Valor pronóstico de la baja expresión del receptor de estrógeno en pacientes con cáncer de mama LUMINAL HER2 negativo / Prognostic value of low estrogen receptor expression in patients with luminal HER2-negative breast cancer

Introducción: El subtipo luminal de cáncer de mama es sensible a la terapia antiestrógenica y muestra un mejor pronóstico que el del cáncer de mama con receptor del factor de crecimiento epidérmico humano 2 enriquecido (HER2) o triple negativo. Sin embargo, el cáncer de mama tipo luminal es heterogéneo y puede tener características clínicas agresivas. Investigamos las implicaciones clínicas y pronósticas de la baja expresión del receptor de estrógeno en un grupo de carcinomas luminales HER2 negativos. Material y método: Recolectamos los datos de un grupo de 367 cánceres de mama luminales HER2 negativo que eran receptor de estrógeno (RE) positivos y receptor de progesterona (RP) positivos o negativos y los dividimos en RE+ alto (RE) y RE+ bajo (REB). Se definió REB de acuerdo a la úl- tima actualización ASCO /CAP de las recomendaciones del testeo de de RH en cáncer de mama como aquellos con expresión entre 1 y 10%. Analizamos los datos clínico-patológicos y la supervivencia según los grupos de RE y REB. Resultados: Edad media 63,9+12.8 años. Tamaño tumoral: 1,9 +0.9 cm. Se realizó Mastectomía radical modificada en 61% de los pacientes. Tipo histológico más frecuente: Ductal Infiltrante en 89,5% de los casos. Hallazgos que concuerdan con publicaciones de otros centros. Discusión: Los tumores REB resultaron en 1,6%. No hubo diferencias estadísticas en el estadio TNM y tipo histológico. Sin embargo, el grupo REB se asoció con menor edad (47 vs 57 años), tipo luminal B, mayor grado histológico y Ki 67 alto (>30%). Si bien las diferencias en supervivencia global (SG) no fueron significativas (p=0,279), observamos que a partir de los 60 meses de seguimiento la SG fue menor en el grupo REB que en el grupo RE. Conclusiones: La baja expresión del RE se asoció peor pronóstico. Podríamos considerar la baja expresión del RE como marcador pronóstico en el subtipo luminal HER2 negativo de cáncer de mama. Debido a la baja incidencia de casos REB consideramos necesario estudios adicionales con mayor número de pacientes que podrían revelar su papel negativo en el cáncer de mama.

Introduction: The luminal subtype of breast cancer is sensitive to antiestrogenic therapy and shows a better prognosis than human epidermal grow- th factor receptor 2 (HER2) enriched or triple negative breast cancer. However, luminal type breast cancer is heterogeneous and can have aggressive clinical features. We investigated the clinical and prognostic implications of low estrogen receptor expression in a group of HER2-negative luminal carcinomas. Material and method: We collected data from a group of 367 HER2 negative luminal breast cancers that were estrogen receptor (ER) positive and progesterone receptor (PR) positive or negative and divided them into ER + high (ER) and ER + low (ERL). ERL was defined when RE expression was < 10%. We analyzed the clinical-pathological data and survival accor- ding to the ER and ERL groups. Results: ERL tumors resulted in 1.6%. There were no statistical differences in TNM stage and histological type. However, the ERL group was as- sociated with younger age (47 vs 57 years), luminal type B, higher histological grade, and high Ki 67 (> 30% ). Although the differences in overall survival (OS) were not significant (p = 0.279), we observed that after 60 months of follow-up the OS was lower in the ERL group than in the ER group. Conclusions: Low ER expression was associated with a worse prognosis. We could consider low ER expression as a prognostic marker in the HER2-ne- gative luminal subtype of breast cancer. Due to the low incidence of ERL cases, we consider necessary additional studies with a larger number of patients that could reveal its negative role in breast cancer.

Cáncer de mama y embarazo. Estudio retrospectivo y descriptivo en la ciudad de Rosario / Breast cancer and pregnancy in Argentina: A retrospective, descriptive study in the city of Rosario

Introducción: el cáncer de mama (CM) es el cáncer más frecuente diagnosticado durante el embarazo (PABC, del inglés Pregnancy Associatied Breast Cancer), con una incidencia de 1:3.000 embarazos. Objetivo: detallar las características clínicas e histopatológicas del PABC. Comparar estadios clínicos y detallar la sobrevida de las pacientes embarazadas y puérperas. Analizar el tratamiento durante el embarazo, los resultados obstétricos y neonatales. Material y método: estudio observacional, descriptivo y retrospectivo de PABC, en el período de enero de 2008 a julio de 2019 en los hospitales públicos y privados de la ciudad de Rosario. Resultados: del total 22 pacientes, 11 se encontraban embarazadas y 11 cursando el puerperio. La edad promedio fue de 37.3 años. La edad gestacional (EG) promedio al momento del diagnóstico fue de 16.8 semanas. En cuanto al subtipo histológico; el 72.72% (16 casos) ductal, 9.1% (2 casos) lobulillar, 4.54% (1 caso) medular, 4.54% (1 caso) cribiforme y 9.1% (2 casos) sin datos. El perfil inmuhohistoquímico mostró un 36.4% (8 casos) de triple negativos, 22.73% (5 casos) de Luminales A, 22.73% (5 casos) de Luminales B, 13.64% (3 casos) Her2 positivos y 4.5% (1 caso) sin dato. Los estudios clínicos al comparar las pacientes embarazadas y puérperas fueron similares. Estadios I y II: 7 pacientes en ambos grupos, estadios III: 2 pacientes en ambos grupos y estadios IV: 2 pacientes en ambos grupos. En el seguimiento medio de las pacientes (52.8 meses) se observó el fallecimiento de 5 de ellas (2 con diagnóstico de CM durante el puerperio y 3 durante el embarazo) y una recidiva locoregional de una paciente diagnosticada en el embarzo. Durante el embarazo, 2 pacientes realizaron cirugía conservadora y linfadenectomía seguida de quimioterapia, 1 paciente quimioterapia neoadyuvante seguida de cirugía conservadora y linfadenectomía, 3 pacientes quimioterapia y 1 paciente mastectomía y linfadenectomía. En 2 casos se difirió el tratamiento luego del parto. 2 pacientes realizaron la interrupción del embarazo en el primer trimestre. La quimioterapia fue administrada finalizando el primer trimestre. La radioterapia (RT) y la hormonoterapia se difirieron posparto, ninguna paciente realizó tratamiento anti Her2 durante la gestación. Los recién nacidos (RN) expuestos a quimioterapia intraútero (6 casos) nacieron vigorosos y sanos, ninguno presentó malformaciones. Se presentó un solo caso de bajo peso para la EG. El 44.4% (4 casos) de los embarazos fue finalizado a término, mientras que la finalización pretérmino representó el 55.6% (5 casos), con una EG medio de 34.4 semanas. En el 100% de los RN pretérmino la finalización del embarazo fue programada. Conclusiones: los subtipos más frecuentes fueron los tumores luminales. Se observó mayor frecuencia de tumores biológicamente más agresivos como el triple negativo comparado con la población general. No se encontraron diferencias al comparar los estadios clínicos al momento del diagnóstico de pacientes embarazadas vs puérperas. La quimioterapia administrada luego del primer trimestre es segura para el feto. Se debe evitar el parto prematuro, dado el pronóstico negativo de la prematuridad en el desarrollo cognitivo de los RN.

Introduction: breast cancer (BC) is the most common cancer diagnosed during pregnancy with an incidence of 1:3.000 pregnancies. Objetive: to detail the clinical and histopathological charactersitics of Pregnancy-associatied Breast Cancer (PABC). To compare clinical stages and to detail the survival of pregnant and postpartum patients. To analyze the treatment during pregnancy, and the obstetric and neonatal outcomes. Material and method: a retrospective, descriptive, and observational study of PABC was carried otu from january 2008 to july 2019 in the state and private hospitals of the city of Rosario. Results: of a total of 22 patients, 11 were pregnant and 11 were in the postpartum period. The patient´s average age was 37.3 years old. The average gestational age (GA) at the time of diagnosis was 16.8 weeks. As for the hitological subtype; 72.72% (16 cases) ductal, 9.1% (2 cases) lobular, 4.54% (1 case) cribriform and 9.1% (2 cases) without data. The immunohistochemical profile showed 36.4% triple negative, 22.73% of Luminal A, 22.73% of Luminal B, 13.64% HER2 positive, and 4.5% without data. The clinical stages when comparing pregnant and postpartum patients were similar. Stages I and II: 7 patients in both groups, stage III: 2 patients in both groups and stage IV: 2 patients in both groups. In the mean follow-up of the patients (52.8 moths), the death of 5 of them was detected (2 with a dignosis of BC during the puerperium and 3 during pregnancy) and a locoreginal recurrence of a patient diagnosed in pregnancy. During pregnancy, 2 patients underwent conservative surgery and lymphadenectomy followed by chemotherapy, 1 patient neoadjuvant chemotherapy followed by conservative surgery and lymphadenectomy, 3 patients chemotherapy and 1 patient underwent mastectomy and lymphadenectomy. In 2 cases, treatment was postponed after delivery. 2 patients performed the termination of pregnancy in the firts trimester. Chemotherapy was performed after the firts trimester. Radiotherapy (RT) and hormone therapy were postpartum deferred. None of the patients underwent anti-Her2 treatment during pregnancy. Newborns exposed to intrauterine chemotherapy (6 cases) were born vigorous and healthy, none of them presented malformations. Only one case presented low weight for gestational age. 44.4% of the pregnancies were due on term, while 55.6% were preterm births, with and average gestational age of 34.4% weeks. In 100% of preterm born infants, the end of the pregnancy was scheduled. Conclusions: the most frequent subtype were lumianl tumors. A preponderance of biologically more aggresive tumors such as triple negative was observed. The clinical stages at the time of diagnosis of pregnant and postpartum patients were similar. Chemotherapy after the first trimester is safe for the fetus. If possible, preterm bith should be avoided, giver the negative pronostic effect of prematurity on cognitive development.

Síndrome de Burnout en médicos residentes de un Hospital público de la ciudad de Areguá en el año 2020

RESUMEN Introducción: El estrés merece especial atención dentro de lo que sería la salud mental, teniendo en cuenta que estados prolongados de estrés podrían acarrear estados depresivos o de ansiedad severos. Las labores hospitalarias son uno de los trabajos de fuente innata para el estrés, este trabajo se enfocará en el estrés en médicos residentes. Objetivo: Determinar el síndrome de Burnout en médicos residentes de un hospital público de la ciudad de Areguá en el año 2020. Metodología: Estudio observacional descriptivo, de corte transversal, muestra no probabilístico por conveniencia, desde junio hasta agosto de 2020, de 24 encuestas, en el Hospital Nacional del Cáncer (Areguá). Se aplicó Cuestionario de Maslach Burnout Inventory- Healt Service Survey (MBI-HSS). Resultados: Se analizaron 24 encuestas. Edades comprendidas entre 24 y 34 años (28,875±3,0405). Se reportan a 12 residentes con Síndrome de Burnout, equivalente al 54,2% de la muestra. Realización personal baja con 66,7% (16); Agotamiento emocional alto 45,8% (11); Despersonalización alta 50% (12). Conclusión: En la presente investigación se encontró que el 54,2% de los residentes encuestados son categorizados con Síndrome de Burnout. Se resalta la investigación de Jacome et al donde el 47,5% de los residentes fueron categorizados con Síndrome de Burnout; mientras que, en el estudio de Estigarribia et al se encontró una baja prevalencia del Síndrome de Burnout, equivalente al 22%; esta diferencia se puede deber al instrumento que fue utilizado en ambos estudios, tratándose del MBI.

ABSTRACT Introduction: Stress deserves special attention within what would be mental health, taking into account that prolonged states of stress could lead to severe depressive or anxiety states. Hospital work is one of the innate source jobs for stress, this paper will focus on stress in medical residents. Objective: To determine the Burnout Syndrome in medical residents of a public hospital in the city of Areguá in the year 2020. Method: Descriptive, cross-sectional, non-probabilistic observational study from June to August 2020, of 24 surveys, at the National Cancer Hospital (Aregua). Maslach Burnout Inventory - Healt Service Survey (MBI-HSS) questionnaire was applied. Results: 24 surveys were analyzed. Ages between 24 and 34 years (28,875±3,0405). Twelve residents with Burnout Syndrome were reported, equivalent to 54.2% of the sample. Low personal realization with 66,7% (16); high emotional exhaustion 45,8% (11); high depersonalization 50% (12). Conclusion: In the present research it was found that 54.2% of the residents surveyed are categorized with Burnout Syndrome. Jacome et al's research is highlighted where 47,5% of the residents were categorized with Burnout Syndrome; while, in the study of Estigarribia et al a low prevalence of Burnout Syndrome was found, equivalent to 22%; this difference can be due to the instrument that was used in both studies, being the MBI.

Rendimiento de la ecografía axilar en cáncer de mama / Axillary ultrasound performance in breast cancer

Objetivo El estatus axilar sigue siendo el factor pronóstico más importante en cáncer de mama. Nuestro objetivo fue evaluar el rendimiento diagnóstico de la ecografía axilar para la detección de ganglio metastásico. Material y método Se evaluaron por ecografía axilar preoperatoria 530 pacientes con cáncer de mama menor o igual a 5 cm con axila clínicamente negativa. Se consideró sospechoso, todo ganglio que cumpliera con la clasificación de Bedi 3, 4, 5 y 6. La sospecha se corroboró con biopsia axilar bajo guía ecográfica, biopsia selectiva del ganglio centinela intraoperatorio y/o disección axilar. Resultados Obtuvimos una sensibilidad del 67,11% y una especificidad del 97,88%. Conclusiones El rendimiento diagnóstico de la ecografía axilar preoperatoria en pacientes con cáncer de mama y axila clínicamente negativa es sensible y específica en la detección de ganglio metastásico

Objective Axillary status remains the most important prognostic factor in breast cancer. Our objective was to evaluate the diagnostic performance of axillary ultrasound for the detection of metastatic nodes. Materials and methods 530 patients with breast cancer less than or equal to 5 cm with clinically negative axilla were evaluated by preoperative axillary ultrasound. It was considered suspicion any node that complies with the Bedi classification 3, 4, 5 and 6. The suspicion was corroborated with axillary biopsy under ultrasound guidance, selective biopsy of the intraoperative sentinel node and / or axillary dissection. Results We obtained a sensitivity of 67.11% and a specificity of 97.88%. Conclusions The diagnostic performance of preoperative axillary ultrasound in patients with breast cancer and clinically negative axillary is sensitive and specific in the detection of metastatic nodes

Barreras y facilitadores en las trayectorias de mujeres con cáncer de mama usuarias de hospitales públicos / Barriers And Facilitators of Health Seeking Behavior Among Women with Breast Cancer Users of Public Hospitals

El cáncer de mama (CM) es el segundo más común en el mundo y el más frecuente entre las mujeres. La incidencia varía entre regiones. Además, el CM es la quinta causa de muerte por cáncer a nivel mundial, la más frecuente en las regiones menos desarrolladas y la segunda en las más desarrolladas y en Sudamérica. En Argentina, registra las mayores tasas de incidencia y mortalidad entre las mujeres. OBJETIVOS: Comprender los motivos de las demoras, las consecuencias y las estrategias usadas por mujeres con diagnóstico de CM para afrontar barreras durante sus trayectorias de atención. MÉTODOS: Se realizó un estudio descriptivo transversal con abordaje cualitativo, basado en mujeres diagnosticadas con CM en dos hospitales públicos de la provincia de Santa Fe. Se efectuaron entrevistas semiestructuradas, que fueron grabadas previo consentimiento informado. Se utilizó el programa Atlas-ti (V.7.2) para el análisis del material. RESULTADOS: Se identificaron barreras a nivel personal (cuestiones financieras, creencias de las pacientes), interpersonal (cuestiones laborales, responsabilidad familiar, comunicación médico-paciente) y del sistema de salud (organización de servicios, calidad de atención). CONCLUSIONES: La investigación aporta evidencia para comprender las barreras que enfrentan las mujeres diagnosticadas con CM y muestra las oportunidades para implementar la estrategia de navegación de pacientes a fin de reducir o mitigar las demoras en la atención

Demoras en el proceso de atención de pacientes con cáncer de mama en dos hospitales públicos de la provincia de Santa Fe / Delays in the process of care of patients with breast cancer in two public hospitals in the province of Santa Fe

INTRODUCCIÓN: el retraso en el inicio de untratamiento efectivo del cáncer de mama reduce la tasa desupervivencia y está asociado a estadios más avanzados aldiagnóstico y a la necesidad de tratamientos más agresivos ycostosos. OBJETIVOS: Describir la trayectoria de la atención médicade mujeres con diagnóstico de cáncer de mama desde la apariciónde un signo o síntoma hasta la finalización del tratamiento.MÉTODOS: Se realizó un estudio descriptivo retrospectivo, quecombinó técnicas cuantitativas y cualitativas. Se estimaron lostiempos utilizados en cada etapa del proceso de atención de cáncerde mama en mujeres diagnosticadas y/o tratadas durante 2012 endos hospitales de la provincia de Santa Fe. RESULTADOS: Se incluyóa 62 pacientes en la muestra. El 20,3% obtuvo su diagnósticodentro del mes posterior a la mamografía y/o ecografía, y sólola mitad fue operada dentro del mes posterior al diagnóstico. El60% de las pacientes con necesidad de quimioterapia adyuvantey el 72,4% con necesidad de radioterapia tras la cirugía tuvierondemoras mayores a 60 días. Ninguna de las pacientes en estadio IVcomenzó el tratamiento antes de los 30 días. CONCLUSIONES: Si secompara con los parámetros establecidos en la guía del ProgramaNacional de Cáncer de Mama, hay demoras en todas las etapas. Esnecesario establecer estrategias que reduzcan los tiempos para laconfirmación diagnóstica en mujeres con sospecha, así como lostiempos de tratamiento en pacientes con cáncer confirmado.

INTRODUCTION: the delay to start an effectivetreatment for breast cancer reduces survival rate and is associatedto advanced stages at diagnosis and to the need for moreaggressive and costly treatments. OBJECTIVES: To describe thehealth care path of women with diagnosis of breast cancersince the first sign or symptom until the end of the treatment.METHODS: A retrospective descriptive study was performed,combining quantitative and qualitative techniques. It estimatedthe time used in each stage of the health care process amongwomen with breast cancer, diagnosed and/or treated during2012 in two hospitals of the province of Santa Fe, Argentina.RESULTS: A total of 62 patients were included in the sample.Of them, 20.3% received her diagnosis within 30 days of themammogram and/or ultrasound and 50% were operatedwithin one month of the diagnosis. There were delays of morethan 60 days in 60% and 72.4% of the patients who had toundergo adjuvant chemotherapy and radiotherapy, respectively.None of the patients with stage IV began the treatment withinthe first 30 days. CONCLUSIONS: Compared to the guidelinesof the National Program of Breast Cancer, there are delaysat all stages. It is necessary to develop strategies to shortenthe time for diagnosis confirmation in women with suspectedbreast cancer and for the access to treatment in patients withcancer confirmed.

The use of 1% toluidine blue eye drops in the diagnosis of ocular surface squamous neoplasia.

PURPOSE: To evaluate the use of in vivo toluidine blue (TB) dye in the diagnosis of ocular surface squamous neoplasia and to correlate staining intensity with the histopathological diagnosis. METHODS: A prospective study was performed at the Federal University of Sao Paulo, Brazil. Patients with conjunctival epithelial lesions were examined by slit-lamp biomicroscopy, with and without 1% TB eye drops, and the results were photo documented. Before the instillation of the dye, 1% proxymetacaine HCl eye drops were used. All patients were submitted to surgery and histopathological analysis to confirm the diagnosis. The patients were grouped according to the histopathological aspects of the lesions into 3 groups: group 1-patients with ocular surface squamous neoplasia; group 2-patients with premalignant lesions; and group 3-patients with pterygium. The digital images were analyzed by 2 masked examiners who had no previous access to the histopathological results. The photographs were classified according to the positivity and intensity of the staining. The statistical analysis method chosen depended on the type of data, with the level of significance set as P < 0.05. RESULTS: Forty-seven patients were included in the study: 10 had benign lesions (pterygium), 10 had premalignant lesions (actinic keratosis), and 27 had malignant lesions (conjunctival intraepithelial neoplasia and conjunctival squamous cell carcinoma). Agreement between observers regarding the analysis of the digital photographs was 100% for positivity and 82.9% for intensity of staining (κ = 0.938). Ninety percent of patients with premalignant lesions and all patients with malignant lesions showed positive staining with 1% TB. One patient had positive staining, but histopathological examination revealed a benign lesion (false positive). CONCLUSIONS: The use of 1% TB eye drops is an efficient method for the clinical diagnosis of ocular surface squamous neoplasia and premalignant lesions. Nevertheless, the intensity of the staining does not correlate with the degree of malignancy of these tumors.

Evaluation of silicon oil on bacterial growth.

PURPOSE: To analyze the antimicrobial properties of silicon oil (Óleo de Silicone®, Ophthalmos, Brazil) on in vitro bacterial growth of different microorganisms related to endophthalmitis. METHODS: The following microorganisms were analyzed: (1) Pseudomonas aeruginosa (ATCC 27583); (2) Escherichia coli (ATCC 25922); (3) Staphylococcus aureus (ATCC 25923); (4) Staphylococcus epidermidis (ATCC 12228); (5) Candida albicans (ATCC 10231); (6) Klebsiella pneumoniae (ATCC 13883); and (7) Streptococcus pneumoniae (ATCC 49619). The plates were incubated at 35 ± 2ºC and its growth examined after 24 hours. An empty disk was placed in the center of each plate as a control. RESULTS: No inhibition halos were verified in any of the plates containing the four different concentrations of the bacterial inocula. CONCLUSIONS: The silicon oil 1000 cps does not have any effect on bacterial growth of any of the studied microorganisms.

Evaluation of silicon oil on bacterial growth / Avaliação dos efeitos do óleo de silicone no crescimento bacteriano

PURPOSE: To analyze the antimicrobial properties of silicon oil (Óleo de Silicone®, Ophthalmos, Brazil) on in vitro bacterial growth of different microorganisms related to endophthalmitis. METHODS: The following microorganisms were analyzed: (1) Pseudomonas aeruginosa (ATCC 27583); (2) Escherichia coli (ATCC 25922); (3) Staphylococcus aureus (ATCC 25923); (4) Staphylococcus epidermidis (ATCC 12228); (5) Candida albicans (ATCC 10231); (6) Klebsiella pneumoniae (ATCC 13883); and (7) Streptococcus pneumoniae (ATCC 49619). The plates were incubated at 35 ± 2ºC and its growth examined after 24 hours. An empty disk was placed in the center of each plate as a control. RESULTS: No inhibition halos were verified in any of the plates containing the four different concentrations of the bacterial inocula. CONCLUSIONS: The silicon oil 1000 cps does not have any effect on bacterial growth of any of the studied microrganisms.

OBJETIVO: Analisar as propriedades antimicrobianas do óleo de silicone (Óleo de Silicone®, Ophthalmos, Brazil) no crescimento in vitro de diferentes microrganismos relacionados à endoftalmite. MÉTODOS: Os seguintes microrganismos foram analisados: (1) Pseudomonas aeruginosa (ATCC 27583); (2) Escherichia coli (ATCC 25922); (3) Staphylococcus aureus (ATCC 25923); (4) Staphylococcus epidermidis (ATCC 12228); (5) Candida albicans (ATCC 10231); (6) Klebsiella pneumoniae (ATCC 13883); and (7) Streptococcus pneumoniae (ATCC 49619). As placas foram incubadas à temperatura de 35 ± 2ºC e o seu crescimento examinado após 24 horas. Um disco de papel filtro neutro, sem óleo de silicone, foi posicionado no centro de cada placa como controle. RESULTADOS: Não foram encontrados halos de inibição em nenhuma das placas contendo as diferentes concentrações de inóculo bacteriano estudadas. CONCLUSÕES: O Óleo de Silicone® 1000 cps não apresenta efeito no crescimento bacteriano de nenhum dos microrganismos estudados.

Direct fluorescent antibody assay and polymerase chain reaction for the detection of Chlamydia trachomatis in patients with vernal keratoconjunctivitis.

OBJECTIVES: To identify Chlamydia trachomatis via polymerase chain reaction and a direct fluorescent antibody assay in patients with vernal keratoconjunctivitis while comparing the efficacies of both tests for detecting Chlamydia trachomatis in these conditions. METHODS: Conjunctival scraping samples were obtained from 177 patients who were divided into two groups: a vernal keratoconjunctivitis group (group A) and a control group (group B). The polymerase chain reaction and a direct fluorescent antibody assay were performed. Sensitivity, specificity, receiver operating characteristic curves, and areas under the curve were calculated for both tests in groups A and B. Receiver operating characteristic curves were plotted using a categorical variable with only two possible outcomes (positive and negative). RESULTS: Statistical analysis revealed a significant association between vernal keratoconjunctivitis and Chlamydia trachomatis infection detected by a direct fluorescent antibody assay with high sensitivity and specificity. All patients in group A with positive polymerase chain reactions also presented with positive direct fluorescent antibody assays. CONCLUSION: The association between vernal keratoconjunctivitis and Chlamydia trachomatis infection was confirmed by positive direct fluorescent antibody assays in 49.4% of vernal keratoconjunctivitis patients and by positive polymerase chain reactions in 20% of these patients. The direct fluorescent antibody assay detected Chlamydia trachomatis in a higher number of patients than did the polymerase chain reaction. Although the diagnosis of trachoma is essentially clinical, the disease may not be detected in vernal keratoconjunctivitis patients. Due to the high frequency of chlamydial infection detected in patients with vernal keratoconjunctivitis, we suggest considering routine laboratory tests to detect Chlamydia trachomatis in patients with severe and refractory allergic disease.

Direct fluorescent antibody assay and polymerase chain reaction for the detection of Chlamydia trachomatis in patients with vernal keratoconjunctivitis

OBJECTIVES: To identify Chlamydia trachomatis via polymerase chain reaction and a direct fluorescent antibodyassay in patients with vernal keratoconjunctivitis while comparing the efficacies of both tests for detectingChlamydia trachomatis in these conditions. METHODS: Conjunctival scraping samples were obtained from 177 patients who were divided into two groups: avernal keratoconjunctivitis group (group A) and a control group (group B). The polymerase chain reaction and adirect fluorescent antibody assay were performed. Sensitivity, specificity, receiver operating characteristic curves,and areas under the curve were calculated for both tests in groups A and B. Receiver operating characteristic curveswere plotted using a categorical variable with only two possible outcomes (positive and negative). RESULTS: Statistical analysis revealed a significant association between vernal keratoconjunctivitis and Chlamydia trachomatis infection detected by a direct fluorescent antibody assay with high sensitivity and specificity. Allpatients in group A with positive polymerase chain reactions also presented with positive direct fluorescentantibody assays. CONCLUSION: The association between vernal keratoconjunctivitis and Chlamydia trachomatis infection wasconfirmed by positive direct fluorescent antibody assays in 49.4 percent of vernal keratoconjunctivitis patients and bypositive polymerase chain reactions in 20 percent of these patients. The direct fluorescent antibody assay detectedChlamydia trachomatis in a higher number of patients than did the polymerase chain reaction. Although thediagnosis of trachoma is essentially clinical, the disease may not be detected in vernal keratoconjunctivitis patients.Due to the high frequency of chlamydial infection detected in patients with vernal keratoconjunctivitis, we suggestconsidering routine laboratory tests to detect Chlamydia trachomatis in patients with severe and refractory allergicdisease.

Dacrioadenite bilateral causada pelo vírus Epstein-Barr: relato de caso / Epstein-Barr virus bilateral dacryoadenitis: case report

Os autores apresentam um caso raro de dacrioadenite aguda bilateral associada à mononucleose. Paciente do sexo feminino, 27 anos, tinha aumento agudo da glândula lacrimal, bilateral, com sinais flogísticos. As alterações tomográficas e laboratoriais confirmaram o diagnóstico e o tratamento com esteróide sistêmico foi introduzido, com resolução completa dos sinais e sintomas. COMENTÁRIOS: A dacrioadenite é uma apresentação incomum da mononucleose infecciosa e pode minimizar outras manifestações desta doença. O diagnóstico de mononucleose deve ser considerado em casos de dacrioadenite aguda bilateral. Os esteróides sistêmicos contribuem para a resolução do quadro inflamatório.

The authors present a rare case of acute bilateral dacryoadenitis in association with infectious mononucleosis. A 27 year-old woman had acute bilateral lacrimal gland enlargement with inflammatory signs. The CT scan findings and laboratorial investigations confirmed the diagnosis of infectious mononucleosis. The systemic treatment with intravenous steroids was initiated leading to complete remission of the signs and symptoms. COMMENTS: Dacryoadenitis is an uncommon manifestation of infectious mononucleosis and may minimize other signs of the disease. Mononucleosis has to be considered in acute dacryoadenitis cases. Systemic steroids contribute to the fast regression of inflammatory condition.

Antibacterial properties of cyanoacrylate tissue adhesive: Does the polymerization reaction play a role?

PURPOSE: To ascertain if the polymerization reaction also contributes additionally to the antibacterial effects of two commonly used cyanoacrylate tissue adhesives. MATERIALS AND METHODS: Fresh liquid ethyl-cyanoacrylate (EC) and N-butyl-cyanoacrylate (BC) adhesives were applied onto 6-mm sterile filter paper discs. In the first group, the adhesive-soaked discs were immediately placed onto confluent monolayer cultures of bacteria, allowing the polymerization reaction to proceed while in culture. In the second group, the adhesive-soaked disc was allowed to first polymerize prior to being placed onto the bacterial cultures. Four types of bacteria were studied: Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. Immediately after the discs were applied, the cultures were incubated at 35 degrees C for 24 h. Bacterial inhibitory halos were measured in the cultures at the end of the incubation period. RESULTS: For EC, exposure of the bacteria to the cyanoacrylate polymerization reaction increased the bacterial inhibitory halos in Streptococcus pneumonia, Staphylococcus aureus and Escherichia coli. For BC, it increased the bacterial inhibitory halos in Staphylococcus aureus and Streptococcus pneumoniae. No inhibitory halos were observed in Pseudomonas aeruginosa. The bactericidal effect was higher in actively polymerizing EC, compared to previously polymerized EC in Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli; however, no such differences were observed for BC. CONCLUSIONS: The polymerization reaction may also be an important factor in the antibacterial properties of EC and BC.

Plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma: case report.

The authors present a rare case of plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma in a 42-year-old woman. The lesion was surgically removed and analyzed. Histopathological examination with immunostaining revealed it to be positive for immunoglobulin G and Kappa chains, demonstrating monoclonality. However, no abnormality was observed on serum electrophoresis, skeletal survey and bone marrow aspiration. Therefore, the tumor was diagnosed solitary plasmacytoma of bone. The patient was treated with external beam radiotherapy and has remained disease free for 5 years and 6 months until 2007, when she presented a pathological fracture due to multiple myeloma. Extensive medical work-up to rule out multiple myeloma or other malignant lymphoproliferative conditions involving orbit or ocular adnexa is needed when the diagnosis of solitary plasmacytoma of bone is suspected because treatment and prognosis are very different.

Plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma: case report / Plasmocitoma da órbita envolvendo glândula lacrimal com transformação secundária para mieloma múltiplo: relato de caso

The authors present a rare case of plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma in a 42-year-old woman. The lesion was surgically removed and analyzed. Histopathological examination with immunostaining revealed it to be positive for immunoglobulin G and Kappa chains, demonstrating monoclonality. However, no abnormality was observed on serum electrophoresis, skeletal survey and bone marrow aspiration. Therefore, the tumor was diagnosed solitary plasmacytoma of bone. The patient was treated with external beam radiotherapy and has remained disease free for 5 years and 6 months until 2007, when she presented a pathological fracture due to multiple myeloma. Extensive medical work-up to rule out multiple myeloma or other malignant lymphoproliferative conditions involving orbit or ocular adnexa is needed when the diagnosis of solitary plasmacytoma of bone is suspected because treatment and prognosis are very different.

Os autores relatam um raro caso de plasmocitoma da órbita envolvendo glândula lacrimal com transformação secundária para mieloma múltiplo em uma paciente de 42 anos. A lesão foi removida cirurgicamente e o exame anatomopatológico, aliado à imuno-histoquímica, revelou positividade para imunoglobulina G e cadeias leve tipo Kappa. Após extensa avaliação sistêmica, nenhuma anormalidade foi observada, sendo feito o diagnóstico de plasmocitoma solitário ósseo. A paciente foi submetida à radioterapia, permanecendo livre da doença por 5 anos e 6 meses até 2007, quando apresentou uma fratura patológica devido à infiltração plasmocitária na coluna lombar, sendo feito diagnóstico de mieloma múltiplo. Uma vez que o plasmocitoma solitário ósseo pode ser a primeira manifestação do mieloma múltiplo, esses pacientes necessitam de adequado diagnóstico e seguimento a longo prazo, pois o tratamento e prognóstico dessas duas condições é diferente.

[Epstein-Barr virus bilateral dacryoadenitis: case report]. / Dacrioadenite bilateral causada pelo vírus Epstein-Barr: relato de caso.

UNLABELLED: The authors present a rare case of acute bilateral dacryoadenitis in association with infectious mononucleosis. A 27 year-old woman had acute bilateral lacrimal gland enlargement with inflammatory signs. The CT scan findings and laboratorial investigations confirmed the diagnosis of infectious mononucleosis. The systemic treatment with intravenous steroids was initiated leading to complete remission of the signs and symptoms. COMMENTS: Dacryoadenitis is an uncommon manifestation of infectious mononucleosis and may minimize other signs of the disease. Mononucleosis has to be considered in acute dacryoadenitis cases. Systemic steroids contribute to the fast regression of inflammatory condition.

Tumor neuroectodérmico primitivo periférico primário da órbita: relato de caso / Primary peripheral primitive neuroectodermal tumour of the orbit: case report

Os autores relatam o primeiro caso de tumor neuroectodérmico primitivo periférico primário da órbita apresentado na literatura nacional. Características clínicas, radiológicas e histopatológicas são discutidas. O diagnóstico foi confirmado por meio de análise imuno-histoquímica, etapa essencial no diagnóstico dos tumores de pequenas células redondas.

The authors present a case of primary peripheral primitive neuroectodermal tumor of the orbit in a 10-month-old girl, which is the first case in the Brazilian literature. Clinical, radiologic and histopathologic features are discussed. The diagnosis was confirmed by immunohistochemical analysis which is essential to the diagnosis of small round cell tumors in the orbit.

Different application volumes of ethyl-cyanoacrylate tissue adhesive can change its antibacterial effects against ocular pathogens in vitro.

PURPOSE: To analyze the antibacterial effects in vitro of ethyl-cyanoacrylate (EC) tissue adhesive in different application volumes. METHODS: Volumes of 4, 6, 8, 10, 12, 14, 25, and 35 mu l of EC were applied onto the surface of monolayer cultures of Staphylococcus aureus (ATCC25924), Streptococcus pneumoniae (ATCC49619), Escherichia coli (ATCC25922), Pseudomonas aeruginosa (ATCC27853), and Klebsiella pneumoniae (ATCC13883). The diameter of each EC drop was measured, and the area of the circle of EC (formed after its application onto the monolayer culture) was calculated. The area of the antibacterial inhibitory halo surrounding the drop of EC on the monolayer culture was calculated. The ratio between the area of the EC and of the corresponding inhibitory halo was obtained for each EC volume and for each of the 5 types of bacteria studied. RESULTS: EC volume-dependent inhibitory halos were seen in Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli, but not in Pseudomonas aeruginosa or Klebsiella pneumoniae. CONCLUSION: The in vitro antibacterial effect of EC against Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli varies in a dose-dependent fashion with its volume. No effect was observed against Pseudomonas aeruginosa and Klebsiella pneumoniae.

[Primary peripheral primitive neuroectodermal tumour of the orbit: case report]. / Tumor neuroectodérmico primitivo periférico primário da órbita: relato de caso.

The authors present a case of primary peripheral primitive neuroectodermal tumor of the orbit in a 10-month-old girl, which is the first case in the Brazilian literature. Clinical, radiologic and histopathologic features are discussed. The diagnosis was confirmed by immunohistochemical analysis which is essential to the diagnosis of small round cell tumors in the orbit.