Granulomatosis eosinofílica con poliangeítis: reporte de caso yrevisión de la literatura / Eosinophilic granulomatosis with polyangiitis: case report and review of the literature

La granulomatosis eosinofílica con poliangeítis (Síndrome de Churg-Strauss) es una enfermedad vasculítica primaria poco frecuente. El diagnóstico actualmente se define a partir de la presencia de al menos cuatro de seis criterios propuestos por la Sociedad Americana de Reumatología, los cuales incluyen: asma bronquial, eosinofilia mayor que 10 por ciento, sinusitis paranasal, infiltración pulmonar, evidencia histológica de vasculitis y compromiso neurológico ya sea mono o polineuropático. En el presente artículo se reporta el caso de un paciente de 56 años con antecedentes de asma bronquial, rinitis alérgica y poliposis nasal operada, derivado a nuestro centro por cuadro de aumento de volumen doloroso en ambas extremidades inferiores, baja de peso, parestesias y debilidad muscular. Asociado a esto desarrolló lesiones purpúricas palpables cuya biopsia resultó compatible con granulomatosis eosinofílica con poliangeítis. El paciente posteriormente recibió tratamiento inmunosupresor con prednisona y un pulso de ciclofosfamida con buena respuesta clínica. Se presenta una revisión bibliográfica a propósito del caso.

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss Syndrome) is an uncommon primary vasculitis. The diagnosis is currently defined by the presence of at least four of six criteria proposed by the American College of Rheumatology, which include: asthma, eosinophilia less than 10 percent, paranasal sinusitis, pulmonary infiltration, histologic evidence of vasculitis and neurologic compromise as mono or polyneuropathy. In the present article, we report the case of a 56 year-old man with history of asthma, allergic rhinitis and operated nasal polyposis, referred to our center with painful bulking in both lower extremities, weight loss, paresthesias and muscle weakness. It also developed palpable purpura. Biopsy of skin lesions was compatible with eosinophilic granulomatosis with polyangiitis. The patient subsequently received immunosuppressive therapy with prednisone and a cyclophosphamide bolus with good clinical response. A review on the subject is also presented.

Anetoderma primaria: revisión de la literatura a propósito de un caso / Primary anetoderma: a case report and literature review

La Anetoderma es una enfermedad elastolítica rara que se caracteriza por la pérdida focal de tejido elástico en la dermis. La patogénesis de esta enfermedad es desconocida y ha sido descrita en asociación con enfermedades autoinmunes, como lupus eritematoso y síndrome antifosfolípidos, y con enfermedades infecciosas, principalmente VIH, sífilis y borreliosis. Su diagnóstico diferencial es amplio e incluye otras enfermedades elastolíticas, liquen escleroatrófico extragenital y morfea, entre otros. Se reporta el caso de una paciente que consultó por un cuadro de larga data de múltiples parches blanquecinos atróficos, cuya biopsia cutánea fue compatible con Anetoderma. Se realiza una revisión de la literatura dada la necesidad de un adecuado estudio y seguimiento de estos pacientes en busca de una pesquisa temprana de enfermedades autoinmunes asociadas.

Anetoderma is a rare elastolytic disease characterized by focal loss of elastic tissue in the dermis. Pathogenesis is unknown and has been described in association with autoimmune diseases such as lupus erythematosus and antiphospholipid syndrome, and infectious diseases, especially HIV, syphilis and Lyme disease. Differential diagnosis is broad and includes other elastolytic disease, extragenital lichen sclerosus and morphea. We report the case of a patient with long-standing history of multiple atrophic white patches on the trunk and extremities, with diagnostic skin biopsy of Anetoderma. We conducted a literature review given the importance of good study and monitoring of these patients for an early investigation of associated autoimmune diseases.

Reconstrucción mamaria con colgajo TRAM pediculado / Breast reconstruction with pedicled TRAM flap

The pedicle transverse rectus abdominus myocutaneous flap (TRAM) is widely used for breast reconstruction, however is not exempt from complications. Between 2004 and 2010 the authors performed breast reconstruction after total mastectomy in 52 patients with pedicled TRAM flaps. Purpose: To describe the demography, outcomes and complications in patients operated for breast cancer and reconstructed with TRAM flap. To assess the influence of smoking, the laterality and timing of reconstruction. Material and Method: Retrospective, observational and comparative. We reviewed the medical records of 52 patients operated by the authors between 2004 and 2010. Four cases were excluded due to incomplete data. Results: In the 48 patients studied were 50 TRAM flaps. The most frequent comorbidity was smoking (27 percent). Regarding the timing of reconstruction, 74 percent (37) was performed immediately post-mastectomy and 26 percent (13) was deferred. Was used by 78 percent (39) ipsilateral TRAM, 18 percent (9) contralateral and 4 percent (2) bilateral. Only minor complications were observed and the cosmetic result evaluated by the surgeon's satisfaction was very good or excellent in 62 percent (31). Smoking, timing of reconstruction and laterality did not affect in complications or cosmetic outcome (p > 0.05). Conclusions: The pedicled TRAM flap is an excellent alternative for reconstruction in breast cancer patients. It is not exempt from complications, with a tendency to get better cosmetic results in the non-smoker group.

El colgajo de recto abdominal con isla transversal de piel infraumbilical (TRAM) pediculado es ampliamente utilizado para la reconstrucción mamaria, sin embargo, no está exento de complicaciones. Entre los años 2004 y 2010 los autores realizaron reconstrucción mamaria post-mastectomía total en 52 pacientes con colgajos TRAM pediculados. Objetivo: Describir la demografía, resultados y complicaciones de las pacientes operadas por cáncer de mama y reconstruidas con colgajo TRAM. Evaluar la influencia del tabaquismo, la lateralidad y el momento de la reconstrucción en dichos resultados. Material y Método: Diseño retrospectivo, observacional y comparativo. Se revisaron las historias clínicas de las 52 pacientes operadas por los autores entre los años 2004-2010. Se excluyeron 4 casos por datos incompletos. Resultados: En las 48 pacientes estudiadas se realizaron 50 colgajos TRAM. La comorbilidad más frecuente fue el tabaquismo (27 por ciento). La reconstrucción se realizó en un 74 por ciento (37) de manera inmediata postmastectomía y en un 26 por ciento (13) fue diferido. Se utilizó en un 78 por ciento (39) TRAM ipsilateral, 18 por ciento (9) contralateral y 4 por ciento (2) bilateral. Sólo se observaron complicaciones menores; el resultado estético evaluado por la satisfacción del cirujano fue muy bueno o excelente en un 62 por ciento (31). El tabaquismo, momento de la reconstrucción y la lateralidad no influyeron en las complicaciones ni en el resultado estético (p > 0,05). Conclusiones: El colgajo TRAM pediculado es una excelente alternativa de reconstrucción en pacientes mastectomizadas. No está exento de complicaciones, con una tendencia a obtener mejores resultados estéticos en el grupo no fumador.

Comparación de los efectos de la radioterapia sobre los resultados estéticos y complicaciones en reconstrucciones mamarias inmediatas versus diferidas con TRAM pediculado / Comparison of the effects of radiotherapy on the aesthetic results and complications in immediate versus delayed breast reconstruction with pedicled TRAM

Negative effect of post-mastectomy radiotherapy in transverse rectus abdominus myocutaneous (TRAM) flap breast reconstruction remains unclear. The immediate post-mastectomy TRAM has shown better cosmetic results than delayed reconstruction, making it necessary to define the effects of radiation on this type of reconstruction. The aim of this study is to compare the effect of radiotherapy on immediate and delayed reconstruction with TRAM, analyzing aesthetic results and complications. We reviewed medical records of 23 patients undergoing mastectomy with TRAM reconstruction and radiation therapy between 2004-2009, distributed in those undergoing immediate reconstruction (n=12) and delayed post-radiotherapy (n=11). Cosmetic results and complications were compared between the groups. There were no differences in age, prevalence of comorbidities or clinical stage. Regarding the aesthetic result of immediate TRAM, 50 percent were classified as excellent, 20 percent very well, 20 percent good and 10 percent regular, while in delayed reconstructions, 64 percent was excellent, 18 percent very good and 18 percent good, no differences between both groups (p=0.51). There were no differences in local complications. Although the study population is insufficient to draw conclusions comparable, our results are comparable to those of other studies showing no deleterious effect of radiotherapy on immediate TRAM reconstructions. Additional studies are needed to recommend the treatment of choice.

Algunos aspectos del compromiso cutáneo por el cáncer de mama: revisión de la literatura a propósito de tres casos / Cutaneous metastasis of breast cancer: three clinical cases and a review of the literature

Las metástasis cutáneas son infrecuentes, reportándose en la literatura rangos entre 0,6 por ciento y 10 por ciento. El cáncer de mama es la neoplasia más común en las mujeres con metástasis cutáneas. La presencia de éstas constituye un signo de enfermedad avanzada y es indicadora de mal pronóstico. Las lesiones pueden tener distintos patrones clínicos: tipo nodular, erisipeloide, alopecia y carcinoma telangiectásico. En el presente artículo se realiza un análisis retrospectivo de tres casos clínicos atendidos en nuestro centro y una revisión de la literatura.

Cutaneous metastases are unusual; their frequency in the literature ranges from 0.6 percent to 10 percent. Breast cancer is the most common cancer in women with cutaneous metastases. They are perceived as a sign of advanced disease and are regarded as a serious prognostic indicator. The lesions may present in distinct clinical forms: nodular pattern, erysipelas like presentations, alopecia and carcinoma telangiectaticum. In this article we analyzed three clinical cases that were seen in our center and a review of the literature.

Evaluation of the nitrate reductase assay for rapid detection of extensively drug-resistant tuberculosis.

BACKGROUND: New diagnostic tools are needed to support tuberculosis (TB) control strategies, particularly in low- and middle-income countries with a high prevalence of TB. OBJECTIVE: To evaluate the nitrate reductase assay (NRA) for the rapid detection of resistance to isoniazid (INH) and rifampicin (RMP), as well as to second-line drugs such as ofloxacin (OFX) and kanamycin (KM). DESIGN: To determine diagnostic accuracy, 192 selected clinical isolates of Mycobacterium tuberculosis were used to compare NRA with BACTEC 460TB for rapid detection of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB strains. RESULTS: A good agreement between NRA and the BACTEC 460TB reference method was observed, with good sensitivity and excellent specificity for INH, RMP and OFX. Results for KM were also promising, although the sensitivity for the detection of KM resistance should be improved. CONCLUSION: NRA is a diagnostic tool of promise for the timely detection of M. tuberculosis resistance to first- and second-line drugs. Our study showed a clear potential for the prompt detection of both MDR- and XDR-TB cases. Further studies are needed to optimise the testing of second-line drugs.

[Characteristics of adolescent and adult young women diagnosed with human papilloma virus infection at the Center for Research on Human Reproduction (CIRH)]. / Características de las adolescentes y adultas jóvenes con diagnóstico de infección por virus de papiloma humano (IVPH) del Centro de Investigación en Reproducción Humana (CIRH).

We reviewed 239 charts of adolescents and young adults, who visited our clinic. The purpose was to know the incidence of the Human Papiloma Virus infection (HPVI), diagnosed by Pap's smears, and the relationship to a population with some gynecological and sociodemographic characteristics. The women age population was between 14-24 years old with a mean age of 19.9 years. Seventy (29.3%) were PIV positive and 169 (70.7%) negatives. About 75% among both groups (PIV + and -) began active sexual life between 15-19 years old. Among the women with 4 or more sexual partners, 55.6% were HPVI positive. About 60% of all women had never used any method before being admitted to the clinic. In this study there is no correlation between IVSA and HPVI. We do demonstrate that the greater the number of sexual partners, the highest the risk of a sexual acquired disease.

Establecimiento en Cuba de la técnica de fertilización in vitro (FIV) y transferencia embrionaria (TE): informe preliminar / Establishment in Cuba of fertilization in vitro technique (FIV) and embryo transference (ET): preliminary report

La infertilidad constituye un serio problema de salud al nivel mundial con repercusiones psicosociales de extrema importancia. La fertilización in vitro y transferrencia embrionaria es considerada actualmente el tratamiento de elección en gran parte de las causas de infertilidad masculina y femenina. Se estableció en nuestro país el primer Programa de este tipo y se logró el primer éxito a los 10 meses de comenzado el trabajo. Hasta el presente se han obtenido 8 embarazos, de los cuales hay 3 nacimientos, 1 embarazo en curso, 1 ectópico y 3 abortos espontáneos tempranos. La tasa de embarazo es de 12,3

Establecimiento en Cuba de la técnica de fertilización in vitro (FIV) y transferencia embrionaria (TE): informe preliminar / Establishent in Cuba of fertilization in vitro technique (FIV) and embryo transference (ET): preliminary report

La infertilidad constituye un serio problema de salud al nivel mundial con repercusiones psicosociales de extrema importancia. La fertilización in vitro y transferrencia embrionaria es considerada actualmente el tratamiento de elección en gran parte de las causas de infertilidad masculina y femenina. Se estableció en nuestro país el primer Programa de este tipo y se logró el primer éxito a los 10 meses de comenzado el trabajo. Hasta el presente se han obtenido 8 embarazos, de los cuales hay 3 nacimientos, 1 embarazo en curso, 1 ectópico y 3 abortos espontáneos tempranos. La tasa de embarazo es de 12,3

Prolactin inhibits the steroidogenesis in midfollicular phase human granulosa cells cultured in a chemically defined medium.

In vitro studies were conducted on prolactin (PRL) effects on human granulosa cell steroidogenesis. Cells derived from healthy midfollicular phase follicles were cultured in a chemically defined medium supplemented with androstenedione (delta 4 A) 10(-7) M. Cultures treated with follicle-stimulating hormone (FSH) showed a dose-dependent increase of estradiol (E2) and progesterone (P) secretion. The authors demonstrated that PRL (greater than or equal to 10 ng/ml) inhibits basal as well as FSH (10 ng/ml)-stimulated E2 and P secretion. This PRL effect was overcome only by FSH maximal stimulating doses (100 ng/ml). These results suggest a direct inhibitory effect of PRL on granulosa cell steroidogenesis acting as a negative modulator of FSH action. These effects might be related to the ovarian dysfunction observed in hyperprolactinemia.

Protein electrophoretic patterns of bovine and porcine ovarian follicular fluid.

Sodium Dodecyl Sulphate polyacrylamide electrophoresis (SDS-PAGE) was used to reveal changes in the protein pattern of porcine and bovine ovarian follicular fluid at different maturational stages. Separate pools were made of follicles with a diameter of 1-2, 3-4, 5-6, 7-8, 9-10 and greater than 11 mm excluding hemorrhagic and cystic follicles. Prior to electrophoresis, estradiol-17 beta and androstenedione were analyzed to define the atresic or healthy state of the follicular. Glucose and total protein content of follicles fluid were determined to assess follicular metabolism. Densitometric analysis of both pig and cow follicular fluids from 3-4 mm follicles revealed a distinct band which was absent in other follicle sizes. On the other hand the protein pattern of follicular fluid of cow and pig showed differences in zones of molecular weight higher than 150,000 and lower than 30,000 dalton. This study suggests the possible existence of a common protein to both species which determines the follicle destiny towards ovulation or atresia.

Chromatographic pattern of circulating prolactin in ovulatory hyperprolactinemia.

Hyperprolactinemia is a major cause of anovulation and female infertility. However, we found 22 hyperprolactinemic patients with preserved ovarian function as assessed by midluteal plasma progesterone levels greater than 7 ng/ml. We performed a gel chromatography on the plasma of six of those patients to study the circulating pattern of prolactin (PRL). In all six patients we found that the vast majority of circulating PRL corresponds to big,big and big PRL, with only a small proportion of monomeric biologically active PRL. This finding might explain the preserved luteal function in those women and might have therapeutic implications.

Steroid secretion by cumulus cells isolated from human preovulatory follicles.

The secretion of progesterone, testosterone, and oestradiol by intact human oocyte-cumulus complexes in vitro was examined in incubations lasting 6-24 h. The complexes were aspirated from preovulatory follicles in 32 women who, due to tubal disease, were participating in an in vitro fertilization program. In 12 of the women follicular maturation was induced with clomiphene and human chorionic gonadotrophin (hCG), in 13 women with human menopausal gonadotrophin (hMG) and hCG and in 7 women with a combination of clomiphene-hMG plus hCG. The net secretion of steroids into the fertilization medium was studied before (0-6 h) and after (6-24 h) the addition of sperm, by RIA of aliquots removed at specific times. A high and sustained secretion of progesterone was found both before and after insemination. Testosterone secretion remained at a low and constant level while a net release of oestradiol was found mainly during the first hours of incubation. The release of steroids, particularly progesterone, varied according to the mode of hormonal stimulation in vivo and was highest in complexes from clomiphene-hMG-treated women, probably reflecting different maturity of the aspirated follicles. In a second series of experiments the dispersed cumulus cells were recovered after fertilization and cultured as monolayers for 2-4 days. The cells underwent spontaneous luteinization and secreted high amounts of progesterone. These results extend previous work in animals showing that also in the human the periovulatory cumulus cells are steroidogenically active. The results also suggest a functional difference in the cumulus cells related to the mode of ovulation induction.