Autopsy findings from the first known death from Severe Acute Respiratory Syndrome SARS-CoV-2 in Spain / Autopsia clínica en Síndrome Respiratorio Agudo Severo por SARS-CoV-2. Primer fallecido conocido en España

The new coronavirus SARS-CoV-2, first identified in Wuhan, China in December, 2019, can cause Severe Acute Respiratory Syndrome (SARS) with massive alveolar damage and progressive respiratory failure. We present the relevant autopsy findings of the first patient known to have died from COVID19 pneumonia in Spain, carried out on the 14th of February, 2020, in our hospital (Hospital Arnau de Vilanova-Lliria, Valencia). Histological examination revealed changes typical of diffuse alveolar damage (DAD) in both the exudative and proliferative phase of acute lung injury. Intra-alveolar multinucleated giant cells, smudge cells and vascular thrombosis were present. The diagnosis was confirmed by reverse real-time PCR assay on a throat swab sample taken during the patient's admission. The positive result was reported fifteen days subsequent to autopsy

El nuevo coronavirus SARS-CoV-2, identificado inicialmente en China en diciembre de 2019 puede cursar con un Síndrome Respiratorio Agudo Severo (SARS) con daño alveolar masivo y fracaso respiratorio progresivo. Presentamos los hallazgos más relevantes encontrados en la autopsia clínica efectuada en nuestro hospital (Hospital Arnau de Vilanova-Lliria de Valencia) a fecha de 14 de febrero de 2020, al primer paciente fallecido conocido en España por neumonía COVID-19. A nivel pulmonar, la autopsia revela cambios típicos de daño alveolar difuso (DAD) en fase exudativa y fase proliferativa. Se observan células multinucleadas gigantes, células tipo smudge intraalveolares y trombosis vasculares. El diagnóstico microbiológico confirmativo mediante PCR se realizó 15 días después de la autopsia sobre la muestra faríngea del enfermo tomada durante su ingreso

Autopsy findings from the first known death from Severe Acute Respiratory Syndrome SARS-CoV-2 in Spain.

The new coronavirus SARS-CoV-2, first identified in Wuhan, China in December, 2019, can cause Severe Acute Respiratory Syndrome (SARS) with massive alveolar damage and progressive respiratory failure. We present the relevant autopsy findings of the first patient known to have died from COVID19 pneumonia in Spain, carried out on the 14th of February, 2020, in our hospital (Hospital Arnau de Vilanova-Lliria, Valencia). Histological examination revealed typical changes of diffuse alveolar damage (DAD) in both the exudative and proliferative phase of acute lung injury. Intra-alveolar multinucleated giant cells, smudge cells and vascular thrombosis were present. The diagnosis was confirmed by reverse real-time PCR assay on a throat swab sample taken during the patient's admission. The positive result was reported fifteen days subsequent to autopsy.

Pelvic actinomycosis mimicking pelvic malignancy / Actinomicose pélvica simulando neoplasia maligna pélvica

Abstract Asymptomatic female genital tract colonization with Actinomyces spp is not uncommon, particularly among intrauterine device users. Pelvic actinomycosis is an extremely rare disease. The clinical picture can resemble an advanced ovarian malignancy. We report a case of pelvic actinomycosis mimicking ovarian malignancy diagnosed postoperatively. Preoperative diagnosis is possible if there is a high index of suspicion, obviating extensive surgery and preserving fertility, since long term antibiotic treatment can be completely effective. Pelvic actinomycosis should be included in the differential diagnosis of women presenting a pelvic mass, especially if there is intrauterine device use history.

Resumo A colonização assintomática do aparelho genital feminino por Actinomyces spp não é infrequente, sobretudo em utilizadoras de dispositivo intra-uterino. A actinomicose pélvica é uma doença extremamente rara. O quadro clínico pode assemelhar-se ao de uma neoplasia maligna do ovário avançada. Relatamos um caso de actinomicose pélvica, simulando uma neoplasia maligna do ovário, com diagnóstico pós-operatório. O diagnóstico pré-operatório é possível se houver um elevado grau de suspeição, permitindo evitar cirurgias extensas e preservar a fertilidade, uma vez que o tratamento antibiótico prolongado pode ser totalmente eficaz. A actinomicose pélvica deve ser incluída no diagnóstico diferencial da mulher que apresente uma massa pélvica, sobretudo se houver história de uso de dispositivo intra-uterino.

Pelvic Actinomycosis Mimicking Pelvic Malignancy.

Asymptomatic female genital tract colonization with Actinomyces spp is not uncommon, particularly among intrauterine device users. Pelvic actinomycosis is an extremely rare disease. The clinical picture can resemble an advanced ovarian malignancy. We report a case of pelvic actinomycosis mimicking ovarian malignancy diagnosed postoperatively. Preoperative diagnosis is possible if there is a high index of suspicion, obviating extensive surgery and preserving fertility, since long term antibiotic treatment can be completely effective. Pelvic actinomycosis should be included in the differential diagnosis of women presenting a pelvic mass, especially if there is intrauterine device use history.

A colonização assintomática do aparelho genital feminino por Actinomyces spp não é infrequente, sobretudo em utilizadoras de dispositivo intra-uterino. A actinomicose pélvica é uma doença extremamente rara. O quadro clínico pode assemelhar-se ao de uma neoplasia maligna do ovário avançada. Relatamos um caso de actinomicose pélvica, simulando uma neoplasia maligna do ovário, com diagnóstico pós-operatório. O diagnóstico pré-operatório é possível se houver um elevado grau de suspeição, permitindo evitar cirurgias extensas e preservar a fertilidade, uma vez que o tratamento antibiótico prolongado pode ser totalmente eficaz. A actinomicose pélvica deve ser incluída no diagnóstico diferencial da mulher que apresente uma massa pélvica, sobretudo se houver história de uso de dispositivo intra-uterino.

Metastatic Breast Cancer in Uterine Cervix: A Rare Presentation.

Uterine cervix involvement by a distant primary tumor is a rare event. We report the following 2 cases of breast tumor metastasis to the uterine cervix with different presentations: case 1 is an isolated cervix metastasis and case 2 is a disseminated metastatic disease with cervix involvement. In both, clinical examination raised the suspicion of cervical tumor, which was confirmed to be a metastatic adenocarcinoma.The poor outcome and lack of symptoms suggest that although its rareness, all patients with breast cancer should undergo a careful routine gynecologic examination.

Supramesocolic access to the left renal pedicle: anatomical and surgical description.

OBJECTIVE: To expose and remind the supamesocolic approach to the left renal pedicle, in addition to review its main indications. METHODS/RESULTS: We perform a detailed description of the surgical technique showing its indications, the position, the incision and retraction systems employed, detailing the steps followed during dissection. CONCLUSIONS: Adequate vascular control and complete resection of large renal and adrenal masses require an adequate exposition; the knowledge of surgical techniques such as supramesocolic approach to the left renal pedicle is very useful and may ease the course of retroperitoneal operations avoiding complications and giving comfort in a frequently difficult operation.

Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma expresses follicular T-cell markers.

Cutaneous CD4 small/medium-sized pleomorphic T-cell lymphoma (CSTCL) is a cutaneous T-cell lymphoma defined by a predominance of small-to-medium-sized CD4 pleomorphic T cells, with a favorable clinical course. Cases are also characterized by the presence of a rich infiltrate of reactive B cells. Recently, it has been reported that follicular helper T cells (TFH cells) display a distinct gene expression profile, positive for PD-1, CXCL13, and BCL-6. We report for the first time the expression of PD-1 and other TFH cell markers in CSTCLs and discuss its biologic significance. Sixteen CSTCLs were included in this study, and also 20 reactive inflammatory conditions, 10 primary cutaneous marginal zone, 10 follicular center lymphomas, and 5 primary CD30 cutaneous lymphomas. They were immunohistochemically analyzed for a large panel of markers. Double immunoperoxidase labeling of paraffin sections was performed for PD-1, OCT-2, and BCL-6. Clonal Ig and T-cell receptor rearrangements and Epstein-Barr virus-encoded RNA expression were also evaluated. Morphologic and clinical data were reviewed. Histologic examination showed a dense polymorphic lymphoid infiltrate throughout the dermis. Atypical large CD4 cells were positive for PD-1, CXCL13, and BCL-6 in all cases, and were attached in small clusters, or formed rosettes around CD30/OCT-2+ B blast cells. Epstein-Barr virus was not apparent in any of the cases. A dominant T-cell clone was identified in 14 cases, whereas polymerase chain reaction IgH gene rearrangement studies showed that all cases were polyclonal. None of the patients had lymphadenopathy or showed any evidence of systemic disease, nor did they have any previous history of mycosis fungoides or drug reactions. FTH cell markers are not exclusive to angioimmunoblastic lymphadenopathy but may also be seen in neoplastic cells of CSTCLs. Moreover, these findings suggest that B-cell stimulation by FTH could also take place in some cutaneous T-cell lymphomas.

[Factor XI deficiency]. / Deficiência de factor XI.

Factor XI deficiency is a rare bleeding disorder in general population, sometimes it can only become clinically evident when patients develop abnormal bleeding after elective surgery. The authors report a clinical case of a 59 year-old woman who after 10 days of vaginal hysterectomy with McCall, anterior and posterior plasties, presented with severe vaginal bleeding. They point out the importance of the pre-operatory blood tests evaluation, mainly investigation of hemostasis/coagulation tests, and describe the management and treatment of the factor XI deficiency.

Treatment of medical databases and their graphical representation on the internet.

The use of new information technologies could facilitate enormously work to process and spread knowledge from medical data and, in particular, epidemiological data from cancer registries. Cancer registries are official institutions that collect information on the occurrence and outcome of cancer in defined population groups (city, region, or country). The aim of the present project was to design and develop a graphical web system to offer clear information about medical information, in this case cancer incidence, using Internet technology. A protocol and a system to process, manipulate, and represent medical data, epidemiological cancer data, from the Epidemiology Unit and Cancer Registry of the Balearic Islands, has been developed. All the steps to change the data format to obtain a medical data graphical representation database have been described. The result of the project is an application built in graphical web format that can be accessed at the following URL: http://gmein.uib.es/registro/resultados/resultados2.htm

Vasculitis por leptospirosis. Presentación de un caso / Vasculitis by leptospirosis. Presentation of a case

Se presenta el caso de un paciente con síndrome vasculítico por hipersensibilidad consecutivo a una leptospirosis del serogrupo pomona la cual es la que con mayor frecuencia produce vasculitis. Se destaca la clínica, los medios diagnósticos y características de nuestro paciente, al mismo tiempo que hacemos una breve revisión sobre el síndrome vasculítivo con sus fundamentales características (AU)

The case of a patient is presented with vasculitic syndrome by serial hipersensibility after suffering leptospirosis of the serogroup pomona which is the one that produces vasculitis with more frequency. Clinic, diagnostic means and characteristics of our patient are stated, at the same time we make a brief review on the vasculitic syndrome with their fundamental characteristics (AU)

Cribado del carcinoma de cérvix en el sistema sanitario público de la Comunidad Valenciana. Límites del test de Papanicolau / Cervical cancer screening in public health system in Valencia Community and Pap test limits

Antecedentes: La infección por HPV es la enfermedadde transmisión sexual más frecuente, condición necesariapara el desarrollo del carcinoma de cérvix y causa mayor demuerte por tumor en mujeres de países latino - americanos.En nuestro entorno no representa un problema de saludpública, siendo España uno de los países con menor mortalidadpor esta causa de la Comunidad Europea.El abordaje clásico basado en el Pap se cuestiona en laactualidad. El acceso a este recurso es irregular y en generalsin programas de cribado organizados. La baja cobertura ylos límites de reproductibilidad del método, agravado por lasdeficiencias en los laboratorios de anatomía patológica, puedeincidir negativamente en la eficiencia de este abordaje.Métodos y resultados: Hemos estudiado la cobertura enlos hospitales públicos de la Comunidad Valenciana (CV)(14,4 % de la población); revisado 56 casos de carcinoma epidermoideinfiltrante/adenocarcinoma de cérvix infiltrantesdiagnosticados en el decenio 1992-2001, en el área sanitaria5, analizando para estas neoplasias infiltrantes: la cobertura:(13,3%); falsos negativos: (25,3%); sensibilidad del Pap:(72,3%) y concordancia inter-observador: (66,6%).Conclusiones: Los límites del Pap, el cambio de papelsocio-sexual de la mujer española, las nuevas tecnologías(test de DNA del HPV) y los ensayos de las primeras vacunasprofilácticas obligan a un debate profundo de las estrategiasfuturas en nuestro sistema de salud y a reubicar elcampo y utilidad de la citología (Pap)

Introduction: Cervical carcinoma is the most frequentsexual transmission disease and also the most importantcause of death in women by tumours in Latin-Americancountries. In Spain it is not a serious public health problem,because cervical cancer mortality is the lowest in the Europeancommunity. The classical approach based on massscreening by Pap method is now questioned. The accessibilityto this resource is more irregular because in our countrythere are few organised mass screening programs. Coverageis very low and the reproducibility limits are not satisfactorybecause of defficiencies in the laboratories quality controlsystems.Material and methods: The present study was made inthe State Hospitals of Valencia Community (CV). A reviewof 56 cases of infiltrating squamous cell carcinoma and adenocarcinomaalong the last ten years was performed.Results and conclusions: The population coverage ratefor cervical infiltrating carcinoma in this period was only13.3 %. False negative rate was 25.3%. Sensitivity, 72.3%and inter-observer concordance, 66.6%.The Pap test screening limitations, the changes in sociosexualbehaviour of Spanish women in the last twenty years,the development of new technologies (DNA-HPV Test) andthe prophylactic vaccine assays induce to stablish a debateabout the adoption of future strategies in the Public HealthService System screening procedures and about cervicalcytology and Pap test roles