Experiencia en loxoscelismo cutáneo y cutáneo visceral de manejo hospitalario: clínica, evolución y propuesta terapéutica / Experience in visceral cutaneous and cutaneous loxoscelism of hospital management: clinical, evolution and therapeutic proposal

Resumen Introducción: El loxoscelismo es una patología frecuente en nuestro medio con un amplio espectro de presentaciones y diagnósticos diferenciales, con complicaciones potencialmente graves, e incluso con riesgo de muerte. A la fecha no existe un tratamiento estándar para estos pacientes. Objetivo: Describir las manifestaciones clínicas, principales complicaciones, manejo terapéutico y evolución de pacientes internados por loxoscelismo en un hospital terciario en Chile. Pacientes y Método: Se analizaron todos los pacientes consultantes e internados por loxoscelismo en el Hospital Clínico de la Pontificia Universidad Católica de Chile entre los años 2014 y 2017, evaluados en interconsulta por Dermatología. Revisión de los registros clínicos incluyendo semiología, imágenes, informes de laboratorio y tratamientos efectuados. Resultados: Se registraron 17 casos de loxoscelismo de manejo hospitalario, cuya presentación responde al patrón epidemiológico nacional. La mayoría de los casos fue manejada con antimicrobianos, corticosteroides sistémicos, antihistamínicos y dapsona. De ellos, 11,8% correspondieron a loxoscelismo cutáneo visceral, manejados exitosamente con medidas de soporte, corticosteroides sistémicos y antihistamínicos. El 59% presentó resolución de las lesiones al mes de tratamiento, con cicatriz residual leve o hiperpigmentación postinflamatoria, sin mortalidad en nuestra serie. Discusión: La mayoría de los casos de loxoscelismo cutáneo presentó excelente respuesta y rápida resolución del cuadro tras el tratamiento asociado de corticosteroides sistémicos, antimicrobianos y dapsona, sugiriendo que el uso de estas terapias podría detener la progresión de la necrosis cutánea y prevenir las complicaciones asociadas al loxoscelismo.

Background: Loxoscelism is a common pathology in our environment with a broad spectrum of differential diagnoses and presentations, with potentially serious complications, even to the point of death. To date, there is no standard treatment for these patients. Aim: To describe the clinical manifestations, main complications, therapeutic management, and evolution of loxoscelism in an inpatient setting from a tertiary hospital in Chile. Methods: All patients consulting and hospitalized in the hospital of the Pontificia Universidad Católica de Chile with diagnosis of loxoscelism between 2014 to 2017 and evaluated by dermatologist were included. Review of clinical files, including symptoms, images, laboratory parameters and treatment. Results: We evaluated seventeen inpatient with loxoscelism, whose presentation responds to the national epidemiological pattern. Most cases were managed with antibiotics, systemic corticosteroids, antihistamines, and dapsone. From these, 11.8% corresponded to viscerocutaneous loxoscelism, successfully managed with supportive measures, systemic corticosteroids and antihistamines. Fifty-nine percent healed their cutaneous lesions after one month of treatment, with slight residual scarring or post inflammatory hyperpigmentation, without associated mortality in our series. Discussion: Most cases of cutaneous loxoscelism presented excellent response and rapid resolution of the disease after combined therapy with systemic corticosteroids, antibiotics and dapsone, suggesting that the use of these therapies could stop the progression of cutaneous necrosis and prevent complications associated with loxoscelism.

Prognostic factors affecting outcomes in multivisceral en bloc resection for colorectal cancer

OBJECTIVES: This study sought to determine the clinical and pathological factors associated with perioperative morbidity, mortality and oncological outcomes after multivisceral en bloc resection in patients with colorectal cancer. METHODS: Between January 2009 and February 2014, 105 patients with primary colorectal cancer selected for multivisceral resection were identified from a prospective database. Clinical and pathological factors, perioperative morbidity and mortality and outcomes were obtained from medical records. Estimated local recurrence and overall survival were compared using the log-rank method, and Cox regression analysis was used to determine the independence of the studied parameters. ClinicalTrials.gov: NCT02859155. RESULTS: The median age of the patients was 60 (range 23-86) years, 66.7% were female, 80% of tumors were located in the rectum, 11.4% had stage-IV disease, and 54.3% received neoadjuvant chemoradiotherapy. The organs most frequently resected were ovaries and annexes (37%). Additionally, 30.5% of patients received abdominoperineal resection. Invasion of other organs was confirmed histologically in 53.5% of patients, and R0 resection was obtained in 72% of patients. The overall morbidity rate of patients in this study was 37.1%. Ureter resection and intraoperative blood transfusion were independently associated with an increased number of complications. The 30-day postoperative mortality rate was 1.9%. After 27 (range 5-57) months of follow-up, the mortality and local recurrence rates were 23% and 15%, respectively. Positive margins were associated with a higher recurrence rate. Positive margins, lymph node involvement, stage III/IV disease, and stage IV disease alone were associated with lower overall survival rates. On multivariate analysis, the only factor associated with reduced survival was lymph node involvement. CONCLUSIONS: Multivisceral en bloc resection for primary colorectal cancer can be performed with acceptable rates of morbidity and mortality and may lead to favorable oncological outcomes.

Changes in mast cell infiltration: a possible mechanism in detrusor overactivity induced by visceral hypersensitivity

ABSTRACT Objective: To establish the detrusor overactivity (DO) model induced by visceral hypersensitivity (VH) and investigate the relationship between mast cell (MC) infiltration and DO. Materials and Methods: Sixty rats are divided into 4 groups randomly: Group 1:Baseline group; Group 2: DO group; Group 3: CON group; Group 4: VH group. The colorectal distension (CRD) and abdominal withdral reflex (AWR) scores are performed to evaluate VH. The cystometric investigation and histological test of MC infiltration are assessed. Results: The threshold pressure of CRD in the VH group is significantly lower than that in the CON group (P<0.001). At the distension pressure ≥20 mmHg, the AWR scores of the VH group are significantly higher than those of the CON group (10 mmHg: P=0.33; 20 mmHg: P=0.028; 40 mmHg: P<0.001; 60 mmHg: P<0.001; 80 mmHg: P<0.001). DO model is successfully established in the VH group (DO rate=100%). Compared with the CON group, the numbers of MC infiltration are significantly increased in the VH group, including submucosa of bladder (P<0.001), mucosa lamina propria/mesentery of small intestine (P<0.001), and mucosa lamina propria/mesentery of large intestine (P<0.001). Furthermore, more MC activation as well as degranulation are observed in the VH group. Conclusions: It is indicated that DO model can be established in the VH rats. The MC infiltration may play an important role in DO induced by VH, and may be helpful to understand the mechanisms of DO in VH patients.

Patterns of cause of death in unknown dead bodies a three year study in a tertiary care hospital.

Opinion about the cause of death in unknown dead bodies is a test of ability of the Forensic expert and on many occasions yields little or no results. The reasons may be inadequate/no history, disinterested Investigating officers unwilling to properly work out the case, partial/complete decomposition/destruction/mutilation of the body, etc. In such cases, identification of the body as such poses problems; rest aside the opinion regarding the cause/manner of death. The present 3 year study was undertaken to find the cause of death and the pattern of causes of death in unknown dead bodies, as well as the efforts made to establish the identity in these cases. Unidentified bodies comprised 4% of the total 1577 cases brought for postmortem examination to the department. Maximum number of cases belonged to the age group 41 -50 years, 35%. Majority of the opinions regarding the cause of death were given as cranio-cerebral damage, 30%, followed by “no definite opinion”, 28%. Viscera for chemical analysis were sent in 24%, histopathology in 8% and for both chemical analysis and histopathology, in 27% cases.

Toxicology unit in department of forensic medicine emphasis from a study from North East India.

In suspected poisoning cases the final opinion as to the cause of death is generally kept pending till receipt of the chemical analysis report from the Forensic Science Laboratory (FSL). Cases of suspected poisoning deaths from Kamrup district coming to the GMCH morgue were studied from 1st August 2008 to 31st August 2009 with aim of analyzing the time consumed at various levels. A total of 2592 autopsies were performed during study period and in 160 cases viscera were preserved. Viscera Report of 60 is awaited as on 1st November 2009. 31 cases gave positive results for poison and 69 cases gave negative report. In 21.9% of cases police took more than a month to take the samples to SFSL and in more than 47.5% cases SFSL took >2 months to convey report. In nearly all cases the final opinion as to the cause of death was given the same day on which the report was received. So, establishment of Toxicological Laboratories in Dept of Forensic Medicine and Toxicology can minimize this delay.

Incidence of mode of death and organ damage

To correlate organ damage with modes of death. Department of Forensic Medicine, Khyber Medical College Peshawar. January 2007 to December 2007. The record of one hundred cases autopsied in the morgue was perused, carefully scrutinized and segregated, and information entered in the tables for analysis. The commonest mode of death was syncope [44%]. coma [40%] and asphyxia [16%]. Organs most commonly involved were brain [43%], lungs [22%], abdominal viscera [17%], heart [15%] and major blood vessel [3%]. Brain damage is commoner than the injuries of the heart, lungs and viscera followed by damage to the major blood vessels

Is there any necessity of preservation of viscera even in cases where cause of death is already determined: A discussion.

During autopsy different viscerae are collected and preserved mainly for chemical examination to ascertain the cause of death. But many a times viscerae is preserved even in cases where cause of death is known. Police and prosecution side often question the merit of preservation of viscerae in such cases because defence lawyer often take this as opportunity to delay the prosecution till the Chemical Examiner’s report is available. Most of the time Chemical Examiner’s report is much delayed and sometimes West Bengal State Forensic Science Laboratory even refuse to accept the viscerae for chemical examination particularly where cause of death is given in P.M.report. In N.R.S. Medical College, Kolkata center around 3500 post mortem examinations are being done annually, on requisitions from Kolkata Police [K.P.], West Bengal Police [WBP] and General Railway Police (GRPS). Kolkata Police in almost all their requisitions request to preserve viscera and other medicolegal articles. An analysis was done on police requisition paper and autopsy report to find out the logical scientific solution.

Hallazgos patológicos en cerdos afectados con el síndrome del desmedro multisistémico postdestete de la República Argentina / Pathological findings in pigs affected by the postweaning multisystemic wasting syndrome in Argentina

El síndrome del desmedro multisistémico postdestete (PMWS) fue descrito por primera vez en Canadá en el año 1991 y desde entonces un número creciente de casos han sido diagnosticados en todo el mundo. En la Argentina, el PMWS fue reportado por primera vez recientemente. Se estudiaron 48 cerdos de 5 a 12 semanas de edad con signos característicos de PMWS procedentes de 19 granjas. Si bien se desconoce la distribución real del virus en nuestro país se observó desde el año 2001 un número creciente de granjas con PMWS y distribuidas en las principales provincias productoras. La histopatología fue una herramienta diagnóstica importante en casos sospechosos de PMWS con la observación de diferentes grados de lesión. En los animales estudiados las infecciones secundarias pudieron ser importantes, ya sea por patógenos oportunistas o por complicaciones bacterianas.

Postweaning multisystemic wasting syndrome was first described in Canada in 1991 and at present an increasing number of cases has been diagnosed worldwide. In Argentina the first cases of PMWS were reported recently. Forty eight 5 to 12 week old pigs with signs characteristic of PMWS from 19 farms were studied. Although the real distribution of the virus in our country is not known it was observed an increasing number of farms with PMWS distributed in the major producing provinces. The histopathology was an important tool in diagnosis of suspicious cases of PMWS with the observation of different degrees of lesion. In the studied animals, the secondary infections, either by opportunistic pathogens or secondary bacteria could be important.

Dor pelviperineal / Pelviperineal pain

Dor pelviperineal cronica e condicao comum especialmente nos individuos do sexo feminino. Muito frequentemente, anormalidades viscerais eventualmente identificadas aos exames complementares nao...

O diagnóstico da AIDS pela ultra-sonografia / Ultrasound in AIDS disease

Este estudo examina os principais sinais ultra-sonográficos encontrados em 105 pacientes com a síndrome da imunodeficiência adquirida e os seus principais achados no fígado, vias biliares, pâncreas, baço e rins. Entre as principais alteraçöes observam-se hepatomegalia(42, 9 por cento), esplenomegalia(84 por cento), linfonodomegalias(39 por cento) e alteraçöes renais com hiperecogenicidade e nefrocalcinose focal. Outras alteraçöes incluem coleçöes pancreáticas, abscessos hepático-esplênicos e até colecistites alitiásticas.

Avaliaçäo baciloscópica na hanseníase virchoviana (estudo de 60 necrópsias) / Lepromatous leprosy avaliation baciloscopy (analyzed 60 necropsies)

Na literatura há referências de que a proliferaçäo do M. leprae nas vísceras pode se manter mesmo na ausência de proliferaçäo, em nível cutâneo-neural, e que isto poderia permitir reativações da hanseníase. Com o fito de avaliar-se a baciloscopia nas diversas localizações viscerais comprometidas na hanseníase virchoviana e, se possível, compará-las com a baciloscopia em material colhido em pele e nervos periféricos, analisamos 60 necrópsias de indivíduos virchovianos. Estas necrópsias foram divididas em grupos de acordo com os resultados de última baciloscopia que o paciente apresentou em vida, ou seja: virchovianos ativos e em progressäo - 15 necrópsias; Virchovianos ativos e em regressäo - 17 necrópsias; virchovianos inativos - 28 necrópsias. Em algumas necrópsias o índice da baciloscopia visceral ultrapassou o mesmo índice em nível cutâneo-neural, e em 3 necrópsias bacilos típicos foram encontrados somente em vísceras (laringe e testículos). Em termos comparativos com a baciloscopia cutâneo-neural estes resultados näo puderam ser valorizados porque limitaçöes de natureza técnica e legal nos impediram de colher fragmentos de pele e nervos periféricos em várias localizaçöes. No entanto, há trabalhos sugerindo que a baciloscopia em linfonodos de drenagem da pele pode dar uma idéia bastante apoximada da baciloscopia cutânea. Em algumas das necrópsias examinadas, em localizaçöes viscerais, o índice baciloscópico ultrapassou o mesmo índice no linfonodo axilar. Excluindo-se linfonodos axiliares, os valores mais elevados do índice baciloscópico para as vísceras foram encontrados na laringe, testículos e faringe, com predominio da primeira localizaçäo. Isto pode confirmar a relaçäo entre temperatura tecidual e capacidade de proliferaçäo bacilar, sugerindo que a laringe apresenta condiçöes de adaptaçäo e proliferaçäo do M. leprae semelhantes à mucosa nasal, que é a via principal de eliminaçäo bacilar

Hanseníase dimorfa com padröes diversos de reaçäo granulomatosa em pele e vísceras / Borderline leprosy with several patterns of granulomatous reactions in skin and visceras

Um paciente com história de no mínimo 12 anos de evoluçao, considerado como portador de Hanseníase virchoviana e com todas as seqüelas características (madarose, queda de pirâmide nasal, fibrose e atrofia dos testículos) além de episódios de Eritema nodoso hansênico, apresenta padroes diversos de reaçao granulomatosa em pele, nervos e vísceras. Observa-se granulomas virchovianos ativos, granulomas virchovianos regressivos, granulomas dimorfos difusos, e granulomas com padrao tuberculóide na presença de rica baciloscopia incluindo bacilos típicos. O aspecto mais interessante é o encontro de granulomas tuberculóides múltiplos em linfonodos, medula óssea, fígado e baço. A rica baciloscopia e a presença de bacilos típicos, apesar do predomínio de reaçao granulomatosa de padrao tuberculóide fala a a favor de uma piora da doença. Discute-se a interpretaçao imunológica deste tipo de reaçao e sua relaçao com a má evoluçao do paciente.