Hemangioma infantil. Reporte de un caso de presentacion clinica anular

Reportamos el caso clínico de un lactante menor con una presentación anular de hemangioma, que nos plantea dudas en su clasificación. Se precisan los diagnósticos diferenciales y la necesidad de la determinación del marcador GLUT 1 en hospitales públicos.

We report the clinical case of a young infant with an annular presentation of hemangioma, which raises doubts regarding its classification. Differential diagnoses and the need to determine the GLUT 1 marker in public hospitals are specified.

Hemangioma infantil. Reporte de un caso de presentacion clinica anular / Infantile hemangioma. Report of a case of annular clinical presentation

Reportamos el caso clínico de un lactante menor con una presentación anular de hemangioma, que nos plantea dudas en su clasificación. Se precisan los diagnósticos diferenciales y la necesidad de la determinación del marcador GLUT 1 en hospitales públicos.

We report the clinical case of a young infant with an annular presentation of hemangioma, which raises doubts regarding its classification. Differential diagnoses and the need to determine the GLUT 1 marker in public hospitals are specified.

Mitral Surgery for Severe Mitral Annular Calcification: Calcium Resection or Exclusion Procedure / 日本心臓血管外科学会雑誌

Background: Extensive calcification of the mitral annulus (MAC) represents a problem for mitral surgery due to a technical difficulty for implanting prosthetic valves, because the calcium does not allow placing direct sutures through the annulus and para-prosthetic leakage or cardiac rupture may result. We describe our experience with mitral valve surgery with or without decalcification of the annulus. Methods: Since 2005, we performed mitral valve operations in 1,327 patients and among them, severe mitral annular calcification was present in 25 (1.9%). Results: The mean age was 75±9 years and there were 6 men and 19 women, with hemodialysis in 4. Mitral valve replacement (MVR) was performed in all patients. A concomitant operation was aortic valve replacement in 19 and coronary artery bypass grafting in 4 patients. The MAC was resected in 14 (Group-R) and was excluded in 11 (Group-E). In-hospital mortality was four patients in Group-R. The cause of death was congestive heart failure in two, cerebellar infarction in one, and respiratory failure in one. Postoperative morbidity included one patient with reexploration and one with prolonged respiratory failure The aortic cross clamp time was a mean of 180±44 min (range 108∼266 min) in Group-R and 139±32 min (range 61∼186 min) in Group-E (p=0.009). The size of the prosthetic mitral valve was 24.3±1.0 mm in Group-R and 24.6±0.8 mm in Group-E (p=0.618). The postoperative echocardiography showed no abnormal mean pressure gradient of mitral valve prosthesis nor para-valvular leak in any patients in either group. Conclusions: The mitral valve replacement without annular decalcification in a severely calcified mitral annulus is a safe and an effective approach in an elderly patient.

A Case Report of Annular Elastolytic Giant Cell Granuloma / 罕见病研究

Annular elastolytic giant cell granuloma(AEGCG) is a rare granulomatous skin condition. We present a case of a 67-year-old man with annular plaques on the face, neck, shoulder, back and upper limbs, and mildly pruritis exceeding one year. Histopathological examination demonstrated granulomatous inflammatory infiltration of lymphocytes, histiocytes and multinuclear giant cells in the middle and the upper dermis, with more local eosinophils. Elastic fiber staining showed that elastic fibers were absent in granuloma area and were engulfed by multinucleated giant cells. Based on the clinical and histopathological findings, a diagnosis of AEGCG was made. The etiology and pathogenesis of this condition are unclear, and atypical manifestations of non-exposed areas can also occur.It is usually related to systemic diseases lacks specific treatment at present.

Aortic valve repair: An exciting journey / Reparación valvular aórtica: una experiencia emocionante

Abstract Aortic valve repair has become an attractive alternative to aortic valve replacement in most of the patients with aortic insufficiency. To improve reproducibility and durability "geometric anatomy" of the valve has been developed to guide the repair. Expert centers were able to publish remarkable short- and long-term results for aortic valve sparing procedures. Therefore, data comparing composite valve grafting and aortic valve sparing procedures revealed similar early mortality. Also, late mortality, thromboembolism, stroke and bleeding risks were significantly lower in patients undergoing aortic valve repair and late durability was equivalent1. However, the complexity of the procedures makes aortic valve repair difficult to be adopted into daily surgical practice. Accordingly, starting your own aortic valve repair program requires conviction, training, facilities, quality control and a well structured heart valve team to let your program succeed.

Resumen La reparación valvular aórtica se ha convertido en una alternativa atractiva al reemplazo, en la mayoría de pacientes con insuficiencia aórtica. Para mejorar la reproducibilidad y la durabilidad, se ha desarrollado una "anatomía geométrica" de la válvula para guiar la reparación. Los centros expertos han publicado resultados notables a corto y largo plazo en preservación valvular aórtica. Además, los estudios que compararon el cambio valvular por tubo valvulado con los procedimientos de preservación valvular, mostraron una mortalidad temprana similar, con riesgos de mortalidad tardía, como tromboembolia pulmonar, accidente cerebrovascular y hemorragia, significativamente menores en los pacientes sometidos a reparación valvular aórtica, con una durabilidad tardía equivalente1. Sin embargo, la complejidad de los procedimientos dificulta la adopción de la reparación valvular aórtica en la práctica diaria. En consecuencia, comenzar un programa de reparación valvular aórtica requiere convicción, capacitación, instalaciones, control de calidad y un equipo bien estructurado para que sea exitoso.

Granuloma actínico: reporte de un caso / Actinic granuloma: a case report

Resumen El granuloma actínico es una dermatosis granulomatosa poco frecuente, que se observa en adultos de mediana edad con antecedentes de fotoexposición. Su patogénesis no es clara; siendo la teoría más aceptada la radiación solar como factor disparador. Se caracteriza por placas anulares con atrofia central y bordes eritematosos elevados que son similares a los observados en el granuloma anular. Se presenta el caso clínico de una paciente de 71 años, con placas anulares en antebrazos compatibles con granuloma actínico. Se comunica el caso por lo infrecuente de esta entidad y se realiza una revisión bibliográfica.

Abstract Actinic granuloma is a rare granulomatous dermatosis, seen in middle-aged adults with a history of photoexposure. Its pathogenesis is not clear; the most accepted theory being solar radiation as a triggering factor. It is characterized by annular plaques with central atrophy and raised erythematous borders that are similar to those seen in granuloma annulare. The clinical case of a 71-year-old patient with annular plaques on the forearms compatible with actinic granuloma is presented. The case is reported due to the infrequent nature of this entity and a bibliographical review is carried out.

Prevalence and Echocardiographic Predictors of Left Atrial Appendage Inactivity in Patients of Mitral Stenosis

Background: Mitral stenosis (MS) is a common valvular heart disease. Thromboembolism is one of the most serious consequences of mitral stenosis, particularly when it is accompanied with atrial fibrillation (AF). When linked with Left atrial appendage inactivity (LAAI), patients with sinus rhythm (SR) are also at risk for this condition. In mitral stenosis, LAA inactivity determined by S-wave is an independent predictor of thromboembolism. The aim of the study was to evaluate the Prevalence and Echocardiographic Predictors of Left Atrial Appendage inactivity in patients of Mitral Stenosis.Material & Methods:Sixty MS patients were evaluated by transthoracic echocardiography (TTE) and all patients underwent transesophageal echocardiography (TEE). The annular systolic (S-wave) and diastolic (Em- and Am-waves) velocities were recorded by tissue Doppler imaging (TDI). LAA inactivity was defined as LAA emptying velocity <25 cm/second determined by pulse wave Doppler at the junction of LA & LAA (TEE). Patients were divided into three groups; group A I (n = 18). Sinus rhythm (SR) and LAA emptying velocity ?25 cm/sec, group A II (n -22): SR and LAA emptying velocity <25cm/sec and group B (n = 20): atrial fibrillation.Results:Thrombus was detected in 14 patients and spontaneous echo contrast (SEC) was detected in 43 patients. Both S-wave and peak LAA emptying velocities were decreasing, while SEC frequency and density were increasing from group A to group B. There was a positive correlation between LAA emptying vs. S-wave and LAA emptying vs. Am velocities (p < 0.001, r= 0.708 and p<0.001, r=0.495). Multivariate regression analysis showed that only S-wave is the independent predictor of inactive LAA (p = 0.001, odds ratio = 0.133, 95% Cl =0.032-0.556). In patients with SR, the cutoff value of S-wave was 10 cm/sec for the prediction of the presence of inactive LAA (sensitivity: 92.3%, specificity: 95.3%).Conclusions:In individuals with severe mitral stenosis in sinus rhythm, there is a significant prevalence of left atrial appendage inactivity. The mean pressure gradient across the mitral valve, as well as S-wave are independent predictors of left atrial appendage inactivity. Inactivity of the left atrial appendage is an independent predictor of left atrial/left atrial appendage smoke and associated thrombus.

Mitral Annular Calcification Detected by Transthoracic Echocardiography is a Marker for High Prevalence and Severity of Angiographically Proven Coronary Artery Disease

Background: MAC was defined as a dense, localized, highly reflective area at the base of the posterior mitral leaflet detected by TTE. Obstructive CAD was defined as either 50% reduction of the internal diameter of the left main coronary artery or 70% reduction of the internal diameter of the left anterior descending, right coronary, or left circumflex artery distribution. Objective: The aim of the study was to evaluate the role of echocardiographically detected MAC as a predictor of coronary artery disease (CAD).Material & Methods:In this prospective, observational, case-control study, coronary angiography was done in 50 patients with MAC and equal number of patients without MAC, detected with transthoracic echocardiography. Analysis was done to observe the association and correlation of MAC with angiographic findings.Results:Mean age of the case control was 55.16 � 10.73 years and control was 49.80 � 8.84 years. In this study 34% of patients with MAC and 32% patients without MAC had single vessel disease, 16% of patients with MAC and 24% patients without MAC had double vessel disease, 42% of patients with MAC and 22% patients without MAC had triple vessel disease (TVD), 16% of patients with MAC and 4% patients without MAC had Left main coronary artery disease and 8% of patients with MAC and 22% patients without MAC had no significant CAD.Multivariate analysis shows MAC (p=0.049) as an independent predictor for coronary artery disease (CAD).Conclusions:Transthoracic echocardiographically detected MAC is an independent predictor of coronary artery disease. The low cost, portable and radiation free nature of the ultrasound approach make MAC an attractive parameter in the ongoing search for the ideal marker of coronary artery disease (CAD).

A modified Tenons sling annular graft for advanced peripheral ulcerative keratitis with an hourglass cornea

Systemic tuberculosis mostly affects the lungs and ocular involvement is rare. The ocular manifestations are varied, and rarely peripheral ulcerative keratitis (PUK) occurs either due to direct invasion of the microorganism or due to immune reaction. We present a case of advanced PUK in a 28?year?old male patient diagnosed with pulmonary TB in the right eye with hourglass cornea. The ulcer was progressing circumferentially with necrosis of corneal stroma and undermined margins similar to Moorens ulcer, and was not responding to anti?tuberculosis treatment and topical steroids. We describe a modified novel surgical technique using tenons sling annular patch graft to manage the progressive advanced PUK with hourglass cornea to optimize visual and structural outcome in our patient.

A Case of Cardiac Mobile Mass That Was Diagnosed as Detached Calcified Mitral Annulus / 日本心臓血管外科学会雑誌

The case was a 77-year-old woman with a history of coronary artery bypass surgery 9 years earlier. After the surgery, aortic stenosis appeared and gradually progressed. During follow-up, she presented with a high degree of mitral annular calcification (MAC). A mobile verrucous mass in the left ventricle attached to the calcified posterior mitral annulus. We replaced the aortic valve and resected the mass (size, 3×26 mm). The mass with a club-shape was hard but fragile. Pathological examination revealed that it was a calcified substance without cell components covered with a thin membrane. Immunostainings with CD31 and Factor VIII-related antigen, a vascular endothelial cell marker, were both positive. Thus, the resected mass was diagnosed as a detached calcified mitral annulus. In order to avoid embolic events, early resection would be appropriate for an MAC-related mobile mass.

Granuloma Anular diseminado: a propósito de un caso / Disseminated annular granuloma: on the purpose of a case

RESUMEN El granuloma anular es un trastorno relativamente frecuente, se desconoce la prevalencia exacta, tiene mayor frecuencia en niños y adultos jóvenes. Se caracteriza por pequeñas pápulas agrupadas, en configuración anular, a menudo con distribución simétrica y acra. La mayor parte los casos se resuelve en forma espontánea dentro de los 2 años, pero la tasa de recidivas es del 40%. Presentamos el caso clínico de una paciente de 72 años de edad con granuloma anular diseminado, tratado con pentoxifilina, con buen resultado terapéutico.

ABSTRACT Annular granuloma is a relatively frequent disorder, the exact prevalence is unknown, it is more frequent in children and young adults. It is characterized by small grouped papules, in annular configuration, often with symmetric and acrid distribution. Most cases resolve spontaneously within 2 years, but the recurrence rate is 40%. We present the clinical case of a 72-year-old patient with disseminated annular granuloma, treated with pentoxifylline, with good therapeutic results.

Estenosis mitral con calcificación severa del anillo mitral: reemplazo mitral con prótesis OnX Conform en posición supraanular / Mitral stenosis with severe annular calcification: mitral valve replacement with an OnX Conform prosthesis in a supra annular position

Abstract A 68-year-old man previously subjected to radiotherapy had a prior aortic valve replacement due de radiation induced calcification of the aortic valve. Presently the patient developed severe calcification of the mitral valve ring leading to critical mitral valve stenosis. A supra annular implantation of an On X Conform valve was successfully achieved. The clinical course was uneventful, and the echocardiographic evaluation demonstrated a normal function of the valve. Different alternatives for the surgical management of this complication are discussed.

Annular pancreas in adults: single unit experience from a tertiary care centre of Northern India

Annular pancreas is a rare congenital anomaly which usually presents with gastrointestinal symptoms early in life. In adults mostly it remains asymptomatic or may present with abdominal or features of duodenal obstruction the increased diagnosis of which is attributed to the improved imaging modalities. We hereby report our experience of adult annular pancreas in whom clinical presentation initially mimicked gastric or duodenal outlet obstruction. Adult annular pancreas was diagnosed with the aid of computed tomography of the abdomen and treated successfully with Roux-en-Y isoperistaltic gastrojejunostomy.

Floral anatomy of the plant Psittacanthus schiedeanus (Loranthaceae)

Loranthaceae hemiparasitic family comprises 76 genera and about 1 050 species distributed in temperate and tropical regions.The subtribe Psittacanthinae contains 14 genera of neotropical mistletoe including Psittacanthus with over 120 species, characterized by large, brightly colored (red, orange, yellow) flowers that are mostly pollinated by hummingbirds. During the 20th century, a number of morphological and embryological studies were conducted mainly on Old World Loranthaceae genera. More recently, attention has been focused on neotropical Psittacanthinae where among the 14 genera, floral anatomy has been examined in only seven.The aim of this study is to describe the floral anatomy of Psittacanthus schiedeanus and compares the results with those derived from related mistletoe, interpreting the variation of the floral characters of the calyculus, nectary, gynoecium and from floral dissections and serial histological sections, detailing the structure of androecium and gynoecium and anthers in the context of the new phylogenetic information. Flowers of P. schiedeanus at different developmental stages were examined using stained serial sections visualized with light microscopy. These flowers have a vascularized, cupular pedicel fused to a bracteole, a non-vascularized calyculus, an annular nectary, a unilocular gynoecium with a single central mamelon and an androecium formed by epipetalous septate stamens. The morphological comparison of pedicel, bracteole and calyculus provides support for the interpretation of the calyculus as a reduced calyx. The annular nectary seems to be a character shared by the entire subtribe Psittacanthinae, which distinguishes it from Ligarinae which has stylar nectary. The unilocular gynoecium formed by a single central structure is a character shared with other genera in Psittacanthinae except Tripodanthus. The androecium is composed of dithecal, tetrasporangiate stamens with septate locules that are here considered an adaptation for pollen releasing over an extended time period rather than previous suggestions that they result from evolutionary pressure to reduce anther size or to facilitate the nutrition of microspores in large anthers.

La familia hemiparásita Loranthaceae comprende 76 géneros y aproximadamente 1 050 especies distribuidas en regiones templadas y tropicales. La subtribu Psittacanthinae contiene 14 géneros de muérdagos neotropicales que incluyen Psittacanthus con más de 120 especies, caracterizadas por presentar flores grandes de colores brillantes (rojo, naranja y amarillo) que son polinizadas principalmente por colibríes. Durante el siglo XX se desarrollaron una serie de estudios morfológicos y embriológicos de géneros de Loranthaceae del Viejo Mundo. Recientemente, la atención se ha centrado en la subfamilia neotropical Psittacanthinae, en donde de los 14 géneros que la conforman, la anatomía floral se ha examinado solamente en siete. El objetivo de este estudio es describir la anatomía floral de Psittacanthus schiedeanus y comparar los resultados con los de otros muérdagos relacionados, interpretando la variación de los caracteres florales del calículo, nectario, gineceo y anteras en el contexto de la nueva información filogenética. Flores de P. schiedeanus en diferentes estados de desarrollo fueron examinadas mediante secciones seriadas teñidas utilizando microscopía óptica. Estas flores tienen un pedículo vascularizado y cupular fusionado con una bracteola, un cáliz no vascularizado, un nectario anular, un gineceo unilocular con un solo mamelón central y un androceo formado por estambres septados epipétalos. La comparación morfológica de pedicelo, bracteola y calículo proporciona apoyo para la interpretación del calículo como un cáliz reducido. El nectario anular parece ser un carácter compartido por toda la subtribu Psittacanthinae, que lo diferencia de la subtribu Ligarinae con nectario estilar. El gineceo unilocular formado por una estructura central única es un carácter compartido con otros géneros de la subtribu Psittacanthinae, con la excepción de Tripodanthus. El androceo está formado por estambres bitecados, tetrasporangiados con lóculos septados que aquí se consideran una adaptación para liberar polen durante un período prolongado de tiempo, en lugar de sugerencias previas que lo explican como resultado de la presión evolutiva para reducir el tamaño de la antera o para facilitar la nutrición de microesporas en anteras grandes.

Granuloma anular perforante: patologia inusual / Perforating Granuloma Annulare: unusual pathology

Resumen El Granuloma Anular (GA) es una dermatosis inflamatoria crónica, benigna, auto limitada, de etiología desconocida. Existen numerosas variantes clínicas dentro de las cuales se encuentra la perforante, de presentación inusual. La histopatología más característica de GA, cuenta con la presencia de histiocitos epitelioides en empalizada alrededor de áreas de degeneración focal de fibras de colágeno con depósitos de mucina. La variedad perforante evidencia eliminación transepidérmica de fibras de colágeno. Se presenta un paciente de 72 años de edad, diabético, dislipémico, con lesiones pruriginosas en dorso de ambas manos, con el diagnóstico de granuloma anular perforante. Realizó tratamiento con clobetasol tópico, más antihistamínicos por vía oral, quedando una cicatriz atrófica.

Abstract Granuloma annulare is a chronic, benign, self-limiting, inflammatory dermatosis of unknown etiology. There are numerous clinical variants within which is the perforating, unusual presentation. The most histopathology characteristic of GA is the presence of palisading epithelioid histiocytes around areas of focal degeneration of collagen with mucin deposits. The perforating variety evidences transepidermal elimination of collagen tissue. A 72 years-old, diabetes, dyslipidemic patient is presented with pruritic lessions on the dorsum of both hands, with the diagnosis of perforating granuloma annulare. I perform medical treatment with topical clobetasol, leaving an atrophic scar.

Tissue doppler imaging for estimation of left ventricular filling pressure in patients with systolic and diastolic heart failure: a comparative simultaneous doppler catheterization study

Background: Noninvasive assessment of diastolic filling by Doppler echocardiography provides important information about left ventricular (LV) status in selected subsets of patients. This study was designed to assess whether the lateral mitral annular velocity as assessed by tissue Doppler imaging is associated with invasive measures of diastolic LV performance in patients with diastolic and systolic heart failure. Aim of the study was to compare the diagnostic accuracy of lateral mitral annular E/E? as an estimate of LV filling pressure with invasive LVEDP measurement in subjects with systolic or purely diastolic heart failure.Methods: Total 100 patients were studied, 50 patients with diastolic heart failure and 50 patients with systolic heart failure in patients undergoing diagnostic coronary angiogram. Detailed 2D Echocardiography, Trans mitral Doppler and Tissue Doppler velocities of lateral mitral annulus was obtained. The ratio of peak mitral velocity (E) to lateral mitral annular velocity (E?) by TDI (E/E?) was calculated.Results: The ratio of E/E? in diastolic group was 13.4�9 and in systolic group it was 13.7�2. The mean LVEDP in diastolic heart failure patients was 14.3�5 and 14.2�9 in systolic heart failure patients. The ratio of E/E? showed a better correlation with LVEDP. E/E? <8 accurately predicted normal LVEDP, and E/E? >15 identified increased LVEDP ?15mmHg.Conclusions: E/E? is a reliable estimate of LV filling pressures in subjects with systolic and diastolic heart failure. In subjects with diastolic heart failure, E/E? seems helpful to identify those with truly elevated LV filling pressures. In patients with diastolic heart failure and normal E/E?, a search for other causes of symptoms (pulmonary disease, obesity and so forth) may be warranted.

A case of urticaria multiforme with unusual presentation

Urticaria multiforme is a condition which manifests as acute, polycyclic, annular oedematous pink plaques with an ecchymosis hue that is associated with acral edema. The condition is often misdiagnosed as erythema multiforme, serum-sickness-like reactions, or urticarial vasculitis. Author present a case of acute annular urticaria in a 3-year-old girl who presented with unusual clinical manifestations of the condition. Through this case report, Author aim to emphasize the wide range of morphologic manifestations that can be seen in urticaria multiforme. This can assist pediatric physicians to differentiate urticaria multiforme from other clinical dermatologic conditions and prevent misdiagnosis. A detailed case history and physical examination, along with relevant diagnostic tests can enable prompt and effective management of the condition.

Sporadic ovarian sex cord-stromal tumor with annular tubules: a rare case report

Ovarian sex cord stromal tumor with annular tubules (SCTAT) is a distinctive, rare subtype of sex cord stromal tumor of the ovary, predominant component of which has morphological features intermediate between that of granulosa cell and sertoli cell. The majority of ovarian SCTAT are benign. So far, malignant behavior in SCTAT has been reported only in sporadic cases. We have presented a case of SCTAT in a 40 year old lady with no association of Peutz-Jegher (P-J) syndrome. The patient’s chief complaints were post-menopausal bleeding for 1 year on and off along with menorrhagia. MRI abdomen was suggestive of intensely enhancing solid tissue mass lesion in the right  adnexa, features suggestive of ovarian mass. Panhysterectomy was done. Grossly uterus and left adnexa appeared to be normal. Right ovary showed mass measuring 17x11x9cm3 in size, on cut section, solid, homogenous lobulated, yellowish areas identified. Microscopic and Immunohistochemistry findings confirmed the diagnosis of sex cord stromal tumor with annular tubules of granulosa cell type. PAS stain supported the diagnosis.

Granuloma anular, pronóstico de diabetes mellitus. A propósito de un caso / Annular granuloma, prognosis of diabetes mellitus. On the purpose of a case

RESUMEN El granuloma anular es una dermatosis de relativa frecuencia en niños, jóvenes y adultos. Está caracterizado por lesiones cutáneas eritemato-pápulo-nodulares, que adoptan una disposición anular. Su etiopatogenia es desconocida, pero con numerosos factores predisponentes, desencadenantes o asociados a ella; como es la diabetes mellitus y/o procesos neoplásicos o paraneoplásicos. Resulta importante el estudio de pacientes con este diagnóstico por su asociación con entidades como las antes mencionadas. Se realizó el reporte de un caso en adulto mayor de 65 años, con diagnóstico de granuloma anular, diabetes mellitus y neoplasia de páncreas.

ABSTRACT Annular granuloma is a dermatosis relatively frequent in children, young and adult people. It is characterized by erythematous-papular-nodular skin lesions adopting annular disposition. Its etio-pathogenesis is unknown, but there are many predisposal, unleashing factors, or associated to this disease, like diabetes mellitus and/or neoplastic or paraneoplastic processes. It is important to study the patients diagnosed with the disease due to its association with entities like those before mentioned. The reported case is the case of a patient elder than 65 years, diagnosed with annular granuloma, diabetes mellitus and pancreas neoplasia.