Validation study of a new dry self-sampling device for detection of human papilloma virus in cervical cancer screening / Estudio de validación de un nuevo dispositivo de automuestreo en seco para la detección del virus del papiloma humano en el cribado del cáncer cervical

Objective: To evaluate the efficiency of IUNETEST(R) self-sampling device by comparing f-HPVtypingTM and Cobas(R) 4800 HPV detection techniques in gynecological cytology and self-sampling up-take. Material and methods: A total of 196 patients were included: Fifty percent (50%) for routine cervical cancer screening (n=98) and the other half presented an abnormal cytology (n=98). Two samples for patient were evaluated. Results: Both sample up-takes showed high concordance for HPV detection (Cohen's kappa > 0.85). Equal sensitivity between molecular techniques was detected in Gynecological cytology up-takes (77.3%). In self-sampling, sensiti-vity was higher in f-HPVtypingTM than in Cobas(R) 4800 (77.3% vs. 75.5%). Roche presented better specificity thanf-HPVtypingTM: 82.3 and 80.7% vs. 79.2 and 78.5% in self-sample and gynecological up-takes. Negative predictive value was similar: 87.3 and 87.7% vs. 87.2 and 86.7% in self-sample and gynecological up-take by Roche and in f-HPVtyping, respectively. The most prevalent types were HPV-16, followed by 52, 39, 58 and 66. Conclusions: Self-sample up-takes may be as good as physician collected samples for screening diagnostic. Both HPV detection methods present a high correlation for both sample collections. The high acceptability of IUNETEST(R) self-sample device, may encourage screening in non-attenders, increasing screening coverage

Objetivo: evaluar la eficiencia del dispositivo de autotoma IUNETEST(R) comparando las técnicas de detección de HPV, f-HPVtypingTM y Cobas(R) 4800 en la citología ginecológica y la toma de auto-muestreo. Material y métodos: se incluyeron un total de 196 pacientes: cincuenta por ciento (50%) para la detección de cáncer de cuello uterino de rutina (n=98) y la otra mitad presentaba una citología anormal (n=98). Se evaluaron dos muestras por paciente. Resultados: ambas tomas de muestras mostraron una alta concordancia para la detección del VPH (kappa de Cohen> 0,85). Igual sensibilidad entre las técnicas moleculares se detectó en tomas de citología ginecológica (77,3%). En el auto-muestreo, la sensibilidad fue mayor en f-HPVtypingTM que en Cobas(R) 4800 (77,3% vs. 75,5%). Roche presentó una mejor especificidad que f-HPVtypingTM: 82,3 y 80,7% vs. 79,2 y 78,5% en muestras de autotoma y ginecológicas. El valor predictivo negativo fue similar: 87,3 y 87,7% vs. 87,2 y 86,7% en la autotoma y la captación ginecológica de Roche y en f-HPVtyping, respectivamente. Los tipos más prevalentes fueron HPV-16, seguido de 52, 39, 58 y 66. Conclusiones: Las tomas de muestras por autotoma pueden ser tan buenas como las muestras recolectadas por el médico para el diagnóstico de detección del HPV. Ambos métodos de detección de HPV presentan una alta correlación para ambas colecciones de muestras. La alta aceptabilidad del dispositivo de auto-muestra IUNETEST(R) puede alentar la detección en personas que no asisten, aumentando la cobertura del screening

Condrosarcoma mesenquimal extraesquelético en un paciente pediátrico: revisión de la literatura a propósito de un caso / Extraskeletal mesenchymal chondrosarcoma in a pediatric patient: a case report

El condrosarcoma mesenquimal extraesquelético pertenece a un grupo de tumores cartilaginosos malignos, que son infrecuentes y habitualmente no presentan compromiso óseo. Se presenta más frecuentemente en la órbita, sistema nervioso central y en los tejidos blandos de los miembros inferiores. El compromiso metastásico es generalmente pulmonar y ganglionar, especialmente en pacientes adultos en quienes se ha demostrado una mayor mortalidad. Este artículo tiene como objetivo presentar el caso de un paciente masculino de 14 años de edad, que ingresó a nuestra institución con una lesión sólida localizada a nivel de los tejidos blandos en el aspecto posterior de la pierna derecha, cuyo estudio histopatológico confirmó un condrosarcoma mesenquimal extraesquelético, junto con una revisión bibliográfica del tema.

The extraskeletal mesenchymal chondrosarcoma belongs to a group of infrequent malignant cartilaginous tumors, which are not obvious mainly in the bone. The most common site of such tumors is within the orbit, the central nervous system and the soft tissues of the lower limbs. The commitment is usually metastatic to the lung and lymph nodes, especially in adult patients, who have shown an increased mortality. The paper aims at presenting the case of male patient aged 14, who was admitted to our institution with a solid lesion located at the level of soft tissues in the posterior aspect of the right leg and whose histopathological study confirmed Extraskeletal mesenchymal chondrosarcoma (CME) and the literature review about the same.

Primary synovial sarcoma of the kidney with rhabdoid features.

Synovial sarcoma is a soft tissue sarcoma with clearly defined histologic, immunophenotypic, and molecular features. It occurs predominantly in the extremities of young adults but has been reported in many other anatomic sites. Histologically, it is classified as biphasic, monophasic, and poorly differentiated. The latter category, which includes tumors with a rhabdoid morphology, has been associated with a more aggressive behavior. Generally, the biphasic variant does not pose any diagnostic problem because of its typical histologic appearance; in contrast, the monophasic and poorly differentiated variants may represent a diagnostic challenge because their microscopic features can be confused with those of other spindle cell tumors with rhabdoid features. The application of molecular techniques, such as reverse transcriptase polymerase chain reaction to detect the fusion transcript associated with the characteristic t(X;18) translocation of synovial sarcoma, has enabled the confirmation of this diagnosis, even in cases of unusual localization, such as the one we present here.

Resolution of rhinocerebral zygomycosis associated with adjuvant administration of granulocyte-macrophage colony-stimulating factor.

We successfully treated 3 consecutive patients who had nonneutropenic rhinocerebral zygomycosis, by use of subcutaneous granulocyte-macrophage colony-stimulating factor therapy combined with traditional surgical and medical treatment. All patients are currently free of disease. Granulocyte-macrophage colony-stimulating factor should be considered as adjuvant therapy for rhinocerebral zygomycosis; however, optimum dose and length of therapy are unknown.

[Bacteremias in a university hospital: study of etiologic agents and their sensitivity patterns]. / Bacteriemias en un hospital universitario: estudio de los agentes etiológicos y de sus patrones de sensibilidad.

OBJECTIVE: To determine the bacterial etiology of bacteremic episodes recorded at our hospital during 1995 and their antimicrobial susceptibility patterns. METHODS: The microbiological records of all bacteremic episodes detected at our hospital from January to December 1995 were analysed. The susceptibility patterns of the 334 gram-positive aerobic isolates to 11 antimicrobials and of 236 gram-negative aerobic isolates to 16 antimicrobial agents were determined. The reference agar dilution method was used for these determinations. RESULTS: The incidence of bacteremia was 19.3/1,000 admissions. Gram-positive aerobic bacteria accounted for 56.6% of monomicrobial bacteremias; the microorganisms recovered most frequently were coagulase-negative staphylococci (22.4%), Escherichia coli (16.5%) and Staphylococcus aureus (14.2%); 75 polymicrobial episodes were recorded. Over half of bacteremic episodes occurred at medical services. Hematologic diseases and solid tumours were the most common underlying diseases. No resistance to glycopeptides was observed among the staphylococci studied. The incidence of resistance to vancomycin in enterococci was small (1.5%). The aminoglycosides tested and some beta lactams showed good activity against the gram-negative bacilli studied. CONCLUSIONS: To carry out an epidemiologic surveillance of bacteremic episodes occurring at every hospital it is necessary to provide information on trends observed in the etiology of such infections, possible outbreaks, antimicrobial resistance, and uncommon pathogens.

Strongyloides hyperinfection in a renal transplant recipient receiving cyclosporine: possible Strongyloides stercoralis transmission by kidney transplant.

Strongyloides hyperinfection and dissemination are recognized complications in kidney allograft recipients; however, the development of strongyloidiasis in renal transplant recipients receiving cyclosporine A (CyA) has not been described, nor has the development of strongyloidiasis in other organ transplant recipients. The former observation has been attributed to the antiparasitic activity of CyA seen in animal studies; the latter has no explanation yet. We report the first case of Strongyloides hyperinfection in a renal transplant patient occurring immediately after CyA was discontinued. From the unique characteristics of this case, it appears that the anti-Strongyloides activity of CyA in animals may also be found in humans.

First report of invasive amebiasis in an organ transplant recipient.

T-cell mediated immunity is an important defense mechanism against amebiasis. However, organ transplant recipients with severe T-cell immunosuppression are not at increased risk of having Entamoeba histolytica invasive disease. The reasons are unclear and probably multifactorial, but it is likely that the absence of intestinal colonization with pathogenic strains in countries where transplants occur and the judicious intake of possible contaminated food and water are important contributing factors. We describe the first report of a liver transplant recipient with severe E. histolytica colitis who was successfully treated with metronidazole without modifying his immunosuppression therapy.

Predominance of gram-positive microorganisms as a cause of septicemia in patients with hematological malignancies.

OBJECTIVE: To ascertain the etiology and outcome of episodes of bacteremia and fungemia over a three-year period (1990-1992) in patients with hematological malignancies. DESIGN: Retrospective study. SETTING: Hematology service of a 1,500-bed Spanish university hospital. RESULTS: Of a total of 178 episodes of significant bacteremia or fungemia in 101 patients, 53% affected patients with acute leukemia. Gram-positive microorganisms were found to be the cause in 70% of the monomicrobial episodes. The most frequently isolated microorganism was coagulase-negative Staphylococcus (35%), followed by Staphylococcus aureus (11%). Most blood-stream infections occurred during an episode of neutropenia (59%). A total of 34 patients died during hospitalization; in 14, infection was the cause of death. CONCLUSIONS: A marked increase in the incidence of bacteremias caused by gram-positive microorganisms has been observed in our hospital over the last 10 years, especially in patients with hematological malignancies. The mortality due to bacteremia is similar to that found by other authors in series of bacteremia in hematological patients, and we have not found significant differences in the mortality due to bacteremia between neutropenic and non-neutropenic patients (Infect Control Hosp Epidemiol 1994;15:101-104).

[Late diagnosis of heart rhabdomyoma with echocardiography]. / Diagnóstico tardío por ecocardiografía de rabdomioma cardíaco.

We describe 2 cases of tuberous sclerosis in a 17 and a 27 years old patients in which images compatible with a cardiac rhabdomioma were detected during an echocardiographic study. In one of the cases these images were multiple. We point out the few clinical repercussions they caused and the length of their undetected presence. We revise the clinical features and diagnosis of these rare tumours and comment on the need to withhold surgical treatment in situations which could put the patient's life in danger.

[Prevalence of antibodies against HIV in drug addicts and convicts]. / Prevalencia de anticuerpos frente a VIH en drogadictos y reclusos.

The presence of anti-HIV (human immunodeficiency virus) antibodies was determined in 325 subjects. The samples were taken from 138 convicts from Carabanchel and Ocaña I jail, 162 parenteral drug addicts (PDA) from a center for rehabilitation of drug addicts (CR), and from 14 family members and 11 stable couples of these PDAs. There was a global seroprevalence of 61.23%, 56.9% in Carabanchel, 68.7% in Ocaña I and 68.5% in the CR. When the results from the jailed convicts were analyzed according to risk factors, it was discovered that drug addiction was the most relevant since there was only a 29.4% of seropositivity in non PDAs with a statistically significant difference (p less than 0.01). This value was also higher than the seroprevalence found in the CR with a statistically significant difference (p less than 0.01). None of the family members of the CR were HIV-positive. Two stable couples were positive in this sexual contact group. This article makes clear the important role of drug addiction in the dispersion of HIV infection in our midst.