Hemangioma cavernoso intraóseo craneal / Cavernous haemangioma of the skull

Introducción. Los hemangiomas cavernosos sontumores benignos que excepcionalmente afectan loshuesos craneales. En ausencia de signos radiológicostípicos, frecuentemente son intervenidos bajo la sospechade otro tipo de neoplasia ósea, obteniéndose el diagnósticoúnicamente tras el procedimiento quirúrgico.Caso clínico. Presentamos el caso de una pacientede 52 años con una tumoración indolora del huesofrontal derecho, de lento crecimiento y característicasosteolíticas desde el punto de vista neurorradiológico.Para descartar un origen metastásico, se llevó a cabo unestudio oncológico sistémico, sin hallazgo de neoplasiaprimaria. Finalmente, la lesión fue extirpada en bloquemediante craniectomía, seguido de craneoplastia.El diagnóstico anatomo-patológico fue hemangiomacavernoso intraóseo.Conclusión. A pesar de su baja frecuencia, el diagnósticode hemangioma cavernoso intraóseo debe serconsiderado ante la presencia de una tumoración cranealde lento crecimiento y características osteolíticasen las pruebas de neuroimagen. El tratamiento deelección consiste en la resección completa de la lesiónmediante craniectomía, incluyendo márgenes de seguridadde hueso sano (AU)

Introduction. Cavernous haemangiomas are benigntumours that rarely affect the skull. A correct suspiciondiagnosis is seldom obtained when typical radiologicalsigns are lacking. In this way a definite diagnosis is onlyobtained after a surgical procedure in most cases.Case report. A 52-year-old female presented a painless,slow-growing tumoration in her right forehead.Skull CT showed an osteolytic lesion located within theright frontal bone. On suspicion of a metastatic originof the lesion, a sistemic research for a primary tumourwas performed without significative findings. Finally,en bloc resection of the lesion was performed followedby cranioplasty. Microscopically, the lesion proved to bea cavernous haemangioma of the frontal bone.Conclusion. Despite their low frequency, cavernoushaemangiomas must be included in the differentialdiagnosis of slow-growing osteolytic lesions locatedwithin the skull. The elective treatment of this tumoursincludes a complete resection by craniectomy, with safebony margins (AU)

[The treatment of AIDS and its associated pathology]. / Tratamiento del SIDA y de su patología asociada.

A distinction has to be made in the treatment of the acquired immune deficiency syndrome (AIDS), on one hand there is the treatment of the associated pathology that these patients suffer when their immune system is unable to cope with diseases such as opportunistic infections and neoplasms; on the other there is the treatment of the human immune deficiency virus (HIV) itself. In this work we review the state-of-the-art of both therapies, paying special attention to the treatment of opportunistic infections, because they hold responsibility for the deaths in 80% to 90% of these patients; the importance of the concept of prophylactic treatment, primary as well as secondary, in these diseases is outlined. The treatment of associated neoplasms has a worse outcome. Finally the antiviral therapies against HIV itself, are discussed, paying special attention to zidovudine (AZT) and didexosinosine, two of the more currently widely used drugs in the treatment of these patients. We end with the review of combined therapy, which probably will become, in the next future, the solution in the treatment of this disease.

[Cryptococcosis in AIDS patients: a study of 19 cases]. / Criptococosis en pacientes con SIDA: estudio de 19 casos.

We discuss 19 cases of infection due to Cryptococcus neoformans diagnosed in 438 AIDS patients admitted to our center (4%). Fourteen of them showed meningitis confirmed by culture of C. neoformans in CSF. Clinical features were rather unspecific and disorders in CSF parameters were non striking. The diagnostic techniques performed with best results were culture of C. neoformans and antigen determination, especially in serum. Survival probability at one year was 75%. Treatment response was good. Treatment with fluocytosine did not seem to provide additional benefits versus amphotericin alone, neither in respect to clinical evolution nor regarding survival probability at one year. Fluconazole has shown effectiveness in maintenance therapy, being not be possible to evaluate it as an acute phase therapy because the low number of cases in which it was studied. It is advisable to follow a suppressive treatment, having found a 10% relapse rate in patients following therapy and a 50% in those who interrupted it.