Las caras del poroma / Poroma's faces

Introducción: El poroma es un tumor benigno de la glándula sudorípara, que se presenta usualmente en plantas y palmas. Se confunde con numerosos cuadros cutáneos y es casi siempre diagnosticado erróneamente. Objetivo: Describir las características clínicas y patológicas de los poromas vistos en el HNSE EsSalud del Cusco entre febrero del 2006 y diciembre del 2008. Tratamos de dar una guía para el enfoque de este tumor. Material y métodos: Estudio descriptivo de ocho casos de poromas que fueron confirmados por histopatología. Adicionalmente en tres casos realizamos estudios con inmunohistoquímica con CEA y EMA. Seis casos fueron tratados con electrocirugía de radiofrecuencia y dos con exéresis convencional. Resultados: Reportamos ocho casos de poromas, cuatro de sexo femenino, con un tiempo de enfermedad entre tres meses y 20 años,dos casos con tiempo de evolución de tres meses se presentaron en mujeres de 25 y 30 años. Siete casos fueron asintomáticos. Cinco casos se ubicaron en miembros inferiores, dos en cuello y uno en cara. La apariencia de las lesiones fue polipoide en un caso, uno con aspecto de placa verrucoide, dos angioides, dos tipo placas anfractuosas, uno fue nodular lobulado oscuro y otro papuloso oscuro. El patrón histopatológico fue epidérmico en dos casos, yuxtaepidérmico en tres y tres correspondieron al tipo dérmico. Tres casos marcaron positivamente con ECA y EMA. La respuesta al tratamiento quirúrgico fue óptima. No se objetivaron recidivas. Conclusiones: Los poromas tienen diversidad clínica, de modo que se pueden confundir con otros cuadros. Es de esperar que ocurran también en adultos jóvenes y en localizaciones insospechadas. Generalmente no dan molestias. El estudio histopatológico es de rigor, mostrando patrones variados, finalmente la inmunohistoquímica afianza el diagnóstico.

Background: Poroma is a benign sweat gland tumor, usually seen in the palm and sole. It may be confused with numerous skin diseases, and it is almost always misdiagnosed. Objective: To describe the clinical and histopathologic features of 8 patients with poroma, seen at the EsSalud National Hospital of Cusco, Peru, between February 2006 and December 2008. We try to give guidance for the management of poromas. Methods: Descriptive study of 8 cases of poroma, confirmed with histopathologic examination. Additionally we made inmunohistochemical evaluation with CEA and EMA in 3 cases. Six patients were treated with radiofrequency surgery and 2 with standard local excision. Results: We report 8 patients with poromas, there were 4 females, with a time of disease between three months and 20 years, the two cases where it was three months occurred in women between 25 and 30. Seven cases were asymptomatic. The lesions in 5 cases were located in the lower limbs, 2 cases in the neck and one in the face. The appearance of the lesions was polypoid in one case, one was a verrucous plaque, 2 had angioid appearance, 2 had simplex plaques, one was a dark multilobulated nodule and one was a dark papule. The histological pattern was epidermic in 2 cases, yuxtaepidermic in 3 and 3 belonged to the dermal type. Three of them marked positive with ECA and EMA. The treatment, mainly with radiosurgery, was satisfactory in all cases. No local recurrences were observed. Conclusions: Poromas have a wide range of clinical presentations, the reason why it can be confused with other conditions. It is also expected to occur in young adults and in unusual locations. They are almost always asymptomatic. Histopatologic evaluation is very important showing varied patterns ant it is immunohistochemistry what ultimately enhances the diagnostic.

Global Equity Gauge Alliance: reflections on early experiences.

The paper traces the evolution and working of the Global Equity Gauge Alliance (GEGA) and its efforts to promote health equity. GEGA places health equity squarely within a larger framework of social justice, linking findings on socioeconomic and health inequalities with differentials in power, wealth, and prestige in society. The Alliance's 11 country-level partners, called Equity Gauges, share a common action-based vision and framework called the Equity Gauge Strategy. An Equity Gauge seeks to reduce health inequities through three broad spheres of action, referred to as the 'pillars' of the Equity Gauge Strategy, which define a set of interconnected and overlapping actions. Measuring and tracking the inequalities and interpreting their ethical import are pursued through the Assessment and Monitoring pillar. This information provides an evidence base that can be used in strategic ways for influencing policy-makers through actions in the Advocacy pillar and for supporting grassroots groups and civil society through actions in the Community Empowerment pillar. The paper provides examples of strategies for promoting pro-equity policy and social change and reviews experiences and lessons, both in terms of technical success of interventions and in relation to the conceptual development and refinement of the Equity Gauge Strategy and overall direction of the Alliance. To become most effective in furthering health equity at both national and global levels, the Alliance must now reach out to and involve a wider range of organizations, groups, and actors at both national and international levels. Sustainability of this promising experiment depends, in part, on adequate resources but also on the ability to attract and develop talented leadership.

Embarazo heterotópico. Comunicación de un caso y revisión de la literatura / Heterotopic pregnancy. Communication of a case and review

Se describe las características de un caso de embarazo heterotópico confirmado por laparotomía y se revisa la literatura. Se trató de una mujer de 31 años, que ingresó al hospital por dolor abdominal y choque. La ecografía pélvica mostró útero ocupado por gestación activa de siete semanas, además de una tumoración anexial derecha en cuyo interior se aprecia imagen ovalada ecolúcida. La anatomía patológica demostró embarazo tubárico.