Xantogranuloma juvenil: una entidad con amplio espectro clínico / Juvenile Xanthogranuloma: An Entity With a Wide Clinical Spectrum

El xantogranuloma juvenil es un trastorno benigno poco frecuente, que pertenece al amplio grupo de las histiocitosis de células no Langerhans. Se presenta con uno o más nódulos eritematosos o amarillentos, ubicados preferentemente en la cabeza y el cuello. La mayoría de los casos se inician durante el primer año de vida, incluyendo lesiones congénitas. La afectación extracutánea es rara, sugiriéndose tradicionalmente en la literatura estudiar el compromiso ocular. El diagnóstico del xantogranuloma juvenil es fundamentalmente clínico, sin embargo, en ocasiones se requiere confirmarlo con biopsia de piel. Las lesiones cutáneas son autolimitadas, por lo que suelen no requerir tratamiento. En la presente revisión se describen los distintos aspectos clínicos y terapéuticos de esta enfermedad, resaltando la evidencia respecto al estudio diagnóstico del compromiso extracutáneo

Juvenile xanthogranulomas (JXGs) are rare, benign lesions that belong to the large group of non-Langerhans cell histiocytoses. JXG presents with 1 or more erythematous or yellowish nodules that are usually located on the head or neck. Most JXG lesions are congenital or appear during the first year of life. Extracutaneous involvement is rare, but the literature traditionally suggests investigating the possibility of ocular compromise. JXG is mainly a clinical diagnosis, but a skin biopsy may sometimes be needed for confirmation. JXGs on the skin are self-limiting and usually do not require treatment. This review describes the clinical and therapeutic aspects of JXG, emphasizing available evidence and the diagnosis of extracutaneous involvement

Juvenile Xanthogranuloma: An Entity With a Wide Clinical Spectrum. / Xantogranuloma juvenil: una entidad con amplio espectro clínico.

Juvenile xanthogranulomas (JXGs) are rare, benign lesions that belong to the large group of non-Langerhans cell histiocytoses. JXG presents with 1 or more erythematous or yellowish nodules that are usually located on the head or neck. Most JXG lesions are congenital or appear during the first year of life. Extracutaneous involvement is rare, but the literature traditionally suggests investigating the possibility of ocular compromise. JXG is mainly a clinical diagnosis, but a skin biopsy may sometimes be needed for confirmation. JXGs on the skin are self-limiting and usually do not require treatment. This review describes the clinical and therapeutic aspects of JXG, emphasizing available evidence and the diagnosis of extracutaneous involvement.

[Registry of perioperative cardiac arrests in a clinical hospital in the period 2006-2017]. / Registro de paro cardiorrespiratorio perioperatorio en un hospital universitario en el período 2006-2017.

BACKGROUND: Perioperative cardiac arrest (PCA) is a rare but important event in the operating room. AIM: To describe PCA events at a Clinical Hospital in Santiago, Chile. MATERIAL AND METHODS: Registry of PCA that occurred in the operating room (OR) and during procedures not carried out in the OR between September 2006 and November 2017. Precipitating events, type of anesthesia and results of resuscitation maneuvers were described. RESULTS: Eighty events (five outside of the OR) during 170,431 surgical procedures were recorded, resulting in an incidence of 4.4 events per 10,000 interventions. Hypotension/hypoperfusion was the most frequently found preexisting condition (42.5%). The main cause was the presence of preoperative complications (57.5%). Nineteen cases (23.8%) were attributable to anesthesia, with an incidence of 1.11 per 10,000 anesthetic procedures. Survival rate at hospital discharge was 52.5%. The figure for PCA caused by anesthesia was 84.2%. CONCLUSIONS: The incidence of PCA and its survival is similar to that reported abroad. In general, PCA has a better prognosis than other types of cardiac arrest, especially if it has an anesthetic cause.

Registro de paro cardiorrespiratorio perioperatorio en un hospital universitario en el período 2006-2017 / Registry of perioperative cardiac arrests in a clinical hospital in the period 2006-2017

Background: Perioperative cardiac arrest (PCA) is a rare but important event in the operating room. Aim: To describe PCA events at a Clinical Hospital in Santiago, Chile. Material and Methods: Registry of PCA that occurred in the operating room (OR) and during procedures not carried out in the OR between September 2006 and November 2017. Precipitating events, type of anesthesia and results of resuscitation maneuvers were described. Results: Eighty events (five outside of the OR) during 170,431 surgical procedures were recorded, resulting in an incidence of 4.4 events per 10,000 interventions. Hypotension/hypoperfusion was the most frequently found preexisting condition (42.5%). The main cause was the presence of preoperative complications (57.5%). Nineteen cases (23.8%) were attributable to anesthesia, with an incidence of 1.11 per 10,000 anesthetic procedures. Survival rate at hospital discharge was 52.5%. The figure for PCA caused by anesthesia was 84.2%. Conclusions: The incidence of PCA and its survival is similar to that reported abroad. In general, PCA has a better prognosis than other types of cardiac arrest, especially if it has an anesthetic cause.

Rinosinusitis crónica: una revisión de su etiopatogenia / Chronic rhinosinusitis: a review of its etiopathogenesis

RESUMEN La rinosinusitis crónica (RSC) se define como una inflamación sintomática de las cavidades nasales y paranasales. Es una enfermedad altamente prevalente, que conlleva una gran carga económica asociada y cuyo tratamiento médico actual consigue un alivio sintomático en aproximadamente 50% de los pacientes. Tradicionalmente se ha clasificado de acuerdo a la presencia o ausencia de pólipos nasales, sin embargo, no se conoce con total claridad los mecanismos que llevan a la diferenciación de ambos fenotipos. Se estima que existirían tanto factores exógenos como endógenos involucrados que configurarían un origen multifactorial de la enfermedad. La RSC es motivo de intensa investigación científica actual dado su impacto y prevalencia, de manera de determinar con mejor precisión los objetivos de un eventual tratamiento de mayor efectividad. Es por ello que presentamos una revisión actualizada en relación a los mecanismos fisiopatológicos subyacentes en RSC.

ABSTRACT Chronic rhinosinusitis (CRS) is defined as a symptomatic inflammation of the nasal and paranasal cavities. It is a highly prevalent disease carrying a large associated economic burden, and its current medical treatment achieves symptomatic relief in approximately 50% of patients. Traditionally, it has been classified according to the presence or absence of nasal polyps. However, the mechanisms that lead to the differentiation of both phenotypes are not fully understood. It has been estimated that there are both exogenous and endogenous factors involved that would configure a multifactorial origin of the disease. Given its impact and prevalence, CRS is currently a subject of intense scientific research, in order to accurately determine the targets for a more effective treatment. For this reason, we present an updated review in relation to the underlying pathophysiological mechanisms in CRS.

Ecografía Doppler color en malformaciones glomuvenosas con correlación clínica e histológica / Color Doppler Ultrasound Study of Glomuvenous Malformations with its Clinical and Histologic Correlations

Las malformaciones glomuvenosas son hamartomas originados por la presencia de células glómicas en el músculo liso de las estructuras vasculares. Presentamos una serie de 13 casos de malformaciones glomuvenosas evaluadas clínicamente, estudiadas con ecotomografía Doppler color y confirmadas histológicamente. En las ecografías se observaron en todos los casos formaciones dérmicas e hipodérmicas superficiales, moderadamente delimitadas, de ecoestructura mixta, pseudonodulares, hipoecogénicas y heterogéneas con áreas tubulares y lacunares anecogénicas pseudoquísticas. El 85% de los casos demostró presencia de vasos arteriales y venosos, con predominio de los de baja velocidad (≤ 15 cm/s) sin shunts arteriovenosos. No se visualizó compromiso de estructuras profundas ni flebolitos. Los hallazgos clínicos y ecográficos podrían ayudar a precisar mejor el diagnóstico, la planificación quirúrgica o el seguimiento no invasivo en estas entidades

Glomuvenous malformations are hamartomatous lesions characterized by the presence of glomus cells in the vascular smooth muscle. We present the clinical and color Doppler ultrasound features of a series of 13 cases of histologically confirmed glomuvenous malformations. In all cases, the ultrasound study revealed moderately delimited superficial dermal and hypodermal pseudonodular structures of mixed echogenicity, with hypoechoic and heterogeneous areas and anechoic, pseudocystic tubular and lacunar zones. Arterial and venous vessels, mainly with a low flow (≤ 15 cm/s) were observed in 85% of patients, but no arteriovenous shunts were present. Deeper structures were not affected and no phleboliths were detected. The clinical and ultrasound findings could facilitate diagnosis, surgical planning, and noninvasive follow-up in these tumors

Color Doppler Ultrasound Study of Glomuvenous Malformations with its Clinical and Histologic Correlations. / Ecografía Doppler color en malformaciones glomuvenosas con correlación clínica e histológica.

Glomuvenous malformations are hamartomatous lesions characterized by the presence of glomus cells in the vascular smooth muscle. We present the clinical and color Doppler ultrasound features of a series of 13 cases of histologically confirmed glomuvenous malformations. In all cases, the ultrasound study revealed moderately delimited superficial dermal and hypodermal pseudonodular structures of mixed echogenicity, with hypoechoic and heterogeneous areas and anechoic, pseudocystic tubular and lacunar zones. Arterial and venous vessels, mainly with a low flow (≤ 15cm/s) were observed in 85% of patients, but no arteriovenous shunts were present. Deeper structures were not affected and no phleboliths were detected. The clinical and ultrasound findings could facilitate diagnosis, surgical planning, and noninvasive follow-up in these tumors.

Menores quemados por el sol y su relación con la radiación ultravioleta y la cubierta de ozono, durante seis veranos (1996 a 2001) en Santiago de Chile (33, 5 degrees S) / Association between sunburn in children and ultraviolet radiation and ozone layer, during six summers (1996-2001) in Santiago, Chile (33,5 degrees S)

BACKGROUND: During the recent 10 years the ozone layer has decreased while ultraviolet radiation has increased in Santiago, Chile. AIM: To determine whether the number of sunburns in children correlate with ultraviolet radiation in Santiago. SUBJECTS AND METHODS: During six Austral Summers (1996-2001) children below 15 years old, consulting for sunburn, were evaluated at the"Corporation for the Aid of Burned Children (COANIQUEM) in Santiago (33.5 degrees S). The number of children with sunburns during each Summer was compared with the corresponding UV-B radiation and the ozone thickness, to establish a probable relation between a geophysical change and its consequences in skin health. The ozone layer values were obtained from the NASA WEB-page and the ultraviolet radiation was measured with a four-channel medium resolution radiometer. RESULTS: In each Summer there was a predominance of sunburns among boys and among ages between 6 and 10 years. During the 96-97 Austral Summer, the highest number of children with sunburns (63) was diagnosed. That Summer also had the highest mean UV-305 nm radiation with an important amount of days with ozone < or = 260 Dobson Units. Only during that Summer an inverse correlation between ozone and UV-305 nm radiation was detected. At the same time the maximal values of Erythemal Dose Rate (33 muWatt cm2), UV Index (13) and Erythemal Daily Dose (7.500 Joule m2) were observed. CONCLUSIONS: In Santiago, Summers with a higher number of days with low ozone protection seem to reappear every 3 years. Understanding the interaction of physical processes that control the ozone layer, may help to design better photo-protection programs for human health.

[Pyoderma gangrenosum: report of 11 cases]. / Pioderma gangrenoso: experiencia clínica en 11 pacientes.

BACKGROUND: Pyoderma gangrenosum is an ulcerative disease of the skin of unknown cause and generally associated to systemic illnesses. It requires an aggressive systemic therapy and there is little information about its long term evolution. AIM: To report the clinical features of patients with pyoderma gangrenosum. PATIENTS AND METHODS: Eleven patients (10 female) aged 27 to 81 years old with pyoderma gangrenosum are reported. All had a pathological study. Patients were followed up for a mean of 60 months. RESULTS: The lesions were located in the lower limbs in 8 patients. Pathological study showed neutrophyl infiltrates in nine patients. Three patients had inflammatory bowel disease [corrected]. During the follow up, the disease recurred in multiple occasions, in six patients, after treatment with steroids or sulphones, and one patient has had permanently active lesions. CONCLUSIONS: Pyoderma gangrenosum appears mostly in the lower limbs and has a high recurrence rate.