Characterization of the autoimmune response against the nerve tissue S100ß in patients with type 1 diabetes.

Type 1 diabetes results from destruction of insulin-producing beta cells in pancreatic islets and is characterized by islet cell autoimmunity. Autoreactivity against non-beta cell-specific antigens has also been reported, including targeting of the calcium-binding protein S100ß. In preclinical models, reactivity of this type is a key component of the early development of insulitis. To examine the nature of this response in type 1 diabetes, we identified naturally processed and presented peptide epitopes derived from S100ß, determined their affinity for the human leucocyte antigen (HLA)-DRB1*04:01 molecule and studied T cell responses in patients, together with healthy donors. We found that S100ß reactivity, characterized by interferon (IFN)-γ secretion, is a characteristic of type 1 diabetes of varying duration. Our results confirm S100ß as a target of the cellular autoimmune response in type 1 diabetes with the identification of new peptide epitopes targeted during the development of the disease, and support the preclinical findings that autoreactivity against non-beta cell-specific autoantigens may have a role in type 1 diabetes pathogenesis.

[Hyperthyroidism due to an ectopic intrathoracic thyroid]. / Hipertiroidismo por tiroides ectópico intratorácico.

We present an 84-year-old woman with hyperthyroidism caused by an ectopic intrathoracic thyroid that was removed by sternotomy. Ectopic intrathoracic thyroid, also called primary intrathoracic goitre, is a rare presentation of thyroid disease and comprises about 1% of all mediastinal masses. Its coexistence with hyperthyroidism is extremely uncommon. Its removal usually requires thoracotomy or sternotomy.

Hipertiroidismo por tiroides ectópico intratorácico / Hyperthyroidism due to an ectopic intrathoracic thyroid

Se presenta el caso de una paciente de 84 años con hipertiroidismo por tiroides ectópico intratorácico que fue tratado quirúrgicamente. El tiroides ectópico intratorácico o bocio intratorácico primario es una presentación rara y comprende el 1% de todas las masas mediastínicas. La coexistencia con hipertiroidismo es extremadamente infrecuente. Su resección generalmente requiere una toracotomía o esternotomía (AU)

We present an 84-year-old woman with hyperthyroidism caused by an ectopic intrathoracic thyroid that was removed by sternotomy. Ectopic intrathoracic thyroid, also called primary intrathoracic goitre, is a rare presentation of thyroid disease and comprises about 1% of all mediastinal masses. Its coexistence with hyperthyroidism is extremely uncommon. Its removal usually requires thoracotomy or sternotomy (AU)

[Assessment of activity of care of a nutritional support multidisciplinary team in the follow-up of total parenteral nutrition]. / Evaluación de la actividad asistencial de un equipo multidisciplinario de soporte nutricional en el seguimiento de la nutrición parenteral total.

INTRODUCTION: In total parenteral nutrition (TPN) nutritional support multidisciplinary teams (NSMT) must provide a high quality nutritional assistance based on evidence and daily follow-up of patients with TPN. OBJECTIVES: To assess the degree of adherence to quality standards of care provided to patients on TPN by the NSMT in two consecutive annual periods, according to structure, procedure, and outcomes indicators, previously defined in the team working protocol. PATIENTS AND METHODS: Prospective study of all patients that received TPN at our Center (421-bed general teaching hospital) during the years 2002 and 2003, using the data introduced in NUTRIDATA by daily follow-up of clinical and analytical conditions, and nutritional and non-nutritional complications, comparing both periods and considering an statistical significance level of p < 0.05. RESULTS: One hundred and sixty-three patients and 145 patients received TPN during 2002 and 2003(65.9% male), respectively, with similar parameters of gender, age, indications for TPN, baseline nutritional status, mean nutritional supply, and non-nutritional complications. As to the different quality indicators established in the comparative study, we found a significant improvement in 2003 vs. 2002 in relation to initial anthropometrical assessment (71.03% vs 51.53%; p < 0.001), initial biochemical assessment (97.93% vs. 92.63%; p < 0.04), performance of systematic monitoring analysis (84.83% vs. 71.78%; p < 0.01), hypernatremia incidence (8.27% vs. 15.34%; p = 0.05) and moderate hyperphosphatemia (26.89% vs. 40.49%; p < 0.02), TPN ending for clinical improve- ment (76.60% vs. 64.40%; p = 0.04), and reduction of days on TPN (15.74 +/- 20.43 vs. 11.88 +/- 8.34; p < 0.02), the impaired electrolyte levels significantly improving as a whole. We also observed a non-significant trend towards an improvement of adequacy of TPN indications, hyperphosphatemia, severe hypophosphatemia, total stay, and post-surgical stay, in 2003 vs. 2002. CONCLUSIONS: The NSMT experience shows that analysis of indicators based on quality standards, in two successive annual periods allows assessing the improvement of efficiency of nutritional intervention in hospital-admitted patients with TPN with regards to indication, assessment, follow-up, and course.

Sepsis extrahospitalaria severa en la Unidad de Cuidados Intensivos / Severe extrahospital sepsis in the Intensive Care Unit

Se realizó un estudio descriptivo, prospectivo con el objetivode describir el comportamiento de la sepsis extrahospitalariasevera en pacientes que ingresaron en la Unidad de CuidadosIntensivos del hospital provincial universitario «Carlos Manuelde Céspedes», de Bayamo desde el 1ro de noviembre del2003 hasta el 31 de octubre del 2004. De 527 pacientesingresados, 94 (17,8%) cumplían los criterios de sepsis severaextrahospitalaria. La edad media fue de 49,4 años (IC =45,5-53,3 y desviación estándar = 19,0). Una estancia hospitalariapromedio de 9,62 días (IC = 8,5-10,8). Las localizacionesmás frecuentes fueron las intraabdominales (51,1%) ylas respiratorias (18,1%). Hubo discreto predominio de los gérmenesgramnegativos en comparación con los grampositivos,(51,56%) y (48,43%) respectivamente, representando a losprimeros la Escherichia coli (15 para 45,45%) y el Estreptococopneumoniae a los segundos (14, para 45,16%). Las complicacionesmás relevantes fueron: los trastornos ácido-básicos(33,17%) e hidroelectrolíticos (20,68%). Los factores deriesgo más importantes tenemos a: la edad mayor o igual de60 años (56,1%), el alcoholismo (15,8%) y la diabetes mellitus(14%). La letalidad fue mayor en estadios más avanzadosdel cuadro con 5 fallecidos de los casos con shock séptico(5,31%) y 7 con disfunción multiorgánica (7,44%)

A prospective descriptive study was carried out to describethe behaviour of severe extra-hospital sepsis in patientsadmitted to the Intensive Care Unit at «Carlos Manuel deCespedes» provincial university hospital of Bayamo, Granmasince november 1st 2003 to october 31st 2004. Out of the527 patients admitted in that period, 94 (17,8%) developed.Severe extra hospital sepsis. The patients average agewas 49,4 years. (IC = 45, 5-53,3). The average hospitalstay was of 9,62 days (IC = 8,5-10,8). Intra-abdominal(51,1%) and respiratory (18,1%) sepses were the mostcommon ones. A slight predominance of gram-negative(Escherichia coli [51,56%]) over gram-positive (StreptococcusPneumoniae [45,16%]) was shown. The major complicationswere acid-base balance disorders (33,17%) andbody water and electrolytes distribution disorders (20,68%).The major risk factors were age (56,1%) of the patientswere over 60 years, alcoholism (15,8%) and diabetes mellitus(14%). Lethality was higher in the more advanced statesof the clinical picture with five deaths case by septic shock(5,31%) and seven deaths as a result of multiple organ dysfunction(13,2%)

Evaluación de la actividad asistencial de un equipo multidisciplinario de soporte nutricional en el seguimiento de la nutrición parenteral total / Assessment of activity of care of a nutritional support multidisciplinary team in the follow-up of total parenteral nutrition

INTRODUCCIÓN: En la Nutrición Parenteral Total (NPT) los equipos multidisciplinarios de soporte nutricional (EMSN) deben proporcionar una asistencia nutricional de calidad basada en la evidencia y en el seguimiento diario de los pacientes sometidos a NPT. Objetivos: Evaluar el grado de cumplimiento de los estándares de calidad en la asistencia prestada a los pacientes con NPT por parte del EMSN en dos períodos anuales sucesivos, de acuerdo con indicadores de estructura, proceso y resultado previamente definidos en el protocolo de trabajo del equipo. PACIENTES Y MÉTODOS: Estudio prospectivo de todos los pacientes que recibieron NPT en nuestro centro (hospital general docente con 421 camas) durante el año 2002 y durante el año 2003, utilizando los datos introducidos en NUTRIDATA© mediante el seguimiento diario de las condiciones clínicas, analíticas y complicaciones nutricionales y no nutricionales, comparando ambos períodos y considerando un nivel de significación de p < 0,05. RESULTADOS: 163 y 145 pacientes recibieron NPT durante 2002 y 2003 (65,90% varones), con parámetros similares en cuanto a sexo, edad, motivos de NPT, estado nutricional inicial, aporte nutricional medio y complicaciones no nutricionales. Respecto a los diferentes indicadores de calidad establecidos en el estudio comparativo encontramos una significativa mejoría en el año 2003 vs 2002 en cuanto a la valoración antropométrica inicial (71,03% vs 51,53%, p < 0,001), valoración bioquímica inicial (97,93% vs 92,63%, p<0.04), la realización de analíticas de control sistematizadas (84,83% vs 71,78%, p < 0,01), la incidencia de hipernatremia (8,27% vs 15,34%, p = 0,05) e hipofosfatemia moderada (26,89% vs 40,49%, p < 0,02), la finalización de la NPT por mejoría clínica (76,60% vs 64,40, p = 0,04) y la reducción de días en NPT (15,74 ± 20,43 vs 11,88 ± 8,34, p < 0,02), mejorando en conjunto significativamente los niveles electrolíticos alterados. También observamos una tendencia no significativa a mejorar en 2003 vs 2002 la adecuación de la indicación de NPT, hiperpotasemia, la hipofosfatemia severa, la estancia total y la estancia postquirúrgica. CONCLUSIONES: La experiencia del EMSN demuestra que el análisis de indicadores de acuerdo con estándares de calidad en dos períodos anuales sucesivos permite evaluar la mejora en la eficiencia de la intervención nutricional en pacientes ingresados con NPT respecto a la indicación, valoración, seguimiento y evolución (AU)íes

INTRODUCTION: In total parenteral nutrition (TPN) nutritional support multidisciplinary teams (NSMT) must provide a high quality nutritional assistance based on evidence and daily follow-up of patients with TPN. Objectives: To assess the degree of adherence to quality standards of care provided to patients on TPN by the NSMT in two consecutive annual periods,according to structure, procedure, and outcomes indicators, previously defined in the team working protocol. PATIENTS AND METHODS: Prospective study of all patients that received TPN at our Center (421-bed general teaching hospital) during the years 2002 and 2003, using the data introduced in NUTRIDATA® by daily follow-up of clinical and analytical conditions, and nutritional and non-nutritional complications, comparing both periods and considering an statistical significance level of p <0.05. RESULTS: One hundred and sixty-three patients and 145 patients received TPN during 2002 and 2003(65.9% male), respectively, with similar parameters of gender, age, indications for TPN, baseline nutritional status, mean nutritional supply, and non-nutritional complications. As to the different quality indicators established in the comparative study, we found a significant improvement in 2003 vs. 2002 in relation to initial anthropometrical assessment (71.03% vs 51.53%; p < 0.001), initial biochemical assessment (97.93% vs. 92.63%; p < 0.04), performance of systematic monitoring analysis (84.83% vs. 71.78%; p < 0.01), hypernatremia incidence (8.27% vs. 15.34%; p = 0.05) and moderate hyperphosphatemia (26.89% vs.40.49%; p < 0.02), TPN ending for clinical improvement (76.60% vs. 64.40%; p = 0.04), and reduction of days on TPN (15.74 ± 20.43 vs. 11.88 ± 8.34; p < 0.02), the impaired electrolyte levels significantly improving as a whole. We also observed a non-significant trend towards an improvement of adequacy of TPN indications, hyperphosphatemia, severe hypophosphatemia, total stay, and post-surgical stay, in 2003 vs. 2002. CONCLUSIONS: The NSMT experience shows that analysis of indicators based on quality standards, in two successive annual periods allows assessing the improvement of efficiency of nutritional intervention in hospital-admitted patients with TPN with regards to indication, assessment, follow-up, and course (AU)

[Detection of malnutrition risk in hospitalized elderly patients]. / Detección del riesgo de malnutrición en ancianos hospitalizados.

UNLABELLED: OBJECTIVE AND SCOPE: To validate a protocol for the detection of malnutrition risk in a population of elderly patients admitted to a general hospital for non-surgical reasons. MATERIALS AND METHOD: The study involved 95 patients (34 of them male) over the age of 65 who were assessed on the third and fifth day after admission by means of a simple screening protocol (PC in its Spanish acronym) that considered recent changes in weight, serum albumin, lymphocyte concentration, food intake and diagnosis on admission, together with a more complex diagnostic protocol (PD in its Spanish acronym) including anthropometric, biochemical and immunological parameters. The PC was applied by personnel not expert in nutrition, while the PD was carried out by persons trained in nutritional assessment. The results of the PC and PD were compared, with statistical significance being considered at levels of p < 0.05. RESULTS: According to the PD, 75 patients (78.9%) suffered protein-energy malnutrition (39 slight, 31 moderate, 5 severe). The score obtained in the PC had a significant relationship with the severity of the malnutrition diagnosed using PD (p < 0.001). Furthermore, the absence or presence of nutritional risk assessed using the PC had a significant correlation with the diagnosis of malnutrition and its degree according to the PD (p < 0.01), thus indicating the validity of the PC as a method for screening of malnutrition. CONCLUSIONS: 1. In our population of geriatric patients admitted for reasons other than surgery, there was a high prevalence of protein-energy malnutrition. 2. The risk of malnutrition in an elderly population in hospital settings is appropriately assessed by means of a simple screening test effected by non-specialized personnel. 3. The score obtained in the PC is linked with the presence of malnutrition and with its severity. 4. The use of simple screening techniques in populations with a high prevalence of malnutrition may contribute to the detection and correction of this problem.

Detección del riesgo de malnutrición en ancianos hospitalizados / Detection of the risk of malnutrition in hospitalized elderly patients

Objetivo y ámbito: Validar un protocolo de detección de riesgo de malnutrición en una población de pacientes ancianos ingresados en un hospital general por motivos no quirúrgicos.Material y métodos: Se estudiaron 95 pacientes (34 varones) mayores de 65 años, evaluados entre el 3.º y 5.º día desde el ingreso mediante un protocolo de cribado (PC) sencillo que valora cambios recientes en el peso, albúmina sérica, concentración de linfocitos, ingesta y diagnóstico al ingreso, así como con un protocolo de diagnóstico (PD) más complejo que incluye parámetros antropométricos, bioquímicos e inmunológicos. El PC fue realizado por personal no experto en nutrición, mientras que el PD fue realizado por personal entrenado en evaluación nutricional. Se compararon los resultados de PC y de PD, considerándose una significación estadística a un nivel de p < 0,05.Resultados: Según el PD, 75 pacientes (78,9 por ciento) padecían malnutrición proteico-energética (39 leve, 31 moderada, 5 severa). La puntuación obtenida en el PC se relacionó significativamente con la severidad de la malnutrición diagnosticada por el PD (p < 0,001). Asimismo, la ausencia o presencia de riesgo nutricional evaluada mediante el PC se correlacionó significativamente con el diagnóstico de malnutrición y su grado mediante el PD (p < 0,01), indicando la validez del PC como método de despistaje de malnutrición.Conclusiones: 1. En nuestra población de pacientes geriátricos ingresados por motivos no quirúrgicos la prevalencia de malnutrición proteico-energética es alta.2. El riesgo de malnutrición en una población anciana en medio hospitalario es evaluado de manera apropiada mediante una prueba de despistaje sencilla realizada por personal no entrenado. 3. La puntuación obtenida en PC se relaciona con la presencia de malnutrición así como con su severidad. 4. El uso de técnicas de despistaje sencillas en poblaciones con alta prevalencia de malnutrición puede contribuir a detectar y corregir este problema (AU)

Objective and Scope: To validate a protocol for the detection of malnutrition risk in a population of elderly patients admitted to a general hospital for non-surgical reasons. Materials and Method: The study involved 95 patients (34 of them male) over the age of 65 who were assessed on the third and fifth day after admission by means of a simple screening protocol (PC in its Spanish acronym) that considered recent changes in weight, serum albumin, lymphocyte concentration, food intake and diagnosis on admission, together with a more complex diagnostic protocol (PD in its Spanish acronym) including anthropometric, biochemical and immunological parameters. The PC was applied by personnel not expert in nutrition, while the PD was carried out by persons trained in nutritional assessment. The results of the PC and PD were compared, with statistical significance being considered at levels of p < 0.05. Results: According to the PD, 75 patients (78.9%) suffered protein-energy malnutrition (39 slight, 31 moderate, 5 severe). The score obtained in the PC had a significant relationship with the severity of the malnutrition diagnosed using PD (p < 0.001). Furthermore, the absence or presence of nutritional risk assessed using the PC had a significant correlation with the diagnosis of malnutrition and its degree according to the PD (p < 0.01), thus indicating the validity of the PC as a method for screening of malnutrition. Conclusions: 1. In our population of geriatric patients admitted for reasons other than surgery, there was a high prevalence of protein-energy malnutrition. 2. The risk of malnutrition in an elderly population in hospital settings is appropriately assessed by means of a simple screening test effected by non-specialized personnel. 3. The score obtained in the PC is linked with the presence of malnutrition and with its severity. 4. The use of simple screening techniques in populations with a high prevalence of malnutrition may contribute to the detection and correction of this problem (AU)

[Risk of hepatitis B virus transmission from hepatitis B core antibody-positive liver donors]. / Riesgo de transmisión del virus de la hepatitis B de donantes de hígado anti-HBc positivos.

BACKGROUND: To study the hepatitis B virus (HBV) transmission from donors HBsAg-/AntiHBc+ to liver transplant recipients. PATIENTS AND METHOD: We studied retrospectively the HBV serological markers in 43 donors from our center and also the serological condition of the 41 recipients. The HBV serological markers were analyzed by ELISA and HBV DNA was detected by hybridation assays. RESULTS: 13 donors samples showed some HBV serological markers: 6 anti-HBc and anti- HBs (13.9%), 4 anti-HBc (9%) and 3 anti- HBs (6.9%). There were no cases of hepatitis B among liver recipients from donors with negative serological markers. Among the 13 recipients with HBV serological markers, 9 were followed during 39 (SD 17) months. The 5 recipients with no HBV markers, who received an anti- HBc+ with or without anti- HBs (100%) developed hepatitis B. The two liver recipients with anti-HBs solely, did not developed infection (0%). Of the 41 recipients, 15 had some HBV markers before transplant and two of them received an anti-HBc+ and did not develop the infection (0%). CONCLUSIONS: In our study, the prevalence of serological HBV infection in donors and recipients was of 30.2 and 31.7%, respectively. Anti-HBc with or without anti-HBs donors transmitted the HBV infection in all the cases (100%) to the susceptible recipients. The presence of anti-HBs in recipients protected these against the infection. Only the anti-HBs positive donors did not trasmit the HBV infection.

Riesgo de transmisión del virus de la hepatitis B de donantes de hígado anti-hbc positivos / Risk of hepatitis B virus transmission from hepatitis B core antibody-positive liver donors

FUNDAMENTO: Estudiar el riesgo de transmitir el virus de la hepatitis B (VHB) a los receptores de hígados de donantes AgHBs negativos y anti-HBc positivos. PACIENTES Y MÉTODO: Se han analizado retrospectivamente los marcadores séricos del VHB (MHB) (AgHBs, anti-HBc y anti-HBs) de 43 donantes, junto con los 41 receptores de estos órganos.La determinación de MHB se realizó por ELISA, y el ADN del VHB por técnica de hibridación molecular. RESULTADOS: Trece sueros de donantes (30,2 por ciento) presentaron algún MHB: 6 anti-HBc y anti-HBs (13,9 por ciento), 4 anti-HBc (9 por ciento) y tres anti-HBs (6,9 por ciento). De los receptores que recibieron un injerto sin MHB, ninguno desarrolló infección después del trasplante de hígado. De los 13 receptores de órganos con MHB, 9 han sido controlados durante 39 (DE 17) meses. Los 5 receptores de un injerto anti-HBc positivo, con anti-HBs o sin él, y que no presentaban MHB desarrollaron hepatitis B (100 por ciento). Los dos receptores de órganos anti-HBs positivos únicamente y sin MHB no desarrollaron infección (0 por ciento). Entre los receptores 15 tenían algún MHB antes del trasplante de hígado (31,7 por ciento); 5 de ellos tenían anti-HBs positivo antes del trasplante. Los dos receptores de este grupo que recibieron un injerto anti-HBc positivo no desarrollaron infección (0 por ciento). CONCLUSIONES: En este estudio la prevalencia de MHB entre los donantes y receptores es del 30,2 y del 31,7 por ciento, respectivamente. Los injertos anti-HBc positivos con anti-HBs o sin él transmitieron la enfermedad en el 100 por ciento de los receptores. La presencia de anti-HBs en el receptor protegió de la infección. Los injertos únicamente positivos para anti-HBs no transmitieron la enfermedad (AU)

[Hereditary hemorrhagic telangiectasia with liver involvement]. / Telangiectasia hemorrágica hereditaria con afectación hepática.

Rendu-Osler-Weber syndrome, or hereditary hemorrhagic telangiectasia, is characterized by vascular alterations that tend to hemorrhage. We present a 56-year-old woman, with a diagnosis of chronic liver disease of unknown origin 15 years earlier, who came to our hospital as a liver transplantation candidate following hemorrhage due to esophageal varices. Rendu-Osler-Weber syndrome can affect the liver in several ways although vascular alterations can be distinguished from those produced in the liver parenchyma. The different types of vascular alterations in the liver may manifest as as telangiectasias, angiomas, aneurysms of the hepatic artery and fistulae between different vessels. This syndrome may also produce alterations in the liver parenchyma although the exact pathogenic mechanisms are unknown. There are three main forms of treatment: embolization of the branches of the hepatic artery, ligature of the hepatic artery and liver transplantation.

Pasteurella spp: un nuevo germen causante de tiroiditis aguda supurada / Pasteurella spp: a new microorganism adding to acute suppurative thyroiditis etiology

La tiroiditis aguda supurada es una entidad poco frecuente debido a la resistencia natural de la glándula a la infección. Patología preexistente sobre el tiroides así como defectos anatómicos locales predisponen a padecer la enfermedad. Presentamos el primer caso descrito en la literatura por Pasteurella spp tras infección de vías respiratorias superiores, con clínica poco florida mimetizando tiroiditis subaguda. La evolución fue satisfactoria tras drenaje quirúrgico (AU)

Síndrome de Cushing secundario a tumor carcinoide bronquial: valor de la gammagrafía con 111In-DTPA octreotide en el diagnóstico de localización / Cushing´s syndrome secondary to bronchial carcinoid tumor: scintigraphy with 111IN-DTPA octreotide in the localizations diagnosis

El carcinoide bronquial (CB) es una causa excepcional de síndrome de Cushing y a menudo plantea problemas de diagnóstico diferencial con la enfermedad de Cushing por adenoma hipofisario. Presentamos dos casos en los que la gammagrafia con octreoscan fue de gran ayuda diagnóstica: en el primero, la tomografia computerizada (TC) mostró un nódulo pulmonar de 1 cm de características indeterminadas, que fue gammagráficamente positivo, que se confirmó tras la intervención. El segundo paciente es un varón de 60 años previamente operado CB secretor de ACTH, en el que persisten niveles elevados de ACTH y que presenta estudios de localización negativos. La gammagrafia mostró una captación compatible con recidiva tumoral. En nuestra opinión, la gammagrafia con octreoscan debe considerarse en pacientes con sospecha de síndrome de ACTH ectópico aunque existan lesiones torácicas demostrables en la TC (AU)

[Cushing's syndrome secondary to bronchial carcinoid tumor: contribution of gammagraphy with 111In-DTPA octreotide in the localization diagnosis]. / Síndrome de Cushing secundario a tumor carcinoide bronquial: valor de la gammagrafía con 111In-DTPA octreotide en el diagnóstico de localización.

Bronchial carcinoid (BC) is a rare etiology of Cushing syndrome, and difficulties in differential diagnosis with Cushing's disease are often present. We report two cases in which octreotide scintigraphy was an important diagnostic tool. The first patient showed a 1 cm non-specific pulmonary nodule on CT scan that was positive on scintigraphy, being confirmed by surgery. The second case was a man that had been operated but not cured of an ACTH secreting BC that continued with high ACTH levels and negative localization imaging studies. A subsequent scintigraphy showed a positive image suggestive of recurrence. Octreotide scintigraphy may be considered in patients with suspicion of ectopic ACTH syndrome although a positive image in CT scan be present.

[Pasteurella spp: a new microorganism to the cause of acute suppurative thyroiditis]. / Pasteurella spp: un nuevo germen causante de tiroiditis aguda supurada.

Acute suppurative thyroiditis is an uncommon disease due to local resistance of the gland to infection. Preexisting gland pathology and local anatomic abnormalities are predisposing factors. We present the first case described in the medical literature caused by Pasteurella spp after upper respiratory infection with insidious manifestations resembling subacute thyroiditis. The course was benign after surgical drainage.

[Granular cell myoblastoma localized in the thoracic wall]. / Mioblastoma de células granulosas localizado en la pared torácica.

We report the case or a 40-year-old man with a large right parasternal tumor. Computerized tomography (CT) and magnetic resonance (MR) imaging showed a soft tissue mass infiltrating contiguous structures with no sign of adenopathy and with disease limited the chest wall. The histological type was granular cell tumor (GCT) with discrete cell pleomorphism and nuclei that varied in form and size, with prominent nucleoli. Eighteen months after surgery, the patient was asymptomatic and disease free. GCT is a rare entity that is uncommonly found on the chest wall. A diagnosis of malignancy is established when metastasis is found to be of the same histological type as that of the primitive tumor. Neither cell pleomorphism or nuclei with nucleoli allows for a diagnosis of malignancy; only a size greater than 5 cm and locally invasive behavior should lead to an assumption that these tumors are of unspecified malignancy. We believe the treatment of choice for these lesions is radical removal