Pulmonary Malakoplakia by Rhodococcus equi in an HIV-Infected Patient in Mexico: A Case Report.

BACKGROUND: Rhodococcus equi-related pulmonary malakoplakia is a rare condition with few reported cases; hereby, we present a case associated with advanced human immunodeficiency virus (HIV) infection, and thus far to our knowledge, the first report in Mexico. It is estimated that approximately 10% of the infections occur in immunocompetent patients, whereas the rest are immune deficient, targeting virtually any organ. Histologically, malakoplakia is characterized by the buildup of infiltrated inflammatory tissue as a consequence of the gathering of histiocytes embedded with concentric inclusions. The diagnosis relies on the cultures and the susceptibility testing as well as the pathologic findings compatible with the disease. Case Presentation. We present a 25-year-old male patient with persistent nonproductive cough for over a year and with weight loss, who comes to the emergency department with recent fever, swollen and tender lymph nodes, and hemoptysis. The patient gets diagnosed and treated for Rhodococcus equi-related pulmonary malakoplakia. CONCLUSION: Knowing the involvement of Rhodococcus in HIV is fundamental for the diagnosis and optimal treatment, which although unknown, a combination of antibiotics with intracellular penetration, on-time resection, and a proper immune reconstitution represents the best approach. Prognosis varies with mortality rates from 34% to 54%.

Restituciones del tránsito intestinal / Intestinal transit restitutions

La restitución de tránsito intestinal es una cirugía cotidiana en pacientes ostomizados que puede presentar complicaciones. Objetivo: Presentar la experiencia de las restituciones de tránsito intestinal del Hospital Dr. Domingo Luciani, servicio de cirugía II. Métodos: Los datos se recolectaron utilizando la base de datos del servicio de Cirugía II del Hospital Dr. Domingo Luciani en el período septiembre de 2008 - septiembre 2013. Los criterios de inclusión fueron pacientes a los que se les realizó restitución del tránsito intestinal. Los datos recolectados incluyeron: edad, sexo,comorbilidades, indicación de ostomía, tipo, duración de ostomía, dehiscencia de anastomosis. Resultados: Fueron sometidos a restituciones del tránsito intestinal un total de 40 pacientes, 7 (17.5%) sexo femenino y 33(82,5%) sexo masculino, edad media fue 33,5 años (18-72), 8(20%) padecían algún tipo de comorbilidad, 26 (65%) por causas traumáticas, la media de duración con la ostomía fue 17,3 meses(3-108). 7 (17.5%) pacientes presentaron dehiscencia de anastomosis, de los cuales 5 (71.42%) se resolvieron con tratamiento médico y 2 (28.5%) ameritaron reintervención. Conclusión:Los traumatismos son la primera causa de ostomías, los pacientes permanecen con estas un mayor tiempo de lo establecido. Las restituciones de tránsito intestinal se realizan en mayor porcentaje en pacientes masculinos y con un porcentaje bajo de complicaciones(AU)

The restitution of intestinal transit is a daily surgery in ostomized patients that can present complications. Objective: To present the experience of intestinal transit restitutions at Hospital Domingo Luciani, Surgery 2 Service. Methods: Data were collected using the database of Surgery 2 Service of Hospital Domingo Luciani in the period September 2008 - September 2013. The inclusion criteria were patients who underwent restoration of intestinal transit. The data collected included: age, gender, comorbidities, ostomy indication, type, duration of ostomy, and anastomotic dehiscence. Results: Were studied a total of 40 patients, 7 (17.5%) femaleand 33 (82.5%) sex male, mean age was 33.5 years (18-72), 8(20%) suffered from some type of comorbidity, 26 (65%) from traumatic causes, the average time with the ostomy was 17.3 months(3-108). Seven (17.5%) patients had dehiscence of anastomosis, of which 5 (71.42%) were resolved with medical treatment and 2(28.5%) by reoperation. Conclusion: Injuries are the leading cause of ostomy, patients remain a longer time with these provisions. Intestinal transit restitutions held in highest percentage in male patients and with a low rate of complications(AU)

Central Nervous System Strongyloidiasis and Cryptococcosis in an HIV-Infected Patient Starting Antiretroviral Therapy.

We report a case of Strongyloides stercoralis hyperinfection syndrome with central nervous system involvement, in a patient with late human immunodeficiency virus (HIV) infection starting antiretroviral therapy, in whom Strongyloides stercoralis larvae and Cryptococcus neoformans were isolated antemortem from cerebrospinal fluid. Our patient was not from an endemic region for the parasite, so strongyloidiasis was not originally suspected. For this reason, we conclude that Strongyloides stercoralis infection should be suspected in HIV-infected patients starting antiretroviral therapy in order to avoid potential fatal outcomes.

Correlación entre los hallazgos del ultrasonido doppler pélvico-trasvaginal: con la anatomía patológica: en tumores de ovario / Correlation between transvaginal color doppler and histologic diagnosis: in ovarian tumors

Correlacionar los hallazgos del ultrasonido doppler pélvico-transvaginal con el congelado y la biopsia definitiva en pacientes con tumores de ovario que acuden al Hospital General del Este "Dr. Domingo Luciani" octubre 2007-2008. Se incluyeron 33 pacientes entre 18-70 años con tumores de ovario. Se les realizó ultrasonido Doppler pélvico-transveginal previa intervención quirúrgica indicada para cada patología. Se les realizó corte congelado y biopsia definitiva y éstos se compararon posteriormente con los resultados del ultrasonido. Un 66% fueron tumores benignos, el cistoadenoma seroso fue el más frecuente (36.3%), 33.3% fueron malignos, con 27.2% para adenocarcinoma. La sensibilidad del sistema de puntuación para masas ováricas fue del 100% y 95% de especificidad. El índice de Resistencia (IR), Indice de Pulsatilidad (IP) y la Velocidad Pico Sistólica (VPS), presentaron sensibilidad de 89%, 100% y 90% con especificidad de 95%, 85% y 91% respectivamente. El corte congelado presentó concordancia en el 100% de los casos con la biopsia definitiva. El ultrasonido pélvico transvaginal con efecto Doppler resultó tener alta sensibilidad y especificidad para la diferenciación de tumores benignos y malignos de ovario.

To corelationate finding of transvaginal color Doppler with frozen section and definitive biopsy in patients with ovarian neoplasms attended at Hospital General del Este "Dr. Domingo Luciani" Octubre 2007-2008. There were included 33 patients with ages between 18-70 years old. It was performed a pelvic-transvaginal Doppler before the surgical exploration. There were performed frozen sectin and definitive biopsy and these results were compared with the ultrasound findings. A 66% were beningn neoplasms: serous cystic adenoma (36.3%) malign, with a 27.2% of adenocarcinoma. Sensitivity was 100% and specifity 95%. Resistence Index, Pulsatility Index and Systolic Velocity, had a sensitivity of 89%, 100% and 90% with a specificity of 95%, 85% and 91% repectively. Frozen section and definitive biopsy were 100% concordant. Pelvic-transvaginal Doppler in our study have high sensitivity and specifity in ovarian's tumors.