Cutaneous Malignant Melanoma in Chile: Differences in Tumor Thickness and Overall Survival Between Patients From Public and Private Health Care Centers.

INTRODUCTION: A low socioeconomic status (SES) is associated with lower survival rates in cutaneous malignant melanoma (CMM). In South America, there are few studies that analyze CMM data according to SES. OBJECTIVES: To determine the differences in microstaging and overall survival in CMM between public and private health care centers. METHODS: Retrospective cohort study. Histopathological reports with a diagnosis of CMM from two public hospitals (PuH) and one private health care center (PrH) in Santiago from 2008 to 2018 were included. Patients' death certificates were obtained to estimate overall survival. RESULTS: 1014 MMC were found. The mean age was 58.6 ± 16.8 years and 59.9% corresponded to female patients. Of these, 33.9% received treatment at PuH and 66.1% at PrH. Patients from PuH had an increased risk of having an invasive CMM and a >1 mm thickness melanoma compared to PrH (odds ratio 2.77 and 6.06, respectively). Patients with invasive CMM from the PuH were 6.29-fold more likely to die than a patient from the PrH. CONCLUSIONS: We observed a great disparity in tumor thickness between the socioeconomic status, reflecting a later detection and lower survival rate in PuH. Our results highlight a gap on which National Public Health should focus.

[Chromoblastomycosis. First allochthonous case treated in Chile]. / Cromoblastomicosis. Primer caso alóctono tratado en Chile.

Chromoblastomycosis is a fungal infection of the skin and subcutaneous tissue, of chronic evolution, caused by dematiaceous fungi. The disease occurs worldwide, mainly in tropical and subtropical regions, but in regions like Chile there is only one report of a human case more than 30 years ago. We present the case of a 46-year-old Haitian man, resident in Chile, with verrucous plaques in the right anterior tibial area of one year of evolution. The diagnosis of chromoblastomycosis was confirmed when muriform cells and dematiaceous colonies were observed in the histopathological analysis and the direct microscopy, respectively. After six months of treatment with systemic antimycotics and cryotherapy, complete remission of the lesions was achieved.

Sweet syndrome associated with secondary nodular syphilis in an immunocompetent patient.

Sweet syndrome is an inflammatory disease characterized by fever, neutrophilia, papules and erythematous plaques, and a skin neutrophilic infiltrate. Syphilis has been reported among the infectious causes of Sweet syndrome. Syphilis can present atypical manifestations; a rare presentation is nodular syphilis, characterized by nodules with granulomas and plasma cells at histopathology. This case report presents a 20-year-old woman patient, with plaques and nodules, and systemic symptoms. The histopathological exam revealed both non-tuberculoid granulomas and a dense infiltration of polymorphonuclear neutrophils in the dermis. These findings, plus laboratory abnormalities, characteristic of both conditions, were conclusive for Sweet syndrome and nodular syphilis association.

Riqueza y densidad de equinodermos en los arrecifes rocosos de Punta Amapala, El Salvador / Richness and density of echinoderms in the rocky reefs of Punta Amapala, El Salvador

Resumen Introducción: Los equinodermos son animales estrictamente acuáticos y de los grupos de invertebrados marinos cuya importancia ecológica es crucial para los ambientes en donde habitan. La característica más destacada es su simetría pentarradial. Estos organismos pueden distribuirse en una amplia variedad de ambientes oceánicos, y no ser exclusivamente habitantes de las formaciones arrecifales. Se han registrado el total de 1 539 especies, de las cuales 717 pertenecen a Pacífico y 60 de ellas se han registrado en El Salvador. Objetivo: El objetivo del trabajo fue registrar la riqueza y densidad de especies de equinodermos en arrecifes rocosos de Punta Amapala (La Unión). Métodos: El muestreo fue llevado a cabo en cinco sitios, dos a 3 m de profundidad y tres a 6 m. Para esto, se utilizó snorkeling y buceo autónomo, recorriendo dos transectos de banda de 30 x 1 m. Dentro de los transectos, se realizó la identificación (riqueza) y contabilización (abundancia) de los organismos. Resultados: La especie que presentó mayor densidad en los arrecifes de 3 m fue Echinometra vanbrunti (0.83 indv/m2), seguido por el ofiuroideo Ophiocomella alexandri (0.16 indv/m2) y Ophiocoma aethiops (0.16 indv/m2). Y en los arrecifes a 6 m fueron Ophiothela mirabilis (0.83 indv/m2), Ophionereis annulata (0.21 indv/m2), Ophiothrix rudis (0.08 indv/m2) y Ophiocomella alexandri (0.01 indv/m2). Conclusiones: Estos organismos, cumplen con diversos roles ecológicos, como ser bioindicadores de calidad de agua al tolerar ciertos cambios en las condiciones físico-químicas, así como cumplir el papel de hospederos de macrofauna por las cavidades que forman algunos erizos. Es por ello que los esfuerzos de muestreo deben incrementarse en estas zonas para monitorear la calidad y salud de los arrecifes rocosos, cuyo papel es clave, por ser junto con Los Cóbanos, los de mayor extensión en el país.

Abstract Introduction: Echinoderms are strictly aquatic animals and one of the groups of marine invertebrates whose ecological importance is crucial for the environments where they inhabit. The most outstanding characteristic is their pentaradial symmetry. These organisms can be distributed in a wide variety of oceanic environments, and are not exclusive inhabitants of reef formations. A total of 1 539 species have been registered, of which 717 belong to the Pacific and 60 of them have been registered for El Salvador. Objective: The objective of the work was to record the richness and density of echinoderm species in rocky reefs of Punta Amapala (La Unión). Methods: The sampling was conducted in five sites, two of them at 3 m of depth and three at 6 m. For this, snorkeling and autonomous diving were used, covering two band transects of 30 x 1 m. Within the transects, the identification (richness) and counting (abundance) of the organisms was carried out. Results: The species that presented the highest density at 3 m reefs was Echinometra vanbrunti (0.83 indv/m2), followed by the ophiuroid Ophiocomella alexandri (0.16 indv/m2) and Ophiocoma aethiops (0.16 indv/m2). And at the 6 m reefs were Ophiothela mirabilis (0.83 indv/m2), Ophionereis annulata (0.21 indv/m2), Ophiothrix rudis (0.08 indv/m2) and Ophiocomella alexandri (0.01 indv/m2). Conclusions: These organisms fulfill various ecological roles, such as being bioindicators of water quality by tolerating certain changes in physicochemical conditions and fulfilling the role of macrofauna hosts due to the cavities formed by some sea urchins. That is why sampling efforts must increase in these areas to monitor the quality and health of the rocky reefs, whose role is key, as they are, together with Los Cóbanos, the largest in the country.

Cromoblastomicosis: primer caso alóctono tratado en Chile / Chromoblastomycosis: first allochthonous case treated in Chile

Resumen La cromoblastomicosis es una infección fúngica de la piel y del tejido subcutáneo, de evolución crónica, causada por hongos dematiáceos que se caracterizan por presentar melanina en su pared celular. La enfermedad se presenta en todo el mundo, principalmente en regiones tropicales y subtropicales. En Chile, solo hay un reporte de caso humano hace más de 30 años. Se presenta el caso de un varón de 46 años, haitiano, residente en Chile, con placas verrucosas en la zona tibial anterior de un año de evolución. El diagnóstico de cromoblastomicosis se confirmó al observar células muriformes en la histopatología y colonias dematiáceas en el cultivo micológico; además, en la miscroscopía directa se observaron conidias compatibles con Fonsecaea spp. Luego de seis meses de tratamiento con antimicóticos sistémicos y crioterapia, se logró la remisión completa de las lesiones.

Abstract Chromoblastomycosis is a fungal infection of the skin and subcutaneous tissue, of chronic evolution, caused by dematiaceous fungi. The disease occurs worldwide, mainly in tropical and subtropical regions, but in regions like Chile there is only one report of a human case more than 30 years ago. We present the case of a 46-year-old Haitian man, resident in Chile, with verrucous plaques in the right anterior tibial area of one year of evolution. The diagnosis of chromoblastomycosis was confirmed when muriform cells and dematiaceous colonies were observed in the histopathological analysis and the direct microscopy, respectively. After six months of treatment with systemic antimycotics and cryotherapy, complete remission of the lesions was achieved.

Sweet syndrome associated with secondary nodular syphilis in an immunocompetent patient

Abstract Sweet syndrome is an inflammatory disease characterized by fever, neutrophilia, papules and erythematous plaques, and a skin neutrophilic infiltrate. Syphilis has been reported among the infectious causes of Sweet syndrome. Syphilis can present atypical manifestations; a rare presentation is nodular syphilis, characterized by nodules with granulomas and plasma cells at histopathology. This case report presents a 20-year-old woman patient, with plaques and nodules, and systemic symptoms. The histopathological exam revealed both non-tuberculoid granulomas and a dense infiltration of polymorphonuclear neutrophils in the dermis. These findings, plus laboratory abnormalities, characteristic of both conditions, were conclusive for Sweet syndrome and nodular syphilis association.

Siringocistoadenoma papilífero y carcinoma basocelular en nevo sebáceo: reporte de caso / Papilliferous sarcomatocystoma and basal cell carcinoma in nevus sebaceous: case report

El nevo sebáceo o nevo de Jadassohn es un hamartoma cutáneo congénito poco frecuente formado por múltiples estructuras cutáneas. Presenta potencial de transformación a una variedad de neoplasias epidérmicas benignas y malignas, que suelen presentarse de manera individual. Si bien esta descrito en la literatura, es inusual el desarrollo de más de una neoplasia sobre un nevo sebáceo. En esta publicación se presenta el caso de un hombre de 62 años con una lesión de 3 años de evolución, cuyo estudio histopatológico demostró la presencia de un carcinoma basocelular y un siringocistoadenoma papilífero sobre un nevo sebáceo de Jadassohn.

Nevus sebaceous of Jadassohn is an infrequent cutaneous congenital hamartoma, formed by multiple cutaneous structures. It possesses a transformation potential to benign and malignant epidermic neoplasms, that usually present individually. Even though a few cases have been published, the coexistence of two or more tumors is rare. We hereby present the case of a 62 years old male, with a nevus sebaceous of Jadassohn history, that after excisional biopsy showed the presence of a basal cell carcinoma associated to a syringocystoadenoma papilliferum.

Measurements of valve circumferences and ventricular wall of fetal hearts in Chile.

Diagnosis of cardiac pathology, valvular stenosis, cardiac dilation, and/or cardiac hypertrophy is underestimated if measures of weight, wall thickness, and valve circumference are not obtained. Routine study methodology protocols allow us to obtain values of these measurements for a correct diagnosis of these cardiopathies. The aim of the study is to establish reference values for cardiac measurements in fetuses and to compare them with an international curve of reference. One hundred seventy-one autopsies from week 17 through 41 of gestation were performed on fetuses from the Pathology Unit at the Hospital Barros Luco in Santiago de Chile. Cases with malformations were not considered. Anthropometric and cardiac measurements for each gestational week were taken. A tabulation of data with values (in percentiles) of cardiac weight, valve circumference, and ventricular wall thickness was obtained. Values were similar to an international reference. The curves of values obtained allow for identification of normal parameters of heart weight, valve circumference, and ventricular wall thickness, thereby providing easily accessible data for each gestational week. Abnormal values that fall outside of the curve must be attributed to cardiac fetal pathology.

Pre-surgical high resolution ultrasound of facial basal cell carcinoma: correlation with histology.

The aim of this study was to analyze the scope of pre-surgical high resolution ultrasound in basal cell carcinoma (BCC). BCC is the most common human cancer. According to recent large prospective studies incomplete excision of BCC is higher than expected. Pre-operative imaging may aid surgical planning by identifying the extent and location of a neoplasm, which can be interesting at zones with higher risk of recurrences such as the face. These are slow growing tumors but there are some aggressive types described that can involve deeper structures. Twenty-five patients were studied (10 F/15 M, 48-91 years old; mean age 69.5+/-11.5 years) with suspicious facial lesions < or =1.5 cm. Pre-surgical ultrasound with compact linear 15-7 MHz probe was performed. Ultrasound reported the morphology and thickness of the tumors. The results were correlated with the histology. Ultrasound identified 29 suspicious facial lesions that were removed with tumor-free borders at the first surgery and confirmed by histology. The main location was the nose. Two subclinical satellite lesions at the nasal zone were detected under ultrasound which led to a change in the surgery plan. The intraclass correlation coefficient (ICC) value was used to compare tumor thickness measurements between ultrasound and histology. ICC was considered as very good (0.9). Therefore, ultrasound can be useful to plan BCC surgery, it can recognize lesions, layers of involvement and vascularity patterns in a non-invasive way. It can show subclinical satellite lesions, even though the number of subclinical cases is small and require further investigations. It has a good thickness correlation with histology and may be used as a technique to monitor disease changes following non-invasive medical treatments in the future.

[Clinical features of 32 patients with cutaneous small vessel vasculitis]. / Vasculitis cutánea de vasos pequeños. Revisión clínica en 32 casos.

BACKGROUND: The skin is a common target of small vessel vasculitis, with a wide assortment of pathological changes. This condition is usually associated to systemic diseases. AIM: To report the clinical and pathological features of patients with cutaneous small vessel vasculitis. MATERIAL AND METHODS: A retrospective review of 32 patients with a pathological diagnosis of cutaneous vasculitis. RESULTS: Seventy two percent of patients were women. Cutaneous lesions were mainly located in the lower limbs (94%). The most common lesion was palpable purpura (62%). Connective tissue diseases and systemic vasculitis were the most commonly associated systemic diseases. CONCLUSIONS: Palpable purpura is the most common manifestation of cutaneous small vessel vasculitis, that is usually associated to connective tissue diseases or systemic vasculitis.

[Clinical manifestation in 5 cases of Behcet's disease]. / Manifestaciones clínicas en 5 casos de enfermedad de Behçet.

Behçet disease is characterized by recurrent oral and genital ulcerations as well as ocular involvement. We report five patients (three women) with this condition. All had oral or genital ulcerations, nodules or pustules. Three patients had an uveitis, two had vestibular involvement and one had a meningoencephalitis. One patient died after a massive hemoptysis.

Embarazo ovárico / Ovarian pregnancy

Se presenta caso clínico infrecuente de embarazo ovárico en paciente portadora de infertilidad secundaria a factor tubario.