Endometriosis y carcinoma de celulas claras. Reporte de caso / Endometriosis and clear cell carcinoma. Case report

RESUMEN La endometriosis corresponde a la presencia de glándulas endometriales o estroma en sitios distintos a la cavidad uterina. Afecta del 5 al 15% de las mujeres en edad reproductiva y se asocia a importante sintomatología. La teoría de la menstruación retrógrada propuesta por Sampson es la más aceptada para explicar su etiología. Varios estudios han asociado esta enfermedad a un riesgo aumentado de neoplasia, ésta entidad, denominada endometriosis asociada a malignidad, se localiza en sitios extra gonadales en un 20% de los casos, donde la pared abdominal no alcanza más de 30 casos reportados. Si bien no existe un tratamiento estándar, la mayoría de los autores han adaptado el protocolo de tratamiento para el cáncer de ovario asociado a endometriosis.

ABSTRACT Endometriosis corresponds to the presence of endometrial glands or stroma at sites other than the uterine cavity. It affects 5 to 15% of women of reproductive age and is associated with a significant symptomatology. The theory of retrograde menstruation proposed by Sampson is the most accepted to explain its etiology. Several studies have associated this disease with an increase in neoplasia, the entity, called endometriosis associated with malignancy, is located in extra gonadal sites in 20% of cases, where the abdominal wall does not reach more than 30 reported cases. Although there is no standard treatment, most authors have adapted the treatment for ovarian cancer associated with endometriosis.

Cardiac, pulmonary and other body changes in children with gaucher disease during therapy

Gaucher disease is a multisystemic lipidosis characterized by hematologic problems, organomegally, skeletal involvement with or without neurological affection. The aim of the study is to identify the multisystemic involvements in children with Gaucher disease and to evaluate the effect of enzyme replacement therapy [ERT] on such patients. This study included 40 patients with Gaucher disease attending the Hematology Unit, Pediatric University Hospital during the period from January to December 2012. All cases were subjected to full history taking, thorough clinical examination, complete blood count, abdominal ultrasonography, radiological examination of the chest, distal end of femur and proximal end of tibia, EEC, echocardiography, Doppler echocardiography, tissue Doppler echocardiography and High Resolution C.T chest [HRCT]. Results: Significant differences were detected between cases and controls in weight, height and skull circumference [p value < 0,001]. Patients during ERT showed a significant decrease in frequency of epistaxis and blood transfusion than those before ERT [p value < 0.05]. Patients during ERT showed a significant increase in mean Hb level and platelet count than those before ERT [p value < 0.05]. There were no significant differences between the two groups of patients regarding the radiological bone changes and neurological aspects of Gaucher disease. Conclusion: Gaucher disease must be suspected in any child with organomegally, bone problems, bleeding tendency with or without neurological affection. ERT is effective in the management of hematological and visceral aspects of Gaucher disease. ERT has no role in the neurological aspect of Gaucher disease

Antibody response to hepatitis B immunization in Egyptian children with sickle cell disease

Despite improvement in the safety of blood products, sickle cell disease [SCD] and thalassemic patients are at greater risk than the general population for hepatitis B infection and chronic liver disease, making hepatitis B immunization especially important for this population. This study was conducted to evaluate and follow up the antibody response to hepatitis B vaccination, in patients with SCD, after 1-15 years of vaccination. participants were 30 SCD and 30 thalassemic patients attending the Hematology Department, Children's Hospital, Cairo University as well as 30 ages and sex matched normal controls. They were subjected to clinical evaluation, complete blood count, and measurement of liver transaminases, serum bilirubin, and serum ferritin levels as well as estimation of anti-HBs titer by enzymatic immunoassay. Anti-HBs titers in SCD patients ranged between 5.6 and 381 IU/L [54.83 +/- 15.30], while the levels of thalassemic patients ranged between 16 and 343 IU/L [93.4 +/- 30] and those of the control group ranged from 10 to 523 IU/L [83.4 +/- 28.1] which revealed statistically significant decrease in SCD patients compared to thalassemic and healthy controls [p =0.0317]. Out of the 30 SCD patients, 40% showed anti-HBs titer below 10 IU/L [non-protective titer], while none of the thalassemic patients or the control group revealed the same. Achievement of a protective titer had no correlation with sex, consanguinity, or any of the clinical or laboratory data tested. Immune dysfunction in thalassemia is not playing a major role in response to hepatitis B vaccination. However, SCD children should have their anti- HBs titer measured after routine hepatitis B immunization to ensure that they achieved protective titer, then after 1 year of vaccination and repeated every 5 years and those who do not seroconvert should receive additional doses. Booster HBV vaccination of unprotected SCD patients seems mandatory

Florid Cemento-Osseous Dysplasia As A Possible Aggravating Factor In A Case Of Trigeminal Neuralgia

Differential diagnosis of orofacial pain is crucial, as the course of each process and its clinical management varies markedly. A case is illustrated here of trigeminal neuralgia in a 49-year-old Indian female whose complaint was initially diagnosed as dental pain leading to sequential extractions of her right mandibular and maxillary molars but with no pain abatement. Subsequent neurological assessment diagnosed her complaint as trigeminal neuralgia but pain remained poorly controlled even with high doses of carbamazepine and gabapentin. A dental referral and orthopantomographic examination revealed multifocal sclerotic masses in her jaws, suggestive of florid cemento-osseous dysplasia (FCOD). Right mandibular incisional biopsy confirmed the diagnosis. A decision was made to curette the right mandibular masses and lateralised the right inferior dental nerve. Follow-up disclosed considerable pain reduction. This case raises the issue as to whether the sclerotic bone masses in FCOD may have caused nerve compression which aggravated her neuralgic pain.

Imiquimod en crema al 5% en el tratamiento de verrugas anogenitales asociadas a VPH: experiencia preliminar / Imiquimod 5% cream in the treatment of anogenital warts HPV associated

Antecedentes: La infección persistente por VPH de alto riesgo se asocia con cáncer cervicouterino, encontrándosepositividad en el 99,7% de los casos. Las verrugas anogenitales son una forma de presentación de la infección persistente. Objetivo: Investigar la eficacia y seguridad de imiquimod en crema al 5%, en el tratamiento de las verrugas anogenitales en mujeres. Método: Estudio prospectivo no randomizado, en mujeres portadoras de verrugas anogenitales asociadas a VPH. El tratamiento consiste en la autoaplicación de imiquiomod en crema al 5% tres veces a la semana por hasta un período de 16 semanas. Se define como respuesta completa al tratamiento aquella en que desaparece completamente la lesión; por respuesta parcial la disminución de al menos un 50% del volumen inicial de la lesión. Resultados: Durante un período de 8 meses fueron ingresadas y tratadas 38 pacientes La duración del tratamiento varió entre 1 y 4 meses. El número promedio de aplicaciones fue de 28,7. El 66% (25 casos) de las pacientes presentaron una respuesta completa, en tres casos no hubo respuesta, uno de ellos en una paciente inmunodeprimida, en 10 casos hubo respuestas parciales. En las pacientes con respuestas completas se necesitó un promedio de 28,7 aplicaciones hasta obtener el resultado. Conclusiones: Imiquimod es un fármaco con buena efectividad y seguridad en el tratamiento de las verrugas anogenitales asociadas a VPH, en tratamiento de tres veces por semana durante mínimo de 10 semanas.

Background: The chronic infection by high-risk HPV serotypes is strongly associated with cervical cancer, detection of HPV on tissue sample has been reported 99.7% of cases. The anal-genital warts represent the clinical manifestation of the persistent infection by this virus. Objectives: To investigate the efficacy and safety of Imiquimod cream 5% concentration, in the treatment of anal-genital warts in women. Methods: A non-randomized prospective study in women diagnosed with anal-genital warts HPV associated. The treatment consists in self-application of imiquimod cream 5%, three times a week for a period of 16 weeks or more. We define complete response to treatment in those patients where the lesion disappeared completely, and partial response to those where the lesion declined at least 50% of its initial volume. Results: Over a period of 8 months were admitted to the study and treated a total of 38 patients. Treatment duration varied between 1 and 4 months. The average number of applications was 28.7 times. 66% (25 cases) of the patients had a complete response, in three cases there was no response, one of them was an immunodepressed patients, in 10 cases there was partial response. The patients with complete response needed an average of 28.7 applications to get that result. Conclusions: Imiquimod is a drug with high effectiveness and safety in the treatment of anal-genital warts HPV associated, in a three times per week and at least 10 weeks total duration treatment.

Lesiones preinvasoras de cuello uterino: una visión actual / Preinvasive injuries of uterine cervix: a current view

En Chile se producen anualmente alrededor de 1200 nuevos casos de cáncer cérvico-uterino y 677 muertes por año (tasa de mortalidad: 8,4/100.000 mujeres). La relación entre el virus papiloma humano de alto riesgo y este cáncer, es la más fuerte e importante de la epidemiología mundial. Se analiza en detalle el rol del virus papiloma en la carcinogénesis cervical y el rol de la tipificación viral en el estudio y manejo de la citología alterada, tanto en la literatura internacional como su aplicación en el modelo chileno.

Early detection of macro vascular diseases of carotid and femoral arteries in patients with Rheumatoid arthritis

Rheumatoid arthritis [RA] is a multi-system disorder with inflammatory process associated with increased cardiovascular risk. The duplex scanning is a noninvasive technique to detect early atherosclerotic plaques and arterial wall changes either in symptomatic or asymptomatic patients. Early detection of asymptomatic vascular disorders allows early intervention and possibly retards the development of symptomatic cardiovascular diseases. A higher risk of cardiovascular morbidity and mortality persists among patients with an abnormal ankle brachial index [ABI] and it is useful to identify asymptomatic patients with established disease. To detect the early manifestations of atherosclerotic changes of carotid and femoral arteries in patients with rheumatoid arthritis. Twenty-four patients with chronic rheumatoid arthritis [six males and eighteen females] aged 26-65 years [45.7 +/- 14.7 years] with mean disease duration 11.12 +/- 6.4 years [2-18 year] were included in the study. All patients were on methotrexate, corticosteroids and nonsteroidal anti-inflammatory lines of treatment. Twenty apparently normal subjects were included in the study as controls. Patients with other types of collagen diseases or patients with ischemic peripheral manifestations, ischemic heart disease, diabetics or smokers were excluded from the study. Full history and thorough clinical examination, including full joints and vascular examination for all peripheral arteries and calculation of ankle brachial index [ABI] was done using pocket Doppler and sphygmomanometer. Patients and controls were subjected for Hb, WBC, platelet count, rheumatoid factor, blood sugar, ESR, levels of plasma cholesterol, triglyciride, HDL and LDL. Duplex study was performed on carotid and femoral arteries. The mean ABI in patients was 1.21 +/- 0.3, non-significantly lower than controls but still within the range of normal. There was a significant increase in the levels of cholesterol, triglyciride, LDL and HDL than controls and still within the range of normal. Duplex changes of carotid and femoral arteries were present in 18/24 [75%] of patients including hemodynamic changes, intimal thickness, plaques, stenotic segment. Duplex of carotid arteries detected hemodynamic changes in 12.5%, intimal thickness, plaques and stenotic segment in 25% of patients for each and detected intimal thickness of femoral arteries in 25% of patients. There was a significant negative correlation between the ABI and duration of disease [r = - 0.506, p<0.01] and a significant positive correlation between the intimal thickness and duration of disease [r =-0.807, p<0.001]. There was no relation between drug intake or type of drug and ABI or intima thikness and there was no relation between cholesterol, triglyciride, LDL or HDL levels and ABI or intimal thickness. There is increased risk of vascular disease in RA patients involving carotid and femoral arteries in the form of hemodynamic changes, intimal thickness, plaques and stenotic segment. Low ABI together with Duplex study are helpful for detection of subclinical ischemic changes in such high-risk patients. Normal levels of plasma cholesterol, triglyciride, HDL and LDL do not exclude underlying vascular changes. So we recommend ABI and Duplex examination for all RA patients and further studies are needed to elucidate non-traditional risk factors such as endothelial dysfunction, immune activation and impaired fibrinolysis in addition to oxidative stress

Cancer cervicouterino en estadio ib2: tratamiento con radioquimioterapia concomitante y cirugia

Objetivos: Analizar la factibilidad, toxicidad y resultados obtenidos en pacientes con cáncer cervicouterino estadio IB2 tratadas con radioterapia (RT) pélvica y quimioterapia concomitante, basada en cisplatino, y cirugía. Material y Método: Se analizan 63 pacientes de 23 a 65 años, con un diámetro tumoral de 4 a 8 cm. Histología 78% carcinoma escamoso. El tratamiento consistió en radioterapia (RT) pélvica y quimioterapia concomitante (cisplatino semanal o cisplatino con gemcitabina semanal) por cinco semanas. Se administró RT pélvica externa por cinco días a la semana, en fracciones de 2,0 Gy diarios, con una dosis total de 50 Gy (ICRU). Posteriormente se realizó un implante de braquiterapia con baja tasa de dosis para lograr una dosis total de 8.500 cGy en superficie. Se realizó histerectomía extrafascial 4 a 7 semanas después de la radioterapia. Resultados: 43 pacientes fueron tratadas con RT-cisplatino, 95% toleró 5 ciclos, 20 fueron tratadas con RT-cisplatino-gemcitabina, de las cuales el 65% toleró 5 ciclos, debido a la mayor frecuencia de toxicidad moderada y severa en este grupo. La respuesta clínica completa fue 81%. Persistencia de cáncer residual en el 18% de casos operados. Sobrevida global de 88,9% y sobrevida sin enfermedad de 84%. Se presentó recidiva local en 6,3% de pacientes, con mediana de seguimiento de 24,6 meses. Se observa una estrecha relación entre lesión residual en pieza operatoria, riesgo de recidiva y mortalidad por cáncer. Conclusiones: El tratamiento con radioterapia pélvica externa y braquiterapia, concomitante a quimioterapia con cisplatino y posterior cirugía, mejoraron significativamente el control local y la sobrevida en pacientes con carcinoma cervicouterino etapa IB2.

Patología preinvasora del cérvix / Preinvasive pathology of cervix

Se presenta una revisión de la bibliográfica y se comentan los principales aspectos epidemiológicos y clínicos de la patología preinvasora del cérvix. La historia natural de esta enfermedad revela la presencia de un fenómeno dinámico de progresión persistencia y regresión de lesiones intraepiteliales en las cuales el virus papiloma humano juega un rol preponderante. Se resalta el rol actual de la colposcopia en el manejo de una citología alterada. Se revisa los resultados del manejo colpohistológico de un frotis atípico demostrando un 9 por ciento de lesiones de alto grado para los ASCUS y de 25 por ciento para los ASC-H. Finalmente se presentan las alternativas terapéuticas y se analizan los resultados de la escisión con asa grande en pacientes portadoras de NIE III demostrando un 89 por ciento de curación.

Plasma lipid profile of healthy Saudi population in Makkah region

Five Hundred healthy Saudi subjects aged 10-80 years [48.65 + SEM] [400 males and 100 females] were randomly included in this pilot study from Makkah area for the estimation of plasma lipids. These subjects were subclassified into four age groups with a gap of 15 years. The sample included representative groups of University students, office and executive workers, Religious leaders and the general population. Standard exclusion criteria were laid down. Blood sugar, S. createnine, urea, S. bilirubin, SGOT and SGPT were also estimated along with the lipid profile in the fasting state. The mean total cholesterol TC] and triglycerides [TC] were 191 mg/dl + 2.15 SEM and 172 mg/dl +6.125 SEM respectively. The mean high density lipoprotein [HDL cholesterol] was 41.5 mg/dl being higher in the younger age group. The study revealed that 28% of the subjects had Total Cholesterol >/- 210mg/dl [5.4mmol/L], 16% had HDL cholesterol < 35 mg/dl[0.9 mmol/L] and 35% were active smokers

Impact of hepatitis C virus [HCV] seropositivity on the serum protein electrophoretic pattern

The impact of HCV seropositivity on the serum protein electrophoretic pattern was analyzed. Abnormalities were tested for prediction of hepatic dysfunction. Sera were obtained from 20 asymptomatic patients seropositive for the virus and 20 control subjects. Sera were subjected to further testing of HCV seropositivity using the second generation enzyme immunonassay kit, and the pattern of binding of anti-HCV antibodies to HCV structural [C1 and C2] and non structural [NS3 and NS4] antigens was determined using the immunoblotting technique. The serum protein electrophoretic pattern was determined and the levels of the different fractions were tested for correlation to the levels of the liver enzymes, serum level of immunoglobulins and to the pattern of reactivity to structural and non structural HCV antigents. The results suggested the importance of the hypergammaglobulinemia as a marker of hepatic dysfunction in HCV seropositive patients, its level might be of value in the follow up of patients with normal liver transaminases levels

Adult asthma in northern Iraq

217 patients attended the out patient department between July 1986-1989 diagnosed to have bronchial asthma depending on clinical history, physical examination and peak flow meter measurement [PEFR]. They included 98 men [45.2%] and 119 women [54.8%]. The age of onset of their first symptoms varied between 13-40 years. The duration of their symptoms ranged between few days to over 20 years. Family history was present in 64 patients [29.5%] and nasal symptoms was present in 60 patients [27.6%%]. The main presenting symptoms were day time and nocturnal dyspnea both indicating moderate to severe air way obstruction with PEFR of 300L/minute or less. The triggering factors precipitating acute attacks in their order of frequency were cigarette smoke, dust, cold weather, respiratory infection and exercise. 106 patients [48.84%] were on no regular medications and only 25 patients [11.5%] were on different types of steroids. Inhalers are underused by our patients. B2 stimulant and steroid inhalers were used in [31.5%] and [3.2%] of our patients respectively

Lactate dehydrogenase and alpha hydroxybutyrate dehydrogenase: Sensitive indicators of disease status and responsiveness to therapy in adult acute lymphoblastic leukemia

To establish the value of serum lactate dehydeogenase [LDH] and alpha hydroxybutyrate dehydrogenase [HBDH] in reflecting the responsiveness of adult a cute lymphoblastic leukaemia [ALL] to the given chemotherapy. Serial measurements of LDH and HBDH in sera of six patients with ALL throughout different phases of therapy [induction, consolidation, maintenance]. Initially high levels of both enzymes were detected in all patients upon presentation. Successful remission induction was associated with normalization of activities of both enzymen in five of six patients. Refractoriness to standard protocol in the remaining patient was accompanied by persistence of high levels of LDH and HBDH. Reappearance of blast cells in circulation was paralleled by elevation of enzyme levels which could be brought again to normal by effective disease control and further chemotherapy. Continuous monitoring of LDH and HBDH is recommended to reflect the disease status and the responsiveness to chemotherapy in ALL

Cáncer de ovario / Ovarian cancer

Se presentan y analizan los resultados en cáncer epitelial del ovario en la Unidad de Oncología del Servicio de Obstetricia y Ginecología, Hospital Paula Jaraquemada. Desde 1976 a 1987 fueron diagnosticadas y tratadas 68 pacientes. La mediana de seguimiento fue de 71,5 meses, no hubo pacientes perdidas al seguimiento. Las pacientes fueron etapificadas según los criterios de FIGO, 24 fueron etapificadas en estadio I, 7 en estadio II, 24 en estadio III y 8 en estadio IV. E tratamiento consistió inicialmente en cirugía con o sin quimio o radioterapia coadyuvante. La sobrevida actuarial fue de 91 por ciento para estadio I, 29 por ciento en estadio II, 6 por ciento en estadio III y sin sobrevida en estadio IV. El tipo de tratamiento, grado de diferenciación, tipo histológico, residuo post cirugía y los hallazgos del Second Look son analizados como factores pronósticos. El peor pronóstico fue para aquellas pacientes con residuo mayor de 2 cms., el cual no es modificado por el tratamiento

Factores pronósticos en cancer epitelial del ovario: un estudio de multivarianza / Prognosis factors in ovarian epithelial cancer: a multivariable study

Se presentan los resultados en cáncer epitelial del ovario, de la Unidad Oncológica del Hospital San Borja-Arriarán desde 1976 a 1989, con un total de 70 pacientes. 33 casos corresponden a estadio I de FIGO, 9 a II, 26 a III y 11 a estadio IV. La mediana de seguimiento fue de 72 meses con un mínimo de 12. La sobrevida actuarial fue de 93,8 por ciento para estadio I, 36,3 por ciento en estadio II, 6,9 por ciento en estadio III y 9 por ciento en estadio IV. Se analizan los factores pronósticos según el modelo de los riesgos proporcionales de Cox. El estadio clínico es el principal factor pronóstico de la muestra y engloba a todas las otras variables. No se encontraron factores pronósticos en los estadios I, II y IV pero sin estadio III, en donde la cirugía completa, los tumores bien diferenciados y la posibilidad de rescate alcanzaron significancia estadística

Physiological coagulation inhibitors [protein S, protein C and antithrombin III] in patients with recurrent venous thromboembolic disease

Protein C, protein S, and antithrombin III were evaluated in plasma of 15 patients with a history of severe recurrent thromboembolic disease and 15 normal controls to determine if plasma deficiency of any of these patients may account for observed disease. A highly significant decrease in the level of protein C and protein S was observed, [P < 0.001] while antithrombin III showed a non significant change compared with the normal control group

Screening for HIV antibodies in the sera of male homosexuals and voluntary blood donors in Alexandria

Sixty male homosexuals confined to Hadara Prison as well as 200 male voluntary blood donors were screened for anti-HIV antibodies. Both the male homosexuals representing the major risk group for HIV infection and the voluntary blood donors representing the healthy population at large were found negative for anti-HIV antibodies. This study thus adds to the many previous negative reports for HIV among different samples of Egyptian population