[Fulminant pneumococcal pancarditis and acute myocardial infarction with cardiac failure]. / Pancarditis neumocócica con infarto agudo de miocardio y fracaso cardiaco de curso fulminante.

Streptococcus pneumoniae is an infrequent cause of endocarditis in adults. Typically occurs in individuals with debilitating illnesses as alcoholism. Frequently the course is aggressive, with rapid destruction of valves. It is associated with high mortality. We describe a young patient without underlying illnesses with pneumococcal endocarditis and meningitis of fulminant course diagnosed in postmorten examination.

Pancarditis neumocócica con infarto agudo de miocardio y fracaso cardíaco de curso fulminante / Fulminant pneumococcal pancarditis and acute myocardial infarction with cardiac failure

Streptococcus pneumoniae es una causa infrecuente de endocarditis infecciosa en los adultos. Típicamente ocurre en individuos con enfermedades debilitantes como alcoholismo. El curso evolutivo es agresivo, con rápida destrucción valvular, por lo que se asocia a una alta mortalidad. Presentamos el caso de un paciente joven sin enfermedades subyacentes con endocarditis y meningitis neumocócica neumocócica de curso fulminante demostrada en estudio post mórtem

Streptococcus pneumoniae is an infrequent cause of endocarditis in adults. Typically occurs in individuals with debilitating illnesses as alcoholism. Frequently the course is aggressive, with rapid destruction of valves. It is associated with high mortality. We describe a young patient without underlying illnesses with pneumococcal endocarditis and meningitis of fulminant course diagnosed in postmorten examination

Síndrome febril intermitente como manifestación inicial de un hemangioma cavernoso gigante hepático / Intermittent fever as the initial manifestation of giant cavernous hemangioma of the liver

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Carcinoma de células en anillo de sello primario de mama. Diagnóstico diferencial inmunohistoquímico / Primary signet-ring carcinoma of the breast. Immunohistochemical differential diagnosis

El carcinoma de células en anillo de sello primario de mama es un tumor infrecuente de histogénesis con-trovertida, de comportamiento agresivo y patrón metastásico inusual hacia el tracto gastrointestinal y superficies serosas, planteando problemas de diagnóstico diferencial con metástasis de carcinoma de células en anillo de sello de otros orígenes, preferentemente gastrointestinal. El perfil inmunohistoquímico con positividad para Citoqueratina 7 y para GCDFP-15 (Gross cystic disease fluid protein-15), y en ocasiones para los receptores hormonales, y negatividad para Citoqueratina 20, posibilita el diagnóstico diferencial con estos tumores. Presentamos un caso de carcinoma de células en anillo de sello primario de mama en una mujer de 72 años con gran masa tumoral en mama derecha, de varios meses de evolución, y revisamos la literatura sobre su histogénesis y el perfil inmunohistoquímico diferencial (AU)

[Bladder transitional cell carcinoma rating, systematization of grading and value of DNA ploidy]. / Contribución a la categorización de los CCT de vejiga, sistemátización de la gradación y utilidad de la ploidía de ADN.

UNLABELLED: TCCs are an heterogenous group of tumors with an uncertain biologic behaviour, especially intermediate grade (G2). Histologic grade and pathologic stage have revealed only partially useful on predicting the outcome. OBJECTIVE: Search and statement of objective and cuantitative parameters able to define prognostic subgroups to TCCs. MATERIAL AND METHOD: We studied consecutive 106 patients with TCC in order to: 1) Identify every variable with independent predictive value in classifying cases of TCC in a three (1,2,3) or two (high/low) grades systems. 2) Make a correlation between DNA ploidy obtained by image analysis and DNA ploidy and S-phase obtained by flow cytometry. RESULTS: Every variable used to define the histologic grade showed significative correlation with both gradation systems. In multivariate analysis, the presence of superficial cells and the mitotic counts revealed us the most valuable variables in predicting the histologic grade. DNA-ploidy (both obtained by static an flow cytometry) correlated well with grade, stage, growth pattern and necrosis, whereas S-phase did so with grade, mitotic index and DNA ploidy. Image cytometry showed similars results to those of flow cytometry and also was able to detect aneuploidy when an situ carcinoma or dysplasia were present in the adyacent mucosa.

[Value of Markovian nuclear texture to predict progression in surface transitional cell carcinoma of the bladder]. / Utilidad de las texturas nucleares Markovianas en la predicción de la progresión en los CCT superficiales de vejiga.

The aim of this work has been to determine if the DNA and nuclear Markovian textures of tissue sections evaluated by image cytometry correlate with the histologic grade and the progression probability of superficial transitional carcinoma of the bladder. In our study, DNA ploidy is related to histologic grade in that aneuploidy frequency increases with a higher grade of malignancy. Image analyses of superficial TCC tissue sections of the bladder, has allowed us to identify "sub-visual parameters" as well as nuclear textures that according to our results can be useful in clarifying the evolutive behaviour of these tumours. Two Markovian textures that identify entropy (TXI) and mean internal contrast (TXB) allow to discriminate between histologic grades as well as progression or non-progression. In conclusion, image analysis cytometry of paraffin embedded tissue sections of TCC of the bladder supplies densitometric parameters related to grade and provides valuable information for the prediction of progression. Quantification of chromatin pattern description in Feulgen-stained nuclei using the Markovian method can be useful in this context.