Melanoma vulvar en una paciente de la tercera edad / Vulvar melanoma in a third age patient

Se describe el caso clínico de una paciente de 62 años de edad, negra, atendida en el Hospital Oncológico Docente Provincial Conrado Benítez García de Santiago de Cuba, por presentar aumento de volumen en el labio menor que comenzó a doler. Se realizó biopsia excisional, cuyo resultado reveló un melanoma vulvar. Se remitió a la consulta de Ginecología oncológica donde se le indicó tratamiento con quimioterapia e inmunoterapia por ser un tumor no operable. Se le administraron 4 ciclos de quimioterapia con buena respuesta y estabilidad. Se continuó su atención en consulta de seguimiento.

The case report of a black-skinned 62 years female patient assisted in Conrado Benítez García Teaching Provincial Oncological Hospital in Santiago de Cuba is described due to an increase of volume in the outer lip that began to hurt. A excisional biopsy was carried out which result revealed a vulvar melanoma. She was referred to the Oncological gynecology service where she was indicated treatment with chemotherapy and immunotherapy for being a non-surgical tumor. Four chemotherapy cycles were administered with good response and stability. Her care continued through follow-up.

Pseudotumor vesical a causa de un dispositivo intrauterino / Vesical pseudotumor due to an intra-uterine device

Se describe el caso clínico de una paciente atendida en el Hospital Oncológico Docente Provincial Conrado Benítez García de Santiago de Cuba por presentar una perforación en la vejiga y desplazamiento de un dispositivo intrauterino hacia la cavidad vesical, lo cual generó la formación de litiasis y, consecuentemente, la aparición de frecuentes infecciones urinarias y dolor en bajo vientre, sin mejoría alguna ante la terapéutica aplicada. Se decidió realizar una cistotomía para extraer la litiasis compacta junto con la T de cobre; la paciente evolucionó favorablemente y los síntomas desaparecieron

The case report of a patient assisted in Conrado Benítez García Teaching Provincial Cancer Hospital in Santiago de Cuba is described, due to a bladder perforation and displacement of an intra-uterine device toward the vesical cavity, which generated the lithiasis formation and, consequently, emergence of frequent urinary infections and pain in lower abdomen, without any improvement with therapy. It was decided to carry out a cystotomy to extract the lithiasis compacted with the copper T; the patient had a favorable clinical course and the symptoms disappeared

Comparison of the clinical efficacy of two different immunosuppressive regimens in patients with chronic vogt-koyanagi-harada disease.

PURPOSE: To prospectively compare 2 immunosupressive regimens in patients with active Vogt-Koyanagi-Harada disease in spite of systemic glucocorticoid treatment. METHODS: Forty-four patients were diagnosed between 1998 and 2005. Twenty-one developed chronic intraocular inflammation in spite of glucocorticoid treatment and were randomized to receive either prednisone and azathioprine (AZA) (n = 12) or prednisone and cyclosporine (CyA) (n = 9). RESULTS: In the AZA group Tyndall score decreased from 1.21 +/- 1.10 to 0.29 +/- 0.62 (p < .01), and visual acuity (LogMAR) improved from 0.32 +/- 0.35 to 0.09 +/- 0.16 (p < .001). In the CyA group Tyndall score decreased from 1.67 +/- 1.08 to 0.16 +/- 0.51 (p < .001), and visual acuity improved from 0.41 +/- 0.40 to 0.25 +/- 0.42 (p < .001). Patients in the AZA group needed a significantly higher average prednisone dose and total cumulative dose than those in the CyA group, p < .01 for each comparison. CONCLUSIONS: Both regimens showed a good clinical efficacy, but CyA seems to be a better glucocorticoid-sparing agent than AZA.

[Retrospective review of 44 Chilean patients with Behçet disease]. / Enfermedad de Behçet en Chile: Análisis clínico de 44 casos.

BACKGROUND: Behçet's disease (BD) is a rare multisystemic inflammatory disease that is potentially disabling and may cause death. AIM: To describe the characteristics of BD patients from two Chilean centers. PATIENTS AND METHOD: Retrospective review of the clinical records of patients with BD attended in two rheumatology services between 1985 and 2007. The "Behçet's Disease Research Committee of Japan" (BDCJ) and the "International Study Group for Behçet's Disease" (ISG) diagnostic criteria were applied. RESULTS: We found 44 cases (25 males), diagnosed as BD. The mean age at the onset of symptoms was 26+/- 12 years. According to BDCJ criteria, 13 patients had complete BD, 24 had incomplete BD and 7 had a suspected BD. Thirty two patients fulfilled the ISG criteria. Forty two patients (95%) had oral ulcers, 33 (75%) had genital ulcers and 29 (66%) had ophthalmological involvement. Eleven and three patients had symptoms of central and peripheral nervous system involvement, respectively. No gender differences were detected. CONCLUSIONS: The clinical characteristics of these patients were similar to those described abroad, except for a higher frequency of peripheral nervous system involvement and a lower rate of arthritis.

Enfermedad de Behçet en Chile: Análisis clínico de 44 casos / Retrospective review of 44: Chilean patients with Behçet disease

Background: Behget's disease (BD) is a rare multisystemic inflammatory disease that is potentially disabling and may cause death. Aim: To describe the characteristics of BD patients from two Chilean centers. Patients and method: Retrospective review of the clinical records of patients with BD attended in two rheumatology services between 1985 and 2007. The "Behget's Disease Research Committee of Japan" (BDCJ) and the "International Study Group for Behget's Disease" (ISG) diagnostic criteria were applied. Results: We found 44 cases (25 males), diagnosed as BD. The mean age at the onset of symptoms was 26± 12 years. According to BDCJ criteria, 13 patients had complete BD, 24 had incomplete BD and 7 had a suspected BD. Thirty two patients fulfilled the ISG criteria. Forty two patients (95 percent) had oral ulcers, 33 (75 percent) had genital ulcers and 29 (66 percent) had ophthalmological involvement. Eleven and three patients had symptoms of central and peripheral nervous system involvement, respectively. No gender differences were detected. Conclusions: The clinical characteristics of these patients were similar to those described abroad, except for a higher frequency of peripheral nervous system involvement and a lower rate of arthritis.

Pronóstico del cáncer cérvico uterino estadios IIB-IIIB tratados con radio quimioterapia: experiencia Hospital Van Buren, Valparaíso, Chile / Prognosis of stage IIB-IIIB cervical cancer treated with radiochemotherapy: experience from the Van Buren Hospital, Valparaíso, Chile

Objetivo: analizar retrospectivamente resultados y factores pronósticos de pacientes con cáncer cérvico uterino estadios IIB-IIIB tratados con radioquimioterapia concomitante.Materiales y métodos: desde septiembre 1999 a diciembre del 2002, 164 pacientes ingresaron con el diagnóstico de cáncer de cérvix, seleccionándose 83 en estadios IIB-IIIB, las que fueron tratadas con radioterapia y cisplatino semanal por cinco semanas.Resultados: el 89,15 por ciento completó cinco ciclos de quimioterapia. La mediana de sobrevida global fue de 41 meses, con una sobrevida global (SG), sobrevida libre de enfermedad (SLE) y sobreviva libre de recurrencia loco-regional (SLRLR) a tres años de 68,8 por ciento, 66,3 por ciento y 83,1 por ciento, respectivamente. Factores pronósticos de sobrevida fueron etapa IIIB, diámetro tumoral clínico ≥ 7 cm, no realización de braquiterapia y enfermedad biparametrial.Conclusiones: el tratamiento con radioterapia y quimioterapia concomitante con cisplatino en pacientes con cáncer cervicouterino estadios IIB-IIIB, es posible de realizar en el Hospital Carlos Van Buren perteneciente al sistema de salud público chileno, con buena tolerancia, resultados y factores pronósticos similares a los de la literatura internacional.

[Role of Azathioprine in steroid resistant non infectious ocular inflammatory diseases]. / Eficacia de la azatioprina en la enfermedad ocular inflamatoria no infecciosa resistente a tratamiento esteroidal sistémico.

BACKGROUND: Topical and systemic steroids are the first line of treatment of non infectious inflammatory ocular disease. Immunosuppresants are reserved as a second line treatment. AIM: To evaluate the role of Azathioprine (AZA) as a coadyuvant immunosuppressive treatment for non infectious ocular inflammatory diseases (OIDs) resistant to systemic steroid therapy in a retrospective, noncomparative interventional case series. PATIENTS AND METHODS: Patients using oral Prednisone due to an active or recurrent OID, without clinical response, and not receiving any other immunosuppressive treatment were studied. A standard protocol of oral Prednisone (0.5 mg/kg/ day) and oral AZA (2-3 mg/kg/day) during one year was used. Ocular and systemic monthly evaluations were done including relapse rate, steroid dosage, inflammatory score and visual acuity. RESULTS: Thirty patients (10 male) aged 18-75 years (mean 44 years) were studied. Three had bilateral anterior uveitis, one had pars planitis, four had diffuse uveitis, eight Vogt-Koyanahi-Harada syndrome, three Behget's disease, three necrotizing scleritis and eight had retinochoroidopathy A complete initial response was observed in 26 patients (87%). The time of response was between 1 to 6 months (mean 2.65 months). Seventeen percent of these had a relapse 6 to 12 months after AZA was started. In 61 %, visual acuity improved. The ocular inflammatory score decreased in 86.5%. Eleven patients had mild controlled side effects that did not require discontinuation of AZA. CONCLUSIONS: Combined systemic steroid and oral AZA therapy is safe and effective in controlling steroid resistant non infectious inflammatory ocular diseases.

Eficacia de la azatioprina en la enfermedad ocular inflamatoria no infecciosa resistente a tratamiento esteroidal sistémico / Role ofAzathioprine in steroid resistant non infectious ocular inflammatory diseases

Background: Topical and systemic steroids are the first line of treatment of non infectious inflammatory ocular disease. Immunosuppresants are reserved as a second line treatment. Aim: To evaluate the role ofAzathioprine (AZA) as a coadyuvant immunosuppressive treatment for non infectious ocular inflammatory diseases (OIDs) resistant to systemic steroid therapy in a retrospective, noncomparative interventional case series. Patients and methods: Patients using oral Prednisone due to an active or recurrent OID, without clinical response, and not receiving any other immunosuppressive treatment were studied. A standard protocol of oral Prednisone (0.5 mg/kg/ day) and oral AZA (2-3 mg/kg/day) during one year was used. Ocular and systemic monthly evaluations were done including relapse rate, steroid dosage, inflammatory score and visual acuity. Results: Thirty patients (10 male) aged 18-75 years (mean 44 years) were studied. Three had bilateral anterior uveitis, one had pars planitis, four had diffuse uveitis, eight Vogt-Koyanahi-Harada syndrome, three Behget's disease, three necrotizing scleritis and eight had retinochoroidopathy A complete initial response was observed in 26 patients (87 percent). The time of response was between 1 to 6 months (mean 2.65 months). Seventeen percent of these had a relapse 6 to 12 months after AZA was started. In 61 percent, visual acuity improved. The ocular inflammatory score decreased in 86.5 percent. Eleven patients had mild controlled side effects that did not require discontinuation of AZA. Conclusions: Combined systemic steroid and oral AZA therapy is safe and effective in controlling steroid resistant non infectious inflammatory ocular diseases.

[Effectiveness of infliximab in patients with Behçet syndrome and severe uveoretinitis. Report of five cases]. / Eficacia del infliximab en pacientes con síndrome de Behçet portadores de úveo-retinitis grave.

The efficacy and safety of repeated administration of infliximab was evaluated in five patients (two men, three women) with Behçet syndrome accompanied by severe uveoretinitis. Ocular and extra ocular inflammation was suppressed in all patients during the observation period without any serious adverse reactions. The results in these patients suggests that TNF-á blockade is effective in patients with severe ocular Behçet syndrome.

Eficacia del infliximab en pacientes con síndrome de Behçet portadores de úveo-retinitis grave / Effectiveness of infliximab in patients with Behçet syndrome and severe uveoretinitis. Report of five cases

The efficacy and safety of repeated administration of infliximab was evaluated in five patients (two men, three women) with Behçet syndrome accompanied by severe uveoretinitis. Ocular and extra ocular inflammation was suppressed in all patients during the observation period without any serious adverse reactions. The results in these patients suggests that TNF-α blockade is effective in patients with severe ocular Behçet syndrome.

Plasma and whole-blood chemokine levels in patients with Behcet's disease.

BACKGROUND: Chemokines are a family of chemoattractants of leukocytes that play a critical role for leukocyte recruitment in various inflammatory diseases. The purpose of this study is to investigate the involvement of chemokines, interleukin-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) in the peripheral blood, with a special reference to disease activities of the patients with Behçet's disease (BD). METHODS: The study population consisted of totally 55 patients with BD who had panuveitis (20 patients with active BD, 35 patients with inactive BD) as well as 19 healthy volunteers as control. Disease activity was defined according to the existence of ocular inflammation. IL-8 and MCP-1 concentration levels in the plasma and whole-blood samples were measured by enzyme-linked immunosorbent assay. Whole-blood samples were obtained by lysing cell membranes of peripheral blood cells. RESULTS: Most of the plasma IL-8 samples were below the detectable limit. Whole-blood IL-8 levels were readily measured. The levels in the patients with active BD were significantly higher than the other two groups. The patients with active and inactive BD showed higher plasma and whole-blood levels of MCP-1 than controls. The plasma and whole-blood MCP-1 levels of the samples collected at the same time showed a linear correlation. CONCLUSION: A close relationship was found to exist between the cell-associated IL-8 and the disease activity, while a persistent role of MCP-1 was observed in BD. Measuring the whole-blood levels of chemokines is useful for monitoring the disease activity.

Estudios sobre el papel del receptor scavenger A, sobre el modelo de uveítis inducido por lipopolisacáridos / Studies of the role of scavenger receptor A, over uveitis model induced by lipopolysacharides

Propósito. Evaluar el papel del receptor scavenger A tipos I y II (SRA) en el modelo de uveítis inducida por lipopolisacárido (LPS). Método. Se indujo uveítis mediante la administración sistémica de LPS, en animales que carecen del gen que codifica SRA (SRA-/-) y en animales que lo tienen en forma normal (SRA +/+). Usando estos animales se realizaron estudios de dosis respuesta y de curso temporal de y de curso temporal de la uveitis, analizando la concentración de proteínas y de la densidad de células inflamatorias en el humor acuoso (HA). Adicionalmente, en un grupo de animales SRA +/+ se inyectó una megadosis de betametasona (1mg/kg), en forma sistémica, 30 minutos antes de la inyección de LPS, y 24 horas después se analizaron la concentración de proteínas y densidad de células en el HA. Por último se realizaron estudios con técnica de inmunohistoquímica, utilizando anticuerpos monoclonales específicos contra SRA, en tejidos hepáticos y oculares de ambos tipos de animales. Resultados. Los animales SRA -/- comparados con SRA +/+ mostraron una dramática reducción de la uveítis inducida por LPS. La dosis supramáxima de LPS resultó ser de 50 ug por animal. Con esta dosis, la concentración de proteínas en el HA de ratones SRA +/+ fue de 10.3 ± 4.88 mg/ml y en SRA -/- fue de 1.81 ±1.14 mg/ml (p< 0.00001). La densidad de células inflamatorias en animales SRA +/+ fue de 300 ± 200/ uL en SRA +/+ y de 81 ± 78/ uL en SRA -/- (p<0.05). La megadosis sistémica de betametasona disminuyó en forma significativa la gravedad de la uveítis en animales SRA +/+ (p<0.05): sin embargo, los valores observados en estos animales no difirieron en forma significativa con los ratones SRA -/-. Los e estudios realizados con inmunohistoquímica, usando un anticuerpo monoclonal específico contra SRA, mostraron un patrón de tinción hepático característico en animales SRA +/+, mientras que en animales SRA -/- no se observó dicha tinción. Por otra parte, lo logró detectar la presencia de SRA en células oculares de SRA +/+ y no de ratones SRA -/-. Conclusiones. Los animales SRA -/- mostraron una capacidad muy significativa para atenuar la gravedad de la uveítis de este modelo. Ésta es la primera que muestra los efectos intraoculares de SRA. Se necesitan mayores estudios para aclarar los mecanismos que participan en la modulación de la uveítis por parte de SRA.

Uveítis experimental por ácido lipoteícoico como modelo de enfermedad humana / Experimental uveitis induced by lipoteichoic acid as human disease model

Propósito: examinar la capacidad del ácido lipoteicoico (ALT) para inducir inflamación intraocular en ratas. Métodos: ALT obtenidos de Staphylococcus aureus y de tres diferentes especies estreptocócicas fueron disueltos en solución salina a distintas concentraciones e inyectados en el cojinete de una pata de ratas Lewis hembras. El efecto inflamatorio intraocular fue evaluado por medio de métodos clínicos e histológicos y la intensidad de la inflamación en la cámara anterior (CA) fue evaluada por medio de la determinaión de la concentración de proteínas y densidad de células en el humor acuoso (HA). Finalmente, posibles mediadores inflamatorios intraoculares de la enfermedad fueron evaluados a través de la determinación semicuantitativa de ácido ribonucleico mensajero (ARNm) de un panel de citoquinas. Resultados: ALT de S. aureus indujo una intensa inflamación intraocular 24-30 horas después de su inyección. La reacción inflamatoria se indujo de un modo dosis dependiente. A una dosis de 15 mg/kg de ALT, la concentración de proteínas y recuento de células en HA fueron 5,6 ñ 0,5 mg/ml y 4075 ñ 1193 células/µl respectivamente. Después de la inyección de ALT de origen estreptocócico no se detectaron células en la CA, mientras que la concentración de proteínas se elevó 2-3 veces comparada con el grupo control