ABSTRACT
BACKGROUND: Ion channels and transporters are potential markers and therapeutic targets for several cancers. However, their expression during hepatocellular carcinoma (HCC) development remains unclear. AIM: To investigate the mRNA expression of Na(+), K(+) and Ca(2+) channels and ABC transporters during rat HCC development, as well as Abcc3 protein in human liver biopsies. METHODS: Wistar rats were treated with diethylnitrosamine (DEN) and developed both cirrhosis (12 weeks of treatment) and either pre-neoplastic lesions (16 weeks of treatment) or multinodular HCC (16 weeks of treatment plus 2 weeks DEN-free). The mRNA expression of 12 ion channels and two ABC transporters was studied using real-time RT-PCR. Tumor-containing or tumor-free liver sections were isolated by laser-capture microdissection. Abcc3 protein expression was studied by immunohistochemistry in healthy, cirrhotic and HCC human biopsies. RESULTS: We observed expression changes in seven genes. Kcna3, Kcnn4, Kcnrg and Kcnj11 potassium channel mRNA expression reached peak values at the end of DEN treatment, while Scn2a1 sodium channel, Trpc6 calcium channel and Abcc3 transporter mRNA expression reached their highest levels in the presence of HCC (18 weeks). Whereas Kcnn4 and Scn2a1 channel expression was similar in non-tumor and tumor tissue, the Abcc3 transporter and Kcna3 potassium channels were preferentially overexpressed in the tumor sections. We observed differential Abcc3 protein subcellular localization and expression in human samples. CONCLUSIONS: The ion channel/transporter expression profile observed suggests that these genes are potential early markers or therapeutic targets of HCC. The differential localization of Abcc3 may be useful in the diagnosis of cirrhosis and HCC.
Subject(s)
Carcinoma, Hepatocellular/metabolism , Ion Channels/metabolism , Liver Neoplasms/metabolism , Animals , Calcium Channels/metabolism , Carcinoma, Hepatocellular/chemically induced , Humans , Immunohistochemistry , Laser Capture Microdissection , Liver Neoplasms/chemically induced , Male , Multidrug Resistance-Associated Proteins/metabolism , Potassium Channels/metabolism , Rats, Wistar , Real-Time Polymerase Chain Reaction , Sodium Channels/metabolismABSTRACT
INTRODUCTION: The examination carried out by the COMMAP for the certification process assessed pathologist formed in dissimilar institutions. In 2007 COMMAP's governing body in turn, decided to digitize it. The purpose of this study is to investigate whether the conversion to virtual slides in the microscopy section, compared with the traditional have had an impact on the scores of the candidates. METHOD: The slides were scanned with high resolution. The virtual microscope is a standard computer screen where there is a program (Aperio Scope Image Viewer) that can display the scanned slides. The results of the microscopy section of the past nine years were compared; two groups were formed: 1) those without digitized examination, and 2) with it. The results were compared by Student t-test and Mann-Whitney. RESULTS: Of a 461 results 240 belonged to the first group and 221 to the second one. On a scale of 1-10, the average scores were 6.6 and 6.8, respectively (p > 0.6 and > 0.5).The minimum and maximum scores were also similar in each group. CONCLUSIONS: According to the results, the digitized exam in the COMMAP's certification process shows no difference between the digitized and the conventional versions.
Subject(s)
Microscopy/methods , Pathology, Clinical/methods , Signal Processing, Computer-Assisted , Retrospective StudiesSubject(s)
Humans , Male , Adult , Hemosiderosis/complications , Hypovolemia/complications , Hemoptysis/etiologySubject(s)
Hemosiderosis , Lung Diseases , Adolescent , Autopsy , Fatal Outcome , Hemosiderosis/pathology , Humans , Lung Diseases/pathology , Male , Hemosiderosis, PulmonaryABSTRACT
Chagasic cardiomyopathy is a common disease in Latin America, however similar clinical pictures exist that can be confused with this, as they give negative results to the tests that detects T. cruzi, like non Chagasic rural endemic chronic cardiopathy, highly common in Venezuela. Using histopathology techniques, "idiopathic cardiomyopathy" is frequently found as the cause of death when the etiology of this disease is not known. This paper presents the case of a man of 26-years-old who died of dilated cardiomyopathy secondary to leptospirosis. Clinically, in addition to the cardiac failure, jaundice, hyperbilirubinemia, transaminases increase, proteinuria and hematuria were present. Initially it was suspected Chagasic cardiomyopathy but the epidemiologic background and the parasitologic and serologic tests for T. cruzi gave negative results. The dark field microscopy videorecording of blood and urine samples, argentic impregnation and immunohistochemistry tests as well as haemoculture in EMJH medium were positive for L. interrogans serovar Pomona. Postmortem we confirmed the presence of leptospira in different tissues through of histopathology, argentic impregnation, indirect immunofluorescence and immunohistochemistry.
Subject(s)
Adult , Humans , Male , Cardiomyopathy, Dilated , Leptospirosis , Fatal Outcome , Mexico , Severity of Illness IndexSubject(s)
Influenza A Virus, H1N1 Subtype , Influenza, Human/pathology , Lung/pathology , Adult , Aged, 80 and over , Cerebral Hemorrhage/etiology , Fatal Outcome , Female , Humans , Influenza, Human/complications , Lung/microbiology , Pneumonia, Bacterial/etiology , Pneumonia, Bacterial/pathology , Young AdultABSTRACT
Chagasic cardiomyopathy is a common disease in Latin America, however similar clinical pictures exist that can be confused with this, as they give negative results to the tests that detects T. cruzi, like non Chagasic rural endemic chronic cardiopathy, highly common in Venezuela. Using histopathology techniques, "idiopathic cardiomyopathy" is frequently found as the cause of death when the etiology of this disease is not known. This paper presents the case of a man of 26-years-old who died of dilated cardiomyopathy secondary to leptospirosis. Clinically, in addition to the cardiac failure, jaundice, hyperbilirubinemia, transaminases increase, proteinuria and hematuria were present. Initially it was suspected Chagasic cardiomyopathy but the epidemiologic background and the parasitologic and serologic tests for T. cruzi gave negative results. The dark field microscopy videorecording of blood and urine samples, argentic impregnation and immunohistochemistry tests as well as haemoculture in EMJH medium were positive for L. interrogans serovar Pomona. Postmortem we confirmed the presence of leptospira in different tissues through of histopathology, argentic impregnation, indirect immunofluorescence and immunohistochemistry.
Subject(s)
Cardiomyopathy, Dilated/microbiology , Leptospirosis/complications , Adult , Fatal Outcome , Humans , Male , Mexico , Severity of Illness IndexABSTRACT
Medical training curricula is a constantly evolving field. The objective of the present study is to analyze the changes the field has undergone. Our sources of information include demographic and health surveys, surveys carried out with students and faculty members and medical school guidelines from prestigious teaching centers. We compared medical curricula offered in Mexico as well as international trends. We analyzed context requirements, current status and future trends in biological, sociomedical and clinical disciplines; research and teaching methods; adequate academic programs. We describe the state of affairs in medical teaching in Mexico and the challenges that academic programs are currently facing. We propose a curricula with horizontal and vertical planning according to skills and competences that focus on health problems to foster scientific reasoning. Teaching strategies that are student-focused and foster significant/long-lasting learning. We suggest the need to include early clinical activities, communication skills and training in technological resources. Finally, there is a need to define a teaching profile that is consistent with training programs, to include experts in technology and modern teaching methods in order to establish permanent monitoring mechanisms, and to offer incentives to academics and administrative personnel.
Subject(s)
Curriculum , Education, Medical , Schools, Medical , Curriculum/trends , Forecasting , Guidelines as Topic , MexicoABSTRACT
Los planes de estudio para la formación de médicos se encuentran en continua transformación. El presente trabajo es un ejercicio para el análisis y modificación de dichos planes. Se fundamenta en información de fuentes oficiales demográficas y de salud, encuestas de opinión de alumnos y profesores, lineamientos de organismos acreditadores, así como en el análisis de la situación de la formación de médicos en México y las tendencias internacionales en la educación médica. Se analizan demandas del contexto, el estado actual y las tendencias futuras de las disciplinas biológicas, sociomédicas y clínicas, situación de la docencia e investigación, planes de estudios afines, características actuales y tendencias de la formación profesional en el país y retos que enfrentan los planes estudio. La propuesta se basa en un currículo esencial, con congruencia horizontal y vertical, por competencias fundamentadas en problemas prioritarios de salud. Propicia el razonamiento científico, estrategias educativas centradas en el alumno y aprendizaje significativo. Incorpora tempranamente actividades clínicas, habilidades de comunicación y empleo de recursos tecnológicos. Define el perfil docente y programas de formación de profesores. Integra expertos en tecnología y pedagogía modernas. Establece mecanismos de evaluación permanente y para incentivar al personal académico y administrativo.
Medical training curricula is a constantly evolving field. The objective of the present study is to analyze the changes the field has undergone. Our sources of information include demographic and health surveys, surveys carried out with students and faculty members and medical school guidelines from prestigious teaching centers. We compared medical curricula offered in Mexico as well as international trends. We analyzed context requirements, current status and future trends in biological, sociomedical and clinical disciplines; research and teaching methods; adequate academic programs. We describe the state of affairs in medical teaching in Mexico and the challenges that academic programs are currently facing. We propose a curricula with horizontal and vertical planning according to skills and competences that focus on health problems to foster scientific reasoning. Teaching strategies that are student-focused and foster significant/long-lasting learning. We suggest the need to include early clinical activities, communication skills and training in technological resources. Finally, there is a need to define a teaching profile that is consistent with training programs, to include experts in technology and modern teaching methods in order to establish permanent monitoring mechanisms, and to offer incentives to academics and administrative personnel.
Subject(s)
Curriculum , Education, Medical , Schools, Medical , Curriculum/trends , Forecasting , Guidelines as Topic , MexicoABSTRACT
INTRODUCTION: Sarcoidosis is a systemic, chronic, granulomatous disease of unknown cause. Pancreatic affection is rare and even more rare is the association among sarcoidosis, acute pancreatitis and diabetes mellitus. This is the first case reported in Mexico. CASE REPORT: Male 29 years. Sarcoidosis is diagnosed from the patient age of 20 years, with intermittent episodes affecting articulate, ophthalmic, cutaneous, lung and central nervous system. At 22 years of age the patient was diagnostic with diabetes mellitus. He was admitted with severe acute pancreatitis, that causes him to die. DISCUSSION: Diabetes mellitus is due to sarcoidotic infiltration of pancreas. Acute pancreatitis has been related with inflammatory or secondary process to frequent presence of hypercalcemia in the sarcoidosis. Diagnosis is not easy. This type of pancreatitis responds to treatment with steroids.
Subject(s)
Diabetes Complications , Pancreatitis/complications , Sarcoidosis/complications , Acute Disease , Adult , Fatal Outcome , Humans , MaleABSTRACT
Introducción: la sarcoidosis es una enfermedad granulomatosa crónica sistémica de causa desconocida. La afección pancreática es rara y aún más la asociación entre sarcoidosis, pancreatitis aguda y diabetes mellitus. Se reporta el primer caso en México. Reporte de caso: masculino de 29 años, con diagnóstico de sarcoidosis desde los 20 años y episodios intermitentes de afección articular, oftálmica, cutánea, pulmonar y en sistema nervioso central. A los 22 años se diagnostica diabetes mellitus. Ingresa con cuadro de pancreatitis aguda grave, que le causa la muerte. Discusión: la diabetes mellitus se debe a infiltración sarcoidotica del páncreas. La pancreatitis aguda se ha relacionado con el proceso inflamatorio o bien secundaria a la presencia frecuente de hipercalcemia en la sarcoidosis. El diagnóstico no es fácil. Esta forma de pancreatitis responde al manejo con esferoides.
Introduction: Sarcoidosis is a systemic, chronic, granulomatous disease of unknown cause. Pancreatic affection is rare and even more rare is the association among sarcoidosis, acute pancreatitis and diabetes mellitus. This is the first case reported in Mexico. Case report: Male 29 years. Sarcoidosis is diagnosed from the patient age of 20 years, with intermittent episodes affecting articulate, ophthalmic, cutaneous, lung and central nervous system. At 22 years of age the patient was diagnostic with diabetes mellitus. He was admitted with severe acute pancreatitis, that causes him to die. Discussion: Diabetes mellitus is due to sarcoidotic infiltration of pancreas. Acute pancreatitis has been related with inflammatory or secondary process to frequent presence of hypercalcemia in the sarcoidosis. Diagnosis is not easy. This type of pancreatitis responds to treatment with steroids.
Subject(s)
Adult , Humans , Male , Diabetes Complications , Pancreatitis/complications , Sarcoidosis/complications , Acute Disease , Fatal OutcomeABSTRACT
Se informan cuatro casos de esclerosis tuberosa. Los hallazgos post mortem más frecuentes fueron hamartomas subependimarios y angiofibromas faciales. También se encontraron astrocitomas subependimarios de células gigantes, rabdomiomas cardiacos múltiples, riñones poliquísticos, fibromas subungueales, manchas hipopigmentadas y angiomiolipomas renales. La presentación clínica y morfológica de la esclerosis tuberosa es variada y heterogénea y en esta breve serie se revisan los aspectos patológicos más importantes para su diagnóstico.
Subject(s)
Humans , Male , Female , Child, Preschool , Adult , Tuberous Sclerosis/pathology , Angiofibroma/pathology , Angiofibroma/pathologyABSTRACT
Se presenta el primer caso de miopatía hipertiroidea en autopsia en el Hospital General de México. Se trata de un hombre de 33 años con enfermedad de Graves-Basedow, quien 30 días antes de su muerte presentó debilidad muscular importante de miembros pélvicos y torácicos, además de disfagia y disfonía. Murió con datos de insuficiencia respiratoria. En los exámenes de laboratorio presentó hipopotasemia. En la autopsia se encontró adelgazamiento, exoftalmos leve, bocio hiperplásico difuso, así como atrofia, infiltración grasa y vacuolación focal en los músculos. Las miopatías relacionadas con hipo e hiperfunción tiroidea son poco frecuentes y recuerdan otras alteraciones musculares primarias y secundarias
Subject(s)
Humans , Male , Adult , Graves Disease/complications , Graves Disease/pathology , Hyperplasia/pathology , Myasthenia Gravis/etiology , Myasthenia Gravis/mortalityABSTRACT
Se informa el primer caso diagnosticado por autopsia de síndrome poliglandular autoinmune tipo II (Síndrome de Schmidt) en 29,568 necropsias practicadas en el Hospital General de México. Correspondió a una mujer de 18 años con diagnóstico de diabetes mellitus tipo I, que ingresó con datos de desequilibrio hidroelectrolítico y neumonía basal derecha, murió por insuficiencia respiratoria. En la autopsia se encontró desnutrición grado II, tiroiditis de Hashimoto, adrenalitis linfocítica, atrofia en ovario y neumonía derecha, sin alteraciones en otras glándulas endocrinas
Subject(s)
Humans , Female , Adolescent , Autopsy , Polyendocrinopathies, Autoimmune/diagnosis , MexicoABSTRACT
Estudios recientes han mostrado que hasta el 70 por ciento de los pacientes que ingieren por largo tiempo antiinflamatorios no esteroideos desarrollan ileítis crónica y, algunos de ellos, complicaciones graves como son: síndrome de mala-absorción, perforación, hemorragia y oclusión intestinal. Informamos el caso de un hombre de 50 años con espondilitis anquilosante, tratado con antiinflamatorios no esteroideos (indometacina, fenilbutazona y naproxeno) desde los 13 años, que presento un cuadro de oclusión intestinal con síndrome abdominal agudo. Fue tratado quirúrgicamente y se encontraron las características macroscópicas y microscópicas que se presentan en la ileítis crónica por antiinflamatorios no esteroideos
Subject(s)
Humans , Male , Middle Aged , Spondylitis, Ankylosing/complications , Spondylitis, Ankylosing/drug therapy , Crohn Disease/diagnosis , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Ileitis/diagnosis , Ileitis/chemically induced , Diagnosis, Differential , Chronic DiseaseABSTRACT
La enterocolitis neutropénica es una complicación que se observa principalmente en pacientes con leucemia tratados con inmunosupresores citotóxicos que posteriormente, debido a su estado de inmunodepresión, presentan infección por agentes oportunistas como bacterias, virus u hongos. En este estudio se encontró que el 4 por ciento de 325 casos de leucemia en material de autopsias del Hospital General de México, presentaron esta complicación. En todos los casos hubo afección extensa del colon e ileon; en dos casos la muerte se debió a perforación y peritonitis. Además se encontraron casos con afección en sitios extraintestinales como lengua, esófago, bronquio y cérvix, por lo que consideramos que esta complicación no es exclusiva de la región enterocólica y proponemos el término de ®lesión neutropénica sistémica¼ cuando exista afección fuera de este sitio en múltiples órganos
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Adult , Middle Aged , Autopsy , Vincristine/adverse effects , Enterocolitis, Pseudomembranous/etiology , Enterocolitis, Pseudomembranous/pathology , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/pathology , Leukemia, Myeloid, Acute/drug therapy , Doxorubicin/adverse effects , Methotrexate/adverse effects , Cytarabine/adverse effects , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapyABSTRACT
El carcinoma adenoide quístico primario del arbol bronquial es una neoplasia poco frecuente en esta localización. Se presenta el caso de un hombre de 40 años con antecedentes de tabaquismo y tosedor crónico, quien presentó dos meses antes de su muerte disnea progresiva y hemoptisis. En la fibrobroncoscopía se encontró un tumor nodular endobronquial que obstruía el 70-80 por ciento de la luz, con extensa invasión de la pared, se tomó biopsia sin poder establecer un diagnóstico. Se presentó sangrado masivo del tumor y el paciente falleció en estas condiciones. La autopsia corroboró la presencia de un tumor en bronquio principal derecho de base ancha con extensa invasión local y metástasis en varios órganos. Histológicamente el tumor correspondió a un carcinoma adenoideo quístico, en el cual predominó un patrón de crecimiento sólido. Esta variedad histológica presenta en un alto porcentaje de recurrencia local, metástasis tempranas y corta sobrevida
Subject(s)
Adult , Humans , Male , Bronchial Neoplasms/pathology , Carcinoma, Adenoid Cystic/pathology , Neoplasm Metastasis/pathologyABSTRACT
Se registraron y revisaron 36 casos de leucemia aguda promielocítica en material de autopsia del Hospital general de México. Esta cifra representó el 0.4 por ciento del total de sujetos (8,140) autopsiados en un periodo de 12 años (1980-1991); el 11 por ciento de los casos diagnosticados como leucemias de todas las variedades (325 casos) y el 12.8 por ciento de leucemias agudas (281 casos). Treinta y cuatro casos fueron clasificados como leucemia aguda promielocítica de la variedad hipergranular y dos de la variedad microgranular. La medida de la edad fue de 20 años, la relación hombre:mujer fue de 1.2:1. Se observó infiltración neoplásica en varios órganos; los más frecuentemente afectados fueron: médula ósea, hígado y ganglios linfáticos. Las hemorragias fueron un dato constante y los sitios más frecuentes fueron pulmones y sistema nervioso central. Se encontraron datos histológicos de coagulación intravascular diseminada en ocho casos. La supervivencia media de los 36 casos fue de 8.2 semanas; esta media no varió para el grupo tratado, pues solamente recibieron la primera dosis de quimioterapia, por lo que no hubo casos de remisión
Subject(s)
Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Autopsy , Leukemia, Promyelocytic, Acute/pathology , Neoplasm Metastasis/pathologyABSTRACT
Se revisaron 44 casos de lesiones linfoproliferativas de cabeza y cuello, 36 fueron linfomas extraganglionares y 8 corresponden a granulomatosis linfomatoide. Los linfomas presentaron 0.07% del material quirúrgico de este hospital. Los tipos histológicos más frecuentes fueron el difuso de células grandes hendidas (27.7%), el difuso mixto de células grandes y pequeñas (27.7%) y el difuso de células pequeñas hendidas (11%). Los sitios afectados más frecuentemente fueron fosa nasal (42.2%), amígdalas (22.2%), orofaringe (11.1%). Los signos más frecuenes fueron tumor, obstrucción nasal y rinorrea. La localización más frecuente en los 8 casos de granulomatosis linfomatoide fué la fosa nasal (87.5%) y clínicamente se manifestaron como tumor, odinofagia y disfagia. Unas de las diferencias estadísticamente significativas entre linfoma y granulomatosis linfomatoide fue el tiempo de evolución, a menor tiempo, mayor probabilidad de linfoma. Probablemente la granulomatosis linfomatoide y los linfomas T nasales corresponden a una misma enfermedad en diferentes fases de evolución.
