Hidatidosis muscular primaria: reporte de un caso / Primary muscular hydatidosis: a case report

Se presenta el caso de una mujer saludable de 28 años con un tumor en la pierna dependiente de tejidos blandos, no tiene antecedentes epidemiológicos de viajes fuera de Lima Metropolitana, sin compromiso pulmonar, hepático osistémico y con serología negativa para Equinococcus granulossus antes, durante y después de la extirpación de la lesión. En una primera oportunidad se realiza la extracción del tumor y no se sospecha de hidatidosis por lo que no sele dio el manejo adecuado, 16 semanas después regresa por recidiva, donde con un diagnóstico específico se realizala intervención quirúrgica y el tratamiento con albendazol, seis meses de seguimiento después, la paciente no presentó recidiva.

It presents a case of a healthy woman of 28 years with a tumor in his leg attached to soft tissue, she doesn't have epidemiological history of travel outside Lima, without pulmonary, hepatic or systemic disease and with negative serology for Equinococcus granulosus before, during and after the surgical excision. In a first opportunity, they removed tumor and they didn't suspect of hydatidosis so they didn't give a proper treatment, so 16 weeks after, she came back with a relapse, where with a specific diagnosis was performed the surgery and treatment with albendazole, followed up after six months, the patient didn't have recurrence.

Variation in the prevalence of gastric cancer in Perú.

Most cases of gastric cancers occur in non-industrialized countries but there is scarce information about the epidemiology of this illness in these countries. Our study examined whether there was a variation in the prevalence of gastric cancer in Lima, Perú over the last 2 decades. Subjects older than 29 years of age were included. They underwent an esophagogastroduedonoscopy at 3 socioeconomically different health facilities in Lima: a county hospital (7,168 subjects), a Peruvian-Japanese Clinic (14,794 individuals) and a private hospital (4,893 individuals). Birth cohort prevalence of gastric cancer was used. Regression models were calculated to predict the future prevalence of gastric cancer. It was found that the birth cohort prevalence of gastric cancer decreased in Perú from 22.7 to 2% (p < 0.001), from 12 to 0.5% (p < 0.001), and from 6.5 to 0.1% (p < 0.001) in the low, middle and high socioeconomic group, respectively. The prevalence of intestinal metaplasia decreased from 44.3 to 12.5% (p < 0.001), from 28.4 to 5% (p < 0.001), and from 19.4 to 2.2% (p < 0.001) in the low, middle and high socioeconomic status, respectively. These trends will likely persist over the future decades. Nevertheless, the prevalence of gastric cancer remains high in subjects older than 59 years of age in the low socioeconomic status. It is concluded that the prevalence of gastric cancer is decreasing in Perú, similar to the current trend undergoing in industrialized nations. However, there are still specific groups with high prevalence that might benefit from screening for early detection and treatment.

Classic Kaposi's sarcoma presenting in the oral cavity of two HIV-negative Quechua patients.

Traditionally, classic KS lesions have a general distribution, often involving the skin of the feet and legs, and to a lesser extent, that of the hands, arms, and trunk. Oral involvement is a rare manifestation. Initial oral involvement is an even rarer occurrence. We report two unusual cases of classic KS presenting in the oral cavity of two patients from indigenous origin; the first patient with primary oral KS lesion on the hard palate, with no other signs of the condition in any other region of the body; the second patient with generalized dermal KS lesions with lymph node and lower lip involvement. In conclusion, clinicians and pathologists should be aware of the typical clinical, gross, and histologic features of KS. Moreover, we would like to emphasize that oral KS may affect patients without AIDS or exposure to immunosuppression. The awareness of oral classic KS as a diagnostic possibility is important in the work-up of vascular lesions in the oral cavity of non-immunosuppressed individuals.

Classic Kaposi’s sarcoma presenting in the oral cavity of two HIV-negative Quechua patients

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Traditionally, classic KS lesions have a general distribution, often involving the skin of the feet and legs, and to a lesser extent, that of the hands, arms, and trunk. Oral involvement is a rare manifestation. Initial oral involvement is an even rarer occurrence. We report two unusual cases of classic KS presenting in the oral cavity of two patients from indigenous origin; the first patient with primary oral KS lesion on the hard palate, with no other signs of the condition in any other region of the body; the second patient with generalized dermal KS lesions with lymph node and lower lip involvement. In conclusion, clinicians and pathologists should be aware of the typical clinical, gross, and histologic features of KS. Moreover, we would like to emphasize that oral KS may affect patients without AIDS or exposure to immunosuppression. The awareness of oral classic KS as a diagnostic possibility is important in the work-up of vascular lesions in the oral cavity of non-immunosuppressed individuals

Human herpesvirus-8 in Peruvian blood donors: a population with hyperendemic disease?

Serum samples from 128 blood donors were tested for antibodies specific for human herpesvirus-8 by an immunofluorescence assay that detects antibodies against mainly lytic antigens. An overall seroprevalence of 56.25% was found (male donors, 54.68%; female donors, 57.11%). These findings indicate that human herpesvirus-8 infection is hyperendemic in Peruvian blood donors.

[Clostridium difficile and cytomegalovirus involved in a case of pseudomembranous colitis]. / Clostridium difficile y citomegalovirus relacionados a un caso de colitis pseudomembranosa.

We report an unusual case of pseudomembranous colitis with fatal outcome where C. difficile and cytomegalovirus coexistense in a Peruvian patient with AIDS and gastrointestinal compromise by a mycobacterium.

Clinical evaluation of a 16S ribosomal RNA polymerase chain reaction test for the diagnosis of lymph node tuberculosis.

UNLABELLED: Reports on the sensitivity of polymerase chain reaction (PCR) for the diagnosis of lymph node tuberculosis (TB) show divergent results. We evaluated the accuracy of the Roche Amplicor Mycobacterium tuberculosis PCR test with lymph node aspirate and biopsy samples. METHODS: The study was conducted at a public reference hospital in Lima, Peru. From the period of January 2003 to January 2004, we included patients who had lymphadenopathy and in whom the attending physician suspected TB. Aspirate and biopsy samples were submitted for culturing in Lowenstein-Jensen medium, for histopathologic testing, and for PCR. The sensitivity and specificity of PCR were calculated against a reference standard based on histopathologic findings and culture. RESULTS: Our study included 154 patients. Median age was 29 years (interquartile range, 21-40 years); 97 patients (62.9%) were men. Twenty-nine patients (18.8%) had acid fast bacilli-positive histopathologic findings, and 44 (28.6%) had a positive culture result. Using the combination of histopathologic findings and culture as reference standard, 55 patients (35.7%) had a diagnosis of tuberculous lymphadenitis. The sensitivity of the PCR test was 58.2%, and the specificity was 93.9%. For biopsy tissue only, the sensitivity of PCR was 52.7%, and the specificity was 97.0%. For aspirate samples only, the sensitivity of PCR was 47.3%, and the specificity was 96.0%. CONCLUSION: The Amplicor PCR test revealed low sensitivity and high specificity for the diagnosis of lymph node TB. The sensitivity was higher in cases in which the bacillary load was high--in acid fast bacilli-positive samples and among HIV-infected patients. Considering the results of microbiological and PCR tests together, there was still a patient group in whom no final diagnosis could be established.

Characteristics of Castleman's disease in Peru.

BACKGROUND: Castleman's disease (CD) is a very rare disorder of unknown etiology that is characterized by masses of lymphoid tissue. METHODS: The records of all patients with a histological diagnosis of CD who were seen at the Hospital Nacional Cayetano Heredia and the Instituto Nacional de Enfermedades Neoplásicas between 1985 and 2003 and 1985 and 2001, respectively, were reviewed. RESULTS: The study included 10 patients. The age of onset ranged from 5 to 65 years. Nine patients met the criteria for localized CD; six of them were asymptomatic. The most common sites of presentation were the cervical lymph nodes (n=5), submaxilar lymph nodes (n=2), parotid gland (n=1), and lung (n=1). Eight patients had histological evidence of the hyaline-vascular variant and one had the plasma-cell variant. The primary treatment was complete surgical resection. One patient met the criteria for multicentric CD; he was asymptomatic, had histological evidence of the plasma-cell variant, and was treated with combination chemotherapy. All ten patients are currently alive with no evidence of recurrence. CONCLUSION: The localized form of CD presents as progressive, painless, slow-growing lymph node enlargement that is generally asymptomatic. The locations most commonly involved in the localized form are the cervical lymph nodes, followed by the submaxillary lymph nodes, where it poses a diagnostic challenge to the clinician because it tends to mimic other head and neck diseases. Localized CD is almost always of the hyaline-vascular variant and complete surgical excision of the tumor allows full recovery in all cases.

[Classic Kaposi Sarcoma in jejunum: case report]. / Sarcoma de Kaposi clásico en yeyuno: reporte de caso.

Classic Kaposi Sarcoma (KS) may affect mucosa, especially oral cavity and any part of the gastrointestinal tract. It has been reported in 10% of patients with classic KS. We report a 35-year old male patient with primary classic KS in jejunum that presented with bowel obstruction. Primary presentation of classic KS in the gastrointestinal tract is very infrequent. There have only been 9 cases of primary KS in colon reported in literature, and none in jejunum. This is the first primary classic KS in jejunum described in our country. Likewise, we recommend that certain patients with classic KS should have an upper gastrointestinal endoscopy to determine compromise. The few gastrointestinal KS reported cases may be due to subdiagnosis.

[Desmoid tumor: report of a case]. / Tumor desmoide: reporte de un caso.

The desmoid tumor is a solid tumor with soft parts and with various possible locations. It is not very frequent and of unknown presentation in our medium. We presented the case of a patient who was treated of extrinsic duodenal obstruction. A compression of the third section of the duodenum was found. The diagnosis was made by pathological anatomy.

Epidemiological and clinical characteristics of classic Kaposi's sarcoma in Peru.

BACKGROUND: Classic Kaposi sarcoma (KS) occurs predominantly among the elderly, with predominance among Jews, Italians, and Greeks. Classic KS has been seen relatively frequently in Peru. OBJECTIVE: Our purpose was to outline the epidemiological and clinical profile of classic KS in Peru. METHODS: Epidemiological and clinical features of all classic KS cases diagnosed between 1969 and 2003 at Hospital Nacional Cayetano Heredia (HNCH) and between 1946 and 2004 at Instituto Nacional de Enfermedades Neoplasicas (INEN) were reviewed and studied retrospectively. RESULTS: An overall incidence of 2.54 per 10,000 attended patients was obtained at the INEN during the 48-year period (mean, 2.39; standard deviation: 1.99; 95% confidence interval, 2.92-1.86). Twenty-one cases were discovered at HNCH and 106 cases at INEN. A male/female ratio of 2.62:1 was found. Mean age at diagnosis was 68.5 years. Lower limbs were involved in 109 patients (85.8%); the trunk was involved in 11 patients (8.6%). Nodules were the most common type of lesion (85.8%); less commonly found were plaques (27.5%), macules (12.5%), papules (12.5%), and ulcers (8.6%). Sixty-two patients had no symptoms (48.8%). Pain was the most common symptom (26.7%), followed by edema (21.2%), bleeding (14.9%), and pruritus (3.9%). A second primary malignancy was found in 11 patients (8.6%). LIMITATIONS: These results were obtained from patients with classic KS in Peru and may not be applicable to other populations. CONCLUSION: Classic KS is quite common in Peru with sporadic cases found throughout the country and some clustering in the coastal region. Classic KS in Peru has a clinical presentation that is very similar, but not identical, to the classic KS described in the Mediterranean region, exhibiting some special clinical and epidemiological characteristics with a nodular, nonsymmetric presentation that usually affects the lower extremities.

Cáncer hepático en area endémica de hepatitis B y delta B: a propósito de 19 casos / Liver cancer in hyperendemic area of B and delta hepatitis: report of 19 cases

Se realiza el estudio en forma prospectiva de 19 pacientes con diagnóstico de cáncer hepático, hospitalizados en los Servicios de Medicina del Hospital Regional del Ministerio de Salud (MINSA) del Cusco. El estudio se hizo entre Agosto de 1992 y Agosto de 1995. En cada paciente se llenó una ficha clínico epidemiológica, se extrajo suero para determinación de Antígeno de Superficie del virus de la hepatitis B (Ag- HBs) y Anticuerpo del virus de la hepatitis Delta (Anti-Delta), así como transaminasas, bilirrubinas, fosfatasa alcalina. Se logró un diagnóstico histopatológico en 14 pacientes por biopsia hepática, en el resto fue clínico y/o de laboratorio por estar contraindicada la biopsia. Los resultados fueron los siguientes: el 92.9 por ciento fueron hepatocarcinoma, y esta neoplasia fue más frecuente en pacientes de sexo masculino entre los 20 y 39 años de edad. Los factores de riesgo más importantes encontrados fueron: la infección por virus de la hepatitis B y Delta, y el alcohol (66.7 por ciento de Ag HBs positivo, 41.6 por ciento de Anti-Delta positivo, abuso de alcohol presente en el 68.5 por ciento). Se concluye que el cáncer hepático más frecuentemente encontrado en el Hospital Regional del Cusco es el Hepatocarcinoma y los factores de riesgo asociados encontrados son la infección por virus B y Delta, así como el abuso de alcohol.

This is a prospective study that includes 19 hospitalized patients with hepatic cancer at the Medicine Department of the Regional Hospital in Cusco (Perú), between August 1992 to August 1995. Epidemiological and clinical information was obtained from all patients. Serum samples were taken for HBsAg, anti-Delta, and liver tests. Histological diagnosis was done in 14 patients by liver biopsy by the Menghinrs method, in the others this was done by clinical ahd laboratorial means because the biopsy was contraindicated. 92.9 per cent were hepatocarcinoma, and this, neoplasm was more frequently in men, between20 to 39 years old. The risk factors were infections by hepatitis B virus and delta virus: 66.7 per cent had HBsAg positive and 41.6 per cent Anti-Delta positive. Excessive alcohol consumption was present in 68.5 per cent. We concluded that the most frequently cancer of the liver seen was hepatocarcinoma and the risk factors that are associated were previous infection of B and Delta virusand alcohol.

[LIVER CANCER IN HYPERENDEMIC AREA OF B AND DELTAHEPATITIS: REPORT OF 19 CASES] / Cáncer Hepático en AreaEndémica de Hepatitis B y Delta B: A propósito de 19 casos.

This is a prospective study that includes 19 hospitalized patients with hepatic cancer at the Medicine Department of the Regional Hospital in Cuzco (Perú), between August 1992 to August 1995. Epidemiological and clinical information was obtained from all patients. Serum samples were taken for HBsAg, anti-Delta, and liver tests. Histological diagnosis was done in 14 patients by liver biopsy by the Menghini's method, in the others this was done by clinical and laboratorial means because the biopsy was contraindicated.92,9% were hepatocarcinoma, and this neoplasm was more frequently in men, between 20 to 39 years old. The risk factors were infections by hepatitis B virus and delta virus: 66.7% had HBsAg positive and 41,6% Anti-Delta positive. Excessive alcohol consumption was present in 68,5%.We concluded that the most frequently cancer of the liver seen was hepatocarcinoma and the risk factors that are associated were previous infection of B and Delta virus and alcohol.

Compromiso del sistema nervioso central en la enfermedad de Carrión / Involvement of central nervous system of Bartonella infections

Se estudió a 68 pacientes en la fase aguda anemizante de la enfermedad de Carrión. El 50 por ciento (34/68) de pacientes en la fase aguda eran residentes nativos de zonas endémicas. Los signos más importantes en la fase aguda fueron: palidez (97 por ciento), regular a mal estado general (91.2 por ciento), hepatomegalia (82 por ciento), fiebre (79.1 por ciento), regular a mal estado nutricional (75.2 por ciento), soplo sistólico (77.9 por ciento) ictericia (71.6 por ciento) y linfadenomegalia (70.1 por ciento). Otros signos destacados en la evoluciónfueron: edema pretibial (29.4 por ciento), mialgias (22 por ciento) y derrame pericárdico (16.4 por ciento). Los signos neurológicos más importantes fueron: somnolencia (26.4 por ciento), fondo de ojo anormal (14.7 por ciento), signo de babinski bilateral (13.2 por ciento), convulsiones (10.2 por ciento), coma (8.8 por ciento), irratibilidad (6 por ciento) y delirio (4.4 por ciento). Un 36.7 por ciento (25/68) de los pacientes en fase aguda presentó alguna complicación infecciosa, predominando la bacteriana con 8 casos (salmonella no tífica, Shigella dysenteriae, Enterobacter sp o Staphilococus aureus); le siguió en forma importante la complicación parasitaria con 5 casos de probable reactivación de toxoplasmosis y un caso con Pneumocytis carinni (primera vez descrito). Además hubo un caso con histoplasmosis diseminada (primera vez descrito). Un 8.8 por ciento (6/68) de los pacientes agudos fallecieron, todos fueron mayores de 14 años; los factores clínicos asociados en forma estadísticamente significativa a la letalidad fueron: delirio, coma, anasarca y dificultad respiratoria. El líquido cefaloraquídeo (LCR) reveló un leve incremento de la pleocitosis, a predominio linfomononuclear; la glucosa estuvo dentro de valores normales y las proteínas levemente incrementadas; en un paciente con compromiso neurológico, se aisló Bartonella baciliformis del LCR. Los pacientes con delirio, síndrome cerebeloso, coma y síndrome convulsivo tuvieron mayores porcentajes de letalidad; en cambio, de los pacientes afectados con somnolencia, fondo de ojo anormal y hemiparesia, ninguno falleció. Merece destacar que tres pacientes en coma tratados con corticoides no fallecieron.

Nódulo tiroideo frío. Caracteristicas clínicas y anatomopatológicas en pacientes migrantes de zonas con deficiencia de Yodo y de la Costa / Cold thyroid nodule. Clinical and anatomopathological characteristics in migrant patient fron iodine deficiency areas and from the Coast

Se han estudiado retrospectivamente 237 pacientes con nodulo tiroideo frio (NTF), 133 inmigrantes de zonas con deficiencia de yodo (ZDY) y 104 de la costa (donde no hay deficiencia de yodo), de un total de 1468 pacientes con patologia tiroidea, atendidos. El NTF representó el 50.5 por ciento del total de bocios nodulares en la costa y 29.8 por ciento en ZDY (p igual a 3x10`7). La edad promedio de los ZDY fue mayor 46.2 mas menos 13.4 años versus 35.5 mas menos 14.4 (p igual que 0.0001). El 4.6 por ciento de los nódulos fueron quisticos sin diferencia en ambos grupos. El 2,5 por ciento tenian Enfermedad de Graves concomitante, 3.8 por ciento en ZDY y 0.9 por ciento en la costa (p igual 0.23). Fueron operados 112 pacientes, 57 de la costa y 55 de ZDY. Se encontró cáncer en 25 por ciento de ZDY y 32 por ciento de la costa (p igual que 0.69), siendo el papilar el cáncer mas frecuente en ambos grupos. Las lesiones benignas más frecuentes fueron el bocio nodular coloide (46.2 por ciento) y el adenoma folicular (31.2 por ciento), sin diferencia entre ambos grupos estudiados

Patología tiroidea operada: 12 años de experiencia en el Hospital Cayetano Heredia / Thyroid pathology operated: 12 years of experience at the Hospital Cayetano Heredia

Se presenta las características clínicas, técnica operatoria, estudio histopatológico y evolución de 173 pacientes con patología tiroidea operada en el Hospital Nacional Cayetano Heredia entre 1976 y 1987. 52.6 por ciento presentaron bocio nodular, 63.5 por ciento presentaron nódulos fríos y 21.1 por ciento nódulos calientes. Las técnicas operatorias empleadas fueron: lobectomía total más istmectomía (65.8 por ciento), tiroidectomía subtotal bilateral (19 por ciento), lobectomía total más istmectomía más lobectomía parcial contralateral (8 por ciento) y tiroidectomía total (4 por ciento). La biopsia por congelación se realizó en 95 por ciento de los pacientes. Bocio coloide fue el resultaado histopatológico más frecuente (67.6 por ciento). La patología benigna se encontró en 84.6 por ciento y la maligna en 15.4 por ciento. Las complicaciones fueron: lesión unilateral del nervio recurrente (4 por ciento), hematomas sofocantes (2.3 por ciento) e hipoparatiroidismo transitorio (1.7 por ciento). La mortalidad fué de 0.5 por ciento