Utilidad de la coloración de Giemsa para diagnosticar Helicobacter pylori en pacientes con lesiones preneoplásicas / The usefulness of Giemsa staining to diagnose Helicobacter pylori in patients with preneoplastic lesions

Resumen Introducción: Helicobacter pylori es una bacteria asociada con enfermedades gastroduodenales inflamatorias y neoplásicas. La histopatología es uno de los métodos diagnósticos empleados para su detección, la cual tiene sensibilidad del 90% al 95% cuando hay alta densidad de H. pylori; sin embargo, la bacteria puede pasar desapercibida en infecciones de baja densidad porque la coloración de rutina de hematoxilina y eosina (H&E) no es una tinción específica para su detección y presenta variabilidad interobservador. El objetivo de este estudio fue determinar la utilidad de la tinción complementaria de Giemsa para el diagnóstico de H. pylori en lesiones preneoplásicas en las que la bacteria se encuentra en baja densidad. Materiales y métodos: se realizó un estudio descriptivo retrospectivo y prospectivo que incluyó a 65 pacientes con diagnóstico de lesiones preneoplásicas. Las biopsias gástricas se tiñeron con H&E y Giemsa, y fueron evaluadas por dos patólogos. Resultados: la coloración de Giemsa diagnosticó 20,3% de casos más de infección por H. pylori que la H&E, la mayoría de ellos con baja densidad de la bacteria. No hubo diferencias estadísticamente significativas en el diagnóstico de H. pylori de acuerdo con el tipo de muestra. Conclusión: este estudio encontró que la tinción de Giemsa mejora el diagnóstico histopatológico de H. pylori en pacientes con lesiones preneoplásicas.

Abstract Introduction: Helicobacter pylori is a bacterium associated with inflammatory and neoplastic gastroduodenal diseases. Histopathology is one of the diagnostic methods used for its detection, which has a sensitivity of 90% to 95% when there is a high density of H. pylori; however, the bacterium may be missed in low-density infections because routine hematoxylin and eosin (H&E) staining is not specific for its detection and has interobserver variability. This study aimed to determine the usefulness of complementary Giemsa staining for diagnosing H. pylori in preneoplastic lesions where the bacterium was found in low density. Materials and methods: A retrospective/prospective descriptive study was carried out that included 65 patients diagnosed with preneoplastic lesions. Gastric biopsies were stained with H&E and Giemsa and evaluated by two pathologists. Results: Giemsa staining analyzed 20.3% more cases of H. pylori than H&E, most with a low density of the bacteria. There were no statistically significant differences in the diagnosis of H. pylori according to the sample type. Conclusion: This study found that Giemsa staining improves the histopathological diagnosis of H. pylori in patients with preneoplastic lesions.

Criptococosis diseminada en paciente inmunocompetente imitando un cáncer de pulmón metastásico / Disseminated cryptococcosis in an immunocompetent patient imitating metastatic lung cancer

El cáncer de pulmón es la principal causa de muerte en el mundo por cáncer, y en Colombia es la segunda. Su pronóstico es pobre cuando se ha documentado enfermedad metastásica en el sistema nervioso central. El diagnóstico se basa en el resultado definitivo de patología. Aunque los hallazgos imagenológicos pueden ser muy sugestivos de malignidad, hay reportes de otras enfermedades que pueden imitar cáncer, tales como infecciones o tumores benignos, los cuales pueden llevar a adoptar conductas terapéuticas inapropiadas. Las infecciones fúngicas como las producidas por Criptococcus neoformans, son capaces de generar lesiones que pueden imitar neoplasias. El objetivo de esta publicación es reportar el caso de un hombre a quien inicialmente se le sospechó un carcinoma pulmonar metastásico al sistema nervioso central, y finalmente se le diagnosticó una criptococosis diseminada posterior a su fallecimiento

Lung cancer is the leading cause of death from cancer in the world and the second in Colombia, its prognosis is bad when the diagnosis of metastatic disease in the central nervous system is documented. The diagnosis is based on the definitive pathologic result. Although the imaging findings can be highly suggestive of malignancy, there are reports of other conditions that can mimic lung cancer, such as infections or benign tumors, which can lead to inappropriate treatment. Fungal infections such as those caused by Criptococcus neoformans are capable of generating lesions that can mimic neoplasms. The objective of this article is to report the case of a man who was initially diagnosed with metastatic lung carcinoma to the central nervous system, and was finally diagnosed with disseminated cryptococcosis after his death

Expression of activator proteins of SHH/GLI and PI3K/Akt/mTORC1 signaling pathways in human gliomas is associated with high grade tumors.

Recent findings have demonstrated a synergic crosstalk between SHH/GLI and PI3K/Akt/mTORC1 signaling in glioblastoma progression cells in vitro and in tumors in mice, but it is not known if this also occurs in human gliomas. We then aimed to investigate the expression of key proteins of these pathways in different human gliomas. The expression of PTEN, phospho-Akt (Ser473), phospho-S6K1 (Thr389), SHH, GLI1, GLI2 and GLI3 was assessed by immunohistochemistry in gliomas and in control brain tissues. The pattern of expression of each protein was established according to glioma type, glioma grade and to cell type; the relative expression of each protein was used to perform statistical analyses. We found that the expression of proteins of both signaling pathways differs between normal brain and glioma tissues. For instance, normal astrocytes had a different protein expression pattern compared with reactive and tumoral astrocytes. Interestingly, we detected a recurrent pattern of expression of GLI3 in oligodendrocytes and of phospho-S6K1 in mitotic neoplastic cells. We also identified differences of cell signaling according to glioma type: oligodendrogliomas and ependymomas are related with the expression of SHH/GLI proteins. Finally, we detected that high grade gliomas statistically correlate with the expression of GLI1 and GLI2, and that GLI1, GLI2, phospho-Akt and phospho-S6K1 are more expressed in patients with less survival, suggesting that activation of these cell signaling influences glioma outcome and patient survival. In summary, our results show that proteins of PI3K/Akt/mTORC1 and SHH/GLI pathways are differentially expressed in human gliomas according to tumor type and grade, and suggest that the activation of these signaling networks is associated with glioma progression.

A novel method for isolation and culture of primary swine gastric epithelial cells.

BACKGROUND: Culturing primary epithelial cells has a major advantage over tumor-derived or immortalized cell lines as long as their functional phenotype and genetic makeup are mainly maintained. The swine model has shown to be helpful and reliable when used as a surrogate model for human diseases. Several porcine cell lines have been established based on a variety of tissues, which have shown to extensively contribute to the current understanding of several pathologies, especially cancer. However, protocols for the isolation and culture of swine gastric epithelial cells that preserve cell phenotype are rather limited. We aimed to develop a new method for establishing a primary epithelial cell culture from the fundic gland region of the pig stomach. RESULTS: Mechanical and enzymatic dissociation of gastric tissue was possible by combining collagenase type I and dispase II, protease inhibitors and antioxidants, which allowed the isolation of epithelial cells from the porcine fundic glands showing cell viability > 90% during the incubation period. Gastric epithelial cells cultured in RPMI 1640, DMEM-HG and DMEM/F12 media did not contribute enough to cell adhesion, cluster formation and cell proliferation. By contrast, William's E medium supplemented with growth factors supports confluency and proliferation of a pure epithelial cell monolayer after 10 days of incubation at 37 °C, 5% CO2. Mucin-producing cell phenotype of primary isolates was confirmed by PAS staining, MUC1 by immunohistochemistry, as well as the expression of MUC1 and MUC20 genes by RT-PCR and cDNA sequencing. Swine gastric epithelial cells also showed origin-specific markers such as cytokeratin cocktail (AE1/AE3) and cytokeratin 18 (CK-18) using immunohistochemical and immunofluorescence methods, respectively. CONCLUSIONS: A new method was successfully established for the isolation of primary gastric epithelial cells from the fundic gland zone through a swine model based on a combination of tissue-specific proteases, protease inhibitors and antioxidants after mechanical cell dissociation. The formulation of William's E medium with growth factors for epithelial cells contributes to cell adhesion and preserves functional primary cells phenotype, which is confirmed by mucin production and expression of typical epithelial markers over time.

Detección de la mutación de la enzima isocitrato deshidrogenasa en gliomas difusos grados II, III y IV / Detection of isocitrate dehydrogenase enzyme mutation in grades II, III and IV diffuse gliomas

Introducción. Los gliomas son las neoplasias malignas primarias más frecuentes del sistema nervioso central, asociadas con una mortalidad y morbilidad elevadas. Las mutaciones en los genes IDH1 e IDH2 de la enzima isocitrato deshidrogenasa (IDH) son clave en la tumorogénesis, y son consideradas un factor pronóstico importante en estas neoplasias. En este estudio se buscó determinar la presencia de mutaciones de los genes IDH1 e IDH2 en pacientes con diagnóstico de glioma difuso en diferentes grados, y su correlación con la sobrevida. Metodología. Se realizó un estudio descriptivo, prospectivo y retrospectivo. La población de estudio fueron pacientes entre los 18 y 45 años con diagnóstico de glioma difuso grado II, III y IV, atendidos en el Hospital San Vicente Fundación de Medellín, entre 2012 y 2017, en quienes se realizó un análisis de mutaciones en los genes IDH1 e IDH2 por secuenciación Sanger y tinción de inmunohistoquímica. Resultados. Se incluyeron 14 pacientes con edad promedio de 37 años, 57% de sexo masculino. Glioblastoma fue la neoplasia más frecuente, diagnosticada en el 42,9% de casos. Por inmunohistoquímica, 10 de los 14 (71,4%) pacientes presentaron mutación de la enzima IDH1, en tanto que 1 de los 11 (9%) pacientes en quienes se logró la secuenciación del gen IDH2, mostró mutación. En general, el 78,6% presentó mutaciones de la enzima IDH, con promedio de sobrevida de 48 meses. Conclusión. Estos hallazgos sugieren que los gliomas son un grupo heterogéneo de tumores, con gran variabilidad genética que impacta en su pronóstico y comportamiento

Introduction. Gliomas are the most common primary malignancies of the central nervous system, associated with high mortality and morbidity. Mutations in the isocitrate dehydrogenase (IDH) enzyme IDH1 and IDH2 genes, are key in tumorigenesis, and are considered an important prognostic factor in these neoplasms. This study aimed to determine the presence of IDH1 and IDH2 gene mutations in patients diagnosed with diffuse glioma in different degrees, and their correlation with survival. Methodology. A descriptive, prospective and retrospective study was conducted. The study population consisted of patients between the ages of 18 and 45 with a diagnosis of grade II, III and IV diffuse glioma, treated at the Hospital San Vicente Fundación in Medellín, between 2012 and 2017, in whom an analysis of IDH1 and IDH2 gene mutations was performed by Sanger sequencing and immunohistochemical staining. Results. Fourteen patients with a mean age of 37 years were included, 57% were male. Glioblastoma was the most frequent neoplasm, diagnosed in 42.9% of the cases. By immunohistochemistry, 10 of the 14 (71.4%) patients had a mutation of the IDH1 enzyme, while 1 of the 11 (9%) patients in whom IDH2 gene sequencing was achieved showed a mutation. In general, 78.6% had IDH enzyme mutations, with an average survival of 48 months. Conclusion. These findings suggest that gliomas are a heterogeneous group of tumors, withgreat genetic variability that impacts their prognosis and behavior

Spinal pleomorphic xanthoastrocytoma: case report and literature review / Xantoastrocitoma pleomórfico espinal: reporte de caso y revisión de la literatura

El Xantoastrocitoma Pleomórfico Espinal (XAPE) es una neoplasia primaria infrecuente del sistema nervioso central, descrita por primer vez en 1979. De estirpe astrocítica y aunque clasificada como grado II por la OMS, pueden existir variantes anaplásicas o malignas. Con localización usualmente temporal, pocos casos espinales se han descrito a la fecha, debido probablemente a un subdiagnóstico o un subregistro. El pronóstico es generalmente bueno y depende en gran medida del tipo histológico y extensión de la resección quirurgica. Describimos el caso de un hombre de 30 años de edad con dorsalgiay paresia del miembro inferior izquierdo. Se encontró en imágenes de resonancia magnética una lesión aparentemente intradural, extraaxial en los segmentos T8-T9 que se llevó a resección. Se confirmó por histopatología la presencia de un XAPE primario. En la presente publicación realizamos una revisión de la literatura disponible.

Spinal Pleomorphic Xanthoastrocytoma (SPXA) is a rare CNS primary neoplasm, first described in 1979. Although of astrocytic lineage and classified as a grade II neoplasm by the WHO, it may be have anaplastic or malignant variants. Usually located in the temporal lobe, few spinal cases have been described to date, probably due to underdiagnosis and underreporting. It usually has a good prognosis, but it depends on its histological type and extent of surgical resection. In this article, we describe the case of a 30-year old male who complained of low back pain and left lower limb paresis. The MRI showed an apparently intradural, extraaxial lesion at T8-T9 segments. The diagnosis of a primary SPXA was confirmed by histopathological studies. In this article, a review of the available literature is presented.

Angiopatía amiloide cerebral con inflamación relacionada y demencia rápidamente progresiva: primer reporte de caso en Colombia / Cerebral amyloid angiopathy-related inflammation and rapidly progressive dementia: first case report in Colombia

La angiopatía amiloide cerebral (AAC) consiste en el depósito de amiloide en la pared de los vasos sanguíneos intracraneales, y conlleva a la aparición de hemorragia, isquemia o leucoencefalopatía. Las manifestaciones clínicas de la AAC son muy variables, tales como alteraciones cognitivas, alteraciones comportamentales, déficit neurológico focal, cefalea o crisis epilépticas. Un subtipo de angiopatía amiloide cerebral con inflamación relacionada (AAC-IR), se ha reportado recientemente en la literatura mundial. Presentamos el caso de una paciente de 74 años de edad, con un cuadro de demencia rápidamente progresiva de aproximadamente tres meses de evolución, asociada a cefalea, meningismo, disminución de la fuerza en hemicuerpo derecho, múltiples lesiones hemorrágicas parenquimatosas, hemosiderosis difusa, edema cerebral focal y estudio histológico con evidencia de amiloide intracerebral. El diagnóstico de la AAC se basa en una historia clínica compatible; neuroimagenes que demuestren hemosiderosis o múltiples hemorragias de predominio en fosa posterior, y en algunos casos estudio histológico que confirme la presencia de amiloide en la microcirculación intracraneal. Los criterios de Boston modificados unifican los hallazgos para el diagnóstico de AAC con diferentes grados de certeza. En algunas ocasiones, como en el caso presentado, la AAC se asocia a un componente inflamatorio, y se manifiesta con una demencia rápidamente progresiva, constituyéndose en un verdadero reto diagnóstico.

Cerebral amyloid angiopathy (CAA) is the deposition of amyloid in the wall of intracranial blood vessels, and leads to the appearance of hemorrhage, ischemia or leukoencephalopathy. The clinical manifestations of the CAA are highly variable, such as cognitive impairment, behavioral abnormalities, focal neurological deficits, headache or seizures. A subtype, Cerebral amyloid angiopathy-related inflammation (CAA-RI) has recently been reported in the world literature. We report the case of a 74-year-old with a rapidly progressive dementia about three months duration, associated with headache, meningismus, decreased strength in right hemisphere, multiple parenchymal hemorrhagic lesions, diffuse hemosiderosis, cerebral edema focal and histological study with evidence of intracerebral amyloid. The diagnosis of CAA is based on a clinical history compatible, neuroimaging showing hemosiderosis or multiple bleeding, predominantly in posterior fossa, and in some cases histological examination to confirm the presence of amyloid in intracranial microcirculation. Modified Boston criteria, unify the findings for the diagnosis of CAA, with varying degrees of certainty. Sometimes, as in the case presented, the CAA is associated with an inflammatory component, and is manifested by a rapidly progressive dementia, becoming a true diagnostic challenge.

Encefalitis por virus de inmunodeficiencia humana, reporte de un caso y revisión de tema / Encephalitis human immunodeficiency virus, a case report and review

En este artículo se presenta el caso de un paciente con diagnóstico histológico de encefalitis por virus de inmunodeficiencia humana - (VIH), con múltiples coinfecciones incluyendo oportunistas. Es un caso llamativo, pues claramente la incidencia de dicha enfermedad ha decrecido ostensiblemente en la era post terapia antiretroviral de gran efectividad (TARGA). Es un paciente masculino heterosexual de 63 años con conductas sexuales de riesgo, que ingresó a un hospital de cuarto nivel con síntomas respiratorios y durante su hospitalización se le diagnosticó VIH / SIDA estadio C3, múltiples infecciones tales como: hepatitis B, neurosífilis, criptococosis sistémica, toxoplasmosis cerebral, histoplasmosis cutánea, candidiasis y herpes oral; recibió tratamiento y falleció 27 días después por criptococosis diseminada. Se le practicó autopsia y se observó en sustancia blanca del sistema nervioso central numerosos nódulos microgliales, linfocitos perivascular y células gigantes multinucleadas sin formación de granulomas, característicos de la encefalitis por VIH. Este paciente es un ejemplo de la historia natural por VIH en estadío avanzado con compromiso del sistema nervioso central.

In this paper we describe the case of a patient with histological diagnosis of human immunodeficiency virus (HIV) encephalitis, which also had multiple co-infections. It is a striking case, because of the incidence of this disease has markedly decreased in the post Highly Active Antiretroviral Therapy HAART era. The patient was a heterosexual male of 63 years old engaged in risky sexual behavior, who was admitted to a reference hospital with respiratory symptoms. During hospitalization He was diagnosed with stage C3 HIV/AIDS, multiple infections such as Hepatitis B, Neurosyphilis, systemic cryptococcosis, cerebral toxoplasmosis, cutaneous histoplasmosis, oral herpes and candida infections; He received appropriate treatments for all of the above, however He died 27 days later by disseminated cryptococcosis. He underwent autopsy and in central nervous system in the white matter were observed numerous microglial nodules, perivascular lymphocytes and multinucleated giant cells without granuloma formation. These giant cells are characteristics of HIV encephalitis. This patient is an example of the natural history of HIV infection that progressed to an advanced stage of AIDS.

Sensibilidad en el Reconocimiento de Emociones Faciales Como Endofenotipo de Esquizofrenia / Sensitivity in the Recognition of Facial Emotions as an Endophenotype for Schizophrenia / Sensibilidade no Reconhecimento de Emoções Faciais Como Endofenótipo de Esquizofrenia

Los endofenotipos son rasgos presentes antes de la aparición de un trastorno y podrían ser útiles para identificar genes de susceptibilidad. Se determinó si personas con esquizofrenia y sus familiares de primer grado no afectados tenían un desempeño menor que los controles en la Tarea de Multitransformación de Expresión Emocional, que mide reconocimiento de emociones faciales. Las personas con esquizofrenia y sus familiares mostraron menor sensibilidad o requirieron más intensidad para identificar emociones que los controles. La exactitud para identificar emociones fue similar entre familiares y controles, pero menor en aquellos con esquizofrenia. Esto sugiere que la sensibilidad para el reconocimiento de emociones faciales es un endofenotipo de la esquizofrenia.

Endophentoypes are the traits present before the appearance of a disorder and could be useful to identify susceptibility genes. The purpose of this study was to determine whether persons suffering from schizophrenia and their immediate relatives performed less well than controls in the Emotional Expression Multi-transformation Task, which measures recognition of facial expressions. Persons with schizophrenia and their relatives showed less sensitivity than controls or required greater intensity to identify emotions than controls did. Accuracy in the identification of emotions was similar in relatives and controls, but lower in individuals with schizophrenia. This suggests that sensitivity in the recognition of facial emotions is an endophenotype for schizophrenia.

Os endofenótipos são traços presentes antes do surgimento de um transtorno e poderiam ser úteis para identificar genes de suscetibilidade. Determinou-se se pessoas com esquizofrenia e seus familiares de primeiro grau não afetados tinham um desempenho menor que os controles na Tarefa de Multitransformação de Expressão Emocional, que mede reconhecimento de emoções faciais. As pessoas com esquizofrenia e seus familiares mostraram menor sensibilidade ou requereram mais intensidade para identificar emoções que os controles. A exatidão para identificar emoções foi similar entre familiares e controles, mas menor naqueles com esquizofrenia. Isso sugere que a sensibilidade para o reconhecimento de emoções faciais é um endofenótipo da esquizofrenia.

Prevalencia de variantes en el gen de la apolipoproteína E (APOE) en adultos de la población general del área urbana de Medellín (Antioquia) / Prevalence of Variants in the Apolipoprotein E (APOE) Gene in a General Population of Adults from an Urban Area of Medellin (Antioquia)

Objetivos: Determinar las frecuencias alélicas y genotípicas del gen de la apolipoproteína E (APOE) en adultos de Medellín durante el año 2010. Métodos: Se tomó una muestra representativa de la población adulta de Medellín, mediante un muestreo polietápico estratificado por conglomerados. Se realizó genotipificación para APOE a cada uno de los sujetos participantes. En el análisis de frecuencias y asociación, se tuvo en cuenta el diseño muestral. Resultados: Las frecuencias de los alelos E2, E3 y E4 de APOE fueron del 3,9, el 92,0 y el 4,1% respectivamente. Las frecuencias genotípicas fueron: 2/2, el 0,2%; 2/3, el 6,8%; 2/4, el 0,6%; 3/3, el 85,0%; 3/4, el 7,2%, y 4/4, el 0,3%. Conclusiones: Las frecuencias alélicas y genotípicas de APOE en adultos de Medellín tienen una distribución similar a las reportadas en poblaciones suramericanas, y son datos que tienen valor para conocer el impacto poblacional de estas variantes genéticas en distintos trastornos psiquiátricos.

Objective: To determine the allelic and genotype frequencies of apolipoproteine E (APOE) gene in a representative sample of the adult population of Medellin in 2010. Methods: A representative sample of the adult population of Medellin, was obtained by means of a multi-stage, stratified, conglomerate based sampling method. APOE genotyping was carried out on each of the participants. The sampling design was taken into consideration for the frequencies and association analysis. Results: The frequencies of the APOE alleles E2, E3 and E4 were 3.9, 92.0 and 4.1%, respectively. The frequencies of the different APOE genotypes were as follows: 2/2, 0.2%; 2/3, 6.8%; 2/4, 0.6%; 3/3, 85.0%; 3/4, 7.2%, and 4/4, 0.3%. Conclusions: The allelic and genotype frequencies of APOE in an adult population of Medellin did not differ substantially from other series reported in South America. These data are important to determine the real impact of APOE on the population risk of several psychiatric diseases.

[Prevalence of Variants in the Apolipoprotein E (APOE) Gene in a General Population of Adults from an Urban Area of Medellin (Antioquia)]. / Prevalencia de variantes en el gen de la apolipoproteína E (APOE) en adultos de la población general del área urbana de Medellín (Antioquia).

OBJECTIVE: To determine the allelic and genotype frequencies of apolipoproteine E (APOE) gene in a representative sample of the adult population of Medellin in 2010. METHODS: A representative sample of the adult population of Medellin, was obtained by means of a multi-stage, stratified, conglomerate based sampling method. APOE genotyping was carried out on each of the participants. The sampling design was taken into consideration for the frequencies and association analysis. RESULTS: The frequencies of the APOE alleles E2, E3 and E4 were 3.9, 92.0 and 4.1%, respectively. The frequencies of the different APOE genotypes were as follows: 2/2, 0.2%; 2/3, 6.8%; 2/4, 0.6%; 3/3, 85.0%; 3/4, 7.2%, and 4/4, 0.3%. CONCLUSIONS: The allelic and genotype frequencies of APOE in an adult population of Medellin did not differ substantially from other series reported in South America. These data are important to determine the real impact of APOE on the population risk of several psychiatric diseases.

Linfoma primario del sistema nervioso central: serie de casos / Primary lymphoma of the central nervous system: case series

INTRODUCCIÓN: el linfoma primario del sistema nervioso central (LPSNC) corresponde a una causa de importante mortalidad dentro de los tumores primarios del sistema nervioso central, además existen pocos datos epidemiológicos actualmente, razón por la cual se decide hacer un reporte de casos en el grupo de neuropatología de la Universidad de Antioquia. OBJETIVO: describir el comportamiento de esta patología en un grupo de pacientes. MATERIALES Y MéTODOS: se revisaros los estudios patológicos e historias clínicas de 12 pacientes con diagnóstico de LPSNC en el servicio de neuropatología de la Universidad de Antioquia 2004 el 2011. RESUTADOS: se encontraron 12 pacientes que cumplían el criterio de inclusión. De estos pacientes el 61.5% fueron hombres y el 38.5% mujeres. La edad promedio al momento del diagnóstico fue de 42.6 años (1- 77 años). El Linfoma B no hodking de células gigantes con patrón difuso fue el tumor más frecuente con un 83.3 %, 8.35% corresponde a linfoma de células T, 8.35% a Linfoma de Burkitt; 33.3 % corresponden a pacientes inmunode-ficientes. CONCLUSIóN: en esta serie de pacientes con linfoma del sistema nervioso central se encontraron características clínicas similares a las encontradas en la literatura, quizás el único hallazgo disímil fue la mayor cantidad de pacientes sin aparente alteración en el sistema inmune.

INTRODUCTION: primary lymphoma of the central nervous system (PCNSL) is a major cause of mortality in primary tumors of the central nervous system, plus there are only a few epidemiological data today, these are the reasons why it was decided to make a report of cases in the group of neuropathology at the University of Antioquia. OBJETIVES: to describe the behavior of this disease in group of patients. MATERIALS AND METHODS: we reviewed the pathological studies and clinical records of 12 patients diagnosed with PCNSL in the service of neuropathology at the University of Antioquia from the years of 2004 to 2011. RESULTS: there were 12 patients who met the inclusion criteria. Of these patients, 61.5% were male and 38.5% women. The average age at diagnosis was 42.6 years (1 - 77 years). The giant cell, diffuse pattern B non-Hodgkin lymphoma was the most frequent tumor with 83.3%,T- cell lymphoma with 8.35%, Burkitt lymphoma 8.35%; 33.3% of the patients were immunodeficient. CONCLUSION: in this series of patients with central nervous system lymphoma similar clinical characteristics were found to those in the medical literature, perhaps the only different finding was a higher rate of patients without an apparent alteration in the immune system.

Características de los suicidios de áreas rurales y urbanas de Antioquia, Colombia / Characteristics of suicides in rural and urban areas in Antioquia, Colombia

Objetivo: Determinar si existen diferencias entre áreas rurales y urbanas de Antioquia en las características asociadas con el suicidio. Método: Se compararon 79 sujetos provenientes de áreas rurales y 75 de áreas urbanas de Antioquia. Se hizo autopsia psicológica y se calcularon razones de prevalencia (RP) (frecuencia de la característica en zona rural/frecuencia de la característica en zona urbana). Resultados: Las características asociadas de manera independiente con provenir de área rural y urbana fueron: “momento del suicidio durante la noche” (RP = 0,65; IC 95%: 0,48-0,89) y “vivir solo” (RP = 0,40; IC 95%: 0,17-0,98), que fueron más frecuentes en zona urbana, y “envenenamiento con pesticidas”, que ocurrió más en zona rural (RP = 1,80; IC 95%: 1,39-2,34). Conclusiones: Los individuos suicidas provenientes de zonas rurales y urbanas tenían características diferentes. Ello puede tener implicaciones para el diseño de las estrategias de prevención del suicidio en cada una de las zonas. Se requieren otros estudios para determinar los factores de riesgo propios de cada área...

Objective: To determine differences in characteristics associated with suicide between rural and urban populations from Antioquia. Method: 79 subjects from rural areas and 75 subjects from urban areas were compared. Psychological autopsy was done and prevalence ratios (PR) (frequency of characteristic in rural zone/frequency of characteristic in urban zone) were calculated. Results: The characteristics that associated independently with coming from rural or urban areas were: “suicide during the night” (PR = 0.65; 95% CI: 0.48-0.89) and “living alone” (PR = 0.40; 95% CI: 0.17-0.98), which were more frequent in urban areas, and “pesticide poisoning” which was more frequent in rural areas (PR = 1.80; 95% CI: 1.39-2.34). Conclusions: Individuals who committed suicide from rural and urban areas have different characteristics. This finding might have implications for the design of preventive strategies in each zone. Additional studies are required to determine specific risk factors in urban and rural areas...

Validación del “inventario de razones para vivir” (RFL) en sujetos con conducta suicida de Colombia / Validation of the Reasons for Living Inventory (Rfl) in subjects with suicidal behavior in Colombia

Objetivo: Evaluar la estructura factorial, la confiabilidad y la validez de contenido y constructo de una versión en español para Colombia del Inventario de Razones para Vivir (Rfl) en una muestra clínica de sujetos con intento de suicidio. Método: Se hicieron dos traducciones al español y dos traducciones en sentido inverso de cada uno de los ítems. Se examinó la validez del contenido y del constructo, la consistencia interna y la reproducibilidad prueba-reprueba. Resultados: La estructura factorial tiene seis dominios que explican el 63,5% de la varianza: “Creencia en la vida y capacidad de afrontamiento”, “Miedo a la muerte y a la desaprobación social”, “Responsabilidad con la familia”, “Preocupación por los hijos”, “Percepción de incapacidad para el suicidio” y “Objeciones morales”. La consistencia interna fue alta (Alfa de Cronbach=0,96), así como la reproducibilidad prueba-reprueba (CCI=0,89, IC95%: 0,78-0,94). Cuando se evaluó la validez del constructo encontramos diferencias significativas en las puntuaciones del Rflentre individuos con riesgo de suicidio alto y bajo, definido clínicamente. Conclusiones: La versión colombiana del Rflmuestra buenas propiedades psicométricas en una población clínica con comportamiento suicida.

Objective: To evaluate the factor structure, reliability, and construct and content validity of the Colombian Spanish version of the Reasons for Living Inventory (Rfl) in a clinical sample of subjects who attempted suicide. Method: Two translations into Spanish and two back-translations for each of the items were done. We assessed content and construct validity as well as internal consistency and test-retest reproducibility. Results: The factor structure has six domains which explain 63.5% of the variance: “survival and coping beliefs”, “fear of death and social disapproval”, “responsibility to family”, “child-related concerns”, “perception of incapacity for suicide” and “moral objections”. The internal consistency was high (Cronbach’s alpha=0.96), as was test-retest reproducibility (ICC=0.89, IC95%: 0.78-0.94). When assessing construct validity, we found significant differences between individuals with clinically defined high and low suicide risk in Rflscores. Conclusions: The Rflversion for Colombia shows good psychometric properties in clinical population with suicidal behavior.

Validación de la Lista de Chequeo de Psicopatía-Revisada (PCL-R) en población carcelaria masculina de Colombia * / Validation of the Psychopathy Check-List Revised (PCL-R) in Colombian Male Jail Inmates

Introducción: La psicopatía se caracteriza por un patrón permanente de déficit afectivo y falta de respeto por los derechos de los otros y las normas sociales. La Lista de Chequeo de Psicopatía Revisada (PCL-R, por su sigla en inglés) es un instrumento de medición compuesto por 20 ítems y es uno de los más utilizados para investigación en psicopatía y trastorno de la personalidad antisocial. Objetivo: Validar la PCL-R en población colombiana carcelaria de sexo masculino. Método: Se hicieron dos traducciones al español y dos traducciones en sentido inverso de cada uno de los ítems. También, una traducción al español y en sentido inverso del instructivo. La validez de apariencia fue evaluada por un grupo de expertos. Se examinó la validez de contenido, consistencia interna, reproducibilidad prueba-reprueba e interevaluador. Resultados: En el análisis factorial para la validez de contenido se encontraron 4 dominios que explican el 61,1% de la varianza. La consistencia interna de la escala fue alta (alfa de Cronbach=0,94), al igual que la reproducibilidad pruebareprueba (CCI=0,83, IC 95%: 0,68-0,91) e interevaluador (CCI=0,92, IC 95% 0,86-0,96). Conclusiones: La versión en español de la PCL-R para la población carcelaria colombiana de sexo masculino muestra buenas propiedades psicométricas.

Introduction: Psychopathy is characterized by a pattern of constant affective deficit and lack of respect for other people's rights and social norms. The Psychopathy Check-List Revised (PCL-R) is an instrument of measurement composed of 20 items and it is one of the most used in psychopathy and antisocial personality disorder research. Objective: To validate the PCL-R in Colombian male inmates. Methods: Two translations into Spanish and two back-translations for each of the items were done. The instruction manual was also translated into Spanish and back-translated. Face validity was assessed by a group of experts. Content validity was examined as well as internal consistency, test-retest and inter-rater reproducibility. Results: In the factor analysis for the content validity, four domains were found which explained 61.1% of the variance. The internal consistency was high (Cronbach's Alpha=0.94). Similarly, the test-retest and inter-rater reproducibility were ICC=0.83, 95% CI: 0.68-0.91 and ICC=0.83, 95% CI: 0.86-0.96, respectively. Conclusions: The Spanish version of the PCL-R for Colombian male jail inmates shows good psychometric properties.

Heart, liver and spleen pathology in chronic alcohol and drug users.

Alcohol- and drug-related deaths remain a major problem in the UK. Although the pathological findings of cardio-, hepato- and splenomegaly are frequently and empirically associated with chronic alcohol and drug use, there is limited published evidence available. This study hypothesises that organomegaly is associated with chronic substance use, and may represent a prognostic indicator. The weights of hearts, livers and spleens from 280 chronic alcoholics (CA) and 33 chronic drug users (CD) were compared to those of 291 controls. Using a forensic pathology database, CA and CD subjects were identified from 4708 autopsies (January 2003-June 2006) by identifying adult cases with no known coexistent diseases. The controls were non-substance users and previously healthy adults who died of traumatic injuries. Alcohol misuse was associated with cardiomegaly (27% vs. 19%, male CA vs. control) and hepatomegaly (38% vs. 15%). Majority of cases had only one organ affected. In CA, occurrence of hepatomegaly was associated with death at a younger age (female mean age 47+/-9.4, p<0.009, male mean age 50+/-11.6, p<0.007). This study demonstrated an association between cardiomegaly and hepatomegaly with chronic alcohol misuse and identifies the potential role of hepatomegaly as a determinant of poorer outcome in chronic alcohol misusers.