[Publications on spine surgery in Mexico: a bibliometric study]. / Estudio bibliométrico de las publicaciones en cirugía de columna en México.

INTRODUCTION: bibliometric analysis is a useful way of assessing the past, present and future publications related to a given area in a qualitative and quantitative way. OBJECTIVE: to determine characteristics of national authors productivity in the field of spine surgery research across the time. MATERIAL AND METHODS: an online research was performed using the Elsevier´s database Scopus in October, 2021. All studies were assessed for the following parameters: year, title, access, language, journal, type of article, focus of research, objective of research, cites, authors and institutions. RESULTS: a total of 404 publications were identified between 1973 and 2021. Between 1991-2000 decade to 2011-2021 decade the number of published articles tended to increase by 68.28 times. The largest number of articles was from South-Central Region (66.16%), followed by Western (15.03%) and Northwest (8.27%). The highest h-index was found for USA journals (102). The highest number of articles was published in Coluna/Columna (15.53%), followed by Cirugía y Cirujanos (10.52%) and Acta Ortopédica Mexicana (8.52%). Instituto Nacional de Rehabilitación published the largest number of articles (17.57%), followed by Centro Médico Nacional de Occidente del IMSS (6.67%) and Centro Médico ABC (5.44%). CONCLUSIONS: the number of articles published in the field of spine surgery in Mexico has increased rapidly in the past 15 years. In terms of quality, publications written in English are the most cited. The geographical distribution of research in Mexico is centralized, the largest number of publications was from South-Central Region of Mexico.

INTRODUCCIÓN: el análisis bi­bliométrico es una forma útil de evaluar el pasado, el pre­sente y el futuro de las publicaciones relacionadas con un área determinada de forma cualitativa y cuantitativa. OBJETIVO: determinar las características de la productividad nacional en investigación escrita por autores mexicanos en el campo de cirugía de columna a través del tiempo. MATERIAL Y MÉTODOS: se realizó una búsqueda exhaustiva en línea en Octubre de 2021 utilizando la base de datos Scopus desarrollada por Elsevier. La información de las publicaciones recolectadas fue la siguiente: año, título, acceso, idioma, revista, tipo de artículo, tema, objetivo, citas, autores e instituciones de afiliación. RESULTADOS: se identificó un total de 404 publicaciones entre 1973 y 2021. El número de publicaciones entre la década 1991-2000 y 2011-2021 incrementó 68.28 veces. La mayoría de las publicaciones se realizaron en instituciones de la región centro-sur de México (66.16%), seguida de la región occidente (15.03%) y noreste (8.27%). El índice H más alto encontrado fue de revistas de origen estadounidense (102). La mayor parte de las publicaciones se realizó en la revista Coluna/Columna (15.53%), seguida de Cirugía y Cirujanos (10.52%) y de Acta Ortopédica Mexicana (8.52%). La institución con la más alta productividad fue el Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra" (17.57%), seguida del Centro Médico Nacional de Occidente del IMSS (6.67%) y del Centro Médico ABC (5.44%). CONCLUSIONES: el número de artículos publicados en el campo de cirugía de columna ha incrementado rápidamente en los últimos 15 años. Las publicaciones escritas en inglés son las más citadas. La distribución geográfica de la investigación en este campo en México está centralizada, realizándose la mayor parte de las publicaciones en la región centro-sur del país (66.16%).

Comparative study between Plate-Graff, Plate-Cage and peek cage in cervical spine fusion.

OBJECTIVE: To compare results of Plate-Graff, Plate-Cage and PEEK cage in patients with cervical stenosis. MATERIAL AND METHODS: Prospective, with before and after intervention and comparative study. From January 2005 to October 2011 we included 37 patients (male: 48.6%, female: 51.4%) post-surgery by anterior approach; 3 groups via: Group I, arthrodesis with Plate-Graff n = 12 (M 41.7%, F 58.3%) with 22 levels, group II, Plate-Cage n = 11 (M 63.6% 36.4% F) 19 levels, group III, PEEK cage, n = 14 (M 0% F 50%) with 25 levels. Functional assessment pre- and postoperative with neck disability index (NDI) and visual analogue scale for pain (VAS). The radiological assessment with X-rays only. Descriptive statistics were obtained. Wilcoxon method use according to data distribution, non parametric tests of ranges with sign of Kruskal-Wallis for comparison between more than two groups, and significance level with p 0.05. We used the statistical package SPSS version 15. RESULTS: The majority of patients was found between the sixth and eighth decade of life. At one year of follow up the NDI and pain with VAS shown improvement with statistical difference in three groups (p = 0.001). However, the radiographic measurements per year of follow-up showed a significant improvement of segmental lordosis (p = 0.02) only in patients with Plate-Graff. CONCLUSIONS: Using the graft offers best clinical and radiographic results compared with the Plate Cage and box peek to one year of follow-up.

OBJETIVO: Comparar resultados de placa-injerto, caja-placa y caja-PEEK, en pacientes con conducto cervical estrecho. MATERIAL Y MÉTODOS: Estudio prospectivo, en panel antes y después, de intervención y comparativo. De Enero de 2005 a Octubre de 2011, muestra de 37 pacientes (masculino: 48.6%, femenino: 51.4%) postoperados por vía anterior; formando tres grupos: grupo I, artrodesis con placa-injerto n = 12 (M 41.7%, F 58.3%) con 22 niveles; grupo II, caja-placa n = 11 (M 63.6%, F 36.4%) con 19 niveles; grupo III, caja-PEEK, n = 14 (M 50%, F 50%) con 25 niveles. La evaluación funcional pre- y postoperatoria mediante la escala de discapacidad cervical y escala visual análoga de dolor. La evaluación radiológica con radiografías de columna cervical. Se obtuvo estadística descriptiva. De acuerdo con la distribución de los datos se usaron pruebas no paramétricas de rangos con signo de Wilcoxon, y Kruskal-Wallis para comparación entre más de dos grupos. Con nivel de significancia de p0.05. Se utilizó el paquete estadístico SPSS versión 15. RESULTADOS: La mayoría de los pacientes se encontró entre la sexta y octava década de la vida. Al año de postoperados el índice de discapacidad cervical y mejoría del dolor con EVA mostraron mejoría con diferencia estadística en los tres grupos (p = 0.001). Sin embargo, las mediciones radiográficas al año de seguimiento mostraron una mejoría significativa de la lordosis segmentaria (p = 0.02) sólo en pacientes operados con placa-injerto. CONCLUSIONES: El uso de la placa-injerto ofrece mejores resultados clínicos y radiográficos en comparación con la caja-placa y caja-PEEK, al año de seguimiento.

A new technique of pedicle screw placement with the use of sequential multilevel navigation templates based on patient-specific 3D CT reconstruction model: applicability in spine deformity.

INTRODUCTION: The technique of placement of pedicle screws has gradually improved, but even misplacement observed in 1.2 to 20% of cases, have appeared techniques fluoroscopic, tomographic and electromagnetic navigation, which led it to 1.3 to 4.3%, but nevertheless they are expensive and complex technologies. Present technique pedicle screw placement by using templates with a modification in the art, performing tomography and reconstruction in the same surgical position and with the templates of 3 or more levels. METHODS: Five cases of idiopathic scoliosis were performed, with correction and instrumentation with pedicular screws, where a three-dimensional model of the spine was performed with a tomography in a surgical position, whose images were exported to a 3D printer to reconstruct the desired trajectory of the screws in a template using cylinders resting on the inverse surface of the vertebrae. The direction of the screw was planned in the center of the pedicle and parallel to the upper platform of the vertebra. Each template was of several levels and transoperative X-rays were not used. RESULTS: Under electrophysiologic monitoring transoperative «red alerts¼ were not reported, the placement of the screws in postoperative CT scan was evaluated, showing a standard deviation in placement of 1.9 and 2.2 mm on the right and left respectively pedicles, with respect to their planning. DISCUSSION: This technique is simple and safe, besides not requiring great technology, its use is suggested in beginner spine surgeons and in severe deformities, it can be performed in any hospital where spinal surgery is performed.

INTRODUCCIÓN: La técnica de colocación de tornillos transpediculares ha mejorado paulatinamente, a pesar de ello, la mala colocación oscila entre 1.2 al 20% de los casos; han surgido técnicas de navegación asistidas por flouroscopía, tomografía y resonancia magnética mejorando el índice de falla al 1.3-4.3%. La presente técnica de colocación utiliza plantillas con la modificación de que la tomografía y la reconstrucción son realizadas con el paciente en la posición quirúrgica, además que las plantillas abarcan tres o más niveles. MÉTODOS: Se presentan cinco casos de escoliosis idiopática tratados con instrumentación y colocación de tornillos transpediculares donde se generó un modelo tridimensional de la columna en posición quirúrgica; las imágenes fueron exportadas a una impresora 3-D para reconstruir la trayectoria apropiada de los tornillos, la dirección de éstos fue planeada tomando de referencia el centro del pedículo y paralela a la plataforma superior de la vértebra. Cada plantilla consta de diferentes niveles y no se requirió del uso de rayos X trans­operatorios. RESULTADOS: Bajo monitoreo electrofisiológico transquirúrgico no se reportó ninguna «alerta roja¼; la evaluación postoperatoria por tomografía de la colocación de los tornillos mostró una desviación estándar de 1.9 y 2.2 mm tanto a la derecha y a la izquierda, respectivamente, de acuerdo con lo planeado. DISCUSIÓN: La técnica es simple y segura, no requiere de mucho despliegue tecnológico, se sugiere su uso para los cirujanos de columna con poca experiencia y para deformidades severas; consideramos que puede desarrollarse en cualquier hospital donde se realice cirugía de columna.

[Comparative study between plate-graft, cage-plate and peek cage in cervical arthrodesis for cervical stenosis]. / Estudio comparativo entre placa-injerto, caja-placa y caja de PEEK en artrodesis de la columna cervical con conducto cervical estrecho.

INTRODUCTION: A variety of systems have been developed to fix and perform arthrodesis of the cervical spine, with the advantages of reducing the risk of pseudoarthrosis, extrusion and graft collapse and achieving a more precise sagittal alignment. We therefore need to compare the results of the following approaches to patients with cervical stenosis: plate-graft, cage-plate and PEEK cage. MATERIAL AND METHODS: Prospective, interventional, comparative trial involving three groups: group I, arthrodesis with plate-graft; group II, cage-plate, and group III, PEEK cage. The pre- and postoperative assessments included the cervical disability scale, the pain visual analog scale (VAS), and cervical spine X-rays. The results were analyzed with non-parametric tests such as the Wilcoxon sign test and the Kruskal-Wallis test for the comparison of more than two groups. Significance level was 0.05. RESULTS: The sample included a total of 37 patients: n = 12 in group I, with 22 levels; n = 11 in group II, with 19 levels, and n = 14 in group III, with 25 levels. Patient age ranged between 60 and 80. One year after surgery there was an improvement in cervical disability and the pain VAS score, with a statistically significant difference among the three groups (p = 0.001). However, radiographic measurements at that time showed a significant improvement in segmental lordosis (p = 0.02) only in plate-graft patients. CONCLUSIONS: The plate-graft approach provides better clinical and radiographic results compared to the cage-plate and PEEK cage techniques, at the one-year follow- up.

[Degenerative adult scoliosis]. / Escoliosis degenerativa del adulto.

Adult scoliosis is a complex three-dimensional rotational deformity of the spine, resulting from the progressive degeneration of the vertebral elements in middle age, in a previously straight spine; a Cobb angle greater than 10° in the coronal plane, which also alters the sagittal and axial planes. It originates an asymmetrical degenerative disc and facet joint, creating asymmetrical loads and subsequently deformity. The main symptom is axial, radicular pain and neurological deficit. Conservative treatment includes drugs and physical therapy. The epidural injections and facet for selectively blocking nerve roots improves short-term pain. Surgical treatment is reserved for patients with intractable pain, radiculopathy and/ or neurological deficits. There is no consensus for surgical indications, however, it must have a clear understanding of the symptoms and clinical signs. The goal of surgery is to decompress neural elements with restoration, modification of the three-dimensional shape deformity and stabilize the coronal and sagittal balance.

[Functional results of surgery for cervical stenosis]. / Resultados funcionales de la cirugía del conducto cervical estrecho.

INTRODUCTION: Cervical stenosis refers to the narrowing of the spinal canal or the intervertebral foramina at different anatomic levels, secondary to pathologic processes of the vertebral elements. Surgical management is used when conservative management fails. The anterior and posterior approaches are the most frequently used ones, and the surgical options resulting from these approaches are: anterior cervical diskectomy plus fusion, anterior corporectomy plus fusion, laminoplasty, laminectomy and arthroplasty. MATERIAL AND METHOD: This is an ambispective study conducted in 195 patients with a diagnosis of cervical stenosis who required surgical treatment at our hospital from January 1995 to January 2007. The neck disability index questionnaire was applied, as well as the Nurick scale. Descriptive statistics was used with frequency and percentage measures. RESULTS: The review of the National Rehabilitation Institute electronic records from January 1st 1995 to December 31st 2007 showed that 195 patients underwent surgery for cervical stenosis. Females were predominant. The most affected age group was 46-55 years. The most frequently affected level was C5-C6. A significant improvement was seen in the neck disability index due to pain and the Nurick scale. CONCLUSION: According to world literature, mean age of patients with cervical stenosis is 57.2 years, and the most compromised levels were C4-C5 and C5-C6. Improvement was evident according to the neck disability index and the Nurick scale.

[Dynamic interspinous stabilization versus transpedicular fixation and arthrodesis in the treatment of lumbar stenosis in patients 45-65 years of age]. / Estabilización dinámica interespinosa versus fijación transpedicular y artrodesis en el tratamiento del conducto lumbar estrecho en pacientes de 45 a 65 años de edad.

INTRODUCTION: Ligamentoplasty is a posterior dynamic stabilization method. The purpose of this study is to compare the incidence of adjacent segment disease in patients undergoing decompression and ligamentoplasty versus patients with standard 360 degrees arthrodesis. MATERIAL AND METHODS: Two groups were studied, each with 15 patients. The first group underwent recalibration with fixation (Group A) and the second group recalibration with ligamentoplasty (Group L). The occurrence of adjacent segment degeneration was assessed, together with the presence of adjacent segment disease in both groups. The statistical analysis was performed with the SPSS 17.0 software. RESULTS: Both techniques showed a statistically significant clinical improvement at the six-month postoperative follow-up (p = 0.001). Radiographic findings showed a higher translational instability index at the one-year follow-up in the arthrodesis group. No statistical difference was found in the clinical course or in the rest of the radiographic variables at the 3-year comparison between both groups. The rate of adjacent segment degeneration in Group A was 33.3%, compared with 20% in Group L at the one-year follow-up. Until now, there have been two cases of radiculopathy, one in Group L and one in Group A, both with adjacent segment disease. CONCLUSION: At the 3-year follow-up it is not possible to say that ligamentoplasty, unlike 360 degrees arthrodesis, decreases the rate of adjacent segment disease. However, this technique has promising results.

[Comparison between arthrodesis and non-arthrodesis in thoracic and lumbar spine fractures: two-year follow-up]. / Comparación entre artrodesis y no artrodesis en fracturas de vértebras torácicas y lumbares: Seguimiento de dos años.

INTRODUCTION: The currently accepted treatment of thoracolumbar fractures is reduction, decompression, fixation and arthrodesis. However, it is not the perfect solution due to the medium- and long-term consequences of arthrodesis, which include the wear of the adjacent segments above and below. Some previous studies have proposed the treatment with fixation without arthrodesis. However, there are no reports on the medium- and long-term clinical and radiographic follow-up. MATERIAL AND METHODS: Two 20-patient groups treated with transpedicular fixation and decompression, one with and one without posterolateral arthrodesis, were compared. CONTROL GROUP: The mean hospital stay was 5 days. The postoperative visual analog scale pain score was 2-3 in 4 patients; the rest were asymptomatic. The functional Oswestry disability index was 8.3%. The functional economic rehabilitation scale was 4.55. Case group: The mean hospital stay was 5 days. The postoperative visual analog scale pain score was 1-2 in 2 patients; the rest were asymptomatic. The functional Oswestry disability index was 6.3%. The functional economic rehabilitation scale was 6.4. CONCLUSIONS: Both groups had very similar results. The group without arthrodesis had better results in the Oswestry functional disability scale and the functional economic rehabilitation scale.

Impacto del tratamiento alergológico integral en la calidad de vida de los pacientes con asma / Wholemeal allergologic treatment impact in the quality of life of patients with asthma

Introducción: Calidad de vida es la percepción del paciente de los efectos de suenfermedad y sus consecuencias terapéuticas. Con los cuestionarios validados yestandarizados se evalúa la calidad de vida de los pacientes con asma.Objetivo: Estimar el impacto del tratamiento alergológico integral en los pacientescon asma que acudieron a consulta al servicio de Alergia e InmunologíaClínica del Hospital Universitario de Puebla.Material y métodos: Se realizó un estudio prospectivo en pacientes con asmaalérgica de ambos sexos y mayores de 18 años, con inclusión de dos meses yseguimiento de 12 visitas. A cada paciente se le realizó la anamnesis, las pruebascutáneas, la espirometría y un cuestionario de calidad de vida y estimaciónde la gravedad al inicio y final del seguimiento. El tratamiento alergológico integralse basó en los criterios de GINA. El tamaño de la muestra se calculó deacuerdo a métodos estandarizados.Resultados: Se incluyeron 20 pacientes y todos terminaron el seguimiento. El85% era mujer y la edad media era de 41,8 años con una desviación estándarde 13,4. La gravedad más frecuente fue la moderada persistente en el 40% alinicio y al final del seguimiento y la intermitente en el 75%. Se observaron diferenciassignificativas entre el índice de calidad de vida al ingreso de los pacientesy durante el seguimiento a partir de la octava visita.Conclusión: El tratamiento alergológico integral modifica la calidad de vida yla gravedad de los pacientes con asma alérgica

Introduction: The quality of life is conceived as the perception of the patient of the functional effects of his/her illness and its therapeutics consequences. Development of validated and standardized questionnaires had may to evaluated the quality of life of patients with asthma. Objective: Determine the impact of integral alergologic treatment on quality of life of patients with allergic asthma visited in the external consultation of the service of Allergy and Clinical Immunology of the Hospital Universitario de Puebla. Material and methods: A prospective study was carried out in patients of both sexes, older than 18 years, whit allergic asthma, through a period of inclusion of two months with twelve visits of follow-up. History, skin test, spirometry and a standarized questionary were obtained in each patient, as well as estimation of severity degree of the illness at the beginning and at the end of the study. The integral allergic treatment was based on the Global Innitiative for Asthma judgments. The size of the sample was calculated according to standardized methods. Results: Twenty patients were included an all of them completed the follow-up. Eighty-five per cent of them were women. The average age was 41.8 years old with a SD of 13.4. The severity degree most frequent were the moderate persistent, with a 40% at inclusion and end of the follow- up, and the intermittent with a 75%. Significative differences between index of quality of life at the inclusion and during the follow-up were observed after 8th visit. Conclusion: The integral treatment modifies the quality of life and severity degree of the patients with allergic asthma

Signaling lymphocytic activation molecule expression and regulation in human intracellular infection correlate with Th1 cytokine patterns.

Induction of Th1 cytokines, those associated with cell-mediated immunity, is critical for host defense against infection by intracellular pathogens, including mycobacteria. Signaling lymphocytic activation molecule (SLAM, CD150) is a transmembrane protein expressed on lymphocytes that promotes T cell proliferation and IFN-gamma production. The expression and role of SLAM in human infectious disease were investigated using leprosy as a model. We found that SLAM mRNA and protein were more strongly expressed in skin lesions of tuberculoid patients, those with measurable CMI to the pathogen, Mycobacterium leprae, compared with lepromatous patients, who have weak CMI against M. leprae. Peripheral blood T cells from tuberculoid patients showed a striking increase in the level of SLAM expression after stimulation with M. leprae, whereas the expression of SLAM on T cells from lepromatous patients show little change by M. leprae stimulation. Engagement of SLAM by an agonistic mAb up-regulated IFN-gamma production from tuberculoid patients and slightly increased the levels of IFN-gamma in lepromatous patients. In addition, IFN-gamma augmented SLAM expression on M. leprae-stimulated peripheral blood T cells from leprosy patients. Signaling through SLAM after IFN-gamma treatment of Ag-stimulated cells enhanced IFN-gamma production in lepromatous patients to the levels of tuberculoid patients. Our data suggest that the local release of IFN-gamma by M. leprae-activated T cells in tuberculoid leprosy lesions leads to up-regulation of SLAM expression. Ligation of SLAM augments IFN-gamma production in the local microenvironment, creating a positive feedback loop. Failure of T cells from lepromatous leprosy patients to produce IFN-gamma in response to M. leprae contributes to reduced expression of SLAM. Therefore, the activation of SLAM may promote the cell-mediated immune response to intracellular bacterial pathogens.

Estudio retrospectivo de pacientes con pénfigo, en un período de diez años / Retrospective study of patients with pemphigus, during an 10 years period

Se presentan 92 pacientes con pénfigo internados durante un período de diez años. De ellos, 50 eran masculimnos y 42 femeninos. Observando como formas clínicas: pénfigo vulgar (79 pacientes), pénfigo vegetante (2 pacientes), pénfigo foliáceo no endémico (6 pacientes) y pénfigo eritematodes (5 pacientes). El 60,8 por ciento correspondieron a formas graves, el 20,6 por ciento a formas moderadas y 18,4 por ciento a formas leves. Más del 50 por ciento de los pacientes graves requirieron dosis superiores a 180 mg/día de 16 ß metilprednisona. La terapéutica esteroidea fue asociada con inmunosupresores (ciclofosmida, azatioprina y metotrexato), daps u oro, mientras que en 10 pacientes no se agregó ninguna medicación y en otros 10 se asoció más de un fármaco en forma sucesiva. Diez pacientes fallecieron, el 50 por ciento por sepsis. Del análisis de la casuística surgen algunas conclusiones: la mejor respuesta terapéutica en pacientes vírgenes de tratamiento; la utilidad del empleo de dosis altas de esteroide desde el inicio; el comportamiento biológico agresivo de algunos pénfigos superficiales; el valor predictivo de la edad y enfermedades concomitantes preexistentes con respecto a la aparición de complicacionmes; el desarrollo de sepsis como primera causa de muerte; la similar incidencia de complicaciones infecciosas, metabólicas y hematológicas, y la trascendencia de enfermedades cardiovasculares preexistentes como factor condicionante del óbito

Estudio retrospectivo de pacientes con pénfigo, en un período de diez años / Retrospective study of patients with pemphigus, during an 10 years period

Se presentan 92 pacientes con pénfigo internados durante un período de diez años. De ellos, 50 eran masculimnos y 42 femeninos. Observando como formas clínicas: pénfigo vulgar (79 pacientes), pénfigo vegetante (2 pacientes), pénfigo foliáceo no endémico (6 pacientes) y pénfigo eritematodes (5 pacientes). El 60,8 por ciento correspondieron a formas graves, el 20,6 por ciento a formas moderadas y 18,4 por ciento a formas leves. Más del 50 por ciento de los pacientes graves requirieron dosis superiores a 180 mg/día de 16 ß metilprednisona. La terapéutica esteroidea fue asociada con inmunosupresores (ciclofosmida, azatioprina y metotrexato), daps u oro, mientras que en 10 pacientes no se agregó ninguna medicación y en otros 10 se asoció más de un fármaco en forma sucesiva. Diez pacientes fallecieron, el 50 por ciento por sepsis. Del análisis de la casuística surgen algunas conclusiones: la mejor respuesta terapéutica en pacientes vírgenes de tratamiento; la utilidad del empleo de dosis altas de esteroide desde el inicio; el comportamiento biológico agresivo de algunos pénfigos superficiales; el valor predictivo de la edad y enfermedades concomitantes preexistentes con respecto a la aparición de complicacionmes; el desarrollo de sepsis como primera causa de muerte; la similar incidencia de complicaciones infecciosas, metabólicas y hematológicas, y la trascendencia de enfermedades cardiovasculares preexistentes como factor condicionante del óbito (AU)

[Cardiac involvement in scleroderma]. / Afectación cardiaca en esclerodermia.

It has been analyzed seven patients, five females and two males, affected by progressive systemic sclerosis. Their ages range from 35 to 60 years. Three of them correspond to the CREST syndrome named variant. There were made: physical examination, electrocardiogram, echocardiogram and radionuclide techniques such as: Thallium perfusion (T201) and ventriculography (Tc99). The cardiac examination of all the patients showed: Left myocardiopathy in six patients, as well right myocardiopathy in two of them. Four patients were affected by chronic cor pulmonale, due to pulmonary hypertension. All the patients had developed diffuse thallium perfusion defects as well, having abnormal resting left ventricular function in three patients and function abnormality from right ventricle in two patients. It is necessary to point out the importance of making such study systematically, even in the case cardiac symptoms absence.

[Cardiac repercussions in the CREST syndrome]. / Repercusión cardiaca en el síndrome de CREST.

Two females patients with CREST syndrome associated with cardiac involvement are reported. One of them has pericardial effusion just shown by echocardiography with patterns of cardiomyopathy of ventricular cavities, the latter as primary myocardial involvement, in the absence of pulmonary or systemic hypertension. The second patient has chronic cor pulmonale secondary to pulmonary hypertension verified by electrocardiography and echocardiography. It is emphasized the utility of the echocardiography and the importance of those anomalies that can lead to the patient's death, transforming the CREST towards a syndrome with potentially but late, severe systemic involvement.

Doença de Crohn: a propósito de um caso / Crohn's disease: apropos of a case

É apresentado um caso de Doença de Crhon do cólon, com manifestaçöes cutâneas específicas (úlceras anoperineogenitais) e inespecíficas (aftas, eritema palmar, dedo hipocrático, queilite angular). É destacado o início da doença com manifestaçöes cutâneas associadas a comprometimento do cólon. É feita uma revisäo dos aspectos clínicos desta entidade, enfatizando-se os diagnósticos diferenciais. Finalmente, é assinalado o papel relevante do dermatologista no diagnóstico precoce da Doença de Crhon

Estudio inmunologico en melanoma. / Immunologic study in melanoma

Se evalua el estado inmunitario en 20 pacientes al momento de efectuar el diagnostico de melanoma, realizandose pruebas de inmunidad celular "in vivo" (candidina, PPD, DNCB y ventana cutanea) y humoral (proteinograma, inmunoelectroforesis, dosaje de complemento, SIA test, COOMBS directo, latex y celulas L.E.). El seguimiento de los mismos, comprendio un periodo maximo de hasta 6 anos. Se intenta relacionar el estado inmunitario inicial con el potencial evolutivo del melanoma

Pioderma gangrenoso: enfoque terapeutico. / Pyoderma gangrenosum: therapeutic approach

Se presentam 5 enfermos, portadores de pioderma gangrenoso. Se destacan las caracteristicas clinicas de cada uno de ellos como asi el tratamiento instituido en cada caso. Se lleva a cabo una revision bibliografica sobre los diferentes recursos terapeuticos propuestos.De acuerdo con los resultados obtenidos, los autores senalan la falta de una medicacion de eleccion, aunque, los mayores beneficios se obtuvieron con la asociacion Prednisona 40 a 60g/dia y Clofazimine 100mg/dia

A proposito de aspectos clinicos y nosologicos de la eritrodermia reticulosica de Sezary-Baccaredda. / Apropos of clinical and nosological aspects of erythroderma reticulosica of Sezary-Baccaredda

Los autores presentan un caso de sindrome de Sezary. Se hace una revision de los caracteres clinicos, citohematologicos, patologicos del cuadro y se plantean distintas posibilidades terapeuticas. Se mencionan los diferentes intentos de ubicacion nosologica de esta entidad.Se llega a la conclusion de encuadrarlo dentro de los linfomas cutaneos a linfocitos T (L.C.L.T) con identidad propia, separandolo de la micosis fungoide