Transcriptional analysis of human papillomavirus type 16 in histological sections of cervical dysplasia by in situ hybridisation.

BACKGROUND: The HPV-16 virus is well described as a causative agent in cervical cancer. AIMS: To individually analyse the transcription profile of the HPV-16 viral genes in patient biopsies of varying grades of cervical dysplasia by a chromogenic in situ hybridisation technique. METHODS: 19 formalin fixed, paraffin embedded (FFPE) biopsies of cervical dysplasia were analysed by a chromogenic in situ hybridisation protocol using novel long single stranded digoxigenin labelled DNA probes targeted to the individual HPV-16 gene RNAs. RESULTS: A transcription pattern for all the HPV-16 genes that is always conserved to the upper intermediate and superficial layers of the cervical epithelium and is independent of the level of dysplasia is described. E1 and E6 transcripts were found to express with a uniquely nuclear localisation; all other transcripts had both nuclear and cytoplasmic localisation. E5 oncogene transcripts were abundant in all cases, being equal to or greater than E7. Deep investigation of the E2 RNA transcript showed a potential alternative transcript with a possible novel start codon. CONCLUSIONS: This data represents new information on HPV-16 viral transcription events that bring into question some of the current beliefs on the mechanism of HPV-16 infection in the progression to cervical cancer. Results support high expression of the E5 and E7 oncogenes in cervical dysplasias infected by HPV-16 in contrast to the low levels identified for the E6 oncogene and a possible alternative transcript for the E2 gene. The diagnostic utility of the detection of HPV-16 RNA transcripts is becoming more apparent and a renewed look at their in situ localisation in cervical biopsies could be beneficial.

[Kikuchi's disease: a case report and literature review]. / Enfermedad de Kikuchi: a propósito de un caso y revisión de la literatura.

Kikuchi-Fujimoto disease, also known as hystiocytic necrotizing lymphadenitis, is an unusual entity which affects predominantely young Asiatic females, although its distribution is world-wide. Cardinal symptoms are fever and adenopathy, generally cervical, although generalized and extraganglionar cases have been described. Considered a self-limiting disease, it has to be differentiated by pathologic analysis from other less-benign disorders such as lymphoma or histiocytoma, which bear worse prognosis and may require specific treatment. Although the origin of this disease is unknown, a viral origin is postulated and the immune system is involved Kikuchi disease has been associated to other entities such as subcutaneous lupus erythematosus, Hashimoto thyroiditis, etc... requiring that patients be followed immunologically alter diagnosis of this disease. We present a case of Kikuchi disease associated with subacute lymphocytic thyroiditis.

Enfermedad de Kikuchi: a propósito de un caso y revisión de la literatura / Kikuchi´s disease: a case report and literature review

La enfermedad de Kikuchi-Fujimoto, también conocida como linfadenitis necrotizante histiocitaria no linfocítica, es una entidad clínica poco frecuente que afecta principalmente a mujeres jóvenes de procedencia asiática, aunque tiene una distribución universal. Es característica la aparición de fiebre y adenopatías, habitualmente localizadas a nivel cervical, aunque hay casos descritos de afectación generalizada o extraganglionar. Su interés estriba en que, aun siendo un proceso benigno y autolimitado, es necesario un diagnóstico anatomo-patológico de exclusión de otras entidades clínicas de peor pronóstico que precisan tratamiento más específico (linfoma, histiocitoma...).A pesar de que su etiopatogenia es desconocida, se postula un origen vírico y una mediación inmunológica en el desarrollo de la enfermedad. Se ha descrito asociación de la enfermedad de Kikuchi con procesos como el lupus eritematoso subcutáneo, tiroiditis/ Hashimoto, lo que obliga a un posterior seguimiento inmunológico de la enfermedad tras su diagnóstico, ante la posibilidad de aparición con el tiempo de un proceso autoinmune. Se presenta el caso de una enfermedad de Kikuchi asociada a tiroiditis subaguda linfocitaria (AU)

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Invasión ganglionar axilar en el carcinoma mamario T1a y T1b / Axillary lymph node involvement in T1a and T1b breast carcinoma

Objetivo. El objetivo de este estudio ha sido valorar en el carcinoma mamario invasivo T1a y T1b la relación entre factores clínicos, histológicos e inmunohistoquímicos con la invasión ganglionar axilar. Material y métodos. Se realizó una revisión retrospectiva de los carcinomas infiltrantes T1a y T1b entre el período comprendido desde enero de 1996 a diciembre de 2001. El número total de pacientes fue de 50. Las variables estudiadas en relación con la infiltración ganglionar axilar fueron: edad, palpabilidad tumoral, localización tumoral, grado histológico de Bloom-Richardson modificado, invasión vasculolinfática, presencia de receptores de estrógenos y de progesterona, expresión de ki67, p53 y de C-erb B2.Resultados. La incidencia de invasión ganglionar axilar fue del 28 por ciento (17 por ciento en T1a y 30 por ciento en T1b). En el análisis univariante se observó una relación estadísticamente significativa entre la edad (< 50), palpabilidad tumoral, invasión vasculolinfática, expresión de p53 y de C-erb B2 con la invasión ganglionar axilar. La asociación de estos 5 marcadores tuvo una sensibilidad del 56 por ciento para predecir infiltración ganglionar y un valor predictivo positivo del 75 por ciento. La ausencia de todos ellos tuvo una especificidad del 50 por ciento y un valor predictivo negativo del 100 por ciento. Conclusiones. Son necesarios nuevos estudios de series más amplias para determinar si se puede omitir la linfadenectomía axilar en un subrupo de pacientes con carcinoma mamario T1a y T1b (AU)

[Cystic dilation of the bile duct in childhood]. / Dilatación quística de la vía biliar en la infancia.

OBJECTIVES: Common bile duct dilatation (CBDD) represents part of a wide spectrum of pancreaticobiliary disorders, with different etiopathogenic mechanisms. The objective of this study was to compile the cases treated in our service during the last five years. PATIENTS AND METHODS: Four cases of CBDD (17 months to 10 years of age) are reported. All of them presented abdominal pain and bilious vomiting. One patient previously had pancreatitis. Cholestatic jaundice was associated in only one patient. The diagnosis was made by ultrasound, being confirmed by endoscopic retrograde cholangiopancreatography (ERCP) in three cases and by computed tomography scan (CT) in one case. RESULTS: Three patients had a single fusiform dilation of the extrahepatic bile duct (type I cyst, Alonso Lej-Todani classification), which were treated by cyst excision and hepaticojejunostomy by using a Roux-en-Y limb. In one patient, the ERCP detected a combined dilatation of the intra- and extrahepatic bile duct (type IV cyst), associated with an anomalous choledochopancreticoductal junction with a distal obstruction of the common bile duct. In the case, the treatment consisted of a transduodenal esfintherotomy. CONCLUSIONS: Based on our experience and a literature review, an increasing incidence of this pathology is deduce. Therefore, the relevance of ultrasounds and ERCP in the diagnosis and visualization of pancreatobiliary ducts and the choice of treatment, depending on the CBDD, are discussed.

[Severe caustic esophagitis in childhood]. / Esofagitis cáusticas graves en la infancia.

OBJECTIVE: A retrospective analysis of patients treated for serious caustic esophagitis in our hospital was performed with the aim of defining epidemiological factors, initial treatment and therapeutic criteria for esophageal stricture with long evolution. PATIENTS AND METHODS: Thirty-four cases of serious caustic esophagitis treated since 1982 were analyzed surveying epidemiologic, clinical and endoscopy data, as well as initial medical treatment, dilatation session number, treatment period, complications, surgical treatment indications if necessary and actual situation. RESULTS: Alkaline caustic agents were swallowed in 71% of the cases, with dishwashing detergent being the most frequent (16 patients), Grade II esophagitis was noticed in 13 cases, grade III in 18. Established esophageal stricture was present in 3 patients when admitted. Repeated esophageal dilations were necessary in 13 patients (38%), with between 1 and 21 dilatation sessions needed. Esophageal stricture persistence forced us to perform an esophageal substitution technique by esophagocoloplasty. Resection and enlargement of a short stenotic segment was performed in 1 patient. Long-term evolution in all cases has been satisfactory. CONCLUSIONS: We consider that adequate treatment of these patients includes conservative corticosteroids, sucralfate and anti-H2 combined with a previous endoscopy evaluation. If evolution turns into stricture, dilatations must be done, sometimes throughout years. If this treatment fails and the injury is extensive, esophagocoloplasty is the surgical technique of choice. Nevertheless, as any accident, the best treatment is good prevention.

[Thyroglossal duct cysts. Do prior inflammatory episodes influence the number of recurrences?]. / Quistes del conducto tirogloso. Influyen los episodios inflamatorios previos en el número de recidivas?

INTRODUCTION: The most common complication in the treatment of thyroglossal duct cysts (TDC) is the high index of relapses. An analysis of this index and the influence of previous inflammatory episodes are presented. PATIENTS AND METHODS: A retrospective study of 120 consecutive TDC cases operated on during a period of 23 years, from 1972 to 1994, is presented. The statistical study was done using the Chi square test and the contrast of hypothesis for two proportions. RESULTS: The mean age of the patients was 4.9 years, with 93 cases (77%) being operated before 7 years of age. An inflammatory episode before surgery occurred in 57 cases (47%). Treatment was the Sistrunk technique in 112 cases (93%) and a simple excision of the cyst in 8 cases, with a relapse occurring in 4 of the latter cases (50%). Those cases where the Sistrunk technique was performed were divided into two groups: Group I (56 cases) those patients which had suffered an inflammatory episode before surgery and group II (56 cases) those that had not. Five relapses (8.9%) were found in group I and 2 (3.5%) in group II. CONCLUSIONS: TDC are fore frequent during early childhood, occurring most frequently before 7 years of age. The number of relapses are dramatically reduced when the Sistrunk technique is used, but no significant differences were found in those that had suffered previously an inflammatory episode.

[Which is the role of laparoscopic surgery in the treatment of cryptorchism?]. / Cúal es el lugar de la cirugía laparoscópica en el tratamiento de la criptorquidia?

OBJECTIVES: The present study analyzed the indications for laparoscopic surgery in cryptorchidism. METHODS: The clinical, surgical and anatomopathological data of 2000 cryptorchid testes submitted to surgery from 1972 to 1993 were reviewed. RESULTS: 17.75% (355 testes) were not palpable at physical examination; of these, 3.45% (69 cases) were anorchid and only 5.4% (108 testes) of the remaining 14.3% were true intra-abdominal testes. The other 8.9% were localized elsewhere. Scrotal descent was achieved only by funiculolysis in 68% of the cases. The remaining 28% (30 testes, since the technique used was not reported in 5) were brought to the scrotum using two-stage procedures, Stephen-Fowler and autotransplantation (one case), which could have been replaced or preceded by laparoscopy. Of the 30 testes, 10 were removed. CONCLUSIONS: Since only 5% (20 testes) can benefit from laparoscopic techniques and, moreover, 68% have a very low tubular fertility index and there is an increased possibility of progressing to malignancy, if other than standard surgical techniques are warranted in cases with unilateral cryptorchidism, testis removal is preferable, which further reduces the application of laparoscopy in cryptorchidism.

[Clinical and anatomopathologic study of 800 cryptorchid testis]. / Estudio clínico y anatomopatológico de 800 testes criptórquidos.

662 children (800 cryptorchid testes) has been studied in order to check if the age and location were important factors in the degree of the lesion found in the biopsy. We have related in this survey the tubular fertility index (IFT) and tubular diameter (DT) to the age and location of the testes and we have not proved statistically their relationship, for which reason we do not advise to plan the age of surgery in terms of possible anatomopathologic damage.

[Multiple intestinal atresia with involvement of the entire gastrointestinal tract]. / Atresia intestinal múltiple con afectación de todo el tracto gastrointestinal.

Two new cases with familiar multiple intestinal atresia (MIA) are reported. Two consecutive siblings with MIA were referred to our pediatric surgical unit over the last year. The second child was diagnosed by means of a pre-delivery conducted ecography in the 28 week of pregnancy. In both cases an abdominal x-ray performed just after the delivery, proved the diagnosis of the first obstruction and suggested the MIA diagnosis. The treatment was surgical, fast; the child was operated on in his twenty four hours of life. The macroscopic malformations as well as the histological findings confirmed the MIA diagnosis, that is different from the classical pattern of MIA, called non hereditary. Therefore we can conclude that the familiar MIA with a possible hereditary pattern is grave enough to be recommended the need of an adequate genetic advice and in the future an intestinal transplant.

[Epididymo-testicular disjunction. Presentation of 23 cases and review of the literature]. / Disyunción epidídimo-testicular. Presentación de 23 casos y revisión de la literatura.

Twenty three cases of alterations of the epididymis-testicular union found in 1,000 children with cryptorchism are discussed. Anatomical and pathological findings are described and world literature on the subject is reviewed, finding very scanty references to this problem in spite of the fact that expected incidence of epididymis testicular non-junction is between 1 and 2% of the patients with cryptorchism.

[Ingestion of batteries: treatment with water overload. Review of 175 cases]. / Ingestión de pilas: tratamiento por sobrecarga hídrica. Revisión de 175 casos.

The authors have treated 6 cases of childhood ingestion of disk batteries with bowel irrigation by nasogastric sonde. The disk was expeled with faeces in less than 12 hours without complications. The world literature (169 cases) on this subject is reviewed.

[Intestinal invagination: 12 years of experience]. / Invaginación intestinal: doce años de experiencia.

One hundred and forty two cases of intussusception were treated in our hospital since 1970 to 1982. Patients were divided for analysis into two groups, each consisting of 71 consecutively treated patients. In the second group (1977-1982) the hydrostatic pressure reduction was attempted under general anaesthesia an was successful in 50% of the patients. We compare both groups from the point of view of hydrostatic pressure reduction and conclude that anaesthesia significantly reduces the number of surgical procedures in children with intussusception.

[Atresia of the esophagus caused by bands]. / Atresia de esófago cordonal.

Authors report clinical and anatomopathological findings in two cases esophageal atresia. Authors found in one of them an anomalous vessel crossing the atresic cord and gastric epithelium in the lower pouch. Authors try to explain the pathogenesis of this atresia.

[Abdominoscrotal hydrocele. Presentation of a new case]. / Hidrocele abdominoescrotal. Aportación de un caso nuevo.

Abdominoscrotal hydrocele is a rarely encountered lesion, with less than 85 cases reported in adults and only seven in children in the world literature. The pathogenesis of this lesion is discussed. It is concluded that all cases of abdominoscrotal hydrocele are due to progressive involvement and distension of the patent processus vaginalis via the inguinal canal into the retroperitoneal space.

[Familial erythrophagocytic lymphohistiocytosis with neonatal presentation]. / Linfohistiocitosis eritrofagocítica familiar de presentación neonatal.

A neonatal case of familial erythrophagocytic lymphohistiocytosis is presented. Evolution was rapidly fatal under a course in which fever, hepatosplenomegaly, pancytopenia, severe coagulation alteration and jaundice were especially significant. Pathology findings after nine days of life, were all conclusive. Diagnostic difficulties of this uncommon entity in its' congenital form only once previously reported, are emphasized.

[Carcinoid tumor of the thymus gland with multiple metastases. Report of a case (author's transl)]. / Carcinoide de timo con metástasis múltiples. A propósito de un caso.

A pregnant woman in the 29th, week of gestation was admitted to the hospital with mediastinal pressure symptoms. A tentative diagnosis of lymphoma was made and the patient was given chemotherapy (vincristine, ciclophosphamide and adriamycin) plus radiotherapy, but no objective response was obtained. During the postoperative period (cesarean section) the patient developed clinical symptoms of muscular paralysis of unknown etiopathogenesis. Biopsy of a cervical lymph node showed histological pattern of tumor of the APUD system (chemodectoma). Multiple metastases appeared in the lungs, bones, brain, heart and ovaries in spite of treatment with various chemotherapeutic agents (vincristine, actinomycin D, CCNU and DTIC). Necropsy revealed the existence of a large tumor of the thymus gland, which histopathologic structure resembles to that of carcinoid. Ultrastructural examination showed abundant granules of neurosecretion confirming an APUD tumor. Cushing-like appearance of the patient was attributed "a posterior" to ACTH released by the tumor. A review ofthe clinical features, endocrine function and anatomical localizations of carcinoid tumors is included.