Hidatidosis muscular primaria: reporte de un caso / Primary muscular hydatidosis: a case report

Se presenta el caso de una mujer saludable de 28 años con un tumor en la pierna dependiente de tejidos blandos, no tiene antecedentes epidemiológicos de viajes fuera de Lima Metropolitana, sin compromiso pulmonar, hepático osistémico y con serología negativa para Equinococcus granulossus antes, durante y después de la extirpación de la lesión. En una primera oportunidad se realiza la extracción del tumor y no se sospecha de hidatidosis por lo que no sele dio el manejo adecuado, 16 semanas después regresa por recidiva, donde con un diagnóstico específico se realizala intervención quirúrgica y el tratamiento con albendazol, seis meses de seguimiento después, la paciente no presentó recidiva.

It presents a case of a healthy woman of 28 years with a tumor in his leg attached to soft tissue, she doesn't have epidemiological history of travel outside Lima, without pulmonary, hepatic or systemic disease and with negative serology for Equinococcus granulosus before, during and after the surgical excision. In a first opportunity, they removed tumor and they didn't suspect of hydatidosis so they didn't give a proper treatment, so 16 weeks after, she came back with a relapse, where with a specific diagnosis was performed the surgery and treatment with albendazole, followed up after six months, the patient didn't have recurrence.

Variation in the prevalence of gastric cancer in Perú.

Most cases of gastric cancers occur in non-industrialized countries but there is scarce information about the epidemiology of this illness in these countries. Our study examined whether there was a variation in the prevalence of gastric cancer in Lima, Perú over the last 2 decades. Subjects older than 29 years of age were included. They underwent an esophagogastroduedonoscopy at 3 socioeconomically different health facilities in Lima: a county hospital (7,168 subjects), a Peruvian-Japanese Clinic (14,794 individuals) and a private hospital (4,893 individuals). Birth cohort prevalence of gastric cancer was used. Regression models were calculated to predict the future prevalence of gastric cancer. It was found that the birth cohort prevalence of gastric cancer decreased in Perú from 22.7 to 2% (p < 0.001), from 12 to 0.5% (p < 0.001), and from 6.5 to 0.1% (p < 0.001) in the low, middle and high socioeconomic group, respectively. The prevalence of intestinal metaplasia decreased from 44.3 to 12.5% (p < 0.001), from 28.4 to 5% (p < 0.001), and from 19.4 to 2.2% (p < 0.001) in the low, middle and high socioeconomic status, respectively. These trends will likely persist over the future decades. Nevertheless, the prevalence of gastric cancer remains high in subjects older than 59 years of age in the low socioeconomic status. It is concluded that the prevalence of gastric cancer is decreasing in Perú, similar to the current trend undergoing in industrialized nations. However, there are still specific groups with high prevalence that might benefit from screening for early detection and treatment.

Classic Kaposi's sarcoma presenting in the oral cavity of two HIV-negative Quechua patients.

Traditionally, classic KS lesions have a general distribution, often involving the skin of the feet and legs, and to a lesser extent, that of the hands, arms, and trunk. Oral involvement is a rare manifestation. Initial oral involvement is an even rarer occurrence. We report two unusual cases of classic KS presenting in the oral cavity of two patients from indigenous origin; the first patient with primary oral KS lesion on the hard palate, with no other signs of the condition in any other region of the body; the second patient with generalized dermal KS lesions with lymph node and lower lip involvement. In conclusion, clinicians and pathologists should be aware of the typical clinical, gross, and histologic features of KS. Moreover, we would like to emphasize that oral KS may affect patients without AIDS or exposure to immunosuppression. The awareness of oral classic KS as a diagnostic possibility is important in the work-up of vascular lesions in the oral cavity of non-immunosuppressed individuals.

Classic Kaposi’s sarcoma presenting in the oral cavity of two HIV-negative Quechua patients

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Traditionally, classic KS lesions have a general distribution, often involving the skin of the feet and legs, and to a lesser extent, that of the hands, arms, and trunk. Oral involvement is a rare manifestation. Initial oral involvement is an even rarer occurrence. We report two unusual cases of classic KS presenting in the oral cavity of two patients from indigenous origin; the first patient with primary oral KS lesion on the hard palate, with no other signs of the condition in any other region of the body; the second patient with generalized dermal KS lesions with lymph node and lower lip involvement. In conclusion, clinicians and pathologists should be aware of the typical clinical, gross, and histologic features of KS. Moreover, we would like to emphasize that oral KS may affect patients without AIDS or exposure to immunosuppression. The awareness of oral classic KS as a diagnostic possibility is important in the work-up of vascular lesions in the oral cavity of non-immunosuppressed individuals

Human herpesvirus-8 in Peruvian blood donors: a population with hyperendemic disease?

Serum samples from 128 blood donors were tested for antibodies specific for human herpesvirus-8 by an immunofluorescence assay that detects antibodies against mainly lytic antigens. An overall seroprevalence of 56.25% was found (male donors, 54.68%; female donors, 57.11%). These findings indicate that human herpesvirus-8 infection is hyperendemic in Peruvian blood donors.

[Clostridium difficile and cytomegalovirus involved in a case of pseudomembranous colitis]. / Clostridium difficile y citomegalovirus relacionados a un caso de colitis pseudomembranosa.

We report an unusual case of pseudomembranous colitis with fatal outcome where C. difficile and cytomegalovirus coexistense in a Peruvian patient with AIDS and gastrointestinal compromise by a mycobacterium.

Clinical evaluation of a 16S ribosomal RNA polymerase chain reaction test for the diagnosis of lymph node tuberculosis.

UNLABELLED: Reports on the sensitivity of polymerase chain reaction (PCR) for the diagnosis of lymph node tuberculosis (TB) show divergent results. We evaluated the accuracy of the Roche Amplicor Mycobacterium tuberculosis PCR test with lymph node aspirate and biopsy samples. METHODS: The study was conducted at a public reference hospital in Lima, Peru. From the period of January 2003 to January 2004, we included patients who had lymphadenopathy and in whom the attending physician suspected TB. Aspirate and biopsy samples were submitted for culturing in Lowenstein-Jensen medium, for histopathologic testing, and for PCR. The sensitivity and specificity of PCR were calculated against a reference standard based on histopathologic findings and culture. RESULTS: Our study included 154 patients. Median age was 29 years (interquartile range, 21-40 years); 97 patients (62.9%) were men. Twenty-nine patients (18.8%) had acid fast bacilli-positive histopathologic findings, and 44 (28.6%) had a positive culture result. Using the combination of histopathologic findings and culture as reference standard, 55 patients (35.7%) had a diagnosis of tuberculous lymphadenitis. The sensitivity of the PCR test was 58.2%, and the specificity was 93.9%. For biopsy tissue only, the sensitivity of PCR was 52.7%, and the specificity was 97.0%. For aspirate samples only, the sensitivity of PCR was 47.3%, and the specificity was 96.0%. CONCLUSION: The Amplicor PCR test revealed low sensitivity and high specificity for the diagnosis of lymph node TB. The sensitivity was higher in cases in which the bacillary load was high--in acid fast bacilli-positive samples and among HIV-infected patients. Considering the results of microbiological and PCR tests together, there was still a patient group in whom no final diagnosis could be established.

Characteristics of Castleman's disease in Peru.

BACKGROUND: Castleman's disease (CD) is a very rare disorder of unknown etiology that is characterized by masses of lymphoid tissue. METHODS: The records of all patients with a histological diagnosis of CD who were seen at the Hospital Nacional Cayetano Heredia and the Instituto Nacional de Enfermedades Neoplásicas between 1985 and 2003 and 1985 and 2001, respectively, were reviewed. RESULTS: The study included 10 patients. The age of onset ranged from 5 to 65 years. Nine patients met the criteria for localized CD; six of them were asymptomatic. The most common sites of presentation were the cervical lymph nodes (n=5), submaxilar lymph nodes (n=2), parotid gland (n=1), and lung (n=1). Eight patients had histological evidence of the hyaline-vascular variant and one had the plasma-cell variant. The primary treatment was complete surgical resection. One patient met the criteria for multicentric CD; he was asymptomatic, had histological evidence of the plasma-cell variant, and was treated with combination chemotherapy. All ten patients are currently alive with no evidence of recurrence. CONCLUSION: The localized form of CD presents as progressive, painless, slow-growing lymph node enlargement that is generally asymptomatic. The locations most commonly involved in the localized form are the cervical lymph nodes, followed by the submaxillary lymph nodes, where it poses a diagnostic challenge to the clinician because it tends to mimic other head and neck diseases. Localized CD is almost always of the hyaline-vascular variant and complete surgical excision of the tumor allows full recovery in all cases.

[Classic Kaposi Sarcoma in jejunum: case report]. / Sarcoma de Kaposi clásico en yeyuno: reporte de caso.

Classic Kaposi Sarcoma (KS) may affect mucosa, especially oral cavity and any part of the gastrointestinal tract. It has been reported in 10% of patients with classic KS. We report a 35-year old male patient with primary classic KS in jejunum that presented with bowel obstruction. Primary presentation of classic KS in the gastrointestinal tract is very infrequent. There have only been 9 cases of primary KS in colon reported in literature, and none in jejunum. This is the first primary classic KS in jejunum described in our country. Likewise, we recommend that certain patients with classic KS should have an upper gastrointestinal endoscopy to determine compromise. The few gastrointestinal KS reported cases may be due to subdiagnosis.

Epidemiological and clinical characteristics of classic Kaposi's sarcoma in Peru.

BACKGROUND: Classic Kaposi sarcoma (KS) occurs predominantly among the elderly, with predominance among Jews, Italians, and Greeks. Classic KS has been seen relatively frequently in Peru. OBJECTIVE: Our purpose was to outline the epidemiological and clinical profile of classic KS in Peru. METHODS: Epidemiological and clinical features of all classic KS cases diagnosed between 1969 and 2003 at Hospital Nacional Cayetano Heredia (HNCH) and between 1946 and 2004 at Instituto Nacional de Enfermedades Neoplasicas (INEN) were reviewed and studied retrospectively. RESULTS: An overall incidence of 2.54 per 10,000 attended patients was obtained at the INEN during the 48-year period (mean, 2.39; standard deviation: 1.99; 95% confidence interval, 2.92-1.86). Twenty-one cases were discovered at HNCH and 106 cases at INEN. A male/female ratio of 2.62:1 was found. Mean age at diagnosis was 68.5 years. Lower limbs were involved in 109 patients (85.8%); the trunk was involved in 11 patients (8.6%). Nodules were the most common type of lesion (85.8%); less commonly found were plaques (27.5%), macules (12.5%), papules (12.5%), and ulcers (8.6%). Sixty-two patients had no symptoms (48.8%). Pain was the most common symptom (26.7%), followed by edema (21.2%), bleeding (14.9%), and pruritus (3.9%). A second primary malignancy was found in 11 patients (8.6%). LIMITATIONS: These results were obtained from patients with classic KS in Peru and may not be applicable to other populations. CONCLUSION: Classic KS is quite common in Peru with sporadic cases found throughout the country and some clustering in the coastal region. Classic KS in Peru has a clinical presentation that is very similar, but not identical, to the classic KS described in the Mediterranean region, exhibiting some special clinical and epidemiological characteristics with a nodular, nonsymmetric presentation that usually affects the lower extremities.

Cáncer hepático en area endémica de hepatitis B y delta B: a propósito de 19 casos / Liver cancer in hyperendemic area of B and delta hepatitis: report of 19 cases

Se realiza el estudio en forma prospectiva de 19 pacientes con diagnóstico de cáncer hepático, hospitalizados en los Servicios de Medicina del Hospital Regional del Ministerio de Salud (MINSA) del Cusco. El estudio se hizo entre Agosto de 1992 y Agosto de 1995. En cada paciente se llenó una ficha clínico epidemiológica, se extrajo suero para determinación de Antígeno de Superficie del virus de la hepatitis B (Ag- HBs) y Anticuerpo del virus de la hepatitis Delta (Anti-Delta), así como transaminasas, bilirrubinas, fosfatasa alcalina. Se logró un diagnóstico histopatológico en 14 pacientes por biopsia hepática, en el resto fue clínico y/o de laboratorio por estar contraindicada la biopsia. Los resultados fueron los siguientes: el 92.9 por ciento fueron hepatocarcinoma, y esta neoplasia fue más frecuente en pacientes de sexo masculino entre los 20 y 39 años de edad. Los factores de riesgo más importantes encontrados fueron: la infección por virus de la hepatitis B y Delta, y el alcohol (66.7 por ciento de Ag HBs positivo, 41.6 por ciento de Anti-Delta positivo, abuso de alcohol presente en el 68.5 por ciento). Se concluye que el cáncer hepático más frecuentemente encontrado en el Hospital Regional del Cusco es el Hepatocarcinoma y los factores de riesgo asociados encontrados son la infección por virus B y Delta, así como el abuso de alcohol.

This is a prospective study that includes 19 hospitalized patients with hepatic cancer at the Medicine Department of the Regional Hospital in Cusco (Perú), between August 1992 to August 1995. Epidemiological and clinical information was obtained from all patients. Serum samples were taken for HBsAg, anti-Delta, and liver tests. Histological diagnosis was done in 14 patients by liver biopsy by the Menghinrs method, in the others this was done by clinical ahd laboratorial means because the biopsy was contraindicated. 92.9 per cent were hepatocarcinoma, and this, neoplasm was more frequently in men, between20 to 39 years old. The risk factors were infections by hepatitis B virus and delta virus: 66.7 per cent had HBsAg positive and 41.6 per cent Anti-Delta positive. Excessive alcohol consumption was present in 68.5 per cent. We concluded that the most frequently cancer of the liver seen was hepatocarcinoma and the risk factors that are associated were previous infection of B and Delta virusand alcohol.

[LIVER CANCER IN HYPERENDEMIC AREA OF B AND DELTAHEPATITIS: REPORT OF 19 CASES] / Cáncer Hepático en AreaEndémica de Hepatitis B y Delta B: A propósito de 19 casos.

This is a prospective study that includes 19 hospitalized patients with hepatic cancer at the Medicine Department of the Regional Hospital in Cuzco (Perú), between August 1992 to August 1995. Epidemiological and clinical information was obtained from all patients. Serum samples were taken for HBsAg, anti-Delta, and liver tests. Histological diagnosis was done in 14 patients by liver biopsy by the Menghini's method, in the others this was done by clinical and laboratorial means because the biopsy was contraindicated.92,9% were hepatocarcinoma, and this neoplasm was more frequently in men, between 20 to 39 years old. The risk factors were infections by hepatitis B virus and delta virus: 66.7% had HBsAg positive and 41,6% Anti-Delta positive. Excessive alcohol consumption was present in 68,5%.We concluded that the most frequently cancer of the liver seen was hepatocarcinoma and the risk factors that are associated were previous infection of B and Delta virus and alcohol.

Pielonefritis xantogranulomatosa / Xanthogranulomatous pyelonephritis

La Pielonefritis Xantogranulomatosa (PNX) es una entidad poco frecuente e importante en el diagnóstico diferencial de enfermedades renales como riñon multiquístico, carbuncio renal e hipernefroma, y es de particular importancia enfatizar que la nefrectomía parcial o total es curativa en estos casos. Se realizó un análisis retrospectivo de 88 historias clínicas de pacientes con diagnóstico confirmado de PNX, registrados entre los años 1969-1986. Se encontró una edad x = 41.25 ñ 18.72 y el 100% correspondió al sexo femenino. En el cuadro clínico se presentó dolor, pérdida de peso y síntomas urinarios en el 87.5%. Antecedentes de infección del tracto urinario (ITU) en el 71.4% y litiasis urinaria (sin historia de eliminación) en el 86%. Entre los hallazgos clínicos obtuvimos dolor y masa abdominal en el 87.5%, palidez y puño percusión lumbar (PPL) exquisita en el 75% y fiebre en el 50%./ Urocultivo positivo, principalmente enteropatógenos en el 75%. En la urografía escretoria observamos riñón ecluído en el 100% y cálculo coraliforme en el 75%. En la ecografía el patrón fue de riñón con múltiples cavidades e hidronefrosis. En este trabajo se presenta, además, un caso clínico de cálculo coralifrome bilateral asociado a acidosis tubular distal no descrito en la literatura y que podría tener importancia en la patogénesis de la enfermedad

Estudio clínico patológico de 81 casos de hígado graso en el Hospital Cayetano Heredia / Clinical pathological study of 81 cases of fatty liver in \"Cayetano Heredia\" Hospital

Se estudian 81 casos clínicos, 16 niños y 62 adultos; con diagnóstico histopatológico de hígado graso que se internaron en el Hospital General Base Cayetano Heredia entre 1970 y 1982. La enfermedad más frecuentemente asociada al hígado graso fue la desnutrición, con predominio en el grupo pediátrico. En ellos la mortalidad fue elevada por la coexistencia de infecciones graves. Los síntomas fueron generados por las variadas enfermedades causales y no directamente por el hígado graso. La hepatomegalia era el signo clínico más frecuente (67%) y la prueba de la Bromosulftaleína fue el examen auxiliar de mayor alteración. De 63 biopsias hepáticas que fueron reexaminadas, 51 mostraban esteatosis sin otras lesiones. El grado de infiltración grasa más severa correspondió a los casos de desnutrición en los adultos y niños. En 12 biopsias la esteatosis se acompañaba de otras lesiones mínimas, como la fibrosis incipiente en casos de alcoholismo y desnutrición, y alteraciones vasculares en un caso de diabetes mellitus. Se discuten los hallazgos en cada grupo de enfermedades asociadas, correlacionando con la literatura revisada

Compromiso ovárico en la pelviperitonitis post-aborto y post-parto / Ovarian involvement in post-abortion and post-partum pelvia pertinitis

En la pelviperitonitis post-aborto y post-parto (40 casos) los ovarios pueden hallarse inafectos, con compromiso periférico (perioforitis) o compromiso parenquimal (oforitis absceso) lo que sugiere dos vías de difusión de infección del foco uterino al ovario por contigüidad y por vía hamatógena a través del ligamento infundíbulo pélvico, estimándose que esta es una estructura importante para la decisión de resección de una gonada, sugiriéndose la conservación de éstas en pacientes jóvenes si están indemnes o afectadas superficialmente y con ligamento infundíbulo pélvicos normales. La ablación de una gonada o persistencia de ambas en 24 casos seleccionados, no incrementaron la morbilidad post-operatoria, ni el tiempo de hospitalización y presentaron recuperación funcional adecuada, constatada por el seguimiento clínico y hallazgos hormonales, a diferencia del síndrome climatérico precoz y florido presentado por pacientes castradas

Compromiso ovárico en la pelviperitonitis post-aborto y post-parto / Ovarian involvement in post-abortion and post-partum pelvia pertinitis

En la pelviperitonitis post-aborto y post-parto (40 casos) los ovarios pueden hallarse inafectos, con compromiso periférico (perioforitis) o compromiso parenquimal (oforitis absceso) lo que sugiere dos vías de difusión de infección del foco uterino al ovario por contig³idad y por vía hamatógena a través del ligamento infundíbulo pélvico, estimándose que esta es una estructura importante para la decisión de resección de una gonada, sugiriéndose la conservación de éstas en pacientes jóvenes si están indemnes o afectadas superficialmente y con ligamento infundíbulo pélvicos normales. La ablación de una gonada o persistencia de ambas en 24 casos seleccionados, no incrementaron la morbilidad post-operatoria, ni el tiempo de hospitalización y presentaron recuperación funcional adecuada, constatada por el seguimiento clínico y hallazgos hormonales, a diferencia del síndrome climatérico precoz y florido presentado por pacientes castradas (AU)

Sífilis gástrica: reporte de un caso / Gastric syphilis: case report

Se describe el caso de un paciente varón, de 31 años de edad; con reacciones serológicas positivas para sífilis (VDRL: 1/8 diluciones y FTA-ABS positivo), en el estadio secundario de esta enfermedad; que presentaba síntomas digestivos altos y baja de peso. La gastroscopia mostró lesiones ulceradas múltiples en la mucosa del estómago y, en las biopsias, el estudio histológico demostró severo infiltrado inflamatorio agudo y crónico. Con el uso de Penicilina Benzatina, en corto tiempo fue evidente la mejoría clínica y de las lesiones gástricas controladas mediante gastroscopia. Se discuten los hallazgos y criterios diagnósticos, comparativamente con los relatos similares de la literatura revisada; los que sustentaron la conclusión de que este caso correspondía a una sífilis gástrica