Debut y manejo de leucemia mieloblástica aguda durante la gestación: a propósito de un caso / Debut and management of acute myeloblastic leukaemia during pregnancy: a case report

La leucemia mieloide aguda (LMA) es una de las neoplasias hematológicas más mortales. Durante el embarazo es una complicación rara, que puede dar resultados adversos, como la muerte, sin tratamiento adecuado. El manejo de la LMA durante el embarazo sigue siendo un desafío. Presentamos el caso de una mujer primigesta de 34 años con 18 semanas de gestación que acudió a Urgencias por cuadro de dolor e hipertrofia de mucosa oral, acompañado de astenia intensa. Se diagnóstico leucemia mieloblástica aguda (LAM-M4). Se ofertó posibilidad de interrumpir la gestación, dada la poca evidencia referente a la evolución materno-fetal, que la paciente rechazó, por lo que se inició tratamiento quimioterápico. En los controles ecográficos no se evidenciaron alteraciones teratogénicas; el crecimiento fetal tuvo parámetros normales, sin alteraciones en los valores del flujo Doppler. Se decidió finalizar gestación a las 32 semanas y tres días. Nació un varón pretérmino mediante parto eutócico con test de Apgar y pH de cordón umbilical normales, sin precisar reanimación. El puerperio fue favorable y a los 15 días del alta ingresó para un trasplante de médula ósea de su hermana, HLA idéntica. La paciente finalmente falleció por rechazo del trasplante y las complicaciones derivadas de este suceso.

Acute myeloid leukaemia (AML) is one of the deadliest haematological malignancies. During pregnancy it is a rare comorbidity and can lead to adverse outcomes, such as death, without adequate treatment. The management of AML during pregnancy remains a challenge. We report the case of a primigravida 34-year-old, with 18 weeks of amenorrhoea, who attended the emergency department presenting with pain and hypertrophy of the oral mucosa, accompanied by intense asthenia. Acute myeloblastic leukaemia was diagnosed. The possibility of terminating the pregnancy was offered given the lack of evidence regarding the maternal-foetal outcome, but the patient rejected it, so chemotherapy treatment was started. In the ultrasound controls there was no evidence of teratogenic alterations nor foetal growth restriction, and there were no alterations in Doppler flow values. It was decided to end the pregnancy at 32+3 GW. A preterm male was born through eutocic delivery with a normal Apgar test and umbilical cord pH, and did not require resuscitation. The puerperium was favourable and 15 days following discharge she was admitted for a bone marrow transplant from her HLA identical sister. The patient died due to rejection of the transplant and the complications derived from this event.

Use of the lymphocyte transformation test in the diagnosis of DRESS syndrome induced by ceftriaxone and piperacillin-tazobactam: two case reports.

Drug-related rash with eosinophilia and systemic symptoms (DRESS) syndrome, or drug-induced hypersensitivity syndrome (DIHS), is a life-threatening multiorgan systemic reaction characterized by rash, fever, lymphadenopathy, hepatitis, and leukocytosis with eosinophilia. Aromatic anticonvulsant drugs and allopurinol have been reported to be the most frequent eliciting agents. Our search of the literature revealed only 2 cases induced by piperacillin and 1 case by ceftriaxone.We present 2 cases of DRESS syndrome induced by the beta-lactam drugs ceftriaxone and piperacillin-tazobactam. An allergological workup including skin prick test, intradermal tests, patch tests, and lymphocyte transformation test (LTT) was performed. LTT was shown to be a useful technique in both cases to help to identify the drugs involved.

Dermatitis de contacto por tatuajes temporales en niños / Temporary tattoo-induced contact dermatitis in children

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Impact of recipient obesity on living donor kidney transplant outcomes: a single-center experience.

The number of overweight and obese patients undergoing renal transplantation has drastically increased in the last two decades. Studies on graft survival and complication rates of these obese patients have had conflicting results, with some reporting a significant risk and others reporting relatively good outcomes. We examined 1-year outcomes in obese and nonobese patients who underwent living donor transplants at our transplant program, a slightly different approach than prior studies of deceased donor transplants into patients with high body mass index (BMI). The mean serum creatinine clearance by the modified MDRD equation at the end of 1 year in the nonobese group was 58.9 mL/min whereas the mean creatinine clearance in the obese group was 48.9 mL/min (P = .09). The length of stay, incidence of delayed graft function, and 1-year graft survival did not differ between the obese and nonobese groups. The results of this single-center experience with living donor transplant into obese subjects suggest no differences in outcomes with regard to surgical or wound complications, delayed graft function, or serum creatinine at 1 year.

[Cerebellopontine angle lipoma: clinical case]. / Lipoma del ángulo pontocerebeloso: caso clínico.

Lipomas of the cerebellopontine angle are extremely rare. These tumors are probably maldevelopment lesions which can cause slowly progressive neurological symptoms. Including the present case, 90 lipomas in this localization have been described in the literature. The authors report a case of cerebellopontine angle lipoma in a 44-year-old male patient who suffered right hearing loss and tinnitus during seven months. The literature concerning this rare cerebellopontine angle tumor is review. The symptoms, radiological features and surgical management are discussed.

Lipoma del ángulo pontocerebeloso: caso clínico / Cerebellopontine angle lipoma: case report

Los lipomas del ángulo pontocerebeloso son lesiones extremadamente raras, de origen probablemente congénito, que producen sintomatología focal lentamente progresiva. En la literatura se han descrito 90 casos de lipomas en esta localización. Se presenta un caso de lipoma del ángulo pontocerebeloso en un varón de 44 años con un cuadro de 7 meses de evolución de hipoacusia derecha y acúfenos. Se revisa posteriormente la literatura publicada sobre estas lesiones y las diferentes posibilidades diagnósticas y terapéuticas, concluyendo que dichas lesiones no son tratables mediante cirugía (AU)

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[Progesterone receptors in the prognosis after therapy of pre- and post-menopausal patients with squamous intraepithelial lesions and cancer of the uterine cervix]. / Receptores a progesterona en el pronóstico de la terapia en pacientes pre y posmenopáusicas con lesiones escamosas intraepiteliales y por cáncer cérvico uterino.

The objective of this study was to know if there is a correlation in contents progesterone receptors (RPg) in biopsies from patients pre and postmenopausal, with normal cervix, Low-Grade squamous intraepithelial lesions (LGESIL) and High-Grade (HGSIL), and invasive cancer. Sixty three patients with abnormal cytology; colposcopy was carried out and two biopsies were taken from the suspicious lesion, they were sent for histopathological study, and for RPg; both studies were correlated later. Both pre and postmenopausal with LGSIL, the RPg the mean values were 16.81 fmol/mg, protein, and values negative, respectively. With regard to HGSIL, the RPg content, the mean values was 20.31 fmol/mg, protein in pre-menopausal patients, whereas it was 3.8 fmol/mg, protein in postmenopausal patients. It was seen that RPg concentration is higher in invasive cancer than to LGSIL and HGSIL patients in pre and postmenopausal. It is concluded that this study on quantification to RPg receptor level measurement may well be to select poor prognostic groups of patients for inclusion in the management of squamous intraepithelial lesions and invasive cancer.

Gradual and oriented B-Z transition in 5'-untranscribed region of mouse ribosomal DNA.

The structural transition of an alternating purine-pyrimidine sequence (CG)5(TG)28) from the 5'-untranscribed region of the mouse ribosomal DNA was analyzed by two-dimensional gel electrophoresis and chemical probes. The repeat undergoes a supercoil-dependent gradual and oriented B-Z transition. At a threshold level of negative supercoiling, a limited region of the repeat encompassing the (CG)5 motif converts cooperatively into Z-DNA. As the superhelical stress increases, the Z-structure propagates along the remaining part of the repeat by successive transitions until the full-length sequence is converted. By in situ OsO4 probing experiments, we show also that this (TG)n-containing repeat adopts the Z-structure in Escherichia coli.

Fibroblast growth factor-2 (FGF-2) in the nucleus: translocation process and targets.

FGF-2 (basic fibroblast growth factor) was recently detected in the nucleus of a variety of cell types. The large isoforms contain a functional nuclear localization signal that allows their nuclear accumulation in producing cells, while a small amount of FGF-2 added exogenously to target cells is translocated to the nucleus in phase G1 of the cell cycle according to an unknown process. We report here using Chinese hamster ovary cell mutants bearing deficiency in heparan sulfate proteoglycans (HSPGs) synthesis that HSPGs are required for transport of exogenous FGF-2 to the nucleus. Furthermore a co-transport was suggested since an active complex containing FGF-2 and HSPGs was isolated from nuclei of treated cells. Several FGF-2 nuclear targets were described. In vivo as in vitro, it activates rDNA transcription and it binds to a specific DNA sequence that is present in the non-transcribed spacer of ribosomal genes. In vitro, FGF-2 has a strong affinity for histone H1 and it activates the protein kinase CKII. In the nucleus FGF-2 could regulate gene expression through modulation of chromatin structure.

Translocation of bFGF to the nucleus is G1 phase cell cycle specific in bovine aortic endothelial cells.

Primary cultures of adult bovine aortic endothelial (ABAE) cells require bFGF to grow. G1-arrested cells, obtained after 48 h without serum and bFGF, were found to enter S phase and grow synchronously for at least two generations on addition of bFGF. In growing cells bFGF was detected both in the cytoplasm (90%) and in the nucleus (10%) where it accumulates in the nucleolus. It was not detected in the nucleus of confluent cells. bFGF uptake was continuous in the cytoplasm throughout the cell cycle with a maximum in G2, while nuclear uptake occurred only in late G1. Cytoplasmic bFGF (18.4 kd) is cleaved into a 16.5 kd peptide in G1 (t1/2 = 30 min). In the nucleus the 18.4 kd form was the only one detected 2 h following bFGF addition and was then cleaved into the 16.5 kd in early S phase. These results are consistent with the possibility that in addition to the classical pathway of signal transduction, bFGF is directly translocated to the nucleus in late G1, and could play a role in replication and/or in transcription of rDNA.

Brachial neuritis involving the bilateral phrenic nerves.

Brachial neuritis with bilateral hemidiaphragmatic paralysis has been reported in two previous cases in the literature. We report a patient who experienced severe right shoulder discomfort three weeks prior to hospital admission which evolved to include both shoulders. Two weeks prior to admission he noticed the onset of discomfort in breathing in the supine position and shortness of breath with minor exertion. The admitting diagnoses were myocardial infarction due to significant ECG changes and idiopathic elevated bilateral hemidiaphragms. The patient had findings significant for tachypnea, dyspnea, decreased breath sounds at the bases bilaterally, impaired motion of the bilateral lung bases on inspiration and paradoxical respirations. Comprehensive medical testing and evaluation revealed bilateral elevated hemidiaphragms and vital capacity 40% of normal. Weakness of the proximal shoulder girdle and bicep musculature bilaterally was noted. Electromyography was significant for reduced recruitment pattern in the bilateral shoulder girdle musculature. Nerve conduction studies suggested bilateral phrenic neuropathy. This case is an unusual presentation of brachial neuritis affecting the bilateral shoulder girdle with phrenic nerve involvement. The differential diagnosis of acute shoulder pain associated with respiratory symptomatology should therefore include brachial neuritis.