Roturas tendinosas bilaterales del aparato extensor de la rodilla: serie de casos / Bilateral tendon tears of the extensor mechanism of the knee: a series of cases

Las roturas bilaterales del aparato extensor de la rodilla son infrecuentes y se asocian clásicamente a enfermedades sistémicas. Estas lesiones pueden ser óseas, de patela o tuberosidad tibial anterior, musculares o tendinosas. Las más comunes de todas son las fracturas de rótula, seguidas de roturas del tendón cuadricipital o rotuliano. Las roturas bilaterales tanto del tendón rotuliano como cuadricipital, al ser infrecuentes, pueden ser infradiagnosticadas retrasando el tratamiento quirúrgico y la posterior rehabilitación; suelen ser traumáticas. En la literatura existen publicaciones sobre algunos casos de roturas tendinosas bilateral del aparato extensor de la rodilla asociadas a enfermedades sistémicas como isuficiencia renal, diabetes mellitus o artritis reumatoide o al uso prolongado de quinolonas o corticoides. En este trabajo describimos 4 casos clínicos de roturas tendinosas bilaterales del aparato extensor, sin y con enfermedades sistémicas asociadas (AU)

Bilateral injuries of the knee extensor mechanism are uncommon and are generally related to systemic diseases. Such injuries may be muscle tears, bone fractures (patella and tibial tubercle) and tendinous disruptures. Patella fractures are described as being the most common of these, followed by injuries of the quadriceps and patellar tendons. As bilateral disruption of either patellar and/or quadricipital tendons is uncommon, it may be underdiagnosed, thus delaying the surgical treatment and subsequent rehabilitation. They are generally traumatic. There are publications in the literature on some cases of bilateral tendinous disruptions of the knee extensor complex associated to systemic diseases such as renal failure, diabetes mellitus or rheumatoid arthritis or the continued use of steroids or fluoroquinolones. We report four cases of bilateral knee tendon disruption in patients with and without systemic disease (AU)

[Erythroid colonies derived from BFU-E from the bone marrow in a patient with type I congenital dyserythropoietic anemia]. / Estudio de colonias eritroides derivadas de BFU-E de medula ósea en un paciente con anemia diseritropoyética congénita tipo I.

The findings of in vitro culture of bone-marrow BFU-E from a patient with type I dyserythropoietic anaemia are reported, scarce data being seemingly available in the literature. The number of BFU-E in the culture was increased four-fold with respect to the normal values. The morphologic study of the colonies showed in all cases varying number of erythroblasts with internuclear bridges (5-20%). Upon ultrastructural examination of the colonies, a great number of erythroblasts exhibited morphologic alterations, spongy chromatin and internuclear bridges being commonest. These findings suggest that an alteration of the progenitor erythroid cells exists in type I dyserythropoietic anaemia, whereas the morphological defects appreciated show great variation in the progeny of each BFU-E.

[Argyriasis. Report of a case (author's transl)]. / Argirosis. Descripción de un caso.

A case of argyriasis in a 45-year-old woman is reported. When the patient was 34 she took for a period of 25 months a silver-containing pharmacological product (colloidal silicon with 0.5 percent of silver) in order to treat an intestinal dyspepsia with diarrheic episodes. A few months after discontinuing the treatment a cutaneous pigmentation of a greyish-blue color extending over the whole body, developed. There was also discoloration of the nails, hair, and of the oral and gingival mucosae. The differential diagnosis with other conditions that also develop anomalies of cutaneous pigmentation was established. It is thought that the appearance of the silver poisoning is due to different factors such as the quantity of silver intake, the individual sensitivity to the metal, and the greater or lesser period of exposure to sunlight. The importance of the skin biopsy in order to confirm the diagnosis is commented on. Typical pathologic findings include the presence of silver granules in the basal membrane of sudoriparous glands, around the pilosebaceous follicles, and in the connective tissue. Lastly, the authors insist on the necessity to avoid the prescription of silver-salt containing drugs as far as possible, since the cutaneous pigmentation is irreversible.

[Immunoblastic sarcoma (author's transl)]. / Sarcoma inmunoblástico.

A case of immunoblastic sarcoma in a 56-year-old man is presented. He had no history of predisposing diseases. His clinical condition was typical of a highly aggressive disseminated malignant lymphoma and he presented important heterogenous hypergammaglobulinemia. The patient died 9 months after the onset of the disease, following brief and incomplete response to various chemotherapeutic associations. The importance of cytological and cytochemical studies of lymph node by touch prep is stressed, since this condition could have been misdiagnosed, in our case, with a malignant histiocytosis. The cell proliferation was shown cytochemically to be of B-lymphoid origin, not histiocytic. It was a monomorphic and nearly massive proliferation of large, intensely basophilic, nonphagocytolytic cells; reactions to naphthol-As-D-acetate esterase, acid phosphatase, beta-glucuronidase, and Perl's stain were negative. The relatively few phagocytolytic cells were shown cytochemically to be normal, true histiocytes, not identifiable with the atypical proliferating cells. This was an essential fact in establishing the diagnosis of immunoblastic sarcoma. In light of today's knowledge, the authors believe that immunoblastic sarcoma is a lymphomatous condition which should be distinguished from centroblastic lymphadenopathy. Lastly, they comment on a retropsective study of lymphomas previously catalogued as reticulo-sarcomas, which has shown that the majority of cases were centroblastic lymphomas and some were immunoblastic sarcomas.

[Malignant hypereosinophilic syndrome. Report of an exceptional case (author's transl)]. / Síndrome hipereosinofílico maligno: presentación de un caso excepcional.

The case of a 43-year-old man with a highly malignant hypereosinophilic syndrome is reported. The condition is classified as such according to Hardy and Anderson's criteria, accepted by many other authors. Other diseases of known etiology which may present high levels of eosinophils in the peripheral blood, such as parasitosis, allergies, neoplasias, collagenosis, etc., were discounted beforehand. The difficulties in distinguishing between these diseases are discussed; they are often accompanied by clinical manifestations which also arise in very different conditions including eosinophilic leukemia, Engfeldt and Zetterström's eosinophilic collagenosis, Löffler's fibroplastic endocarditis, etc. A particularly striking feature of this condition is the formation of large tumor masses of mature eosinophils. They begin in various bones, which they destroy almost completely, and invade the surrounding tissues, destroying them as well. These tumors act similarly to malignant eosinophilic myelocytomas, a fact which has not been reported previously in the literature as far as we know. Although the eosinophils act as though they were neoplastic, they maintain the characteristics of mature cells, both cytomorphologically and ultrastructurally as well as cytochemically (consistently chloroacetate esterase negative). The tendency to diagnose eosinophilic leukemia solely on the basis of the malignancy of the condition and a tissue infiltration of eosinophils without determining the existence of cytologic and/or cytochemical anomalies of the cells showing them to be leukemic is discussed. The authors were unable to find any reports in the literature in which the eosinophils were presented with unmistakeably blastic cellular characteristics. Various nosologic considerations are offered.