Un caso de neumonía organizada tras la ruptura intracapsular de implantes mamarios de silicona / A case of organized pneumonia after intracapsular rupture of silicone breast implants

La neumonía organizada es una entidad poco frecuente, caracterizada por la formación de conglomerados fibroblásticos intraalveolares conocidos como cuerpos de Masson, que puede ser criptogénica o secundaria a una respuesta inmunitaria a diversos estímulos, tales como enfermedades hematológicas, autoinmunitarias, exposición a sustancias químicas, fármacos, tóxicos, etc. Detectada y tratada de forma precoz, suele tener una buena respuesta a la corticoterapia, aunque si se diagnostica de forma tardía, la afectación pulmonar puede ser extensa, y, además, si el estímulo antigénico persiste, la respuesta al tratamiento será incompleta. Presentamos el caso clínico de una paciente de 65 años de edad quien hace 18 meses aproximadamente presentó la rotura intracapsular de sus implantes mamarios, 27 años después de su colocación. Con el mismo tiempo de evolución ha desarrollado progresivamente disnea, tos seca y dolor inframamario, habiendo llegado al diagnóstico de neumonía organizada bilateral difusa, asociada a dicha rotura de implantes.

Organizing pneumonia is a rare entity, characterized by the formation of intraalveolar fibroblastic conglomerates known as Masson bodies, which may be cryptogenic or secondary to an immune response to various stimuli, such as hematological, autoimmune diseases, exposure to chemical substances, drugs, toxics, etc. If it is detected and treated early, it usually has a good response to corticosteroid therapy, although if it is diagnosed late, the lung involvement can be extensive, and furthermore, if the antigenic stimulus persists, the response to treatment will be incomplete. We present the clinical case of a 65-year-old patient who had intracapsular rupture of her breast implants approximately 18 months ago, 27 years after their placement. With the same evolution time, she progressively developed dyspnea, dry cough and under mammary pain, having reached the diagnosis of diffuse bilateral organizing pneumonia, associated with implant rupture.

Effect of tolerance induction to immunodominant T-cell epitopes of Sendai virus on gene expression following repeat administration to lung.

Sendai virus (SeV) is able to transfect airway epithelial cells efficiently in vivo. However, as with other viral vectors, repeated administration leads to reduced gene expression. We have investigated the impact of inducing immunological tolerance to immunodominant T-cell epitopes on gene expression following repeated administration. Immunodominant CD4 and CD8 T-cell peptide epitopes of SeV were administered to C57BL/6 mice intranasally 10 days before the first virus administration with transmission-incompetent F-protein-deleted DeltaF/SeV-GFP. At 21 days after the first virus administration, mice were again transfected with DeltaF/SeV. To avoid interference of anti-GFP antibodies, the second transfection was carried out with DeltaF/SeV-lacZ. At 2 days after the final transfection lung beta-galactosidase expression, T-cell proliferation and antibody responses were measured. A state of 'split tolerance' was achieved with reduced T-cell proliferation, but no impact on antiviral antibody production. There was no enhancement of expression on repeat administration; instead, T-cell tolerance was, paradoxically, associated with a more profound extinction of viral expression. Multiple immune mechanisms operate to eradicate viruses from the lung, and these findings indicate that impeding the adaptive T-cell response to the immunodominant viral epitope is not sufficient to prevent the process.

Complementary and alternative medicine use in children.

OBJECTIVE: Adults frequently use complementary and alternative medicines (CAM). Few studies have reported how often CAM therapies are used to treat children. The purpose of this study is to describe the use of alternative therapies by children visiting an emergency department (ED) and to identify sociodemographic factors that may influence the decision to use such therapies. DESIGN: Survey of families using a self-administered questionnaire. SETTING: An urban, tertiary care pediatric emergency department. PARTICIPANTS: Convenience sample of families presenting to the ED for acute care. MAIN OUTCOME MEASURE: Use of CAM therapies to treat children. Secondary measures include the type of therapies used, types of medical problems the therapies were used for, reasons for using such therapies, use of such therapies by the child's caretakers, and sociodemographic characteristics of the children and families. RESULTS: A review of 525 completed surveys identified 63 caretakers (12%) who acknowledged that they had used at least one form of CAM therapy to treat any of their children. Homeopathic and naturopathic remedies were the most common therapies used. Parents most often used CAM therapies to treat respiratory problems in their children and were most influenced by word-of-mouth. Children who were treated with CAM therapies were more likely to have a caretaker who used such therapies. Twelve (40%) of 30 families who reported using either an herbal or homeopathic remedy, also used a prescription or over-the-counter medication at the same time to treat their child. Thirty-nine of 55 families (70.9%) reported informing their child's physician of their use of CAM therapies. CONCLUSION: CAM therapies are frequently used to treat children. Most parents who use CAM therapies to treat their children use such therapies themselves. Large proportions of children who are taking herbal supplements are also taking prescription or over-the-counter medications concurrently.

[Application of electron microscopy and immunohistochemistry to the study of malignant tumors: a review of their diagnostic importance]. / Aplicación de la microscopía electrónica y de la inmunohistoquímica a1 estudio de los tumores malignos: una revisión de su importancia diagnóstica.

The results of examining in the course of the past twenty years a considerable number of malignant tumors with transmission electron microscopy and immunohistochemistry are discussed. The neoplasms were divided into epithelial tumors, tumors of fusiform cells, malignant round cell tumors and tumors of endocrine nature. The main ultrastructural findings and the results of immunohistochemical studies were pointed out regarding their contributory role in the diagnosis as well as for the prognosis and treatment of patients with cancer.

Protein quality of enteral nutrition products is consistent with label claims during shelf life and beyond expiration date.

OBJECTIVE: Eternal formulas were monitored during their shelf life and beyond expiration date to examine protein quality. DESIGN: Protein quality was determined by protein efficiency ratio (PER) bioassays and amino acid analyses. SETTING: A certified laboratory performed the PER tests according to procedures established by the Association of Official Analytical Chemists and recognized by the US Food and Drug Administration (FDA). The amino acid analyses were performed in our laboratory using validated methods. SAMPLES: Commercially available formulas (Ensure, Osmolite HN, TwoCal HN) that contained protein blends of caseinates or caseinates with soybean protein isolate were studied. MAIN OUTCOME MEASURES: Achievement of protein-quality values greater than or equal to 70% of the fresh reference casein value as determined by the PER method would be consistent with adequate protein quality as described by the FDA. Levels of indispensable amino acids that meet or exceed the standards established by the National Research Council of the National Academy of Sciences are considered high-quality proteins. Levels of amino acids throughout shelf life were compared with published label claims. RESULTS: Amino acid analyses, which included measurement of tryptophan and total sulfur amino acids, revealed that both fresh and outdated products met or exceeded standards for proteins of high biologic value and were consistent with label claims. The PER values ranged from 90% to 96% of the control diet for fresh product and 82% to 87% for products evaluated after expiration. CONCLUSION: The enteral products studied provide high-quality protein throughout the shelf life of the product.

Self-regulation of food intake among rural Mexican preschool children.

Access to food and the amount consumed were investigated within a group of 45 children aged 33 to 60 months, among whom growth stunting was common. Children were observed throughout 1 day; all foods offered and consumed were weighed, and food-related behaviors noted. Children ate frequently, at least 2 meals and an average of 7.4 +/- 2.6 snacks daily. Children had access to 2029 +/- 575 kcal (8493 +/- 2407 kJ) yet only consumed 1528 +/- 343 kcal (6396 +/- 1436 kJ) daily; thus food availability was not restricting intake. A higher proportion of snacks than meals (85 per cent vs. 71 per cent) was consumed. Children requested foods frequently (x = 9.2 +/- 4.3) and 76 per cent of requests were fulfilled. Neither amount of accessible food nor amount consumed differed by age, gender, or socioeconomic status. The importance of the child's role in determining food intake, and of snacking to overall food consumption, was demonstrated.

The relationship of eating frequency and caloric density to energy intake among rural Mexican preschool children.

The energy intake of children in a population characterized by chronic malnutrition was measured in order to examine the effects of eating frequency and caloric density. Forty-five children aged 33-60 months were each observed continuously throughout one day. Food intake was determined by weighing and all aspects of food-related behavior were recorded. The children ate on average 13.5 +/- 4 times each day. Children who ate more frequently had significantly higher energy intake than children who ate fewer than 13 times [1655 vs. 1395 kcal (6928 vs. 5839 kJ)], and the excess was consumed during snacks. The caloric density of all foods consumed averaged 121 kcal (507 kJ) per 100 g. While children served meals of low caloric density [less than 100 kcal (419 kJ) per 100 g] consumed less energy at meals than did other children [709 vs. 900 kcal (2968 vs. 3767 kJ)], they consumed more energy from snacks [917 vs. 617 kcal (3839 vs. 2583 kJ]. Thus, total energy intake did not differ significantly between children served meals of lower vs. higher caloric density.

Alteraciones iniciales inducidas en los vasos placentarios de la rata por el virus de la encefalitis equina venezolana. / Initial changes induced in placental vessels of rats by Venezuelan equine encephalitis virus

Los virus de la rubeola y de la EEV pertenecen ambos a la familia Togaviridae. Las alteraciones iniciales en los vasos placentarios durante la infeccion con el virus de la EEV fueron examinados por metodos virologicos, histologicos e inmunohistoquimicos. Se vieron celulas citotrofoblasticas que reemplazan a las celulas endoteliales y mostraban signos de inflamacion y evidencia inmunohistoquimica de antigenos del virus de la EEV en ellas y en las celulas deciduales perivasculares.La comparacion de los hallazgos virologicos y morfologicos en la infeccion placentaria con el virus de la EEV en la rata y el mecanismo patogenetico propuesto para explicar el dano intrauterino inducido en los seres humanos por el virus de la rubeola, demuestra grandes similitudes. Se propone una cuidadosa evaluacion del papel del virus de la EEV como causa de malformaciones congenitas en las areas endemicas de esta infeccion en Venezuela