Traumatismos periféricos atendidos en el Servicio de Urgencias Pediátricas. Estudio descriptivo.

INTRODUCTION: Peripheral trauma is a very frequent cause of consultation in paediatric emergency departments but few studies have been published describing the characteristics of these patients. MATERIAL AND METHODS: We performed a retrospective descriptive study by reviewing computerised emergency department forms during January and February 2020. OBJECTIVE: To describe the characteristics of traumatic injuries in our area and to detect possible areas for improvement. RESULTS: A total of 714 peripheral trauma cases were attended, which represents 9.5% of the total consultations. A total of 52.7% were schoolchildren (6-11 years). The most frequent locations were the ankle (27.5%) and fingers (17.2%). Fracture was detected in 6.7% of cases. Radiographs were requested in 78.6% of the patients, with pathological findings in 9.6% of them. Half of the X-rays were requested due to ankle or finger trauma. Referral to traumatology was made in 16.4% of patients, mainly for elbow and knee trauma, and the most commonly used treatment was general measures (49%) and bandaging (29.4%). CONCLUSIONS: Peripheral trauma is very common and, in general, banal. A large number of X-rays are requested with a very low yield, so it seems necessary to establish new protocols to reduce the number of requests. Improving training in elbow and knee trauma could improve paediatricians' autonomy in dealing with these more complex injuries.

Comparative response to PDT with methyl-aminolevulinate and temoporfin in cutaneous and oral squamous cell carcinoma cells.

Cutaneous and Head and Neck squamous cell carcinoma (CSCC, HNSCC) are among the most prevalent cancers. Both types of cancer can be treated with photodynamic therapy (PDT) by using the photosensitizer Temoporfin in HNSCC and the prodrug methyl-aminolevulinate (MAL) in CSCC. However, PDT is not always effective. Therefore, it is mandatory to correctly approach the therapy according to the characteristics of the tumour cells. For this reason, we have used cell lines of CSCC (A431 and SCC13) and HNSCC (HN5 and SCC9). The results obtained indicated that the better response to MAL-PDT was related to its localization in the plasma membrane (A431 and HN5 cells). However, with Temoporfin all cell lines showed lysosome localization, even the most sensitive ones (HN5). The expression of mesenchymal markers and migratory capacity was greater in HNSCC lines compared to CSCC, but no correlation with PDT response was observed. The translocation to the nucleus of ß-catenin and GSK3ß and the activation of NF-κß is related to the poor response to PDT in the HNSCC lines. Therefore, we propose that intracellular localization of GSK3ß could be a good marker of response to PDT in HNSCC. Although the molecular mechanism of response to PDT needs further elucidation, this work shows that the most MAL-resistant line of CSCC is more sensitive to Temoporfin.

Peripheral trauma treated in the pediatric emergency department: Descriptive study. / Traumatismos periféricos atendidos en el Servicio de Urgencias Pediátricas. Estudio descriptivo.

INTRODUCTION: Peripheral trauma is a very frequent cause of consultation in paediatric emergency departments but few studies have been published describing the characteristics of these patients. MATERIAL AND METHODS: We performed a retrospective descriptive study by reviewing computerised emergency department forms during January and February 2020. OBJECTIVE: To describe the characteristics of traumatic injuries in our area and to detect possible areas for improvement. RESULTS: A total of 714 peripheral trauma cases were attended, which represents 9.5% of the total consultations. A total of 52.7% were schoolchildren (6-11 years). The most frequent locations were the ankle (27.5%) and fingers (17.2%). Fracture was detected in 6.7% of cases. Radiographs were requested in 78.6% of the patients, with pathological findings in 9.6% of them. Half of the X-rays were requested due to ankle or finger trauma. Referral to traumatology was made in 16.4% of patients, mainly for elbow and knee trauma, and the most commonly used treatment was general measures (49%) and bandaging (29.4%). CONCLUSIONS: Peripheral trauma is very common and, in general, banal. A large number of X-rays are requested with a very low yield, so it seems necessary to establish new protocols to reduce the number of requests. Improving training in elbow and knee trauma could improve paediatricians' autonomy in dealing with these more complex injuries.

Sticholysin II shows similar immunostimulatory properties to LLO stimulating dendritic cells and MHC-I restricted T cell responses of heterologous antigen.

Induction of CD8+ T cell responses against tumor cells and intracellular pathogens is an important goal of modern vaccinology. One approach of translational interest is the use of liposomes encapsulating pore-forming proteins (PFPs), such as Listeriolysin O (LLO), which has shown efficacy at priming strong and sustained CD8+ T cell responses. Recently, we have demonstrated that Sticholysin II (StII), a PFP from the sea anemone Stichodactyla helianthus, co-encapsulated into liposomes with ovalbumin (OVA) was able to stimulate, antigen presenting cells, antigen-specific CD8+ T cells and anti-tumor activity in mice. In the present study, we aimed to compare StII and LLO in terms of their abilities to stimulate dendritic cells and to induce major histocompatibility complex (MHC) class I restricted T cell responses against OVA. Interestingly, StII exhibited similar abilities to LLO in vitro of inducing dendritic cells maturation, as measured by increased expression of CD40, CD80, CD86 and MHC-class II molecules, and of stimulating OVA cross-presentation to a CD8+ T cell line. Remarkably, using an ex vivo Enzyme-Linked ImmunoSpot Assay (ELISPOT) to monitor gamma interferon (INF-γ) producing effector memory CD8+ T cells, liposomal formulations containing either StII or LLO induced comparable frequencies of OVA-specific INF-γ producing CD8+ T cells in mice that were sustained in time. However, StII-containing liposomes stimulated antigen-specific memory CD8+ T cells with a higher potential to secrete IFN-γ than liposomes encapsulating LLO. This StII immunostimulatory property further supports its use for the rational design of T cell vaccines against cancers and intracellular pathogens. In summary, this study indicates that StII has immunostimulatory properties similar to LLO, despite being evolutionarily distant PFPs.

Evaluation of a novel multiplex RT-qPCR assay for the quantification of leukemia-associated BCR-ABL1 translocation.

Although monitoring of BCR-ABL1 translocation has become an established practice in the management of chronic myeloid leukemia (CML), the detection limit of the BCR-ABL1 transcripts needs more standardization. The aim of the present study was to evaluate the clinical performances of a novel assay for the quantification of BCR-ABL1 fusion transcripts (e13a2 and e14a2) and ABL1 in a single reaction. This assay is based on the real-time reverse transcription polymerase chain reaction (RT-qPCR) in multiplex format. In a retrospective comparative clinical study performed in a reference laboratory, RNA was extracted from 48 CML patient blood samples with various BCR-ABL1/ABL1 ratios and RT-qPCR was performed using either MAScIR assay or the RT-qPCR simplex reference assay used in routine clinical testing. The comparative clinical results showed high qualitative and quantitative concordance (correlation coefficient >0.95) between MAScIR and the reference assays. The present study illustrates the utility of MAScIR assay as a sensitive, rapid, and cost-effective quantitative device to monitor the BCR-ABL1 ratios by RT-qPCR on whole blood of diagnosed Philadelphia chromosome-positive (Ph+) leukemia patients. This test could be used as an aid in the assessment of molecular response to available treatments.

Lung metastases in oligometastatic patients: outcome with stereotactic body radiation therapy (SBRT)

Purpose. To assess the clinical results in terms of local control, toxicity, failure pattern and toxicity of SBRT in oligometastatic patients with inoperable lung metastases. Methods. Forty-four patients were treated (53 metastases). Dose regimen: 5 × 12 Gy (66 %), 8 × 7.5 Gy (20.8 %) and 10 × 5 Gy (13.2 %). Response was assessed using PET/CT at 6 months after SBRT. Results. Local control at 1 and 2 years was 86.7 %. Seventy-five percent of local failures had received a BED <105 Gy. After a median follow-up of 13.3 months, 25 % experienced distant progression. Overall survival at 1 and 2 years was 86.7 and 60.4 %, and cancer-specific survival was 95.3 and 75.2 %, respectively. Grade 2 toxicity was 6.8 %. There was no grade 3–4 toxicity. Conclusion. SBRT is effective and safe. The main failure pattern is distant progression. The selection of patients with a high probability of remaining oligometastatic is crucial for the efficiency of SBRT, both clinically and in terms of resources (AU)

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Lung metastases in oligometastatic patients: outcome with stereotactic body radiation therapy (SBRT).

PURPOSE: To assess the clinical results in terms of local control, toxicity, failure pattern and toxicity of SBRT in oligometastatic patients with inoperable lung metastases. METHODS: Forty-four patients were treated (53 metastases). Dose regimen: 5 × 12 Gy (66 %), 8 × 7.5 Gy (20.8 %) and 10 × 5 Gy (13.2 %). Response was assessed using PET/CT at 6 months after SBRT. RESULTS: Local control at 1 and 2 years was 86.7 %. Seventy-five percent of local failures had received a BED <105 Gy. After a median follow-up of 13.3 months, 25 % experienced distant progression. Overall survival at 1 and 2 years was 86.7 and 60.4 %, and cancer-specific survival was 95.3 and 75.2 %, respectively. Grade 2 toxicity was 6.8 %. There was no grade 3-4 toxicity. CONCLUSION: SBRT is effective and safe. The main failure pattern is distant progression. The selection of patients with a high probability of remaining oligometastatic is crucial for the efficiency of SBRT, both clinically and in terms of resources.

Radiotherapy in rectal cancer: development, adequacy and radiotherapy utilisation rate. A comparative analysis with the most frequent tumour sites

INTRODUCTION: Radiotherapy is a basic weapon in the local treatment of multiple solid tumors. The radiotherapy activity has been evaluated in our centre during the past eleven years. The study focused on rectal cancer. MATERIALS AND METHODS: This is a descriptive study of all radiotherapy procedures performed between January 1998 and December 2008. It quantifies the workload of each pathology treated, the rate of irradiation and its adequacy with optimal rates of irradiation according to the best available scientific evidence. RESULTS: We quantified 9,622 external radiotherapy procedures of which 6,009 were associated with the five pathologies that involved the highest workloads. Of these, 905 were performed in rectal cancer. The workloads due to cancers of the breast, prostate, lung, gynaecological pathologies and rectal cancers were 23.2%, 11.8%, 11.6%, 6.3% and 9.3% respectively. The real "radiotherapy utilisation rates" of these pathologies were 62%, 20.2%, 34.3%, 21% and 64% respectively, while the "rates of adequacy" were 74.7%, 33.6%, 45.1%, 60% and 104.8%. CONCLUSIONS: The "radiotherapy utilisation rate" for rectal cancer was equivalent to the estimated optimum rate as defined on the basis of reference groups. The therapy utilised developed chronologically in parallel with the available scientific evidence. The radiotherapy utilisation rates for breast and prostate cancer gradually increased, with a tendency to reach optimal rates. Radiotherapy as a treatment for lung cancer was underutilised. In global terms, the rate of utilisation of radiation therapy was low, although it displayed a tendency to increase (AU)

Kinetics of antibodies in sera, saliva, and urine samples from adult patients with primary or secondary dengue 3 virus infections.

OBJECTIVES: The kinetics of three serological markers (IgM, IgA, and IgG) in serum, saliva, and urine samples from adult patients with primary or secondary dengue infection were studied. DESIGN: Serum, saliva, and urine samples were collected from 22 patients with clinical and confirmed dengue 3 virus infection during the outbreak in Havana City in 2001. They were tested by capture IgM (MAC-ELISA), IgA (AAC-ELISA), and IgE (EAC-ELISA) and IgG ELISA inhibition method (EIM) to detect specific dengue antibodies. RESULTS: Similar kinetics were observed in IgM, IgA, and IgG antibodies in saliva and IgA and IgG in urine samples from secondary cases compared with kinetics in serum samples, although the values were lower. No IgG antibody was detected in saliva and urine samples in primary cases and IgM antibody was not detected in urine samples from either primary or secondary infection. All secondary cases were positive for IgG in saliva and urine samples at day 7. The kinetics of specific IgE antibodies in primary and secondary cases were different. CONCLUSIONS: The kinetics of three serological markers (IgM, IgA, and IgG) in serum, saliva, and urine samples from adult patients with primary or secondary dengue 3 virus infection were studied for the first time, showing its behavior and usefulness in dengue virus diagnosis. The specific IgE could play a role as a serological marker in secondary infections.

Niveles de resistencia a drogas antituberculosas en pacientes con coinfección VIH / tuberculosis, Lima 1998-2001 / Resistance rates to antituberculous drugs in patients co-infected with the human immunodeficiency virus and tuberculosis, Lima 1998-2001

Objetivos: Determinar los niveles de resistencia a drogas antituberculosas de primera línea en muestras clínicas depacientes con coinfección por el virus de la inmunodeficiencia humana y tuberculosis (VIH-TB) en cinco hospitales deLima en el periodo 1998-2000. Materiales y métodos: Estudio descriptivo que incluyó las muestras de cultivos deMycobacterium tuberculosis de pacientes con coinfección VIH-TB, a los que se realizó las pruebas de sensibilidad porel método de las proporciones para isoniacida (H), estreptomicina (S), etambutol (E) y rifampicina (R), y el método deWayne para pirazinamida (H). Resultados: De 523 muestras de pacientes incluidos, 78,2 por ciento correspondieron a varones,72,7 por ciento fueron de pacientes sin antecedentes de tratamiento previo. Los valores de resistencia global primaria ymultidrogorresistencia (MDR) primaria fueron 55,8 por ciento y 32,1 por ciento, respectivamente; en tanto que los valores de resistenciaglobal adquirida y MDR adquirida fueron 93,0 por ciento y 74,8 por ciento. La resistencia primaria por drogas fue H (42,1 por ciento), R (35,0 por ciento),S (35,3 por ciento), E (19,0 por ciento) y Z (24,5 por ciento) respectivamente; y la resistencia adquirida por drogas fueron H (85,3 por ciento), R (78,3 por ciento),S (64,4 por ciento), E (42,0 por ciento) y Z (46,2 por ciento). Conclusión: Los niveles resistencia a drogas antituberculosas y la MDR en pacientescon coinfección VIH-TB provenientes de hospitales de Lima son elevados

Objective: To determine resistance rates to first-line antituberculous drugs in clinical samples from patients co-infected with the human immunodeficiency virus (HIV) and M. tuberculosis (TB) in five hospitals in Lima between 1998–2000. Materials and methods: A descriptive study including samples sent for culturing Mycobacterium tuberculosis in patients co-infected with HIV-TB. Susceptibility tests for isoniazid (H), streptomycin (S), ethambutol (E), and rifampin (R) were performed using the proportion method and Wayne’s method for pyrazinamide (Z). Results: Out of 523 samples, 78,2% were from male patients, and 72,7% were from naive patients. Overall primary resistance and multidrug-resistance (MDR) rates were 55,8% and 32,1%, respectively; and overall acquired resistance and MDR rates were 93,0% and 74,8%, respectively. Primary resistance rates were: H, 42,1%; R, 35,0%; S, 35,3%; E, 19.0%, and Z, 24,5%, respectively; and acquired resistance rates were: h, 85,3%; R, 78,3%; S, 64,4%; E, 42,0%; and Z, 46,2%. Conclusion: There are high resistance rates to antituberculous drugs and MDR TB in patients co-infected with HIV and TB in Lima hospitals.

Hiperendemicidad de hepatitis viral B y delta en pueblos indígenas de la Amazonía Peruana / Hyperendemicity of viral hepatitis B and delta in indigenous populations in te Peruvian Amazon jungle

Objetivos: Determinar la prevalencia de marcadores serológicos de hepatitis viral B y delta en pueblos indígenas de laAmazonía, así como su distribución en las diferentes cuencas y cuales son los factores de riesgo asociados. Materialesy métodos: Se realizó un estudio transversal en 870 pobladores de 37 comunidades nativas distribuidas en 12 cuencasde la Amazonía peruana. Se obtuvieron datos epidemiológicos en relación a hepatitis viral B y delta y una muestrade sangre venosa para determinar la presencia de HBsAg, HBeAg, anticuerpos totales anti-HBcAg, IgM Anti-HBcAg,Anti-HBeAg y anti delta usando la técnica de ELISA. Resultados: La edad promedio fue de 22,7 años (1-94 a), 50,7 por ciento(441/870) fueron varones. Se determinó infección previa por HVB en 519 (59,7 por ciento) e infección reciente en 16 (1,8 por ciento). Seencontraron 82 portadores de HBsAg (9,4 por ciento) de estos 18 (21,9 por ciento) tenían HBeAg positivo, y 15 (83,3 por ciento) eran varones.44,2 por ciento de los menores de diez años tenían antecedente de infección. 39 por ciento(32/82) de los portadores de HBsAg teníainfección por HVD. Fue mayor la prevalencia de HVB en nativos (64,3 por ciento) que en mestizos (50,6 por ciento); así como en lascuencas de la selva norte (73 por ciento) que en las de centro y sur (42 por ciento). La infección por HVB se encontró asociada con elconsumo de masato (OR: 4,9; IC95 por ciento: 3,4-7,4) y al antecedente de mordedura por murciélago (OR: 1,7; IC95 por ciento: 1,2-2,4).No se encontró diferencias significativas con relación al sexo. Conclusiones: La población indígena y mestiza de lasdiferentes cuencas de la Amazonía peruana es hiperendémica para la infección por hepatitis viral B y delta

Objective: To determine the prevalence of serological markers for viral hepatitis B and delta in indigenous communities in the Peruvian Amazon jungle, as well as their distribution in the different river basins and what are the associated risk factors. Materials and methods: A cross-sectional study was performed in 837 inhabitants from 37 native communities distributed alongside 12 river basins in the Peruvian Amazon jungle. Epidemiological data were obtained with respect to the presence of viral hepatitis B and delta, and a venous blood sample was taken in order to determine HBsAg, HBeAg, total anti-HBcAg anti-HBcAg IgM, and anti-delta antibodies using an ELISA technique. Results: Average age in the studied population was 22,7 years (range 1–94 years), and 50,/% were male. Previous infection caused by hepatitis B virus was determined in 519 (59,7%) subjects, and a recent infection was detected in 16 (1,8%) subjects. 82 HBsAg carriers were found (9,4%); of them, 18 (21,9%) were positive for HBeAg, and 15 (3,3%) were male. 44,2% of subjects less than ten years old had past history of infection. 39% (32/82) of HBsAg carriers had also hepatitis delta virus infection. The prevalence of HBV was higher in natives (64,3) compared to that in mestizos (50,6%); as well in northern jungle river basins (73%) compared to findings in central and southern areas (42%). HBV infection was associated with masato (liquor made of yucca) use (OR: 4,9; 95% CI: 3,4 – 7,4) and with history of being bitten by bats (OR: 1,7; 95% IC: 1,2 – 2,4). There were no significant differences with respect to sex distribution. Conclusions: Viral hepatitis B and delta is hyperendemic in indigenous and mestizo populations in different river basins in Peruvian Amazon jungle.

Dengue en el Perú: Aportes para su diagnóstico y control / Dengue in Peru: contributions for its diagnosis and control

El dengue es la arbovirosis más importante en salud pública; reingresó al Perú en 1990 y se encuentra presente en la Amazonía y costa norte, incluyendo, recientemente a Lima. En este artículo se abordan aspectos sobre la historia, fisiopatología, entomología, vigilancia y control, enfatizando en los aportes del Instituto Nacional de Salud (INS), para el control del dengue en el Perú, entidad que ha cumplido un papel importante en el esfuerzo por controlar al dengue, a través de investigaciones e incorporando progresivamente en la Red Nacional de Laboratorios, técnicas de diagnóstico desde el ELISA para la detección de anticuerpos, el aislamiento viral y últimamente el RT-PCR y la genotipificación, así también en el área entomológica, para la verificación de la presencia del Aedes aegypti, su susceptibilidad a los insecticidas y nuevas técnicas para este propósito

Equipamiento y perspectivas de futuro de la Radioterapia Oncológica. Situación española / Equipment and Outlook for Radiotherapy Oncology. The situation in Spain

Durante la última década la radioterapia ha presentado un desarrollo tecnológico y radiobiológico exponencial. La aplicación clínica del avance en conocimientos biológicos es todavía escasa pero se augura un gran potencial de mejora en resultados terapéuticos. La evolución tecnológica está consiguiendo optimizar la distribución de la dosis en los volúmenes irradiados y conseguir tratamientos menos tóxicos. Hasta la fecha se desconoce la exacta repercusión del mejor control local tumoral sobre la supervivencia de la enfermedad. El nivel de desarrollo tecnológico español era escaso en 1999. La dotación actual es sin duda superior en parte fruto de la evidente infradotación explicita en el inventario practicado por la Asociación Española de Radioterapia y Oncología en los años 1999-2000 y cuyos datos se resumen (AU)

The authors of this paper describe the advances Radiotherapy has brought to this country over the last decade. They discuss the technological developments which are allowing radiation volume dosing to be optimized, leading to less toxic treatment (AU)

Breast cancer screening: another point of view.

The breast cancer screening programmes (BCSP) are very controversial at the present time. They are evaluated by different socio-economic sectors, each with its own particular point of view. Large numbers of breast cancer cases are concentrated in the Oncology Services, which are, therefore, sensitive to the changes that these programmes could bring about. All patients attending the medical oncology and radiotherapy services of the Reina Sofia University Hospital, Cordoba from January 1994 until January 2003 were reviewed. Of 1785 patients, 829 went to these services after the start of the BCSP introduced in March 1999 and 956 before it. The variables analysed were age, presentation form, stage and treatment received. In conclusion, the BCSP has produced favourable changes with respect to stage (increasing the percentage of early breast cancer) and therapeutic management (increasing conservative surgery and decreasing the number of adjuvant treatments (radiotherapy and chemotherapy)). These changes are more outstanding in the population group covered by the BCSP.

Hipertermia durante el fenómeno de El Niño, 1997-98 / Hyperthermia during El Niño phenomenon, 1997-98

Objetivo: Describir el cuadro clínico y la evaluación de los casos de síndrome febril presentados durante el fenómenos de El Niño de 1997-98, y presentar una revisión de la fisiopatología del cuadro de hipertermia. Material y métodos: Se realizó un estudio descriptivo longitudinal en la ciudad de Chimbote, Ancash. Se definió como caso de síndrome febril: niños menosre de 5 años con fiebre refractaria al uso de antipiréticos sin foco aparente de infección al examen físico y con examen de laboratorio negativo. Resultados: Fueron estudiados 25 casos (68 por ciento varones, 80 por ciento con edades entre 5 y 18 meses) con un tiempo de enfermedad promedio de 15,17 (13,52) días ± desviación standar (±DS). La mediana de la temperatura fue 38,8 grados centígrados con un promedio de 38,84 grados centígrados (rango 38-40 grados centígrados). 68 por ciento tuvo un tiempo de enfermedad mayor de 15 días; 52 por ciento había visitado al menos una vez un centro médico anterior; 68 por ciento recibió antibióticos y antipiréticos; y, 52 por ciento ingresó al hospital por emergencia. Todos los casos presentaron alza térmica, asociado a piel seca (72 por ciento), diarrea (64 por ciento), tos (52 por ciento), baja de peso (52 por ciento), irritabilidad (44 por ciento),náuseas o vómitos (40 por ciento), rinorrea (24 por ciento) y convulsiones (20 por ciento). El tiempo de hospitalización promedio fue 4,7 días y el estado febril promedio fue 2,5 días. Ninguno tuvo examen de laboratorio compatible con causa infecciosa. Conclusiones: En situaciones ambientales adversas debe considerarse al calor ambiental como un factor importante en el desarrollo de la hipertermia, con el propósito de brindar un manejo más apropiado a los afectados en el menor tiempo posible

Experiencia en traumatismo torácico: Hospital Valparaíso / Experience in thoracic traumatism: Valparaiso Hospital

Las lesiones del tórax son el resultado de trauma cerrado o abierto, que generalmente ocurren como consecuencia de lesiones por arma de fuego, arma blanca, accidentes de tránsito o compresiones torácicas por aplastamientos, entre otros. Se revisaron 163 fichas clínicas del Servicio de Cirugía Torácica del Hospital de Valparaíso entre enero de 1998 y junio de 2001. Se confeccionó un protocolo con datos a obtener de la ficha. Se analizaron los datos en valores absolutos y porcentajes. Posteriormente se efectuó una comparación de algunas variables entre el grupo de trauma abierto y el de cerrado. El 94,5 por ciento (154 pactes) correspondió a hombres y 5,5 por ciento (9 pactes) a mujeres. El promedio de edad fue de 30,9 años (rango 16-86). El mecanismo de trauma más frecuente fueron lesiones por armas blancas, (125 casos), seguido de caídas de altura (19 casos), accidentes de tránsito (9 casos), y armas de fuego (6 casos). Ciento veintiséis pacientes presentaron traumatismo abierto y 37 cerrado. Las lesiones más frecuentes fueron: neumotórax, 116 casos; hemotórax, 92 casos; y fracturas costales, 28 casos. El 87,1 por ciento de los traumatismos se manejó con tubo pleural (142 pactes). Sólo 11 pacientes necesitaron toracotomía de urgencia.

Quiste de Baker simulando una tromboflebitis aguda y trombosis venosa profunda en urgencias / Baker's cyst presenting as an acute thrombophlebitis and deep venous thrombosis at Emergency Department

Introducción: El quiste de Baker (QB) o quiste poplíteo es una masa de tejido blando en la cara posterior de la rodilla que se llena de un líquido gelatinoso; a veces puede simular un síndrome equiparable a una tromboflebitis aguda (TFA) y trombosis venosa profunda (TVP).Objetivos: Conocer la incidencia del QB en el diagnóstico diferencial de la TFA y TVP. Analizar las distintas estrategias de tratamiento. Método: Revisamos los 19 pacientes que fueron diagnosticados de QB, en el periodo de 3 años, en nuestra unidad de urgencias y en los que el diagnóstico inicial fue TFA o TVP. Resultados: Se diagnosticaron 19 QB mediante eco doppler. El 80 por ciento (15 pacientes) eran varones con edad media de 59 años (DT 6,3). Trece pacientes (68 por ciento) referían episodios diagnosticados de flebitis profundas tratadas en Atención Primaria. Los seis restantes (32 por ciento) no presentaban antecedentes de patología vascular en miembros inferiores. Todos presentaban signos de TFA y TVP con maniobra de Homans positiva. Los pulsos distales eran normales en 12 (64 por ciento) y en 7 (36 por ciento) levemente disminuidos. El Dímero D fue positivo en 4 casos (21 por ciento). La eco doppler mostró en 8 casos (42 por ciento) rotura del QB, en 5 (26 por ciento) compresión de la vena safena por el QB y en 6 (32 por ciento) inflamación del QB. El 90 por ciento de los pacientes fue tratado con antiinflamatorios no esteroideos (AINEs) y reposo y el 10 por ciento fue intervenido quirúrgicamente (2 casos de rotura de QB). Los pacientes con pulsos levemente disminuidos correspondían a los casos de rotura de QB. Conclusiones: El QB puede simular una TFA y TVP (rotura QB o compresión de la vena safena interna). Es más frecuente en varones de unos 59 años y con antecedentes sugestivos de flebitis de repetición. El diagnóstico clínico es muy complicado, necesitando una eco doppler para el diagnóstico de certeza. El tratamiento se realiza mediante AINEs habituales y reposo (AU)

Ameloblastomas maxilares: a propósito de un caso clínico y revisiónde la literatura / Maxillary ameloblastoma: about a clinical case and review of the literature

- Propósito: se revisan los datos epidemiológicos, clínicos, anatomopatológicos y los procedimientos diagnósticos y terapéuticos de los ameloblastomas maxilares.- Material y métodos: se presenta un caso de ameloblastoma de maxilar superior en una mujer de 36 años.- Resultados: se realizó tratamiento con radioterapia postoperatoria tras cirugía radical, dado que se trataba de una lesión extensa en una paciente joven. Tras un seguimiento de 5 años y medio la paciente se encuentra libre de enfermedad.- Conclusiones: se describe el comportamiento de este tumor así como su tratamiento (AU)

Intracerebral regulation of immune responses.

Major progress has been made over the last years in our understanding of the mechanisms underlying immune privilege and immune surveillance of the central nervous system (CNS). Once considered a passive process relying only on physical barriers, immune privilege is now viewed as a more complex phenomenon, which involves active regulation of immune reactivity by the CNS microenvironment. Evidence has also emerged that the immune system continuously and effectively patrols the CNS and that dysregulated immune responses against CNS-associated (exogenous or self) antigens are involved in the pathogenesis of various neurological diseases. In this article we shall briefly review current knowledge of how the immune response is regulated locally in the CNS and which cell types and molecular mechanisms are involved in shaping intracerebral immune responses.

Intracerebral recruitment and maturation of dendritic cells in the onset and progression of experimental autoimmune encephalomyelitis.

Dendritic cells (DCs) are thought to be key elements in the initiation and maintenance of autoimmune diseases. In this study, we sought evidence that DCs recruited to the central nervous system (CNS), a site that is primarily devoid of resident DCs, play a role in the effector phase and propagation of the immune response in experimental autoimmune encephalomyelitis (EAE). After immunization of SJL mice with proteolipid protein 139-151 peptide, process-bearing cells expressing the DC markers DEC-205 and CD11c appeared early in the spinal cord. During acute, chronic, and relapsing EAE, DEC-205(+) DCs expressing a lymphostimulatory phenotype (including the mature DC marker MIDC-8, major histocompatibility complex class II, CD40, and CD86 molecules) accumulated within the CNS inflammatory cell infiltrates. More prominent infiltration of the spinal cord parenchyma by mature DCs was observed in mice with relapsing disease. Macrophage inflammatory protein 3alpha, a chemokine active on DCs and lymphocytes, and its receptor CCR6 were up-regulated in the CNS during EAE. These findings suggest that intracerebral recruitment and maturation of DCs may be crucial in the local stimulation and maintenance of autoreactive immune responses, and that therapeutic strategies aimed at manipulating DC migration could be useful in the treatment of CNS autoimmune disorders.