Epidermodisplasia verruciforme adquirido en un paciente con infección congénita por VIH / Acquired Epidermodysplasia Verruciformis in a Patient With Congenital HIV Infection

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Primary cutaneous mantle cell lymphoma: a case report.

Primary cutaneous mantle cell lymphoma (MCL) is a rare cutaneous proliferation of naive pregerminal CD-5 positive B cells in the skin with no extracutaneous involvement. Overexpression of cyclin D1 is pathognomonic of this condition, and surgery and radiation therapy are the most common therapeutic options. In this case, we describe the clinical, histopathological, immunohistochemical, and molecular characteristics of a new case of primary cutaneous MCL.

Adenoviral-mediated gene transfer into bone marrow: an effective surgical technique in rat.

BACKGROUND: The role of transforming growth factor-beta 1 (TGF-ß1) in the onset of bone marrow fibrosis has been confirmed in some animal models. To further understand the genetic expression of some myeloproliferative disorders affecting marrow stem cells, however, it is necessary to develop a specific and reliable procedure to deliver modified adenoviral vectors into the bone marrow cavity. The aim of this paper is to report a surgical technique designed to deliver an adenoviral vector-mediated gene expressing TGF-ß1 into the bone marrow of rat femurs. METHODS: Forty-two Sprague-Dawley rats were used in the study. Rat femurs were exposed and the compact and trabecular bones at the proximal head removed. An intrabone marrow injection of a mutated TGF-ß1 adenoviral vector, a null adenoviral vector, or PBS was delivered into the bone. Three groups were accounted (n = 14 per group): fibrogenic and positive and negative controls. The quality of the surgical entrance was assessed by means of computerized tomography and histological changes were assessed by histochemistry. The concentration of TGF-ß1 in the bone marrow was determined by ELISA. RESULTS: The surgical technique was conducted under ideal timing (approx. 10 min) and no surgical or postsurgical complications were observed. Computerized tomography revealed no changes in the bone tissue and a clean entrance was delimited through the bone to the bone marrow. HE and Masson's trichrome staining indicated highly fibrotic areas in the profibrotic group and bone marrow lavage reported a significantly higher concentration of TGF-ß1 (p < 0.05) in that same group. CONCLUSIONS: The present study confirmed that the proposed surgical technique is an effective method to deliver adenoviral vectors into the femoral bone marrow to investigate the physiopathology of bone marrow fibrosis in rats.

Supplementation of increasing amounts of linseed oil to dairy cows fed total mixed rations: effects on digestion, ruminal fermentation characteristics, protozoal populations, and milk fatty acid composition.

The effect of linseed oil (LO) supplementation on nutrient digestibility, forage (i.e., timothy hay) in sacco ruminal degradation, ruminal fermentation characteristics, protozoal populations, milk production, and milk fatty acid (FA) profile in dairy cows was investigated. Four ruminally cannulated, primiparous lactating cows were used in a 4 × 4 Latin square design (28-d periods). They were fed a total mixed ration (50:50 forage:concentrate (F:C) ratio [dry matter (DM) basis] without supplementation (control, CTL), or supplemented (wt/wt; DM basis) with LO at 2, 3, or 4%. Supplementation with LO had no effect on DM intake (19 kg/d) and apparent total-tract digestibility of nutrients (organic matter, neutral detergent fiber, acid detergent fiber, starch, and gross energy). Ruminal pH, ammonia, and total volatile FA concentrations were not changed by LO supplementation to diets. Extent of changes in volatile FA pattern and effective ruminal degradability of DM of timothy hay were minor. Neither the total numbers nor the genera distribution of protozoa was changed by the addition of increasing amounts of LO to the diet. Milk yield increased linearly (26.1, 27.3, 27.4, and 28.4 kg/d for CTL to LO4, respectively) as the amount of LO added to the diet increased. Milk fat content was not affected by LO supplementation, whereas milk protein content decreased linearly with increasing amounts of LO in the diet. Milk fat proportions of several intermediates of ruminal biohydrogenation of polyunsaturated FA (i.e., trans-10 18:1, trans-11 18:1, cis-9,trans-11 18:2, trans-11,cis-15 18:2, and cis-9,trans-11,cis-15 18:3) increased linearly with LO addition to the diet. The proportion of cis-9,cis-12 18:2 decreased linearly (2.06, 1.99, 1.91, and 1.83% for CTL to LO4, respectively) as the amount of LO in the diet increased. Milk fat content of cis-9,cis-12,cis-15 18:3 increased as the level of LO in the diet increased up to 3% but no further increase was observed when 4% of LO was fed (0.33, 0.79, 0.86, and 0.86% for CTL to LO4, respectively). A similar quadratic response to LO supplementation was also observed for cis-5,cis-8,cis-11,cis-14,cis-17 20:5 and cis-5,cis-7,cis-10,cis-13,cis-16 22:5. The results of the present study show that LO can be safely supplemented up to 4% in forage-based diets of dairy cows to enrich milk with potential health beneficial FA (i.e., n-3 FA) without causing any detrimental effects on rumen function, digestion, and milk production.

Amputation and the prevention of phantom pain.

Although it has been proposed that preoperative analgesia with epidural administration of analgesics may prevent long-term phantom pain, published results to date have been contradictory and controversial. In this case report, we describe a 41-year-old man with local recurrence of squamous cell carcinoma of the anus who underwent a hemipelvectomy. Preoperatively he had a significant neuropathic pain syndrome requiring oxycodone 60 mg every 4 hours. An epidural infusion of morphine and bupivacaine was started 24 hours preoperatively and discontinued on the third postoperative day. Over the next 10 days the oxycodone was gradually decreased and eventually discontinued prior to discharge. A review of the literature reveals conflicting reports on the benefit of preoperative epidural pain management in the prevention of postoperative pain syndromes. Conflicting research and conclusions of commentators leaves unanswered questions for clinicians. Nevertheless, we do know that we need to provide the best pain relief for patients both before and after amputation. This may require a combination of the oral, subcutaneous or intravenous, and epidural routes.

Cocaínas fumables en latinoamérica / Smokable cocaine in Latinamerica

La cocaína es frecuentemente fumada en el continente americano en aquellas formas que permiten hacerlo: "el Basuco", "el Crack" y "la Base Libre". Las "cocaínas fumables" derivan del procesamiento de la hoja de coca y tienen un muy bajo punto de fusión, lo que les permite ser volatilizadas fácilmente lo que les da un mayor poder adictivo, produciendo en los consumidores una rápida dependencia y un grave deterioro biopsicosocial. El consumo de pasta básica de cocaína aparece circunscrita a principios de la década de los '70 al área Andina en países como Perú, Colombia, Bolivia y Ecuador, casi al mismo tiempo que se reportan los primeros casos de uso de base libre en los Estados Unidos de América. Los índices de prevalencia de vida elaborados a partir de diversos estudios son: Colombia 1.5 por ciento; Perú 3.1 por ciento; Bolivia 1.7 por ciento y Ecuador 1.0 por ciento, con un predominio de consumo en el sexo masculino. En general los planteamientos propuestos para el tratamiento de adictos a las "cocaínas fumables", han sido diversos y en ocasiones controvertidos. Los resultados hasta ahora no son satisfactorios, la retención en los procesos de rehabilitación han sido pobres y las recaídas frecuentes, lo que ha hecho que algunos expertos incluyan dentro del arsenal terapéutico la aplicación de estrategias de Reducción de Daño. Algunas experiencias en este sentido han sido desarrolladas en países como Colombia, Bolivia y Brasil (AU)

[Pancreatic pseudocyst. A review of 10 years]. / Pseudoquiste pancreático. 10 años de revisión.

In the hope of finding those patients whose pancreas pseudocyst resolution were spontaneous, we undertook a retrospective review of such cases admitted at the Hospital Central de San Cristobal y Hospital Patrocinio Peñuela Ruiz (from IVSS), with the diagnosis of acute pancreatitis. From 619 patients with pancreatitis, 40 developed a pseudocyst (5.78%). The most frequent ethiology was biliary disease (47.5%) and abdominal pain in 87.5%, the most common symptom. Abdominal ultrasonography was the best diagnostic aid. Spontaneous resolution occur in 24 cases (60%) in juntion with the normalization of seric and urinary amylases values, the size of the cyst in these patients was less than 5 cms. Sixteen patients needed surgery, in 8 of them the seric amylase value remained high and in 3 cases this value was normal but with a cyst size more than five cms. Internal drainage in 11, external in 4 and surgical resection in one. There was no deaths in this review.

[Intestinal obstruction caused by milk curds in newborns]. / Obstrucción intestinal por tapón de leche en neonatos.

Intestinal obstruction due to milk curds syndrome may present with a clinical picture and radiological findings which suggest the correct diagnosis. This type of intestinal obstruction usually affects neonates, previously healthy, with concentrated formula feeding. Surgical treatment may be avoided in some cases by the administration of Gastrografin enemas. Two patients with milk curd obstruction treatment in our Hospital, are presented.

Polyorchidism: an exceptional case of three homolateral testes.

Polyorchidism is an uncommon congenital anomaly defined as the presence of more than two histologically proved testes. The present case of polyorchidism was discovered casually in an 11-year-old boy while performing an orchiopexy. Three testes were found on the left side; we have been unable to find this exceptional anomaly previously published in the medical literature.

[New aspects of gallbladder pathology in children]. / Nuevos aspectos de la patologia de la vesicula biliar en niños.

We have reviewed in a retrospective study 38 children treated in our Hospital, during the last seven years, because of non congenital gall-bladder disease. The diagnosis established were cholelithiasis 58 for 100, hydrops 26 for 100, acalculous cholecystitis 13 for 100 and hemobilia in one child. Cholelithiasis was more frequent in females at a rate of 2/1. Just the opposite incidence was found for acalculous gall-bladder pathology. Mean age at time of first hospitalization was 7.6 years for the cholelithiasis group and 6.6 years for the rest. Symptoms in order of frequency were abdominal pain, vomiting and fever. Abdominal sonography has been basic in establishing to correct diagnosis in practically all cases. Our most interesting finding has been the clinical manifestations of patients with "Hydrops", consisting of abdominal pain which disappears spontaneously after 24 to 48 hours. The diagnosis has been established only after performing abdominal sonographic studies in children with abdominal pain of unclear etiology.

[Pyeloureteral stenosis secondary to Schoenlein-Henoch purpura]. / Estenosis pieloureteral secundaria a púrpura de Schönlein-Henoch.

We present an 8-year-old male suffering from Schönlein-Henoch purpura with multisystemic clinical manifestations, which developed as a complication a pyeloureteral stenosis secondary to vasculitis. He was operated on and a ureteropyeloanastomosis was carried out according to the Anderson-Hynes technique with good results. We discuss the etiology, diagnostic methods and therapeutic possibilities. It is the eighth case in the literature requiring surgical correction as a result of this exceptional complication.

[Tendon and/or nerve lesions of the hand in childhood]. / Lesiones tendinosas y/o nerviosas de la mano en la infancia.

We have reviewed 50 consecutive children treated during the last five years of injuries of nerves and tendons of the hand, wrist and forearm. Seventy six per cent of these injuries affected the hand and/or fingers. The rest were located in the wrist or forearm.

Hepatic artery aneurysm in a child.

The present report refers to a child hospitalized because of nonspecific symptomatology, who was found to have aneurysms of both hepatic arteries. A year after simple proximal ligature of both hepatic arteries, the child remains symptom-free and developing normally. Proximal ligation appears to be a simple and effective technique for treating hepatic artery aneurysm in children in preference to direct approach of the vascular pathology.

Bilateral multifocal Wilms' tumor.

A three-year-old boy who presented with symptoms of peritonitis was found to have four Wilms' tumors affecting both kidneys. Individual enucleation of three tumors in the right kidney plus left lower nephrectomy were performed. Chemotherapy was administered for one year. The diagnosis of Wilms' tumor was confirmed on each specimen by the histologic studies. The child remains asymptomatic and developing normally six years after the initial surgical treatment. Bilateral partial nephrectomies is the most conservative of the surgical treatments available for bilateral Wilms' tumor.

[Complete sternal fissure. Use of autogenic grafts in modified surgery]. / Fissure sternale complète. Utilisation de greffons autogènes en chirurgie différée.

A patient with complete sternal cleft, was referred to us over the neonatal period. For this reason, she was treated with a modified technic consisting of breaching the sternal defect with free rib grafts covered by prosthetic material made of silastic and teflon. Late results were excellent.