoral immune response that can improve prognosis and therapy decisions in early stage non-small cell lung cancer (NSCLC). METHODS/PATIENTS: Eighty-four completely resected stage I/II NSCLC without adjuvant therapy were classified by expression profiling using whole genome microarrays. An external cohort of 162 tumors was used to validate the results. Immune cells present in tumor microenvironment were evaluated semiquantitatively by CD20, CD79, CD3, CD8, CD4 and CD57 immunostaining. Univariate and multivariate analyses of variables associated with recurrence-free survival were performed. RESULTS: Initial molecular classification identified three clusters, one with significantly better RFS. A reduced two-subgroup classification and a 50-gene predictor were built and validated in an external dataset: high and low risk of recurrence patients (HR = 3.44; p = 0.001). Analysis of the predictor´s genes showed that the vast majority were related to a B/plasma cell immune response overexpressed in the low-risk subgroup. The predictor includes genes coding for unique B lineage-specific genes, functional elements or other genes that, although non-restricted to this lineage, have strong influence on B-cell homeostasis. Immunostains confirmed increased B-cells in the low-risk subgroup. Gene signature (p < 0.0001) and CD20 (p < 0.05) were predictors for RFS, while CD79 and K-RAS mutations showed a tendency. CONCLUSIONS: Favorable prognosis in completely resected NSCLC is determined by a B-cell-mediated immune response. It can be differently scored by a 50-gene expression profile or by CD20 immunostaining. That prognosis information not reflected by traditional classifications may become a new tool for determining individualized adjuvant therapies.

BHV-1 DNA vaccination: effect of the adjuvant RN-205 on the modulation of the immune response in mice.

It is well documented that adjuvants improve the immune response generated by traditional viral vaccines, but less is known about the effects of adjuvants on the immune response elicited by DNA vaccines. In this study, we have investigated the use of RN-205 (immunomodulator containing a membrane rich in lipopolysaccharide from gram-negative bacteria) as an adjuvant and analyzed the humoral and cellular specific immune responses elicited by DNA vaccines based on the bovine herpesvirus-1 (BHV-1) glycoprotein D (gD). The comparison of the antibody response induced in mice by a mixture of the three different versions of DNA gD (membrane-anchored, secreted and cytosolic) formulated with or without RN-205 showed that the immunomodulator did not affect the total specific humoral response. The cellular immune response induced in mice immunized with vaccines plus RN-205 was higher than that obtained in mice vaccinated without RN-205, not only in the indexes of proliferation tests but in the number of IL-4 and gammaIFN secreting cells. When total spleen cells were marked with specific monoclonal antibodies against surface markers, a significant increase in the macrophage population of all the groups receiving RN-205 was observed. CD8 and CD4 positive cells were also increased but to a lesser extent. Our results indicate that the incorporation of RN-205 into DNA vaccines induces an increase of the cellular specific immune response in mice.

Detection and characterization of functional T-cell epitopes on the structural proteins VP2, VP3, and VP4 of foot and mouth disease virus O1 campos.

Foot and mouth disease virus (FMDV) is the cause of a widespread infectious disease affecting cloven-hoofed animals. It is controlled by vaccination with immune-inactivated virus grown in tissue culture. However, peptide vaccines represent a safer alternative to the current virus-inactivated immunogens. Their design requires the identification and evaluation of the sequences recognized by T- and B-lymphocytes. Four structural proteins, VP1, VP2, VP3, and VP4, comprise the viral capsid of the FMDV, but only VP1 has been extensively studied regarding the existence of relevant T-cell epitopes. Here, we utilize a murine model to present a functional T-cell epitope mapping on the complete sequences of VP2, VP3, and VP4 of FMDV O1 Campos. We used two in vitro assays to describe 13 amino acid sequences, each one of them including at least one T-cell epitope. The in vivo T-cell helper function of these sequences was studied in an adoptive cell-transfer assay in mice. Immunization experiments with a fusion peptide containing one of the sequences characterized were also done comparing the helper activity of this sequence with other T-cell epitopes included in the major immunogenic region of VP1.

Improvement of the immune response to foot and mouth disease virus vaccine in calves by using Avridine as adjuvant.

The epidemiological analysis of the cattle population during the eradication plan of foot and mouth disease (FMD) in Argentina clearly indicated a higher incidence of the disease in animals within their first year of age. It is important to improve the efficacy of the vaccination in those animals. In a previous report, we have shown the effect of an immunomodulator, Avridine (Avr), in the enhancement of the immune response elicited by FMD virus (FMDV) vaccines in experimental hosts [Berinstein, A., Pérez Filgueira, M., Schudel, A., Zamorano, P., Borca, M., Sadir, A.M., 1993. Avridine and LPS from Brucella ovis: effect on the memory induced by foot-and-mouth disease virus vaccination in mice. Vaccine 11, 1295-1301]. In this report, we analyze the effect of Avr in the improvement of the anti-FMDV immune response elicited in young animals immunized with a tetravalent vaccine. The anti-FMDV antibody response was evaluated using a liquid-phase blocking sandwich ELISA (LPBE) [Smitsaart, E.N., Zanelli, M., Rivera, I., Fondevila, N., Compaired, D., Maradei, E., Bianchi, T., O'Donnell, V., Schudel, A.A., 1998. Assessment using ELISA of the herd immunity levels induced in cattle by foot and mouth disease oil vaccines. Prev. Vet. Med 33, 283-296] while the cellular response was detected using an antigen specific lymphoproliferative test [Zamorano, P., Wigdorovitz, A., Chaher, M., Fernández, F., Sadir, A., Borca, M., 1994. Localization of B and T cell epitopes on a synthetic peptide containing the major immunogenic site of FMDV O1 Campos. Virology 201, 383-387]. The results show that, while no differences were detected in the cellular response, the anti-FMDV antibody reaction was significantly (<0.05) higher in animals immunized with the immunogen containing Avr. At 90 days post vaccination, 89-100% of the animals immunized with Avr presented predicted protection (PP) higher than 82% while just 50-61% of the animals immunized with vaccine without immunomodulator presented that characteristic. Also, it is shown that the increase in the anti-FMDV antibody titre in animals immunized with the vaccine containing Avr was mediated by an increase in the levels of both IgG1 and IgG2 which presented a significative correlation with LPELISA antibodies titres. It is concluded that the addition of Avr in the FMDV vaccines improve the immune status of the calves, the cattle population that suffers the highest epidemiological risk.

Effect of Mycobacterium sp. wall and Avridine on the antibody response, IgG isotype profile and proliferative response induced by foot and mouth disease virus (FMDV) vaccination in cattle.

Different immunomodulators have been previously tested in our laboratory as enhancers of the specific immune response to FMDV vaccines in a murine model [2-4]. Here, we present results of two of these immunomodulators, a water-soluble fraction of the cell wall of Mycobacterium sp. (WSF) and a synthetic lipoamide, Avridine (AV), which were tested in bovines included in FMDV oil vaccines. Two different concentrations of inactivated viral antigen were employed and the effect of different concentrations of the adjuvants were studied when added to the lower viral dose. It is shown that the inclusion of these adjuvants in the higher concentration in vaccines formulated with low antigen concentration induced the same antibody levels as those induced by vaccines containing twice the concentration of virus, and no adjuvants, and as a commercial formulation which performed with 100% of protection in the potency test. The IgG isotypes profiles induced in these experimental vaccines differed from those elicited by the commercial and control vaccines. Both IgG1 and IgG2 were augmented by the experimental formulations. These adjuvants, specially the WSF, also enhanced the cellular immune response against the FMDV in antigen driven proliferation assays, thus acting on a broad range of immune mechanisms.

[Semantic scales for noise evaluation. Third stage: subjective characterization of sound stimuli]. / Escalas semánticas para la evaluación del ruido. Tercera etapa: caracterización subjectiva de estímulos sonoros.

This is the third step of a research for which Osgood's Differential Semantic Technique was resorted to in order to get suitable scales on a subjective evaluation of sound stimuli. Thus, a three-stage work was fulfilled. The first one dealt with the construction of seven-point bipolar scales starting from experimentally selected adjectives. The second one succeeded in finding the subjacent dimensions of the said scales by means of Factorial Analysis Method. The present stage aims at characterizing 40 sound stimuli through the discovered dimensions most representative scales. A special Semantic Differential Program was used to getting the following Index: Scalar Scores, Polarity, Familiarity and Interconcept Distances. The interpretation of the Index showed the best characterized stimuli altogether with their affective meanings and their similarities and differences as well.

Escalas semánticas para la evaluación del ruido. Tercera etapa: caracterización subjectiva de estímulos sonoros. / [Semantic scales for noise evaluation. Third stage: subjective characterization of sound stimuli]

This is the third step of a research for which Osgoods Differential Semantic Technique was resorted to in order to get suitable scales on a subjective evaluation of sound stimuli. Thus, a three-stage work was fulfilled. The first one dealt with the construction of seven-point bipolar scales starting from experimentally selected adjectives. The second one succeeded in finding the subjacent dimensions of the said scales by means of Factorial Analysis Method. The present stage aims at characterizing 40 sound stimuli through the discovered dimensions most representative scales. A special Semantic Differential Program was used to getting the following Index: Scalar Scores, Polarity, Familiarity and Interconcept Distances. The interpretation of the Index showed the best characterized stimuli altogether with their affective meanings and their similarities and differences as well.

[Semantic scales for the evaluation of noise (II). Subjacent dimensions in subjective judgments of sound stimuli]. / Escalas semánticas para la evaluación del ruido (II). Dimensiones subyacentes en los juicios subjetivos de estímulos sonoros.

Second stage of a research in which Osgood's Diferential Semantic Technique was used in two experiments with the following aims: a) to find out the subyacent dimensions of subjective evaluation of sound stimuli; b) to know if Osgood's Evaluation, Potency and Activity dimensions appear when sound stimuli are judged; c) to obtain a group of semantic scales that represent the found dimensions, which can be used in other researches in the same field. In the first experiment 37 scales were used by 98 Ss for judging 10 sound stimuli. In the second, 120 Ss performed the same task through 46 scales and 40 sound stimuli. Data of both experiments were processed by factor analysis method and a Varimax rotation was done. Having obtained 12 similar factors in both experiments the results were analized in a comparative way. Eight dimensions that explain the subject-sound stimuli relation were found. The other dimensions deal with the stimulis control, cognitive experience and structural caracteristics of sound stimuli, being the affective component also present in some of their scales. In the third stage the sound stimuli used will be analized through the found dimensions.

Escalas semanticas para la evaluacion del ruido (II). Dimensiones subyacentes en los juicios subjetivos de estimulos sonoros. / Semantic scales for the noise (II). Subjacent dimensions in subjective judgement of sound stimuli

Segunda etapa de una investigacion en la cual utilizando la tecnica del diferencial semantico de Osgood se realizaron dos experiencias con el objeto de investigar: a) las dimensiones que subyacen en la evaluacion de estimulos sonoros; b) si las dimensiones EPA del mismo autor aparecen en el dominio estudiado; c) si existe un grupo de escalas semanticas representativas de las dimensiones encontradas. Dos muestras de sujetos juzgaron diferentes grupos de estimulos sonoros mediante escalas de adjetivos bipolares.Los datos obtenidos en cada experiencia fueron procesados por el metodo de analisis factorial, interpretandose los resultados en forma comparativa.Obtuvieron 8 dimensiones que explican la relacion sujeto-juicio-estimulo sonoro, comprobandose la importancia de las dimensiones afectivas en esta relacion

Escalas semanticas para la evaluacion del ruido (II). Dimensiones subyacentes en los juicios subjetivos de estimulos sonoros. / Semantic scales for the noise (II). Subjacent dimensions in subjective judgement of sound stimuli

Segunda etapa de una investigacion en la cual utilizando la tecnica del diferencial semantico de Osgood se realizaron dos experiencias con el objeto de investigar: a) las dimensiones que subyacen en la evaluacion de estimulos sonoros; b) si las dimensiones EPA del mismo autor aparecen en el dominio estudiado; c) si existe un grupo de escalas semanticas representativas de las dimensiones encontradas. Dos muestras de sujetos juzgaron diferentes grupos de estimulos sonoros mediante escalas de adjetivos bipolares.Los datos obtenidos en cada experiencia fueron procesados por el metodo de analisis factorial, interpretandose los resultados en forma comparativa.Obtuvieron 8 dimensiones que explican la relacion sujeto-juicio-estimulo sonoro, comprobandose la importancia de las dimensiones afectivas en esta relacion

Escalas semánticas para la evaluación del ruido (II). Dimensiones subyacentes en los juicios subjetivos de estímulos sonoros. / [Semantic scales for the evaluation of noise (II). Subjacent dimensions in subjective judgments of sound stimuli]

Second stage of a research in which Osgoods Diferential Semantic Technique was used in two experiments with the following aims: a) to find out the subyacent dimensions of subjective evaluation of sound stimuli; b) to know if Osgoods Evaluation, Potency and Activity dimensions appear when sound stimuli are judged; c) to obtain a group of semantic scales that represent the found dimensions, which can be used in other researches in the same field. In the first experiment 37 scales were used by 98 Ss for judging 10 sound stimuli. In the second, 120 Ss performed the same task through 46 scales and 40 sound stimuli. Data of both experiments were processed by factor analysis method and a Varimax rotation was done. Having obtained 12 similar factors in both experiments the results were analized in a comparative way. Eight dimensions that explain the subject-sound stimuli relation were found. The other dimensions deal with the stimulis control, cognitive experience and structural caracteristics of sound stimuli, being the affective component also present in some of their scales. In the third stage the sound stimuli used will be analized through the found dimensions.

[Construction of semantic scales for the subjective evaluation of noise]. / Construcción de escalas semánticas para la evaluación subjetiva del ruido.

This is the first stage of a research the aim of which is to construct proper scales for the subjective evaluation of noise, using Osgood's Differential Semantic Technique. 137 adjectives were selected using two criteria. For the first criterium a method based on Gougenheim's and Hogenraad's researches was used. 200 subjects were asked to write 30 adjectives that could be used for qualifying sonorous stimuli. The frequencies of the adjectives given by the subjects were calculated and 25 of them were selected for being under the 10% limit of the probability, arbitrarily chosen as a criterium for the selection. For the second criterium 10 acoustic researchers were asked to write all those adjectives they considered important for noise evaluation. Thus, 112 adjectives were selected. The 137 adjectives got by the two criteria were judged by 15 university professors of different careers, for getting their opposites. A level of agreement of at least 6 of 15 judges was considered. 62 adjectives with their opposites were got and using other two criteria they were reduced to 37. A hypothesis was formulated grouping the adjectives into 8 factors taking into account the three universal factors: Evaluation (E), Potency (P) and Activity (A) according to the Differential Semantic Technique. Seven point scales were constructed with the adjectives. The construction of the scales, the selection of concepts, the application of them to a sample of subjects and data analysis will be the second stage of this research.

Construccion de escalas semanticas para la evaluacion subjetiva del ruido. / Construction of semantic scales for the subjective evaluation of noise

Primera etapa de un trabajo cuyo objetivo es construir mediante la tecnica del Diferencial Semantico, escalas adecuadas para evaluar subjetivamente estimulos sonoros.Se seleccionaron en primer lugar adjetivos utilizando 2 criterios experimentales y se obtuvieron sus opuestos mediante el Sistema de Jueces. Se seleccionaron los mas relevantes, teniendo en cuenta todos los aspectos de la relacion sujeto-estimulo sonoro. Se formularon hipotesis sobre los factores subyacentes, quedando la construccion y seleccion de escalas asi como la comprobacion de los factores para la segunda etapa de esta investigacion

Construccion de escalas semanticas para la evaluacion subjetiva del ruido. / Construction of semantic scales for the subjective evaluation of noise

Primera etapa de un trabajo cuyo objetivo es construir mediante la tecnica del Diferencial Semantico, escalas adecuadas para evaluar subjetivamente estimulos sonoros.Se seleccionaron en primer lugar adjetivos utilizando 2 criterios experimentales y se obtuvieron sus opuestos mediante el Sistema de Jueces. Se seleccionaron los mas relevantes, teniendo en cuenta todos los aspectos de la relacion sujeto-estimulo sonoro. Se formularon hipotesis sobre los factores subyacentes, quedando la construccion y seleccion de escalas asi como la comprobacion de los factores para la segunda etapa de esta investigacion

Construcción de escalas semánticas para la evaluación subjetiva del ruido. / [Construction of semantic scales for the subjective evaluation of noise]

This is the first stage of a research the aim of which is to construct proper scales for the subjective evaluation of noise, using Osgoods Differential Semantic Technique. 137 adjectives were selected using two criteria. For the first criterium a method based on Gougenheims and Hogenraads researches was used. 200 subjects were asked to write 30 adjectives that could be used for qualifying sonorous stimuli. The frequencies of the adjectives given by the subjects were calculated and 25 of them were selected for being under the 10

limit of the probability, arbitrarily chosen as a criterium for the selection. For the second criterium 10 acoustic researchers were asked to write all those adjectives they considered important for noise evaluation. Thus, 112 adjectives were selected. The 137 adjectives got by the two criteria were judged by 15 university professors of different careers, for getting their opposites. A level of agreement of at least 6 of 15 judges was considered. 62 adjectives with their opposites were got and using other two criteria they were reduced to 37. A hypothesis was formulated grouping the adjectives into 8 factors taking into account the three universal factors: Evaluation (E), Potency (P) and Activity (A) according to the Differential Semantic Technique. Seven point scales were constructed with the adjectives. The construction of the scales, the selection of concepts, the application of them to a sample of subjects and data analysis will be the second stage of this research.