[Stress hip fractures in men in military training]. / Fracturas de cadera por estrés en hombres en entrenamiento militar.

INTRODUCTION: Stress fractures are common injuries in the military population, they begin with the imposition of repetitive and excessive effort on the bone. This leads to the acceleration of bone remodeling and production of microfractures. The incidence, during their basic combat training, is 0.8 to 5.1% for men compared to 1.1 to 18% among women. We present a series of hip stress fractures in young male military men with progressive training of 8 hours a day over a period of 14 weeks. RESULTS: Mean age 19.72 years, 4 transcervical and 7 basicervical fractures, 6 displaced and 5 no, 54.5 % right. All treated with osteosynthesis, DHHS (blockable compression plate system with hip spiral blade) in 3, cannulated screws in 3 and the proximal femoral fixation system with trochanteric nail (TFN) in five patients. The only common factor in all of them was intensive military training, pathology of metabolic or endocrine origin was ruled out. Onset of symptomatology measured in weeks with an average of 5. All patients had a delay in diagnosis with an average of 12.09 days at the time of definitive diagnosis. CONCLUSION: The diagnosis in stress fractures should be made based on clinical suspicion since the pain is insidious and in the report of the current condition patients fail to identify an exact moment as the onset of injury. The functional results were good and all of them managed to finish their military training.

INTRODUCCIÓN: Las fracturas por estrés son lesiones comunes en la población militar, inician con la imposición de esfuerzo repetitivo y excesivo al hueso. Esto conduce a la aceleración de la remodelación del hueso, la producción de microfracturas. La incidencia durante su entrenamiento básico de combate es de 0.8 a 5.1% para hombres comparado contra 1.1 a 18% entre mujeres. Presentamos una serie de fracturas por estrés de cadera en jóvenes militares masculinos con entrenamiento progresivo de ocho horas al día durante un período de 14 semanas. RESULTADOS: Media de edad 19.72 años, cuatro fracturas transcervicales y siete basicervicales, seis desplazadas y cinco no, 54.5% derechas. Todos tratados con osteosíntesis, sistema de placa de compresión bloqueable con hoja espiral de cadera (DHHS) en tres, tornillos canulados en tres y el sistema de fijación femoral proximal con clavo trocantérico (TFN) en cinco pacientes. El único factor común en todos ellos fue el entrenamiento militar intensivo, se descartó patología de origen metabólico o endocrino. Inicio de la sintomatología medido en semanas con una media de 5. Todos los pacientes presentaron un retraso del diagnóstico con una media de 12.09 días en el momento del diagnóstico definitivo. CONCLUSIÓN: El diagnóstico en las fracturas por estrés debe realizarse con base en la sospecha clínica, ya que el dolor es insidioso y en el relato del padecimiento actual los pacientes no logran identificar un momento exacto como inicio de lesión. Los resultados funcionales fueron buenos y todos ellos lograron terminar su entrenamiento militar.

Prophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy could reduce the frequency of portomesenteric venous thrombosis.

INTRODUCTION: Portal and mesenteric venous thrombosis is a rare but potentially serious complication after laparoscopic sleeve gastrectomy. There are no consistent studies that prove the safety and effectiveness of oral anticoagulant thromboprophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy. The objective was to evaluate the effect of rivaroxaban on the frequency of portal and mesenteric venous thrombosis and its safety profile after laparoscopic sleeve gastrectomy. MATERIALS AND METHODS: This retrospective analysis of prospectively collected data includes all laparoscopic sleeve gastrectomies performed by a single surgeon at Pontificia Universidad Católica de Chile Hospital between January 2009 and June 2019. All patients received low molecular weight heparin thromboprophylaxis during the whole hospital stay. Between July 2012 and June 2019, patients received additional post-discharge thromboprophylaxis with rivaroxaban. Patient demographics, impaired renal, post-surgical portal and mesenteric venous thrombosis, and bleeding episodes were registered. RESULTS: A total of 516 patients were identified; 95 patients were excluded. Results for 421 patients were analysed: 198 received only intrahospital thromboprophylaxis (group 1) and 223 received additional post-discharge thromboprophylaxis with rivaroxaban (group 2). There was no statistically significant difference between the two groups concerning age, sex and body mass index. In group 1, four cases of portal and mesenteric venous thrombosis were registered and no cases were reported in group 2 (p < 0.05). All cases occurred before 30 days after surgery. No bleeding episodes and no adverse reactions were detected in group 2. CONCLUSIONS: Thromboprophylaxis during the whole hospital stay (two to three days), followed by rivaroxaban 10mg once daily for 10 days after discharge (completing in total 13-14 days of prophylaxis), could reduce cases of post-surgical portal and mesenteric venous thrombosis without an increase in bleeding complications.

Antibacterial activity of chitosan biofilm for the conservation of fertile and table eggs / Atividade antibacteriana de biofilme de quitosana para conservação de ovos férteis e de mesa

The aim of this study was to develop a chitosan biofilm against Salmonella enteritidis, for the conservation of fertile and table eggs. Two experiments were performed. Experiment 1: 400 specific pathogen-free table eggs were divided in a completely randomized design into four treatments, five replicates and each replicate with 20 table eggs. Experimental groups were assigned to control and 1, 5 and 10% chitosan treatment. The eggs were immersed in the chitosan solution. They were then exposed to Salmonella enteritidis and stored for 1, 24, 96 and 168h at 4ºC. The eggs were then washed with 10mL of physiological saline solution. Experiment 2: 80 specific pathogen-free fertile eggs were tested, the assays were assigned to control and 1, 5 and 10% chitosan treatment. Each treatment had 20 fertile eggs. The eggs were immersed in the chitosan solution. They were individually weighed and incubated. Egg weight, humidity loss, and hatchability (weight and length of newly hatched chicks) characteristics were assessed. In Experiment 1, comparison between treatments showed differences (P< 0.05) in the total recovered of Salmonella enteritidis on eggshell, with the lower values in 5 y 10% chitosan treatment at 96 y 168h respectively. In Experiment 2, chitosan did not show any effect on the egg weight and chick weight, where the average was 57.44 and 38.23g respectively. The humidity loss and chick length showed differences (P< 0.05), with the lower values in 5 y 10% chitosan treatment. The antibacterial activity of chitosan biofilm provide a practical tool against Salmonella enteritidis in fertile and table eggs because the chitosan did not affect egg weight and chick weight, relevant parameters in the poultry industry.(AU)

O presente estudo teve como objetivo desenvolver um biofilme de quitosana contra Salmonella enteritidis, para conservação de ovos férteis e de mesa. Dois experimentos foram realizados. Experimento 1: 400 ovos de mesa livres de patógenos especificados foram divididos em delineamento inteiramente casualizado em quatro tratamentos, cinco repetições e cada réplica contendo 20 ovos de mesa. Grupos experimentais foram designados para controle e 1, 5 e 10% de tratamento com quitosana. Os ovos foram imersos em solução de quitosana. Em seguida foram expostos a Salmonella enteritidis, e armazenados por 1, 24, 96 e 168h a 4ºC. Após, os ovos foram lavados com 10mL de solução salina fisiológica. Experimento 2: 80 ovos férteis livres de patógenos especificados foram testados. Os ensaios foram atribuídos a controle e 1, 5 e 10% de tratamento com quitosana. Cada tratamento teve 20 ovos férteis. Os ovos foram imersos em solução de quitosana. Em seguida foram individualmente pesados e incubados. Peso dos ovos, perda de umidade e características de eclodibilidade (peso e comprimento dos pintinhos recém-nascidos) foram avaliados. No Experimento 1, a comparação entre tratamentos mostrou diferenças (P< 0,05) na quantidade total recuperada de Salmonella enteritidis na casca, com os menores valores em 5 e 10% de tratamento com quitosana a 96 e 168h respetivamente. No experimento 2, a quitosana não mostrou nenhum efeito no peso do ovo e no peso do pintinho, onde a média foi de 57,44 e 38,23g respetivamente. A perda de umidade e comprimento do pintinho apresentaram diferenças (P< 0,05), com os menores valores em 5 e 10% de tratamento com quitosana. A atividade antibacteriana do biofilme de quitosana, fornece uma ferramenta prática contra Salmonella enteritidis em ovos férteis e de mesa, pois a quitosana não afetou o peso do ovo e peso do pintinho, parâmetros relevantes na indústria avícola.(AU)

[IGF-1 levels in anterior cruciate ligament reconstruction using allograft vs autograft in patients at Central Military Hospital]. / Niveles de IGF-1 en la plastía de ligamento cruzado anterior de rodilla empleando aloinjerto vs autoinjerto en pacientes del Hospital Central Militar.

BACKGROUND: Treatment of ACL injury is surgical reconstruction. It is not known whether the result is better depending on the type of graft used. Insulin-like growth factor type 1(IGF-1) is a powerful stimulant of extracellular matrix and chondrocyte growth. MATERIAL AND METHODS: Experimental, analytical, prospective, longitudinal study in patients with ACL reconstruction in a period from 2016 to 2017. The concentration of IGF-1 in synovial fluid of these patients operated with allograft and autograft was determined, its association with postoperative evolution was determined. For statistical analysis, two-way ANOVA with Mann-Whitney post-hoc U was used. RESULTS: A significant increase in IGF-1 was identified in the allograft group at 90 days of postopertory. In the autograft group, a significant increase in IGF-1 was observed from 30 days of postoperative. The autograft group was found to have significantly higher levels of IGF-1 (3.27 ± 0.09 ng/ml) compared to the allograft group (2.80 ± 0.11 ng/ml; p 0.001) at 90 days after graft placement. DISCUSSION: IGF-1 levels were higher in patients with autologous graft, knee functionality was clinically similar in both groups at 30 and 90 days.

ANTECEDENTES: El tratamiento para la lesión del ligamento cruzado anterior (LCA) es la reconstrucción quirúrgica. Se desconoce si el resultado mejora, pues depende del tipo de injerto empleado. El factor de crecimiento semejante a la insulina tipo 1(IGF-1) es un potente estimulante de matriz extracelular y del crecimiento de condrocitos. MATERIAL Y MÉTODOS: Estudio experimental, analítico, prospectivo, longitudinal en pacientes con reconstrucción del LCA en un período comprendido entre los años 2016 y 2017. Se determinó la concentración de IGF-1 en el líquido sinovial de estos pacientes operados con aloinjerto y autoinjerto además de determinar su asociación con la evolución postoperatoria. Para el análisis estadístico, se utilizó ANOVA de dos vías post hoc con la prueba U de Mann-Whitney. RESULTADOS: Dentro del grupo de aloinjerto, se identificó un aumento significativo de IGF-1 a los 90 días del postoperatorio. En el grupo de autoinjerto, se observó un aumento significativo de IGF-1 desde los 30 días de postoperatorio. Se encontró además que el grupo de autoinjerto presentó niveles significativamente más altos de IGF-1 (3.27 ± 0.09 ng/ml) en comparación con el grupo de aloinjerto (2.80 ± 0.11 ng/ml; p 0.001) a los 90 días después de la colocación del injerto. DISCUSIÓN: Los niveles de IGF-1 fueron más altos en pacientes con injerto autólogo; la funcionalidad de la rodilla fue clínicamente similar en ambos grupos a los 30 y 90 días.

Estimación del intervalo post-emersión de un cadáver hallado en un embalse en Granada (España) / Estimation of post-emersion interval of a corpse found in a reservoir in Granada (Spain)

El período de actividad de los insectos es un parámetro que ha demostrado ser de gran utilidad a la hora de realizar aproximaciones a distintos fenómenos cronológicos relacionados con la descomposición cadavérica. Exponemos el caso de un cadáver hallado a finales de enero de 2011 en la orilla de un embalse en la provincia de Granada. Por la zona en la que se recuperaron los restos, la presencia de saponificación en la parte dorsal del tórax y la maceración de manos y pies, se sospechó inmediatamente de una sumersión de los restos y posterior emersión de los mismos. Tras recoger las evidencias entomológicas, se pudo determinar que consistían en larvas en diferentes fases de desarrollo de Calliphora vomitoria (Linnaeus, 1758), siendo las más antiguas recogidas en el cadáver las larvas en fase de desarrollo III migratoria. A partir del tratamiento estadístico de la información meteorológica recogida en dos estaciones agroclimáticas cercanas y del conocimiento del desarrollo y de la distribución de esta especie necrófaga, se pudo estimar que el tiempo mínimo que transcurrió desde que el cuerpo emergió del agua hasta que se encontró fue de 22 días. El díptero de la especie antes mencionada es compatible con la zona biogeográfica donde fue hallado el cadáver (AU)

Period of insect activity is a parameter that has been shown to be of great usefulness at the moment of making approximations to different chronological phenomena related to cadaveric decomposition. We expose the case of human remains found at the ending of January 2011 in the shore of a reservoir in the province of Granada. Because of the zone in which the remains were recovered, saponification in the dorsal area of the thorax, feet and hands maceration, submersion and a later emersion of the remains were immediately suspected. After collecting the entomological evidences, it was possible to determine that they were consisting of different developmental stages larvae of Calliphora vomitoria (Linnaeus, 1758), being the most aged ones recovered from the corpse corresponding to the larva III postfeeding developmental stage. From the statistical treatment of the meteorological data registered in two nearby agroclimatic stations and the knowledge of development and distribution of this necrophagous specie, it was possible to estimate that the minimum time elapsed from the moment when body emerged from the water until it was recovered was of 22 days. Diptera of the species previously mentioned is compatible with the biogeographic zone where the corpse was found (AU)

Suicidio por decapitación con sierra mecánica / Suicide by decapitation using a tapesaw

Se expone un caso de decapitación suicida realizada con una sierra de cinta para cortar metales. Precisó una laboriosa preparación previa en el taller de metalistería donde se ubicaba la máquina. El corte se realizó de delante a atrás con dirección oblicua, seccionando la escama del occipital en gran parte (AU)

A suicide decapitation case is presented that was committed using a tapesaw to cut metals. It required a previous laborious preparation at the metalwork place where the machine was located. Cut was made from the front to back with an oblique direction which caused the cut of a large part of the occipital squama (AU)

Situación actual de las vacunas antigripales / Current situation of the vaccine against influenza virus

La gripe es una enfermedad que conlleva cada año unas altas tasas de morbilidad durante su época epidémica, así como importantes complicaciones en personas con factores de riesgo. A pesar de existir unas claras recomendaciones en cuanto a su administración, las coberturas alcanzadas podrían mejorar. Se propone una revisión de la enfermedad y de las vacunas existentes, así como de las nuevas vacunas atenuadas intranasales que podrían ser mejor aceptadas al evitar la incomodidad de la administración parenteral

Flu is a disease with a high morbidity rate duringi ts epidemic season every year; it also damages the health of those people with risk factors. In spite of there being clear recommendations as to its administration, the coverage could definitely be improved. A revision of disease and the existing vaccines with a weaker effect, which could be better acceptedas their administration is much more comfortable than the parenteral one

Serotyping and virulence genes detection in Escherichia coli isolated from fertile and infertile eggs, dead-in-shell embryos, and chickens with yolk sac infection.

Escherichia coli is a common avian pathogen mainly associated with extraintestinal infections such as yolk sac infection (YSI). The aim of this study was to determine the serotypes and the presence of some virulence genes of E. coli strains isolated from different samples in a vertically integrated poultry operation in Mexico. Two hundred sixty-seven E. coli isolates from different samples were serotyped using rabbit serum against the 175 somatic (O) and 56 flagellar (H) antigens of the typing schema. Virulence genes were determined by colony blot hybridization, using DNA probes for st, eae, agg1, agg2, bfp, lt, cdt, slt, and ipaH diarrhea-associated virulence factors. The serogroup of 85% of the strains was determined; O19 (12%), 084 (9%), 08 (6%), and 078 (5%) were the most common. Using the complete antigenic formula (O and H), O19:NM (n = 31) was the serotype most frequently isolated from dead-in-shell embryos and in broilers that had died on the fourth, fifth, sixth, and seventh days after hatch. One hundred ten strains (41.2%) hybridized with one or more of the used probes. Of these, ipaH (72%), eae (30%), and cdt (27%) were the most common. Considering the origin of the respective isolates, 40% of the broiler farm strains were positive for at least one probe. Results show that some avian E. coli strains isolated in Mexico are included in avian pathogenic E. coli serotypes not previously reported, suggesting that they could be specific for this geographic area. The wide distribution of the ipaH gene among nonmotile strains suggests that this invasiveness trait could be important in YSI pathogenesis. On the other hand, some other genes could contribute to E. coli virulence during YSI.

Evaluation of an early granulocytic response of chick embryos inoculated with herpesvirus of turkeys.

1. Early granulocytic response was evaluated in chick embryos inoculated with herpesvirus of turkeys (HVT). 2. Fifty 10-d-old specific pathogen-free embryos were divided into two groups, inoculated via yolk sac. Group 1 were inoculated with a complete dose of HVT and group 2 with vaccinediluent only. 3. Samples were taken for histological evaluation of yolk sac, liver, chorioallantoic membrane, brain and heart from 5 embryos per group on days 12, 14, 16, 18 and 20 of embryonic life. 4. Increases in numbers of granulocytes were detected on days 14 and 16 in the yolk sac, and on d 14 and 20 in the liver of in embryos, which received HVT. In addition, the chorioallantoic membrane was infiltrated with granulocytes. 5. The results confirm that granulopoiesis in the yolk sac is stimulated in the early stages of incubation if a viral antigen is present. The virus also appears to trigger the presence of granulocytes in embryonic liver and chorioallantoic membranes.

A significant number of human immunodeficiency virus epitope-specific cytotoxic T lymphocytes detected by tetramer binding do not produce gamma interferon.

Despite the seemingly important role of cytotoxic T-lymphocyte (CTL) responses in human immunodeficiency virus (HIV) disease pathogenesis, their measurement has relied on a variety of different techniques. We utilized three separate methodologies for the detection of CTLs in a cohort of HIV-infected individuals who were also human leukocyte antigen A2 (HLA-A2) positive. Among the different CTL assays, a correlation was seen only when the Gag epitope-specific HLA A*0201-restricted tetramer assay was compared with the ELISPOT assay performed after stimulation with the Gag epitope; however, this correlation was of borderline statistical significance. On average, the tetramer reagent detected a 10-fold-higher number of cells than were seen to produce gamma interferon by the ELISPOT assay. The implications of this CTL assay comparison and the possibility of phenotypic differences in HIV-specific CD8(+) T lymphocytes are discussed.

Sporotrichosis in Peru: description of an area of hyperendemicity.

Sporotrichosis is a sporadic and rare mycotic infection in most of the developed world. In many parts of the developing world, sporotrichosis is much more commonly recognized, but epidemiological data are generally lacking from these regions. We report epidemiological, clinical, and treatment data from 238 cases of culture-proven sporotrichosis occurring in a relatively remote area of the south central highlands of Peru that were retrospectively collected during 1995-1997. Most cases (60%) occurred in children aged

Citrobacter diversus endocarditis.

Citrobacter species are motile Gram-negative bacilli that cause disease in humans, such as urinary tract infection, pneumonia, superficial and deep wound infections, gastroenteritis, meningitis, bacteremia, and rarely endocarditis. In those cases of endocarditis, intravenous drug use has been associated with Citrobacter species. Gram-negative organisms are present in less than 10% of cases of endocarditis in intravenous drug users. We present a case of tricuspid valve endocarditis in an intravenous drug user caused by Citrobacter diversus alone.

Extracardiac vascular and neural lesions in the toxic oil syndrome.

The toxic oil syndrome is a multisystemic disease caused by the ingestion of adulterated rapeseed oil. The basic lesion is a peculiar vasculitis that affects mainly the intima, showing the features of an endovasculitis. Vessels of every type and size are involved, affecting practically every organ. The vascular lesions begins with endothelial damage that varies from cellular swelling to cellular necrosis. It then progresses by mixed cellular inflammatory infiltration of the intima and, in some cases, of the media and adventitia. In some cases the infiltrate is rich in eosinophils and a few show foamy histiocytes. Proliferation of myointimal cells and in advanced stages fibroblastic proliferation causes narrowing or obliteration of the vascular lumen. Thromboembolic complications perpetuate the vascular lesion and compound the ischemia and parenchymal atrophy of several organs. The peripheral nerve lesions begin with an inflammatory neuropathy with lymphocytic perineuritis and progress to perineural fibrosis with secondary axonal degeneration. Skeletal muscle lesions exhibit an interstitial inflammatory myopathy at first, followed by a neurogenic muscular atrophy. A direct effect of unidentified toxic substances, possibly free radicals, may cause the endothelial lesion. Other factors, such as immunopathologic mechanisms of delayed hypersensitivity, may contribute to the progression of the vascular lesions.

Chromatolytic changes in the central nervous system of patients with the toxic oil syndrome.

Five patients died of a severe neuromyopathy months after the ingestion of adulterated rapeseed oil. These patients were selected for this study due to the presence of striking chromatolytic lesions in symmetric and scattered nuclei of the brain stem, including the locus coeruleus, midline raphe, lateral reticular nuclei of the medulla and cuneate nuclei. Two of the five cases, in addition to these topographic levels of involvement, had remarkable chromatolysis, vacuolar degeneration and heavy silver impregnation of the swollen perykarya and proximal dendrites in the nuclei of the basis pontis. In this paper we analyze the features of the chromatolytic lesion and suggest that the neuronal pathology observed in these cases is an example of irreversible chromatolysis involving vacuolization and filamentous proliferation as final events of the chromatolytic process. The cause of the cell degeneration in the toxic oil syndrome (TOS) is yet undetermined. Chromatolysis in this disease may be the result of a neurotoxic action of the toxic factor in the adulterated oil.

Neuromuscular disorders in a new toxic syndrome: electrophysiological study--a preliminary report.

The electrophysiological features in 145 patients with a new toxic syndrome related to ingestion of adulterated oil are described. Myalgia, joint limitation, weight loss, cramps, progressive weakness and wasting, sensory disturbances that can be asymmetrical or patchy, and scleroderma-like changes were the main clinical features. The electrophysiological findings suggest that the neuromuscular impairment in the new toxic syndrome is a slowly progressive mixed axonal neuropathy, which starts asymmetrically in some patients, with involvement of proximal and distal muscles as well as paraspinal and respiratory muscles. Muscle and nerve biopsies confirm the neuropathy, and show severe perineuritis and perineurial and perimysial fibrosis. The single fiber electromyography (SFEMG) study showed increased motor unit fiber density directly related to the time after onset of the illness. Unstable complex potentials were found after 6 months of evolution, which suggests that an effective collateral reinnervation was delayed following a long period of progressive denervation.

Neuropathological studies on the toxic syndrome related to adulterated rapeseed oil in Spain.

Biopsies of muscle and sural nerves, and autopsies of patients affected by the toxic and neuromuscular syndrome produced by ingestion of adulterated rapeseed oil were studied using morphological, histochemical and ultrastructural methods. In muscle, two pathological pictures were distinguished according to their temporal sequence. In the early phase, the neuromuscular syndrome was characterized by myalgia and an inflammatory infiltration of the perimysium, the capsules of muscle spindles and intramuscular nerves. The muscle fibres exhibited small subsarcolemmal zones of fibril disintegration and accumulation of electron-dense material similar to Z bands. Areas of peroxidase activity were found in relation to the surface of many muscle fibres. In late stages there was severe neurogenic atrophy of muscle with intense endomysial fibrosis. Minimal perivascular inflammation by round cells, with no interstitial infiltrates, was finally present. The inflammatory myopathy that initially affected these patients differs from other forms of polymyositis and seems to be related to the inflammation present in other systems. The onset of denervation atrophy is secondary to the involvement of peripheral nerves which is the most salient and distinctive pathological feature of the syndrome. The involvement of peripheral nerves was the most severe pathological feature. Perineuritis and, later, fibrosis of the perineurium were conspicuous and peculiar to this toxic syndrome. Degeneration of myelinated axons was constant in late stages. Distal nerves were more affected than proximal nerves. In the CNS, chromatolysis of anterior horn cells and occasionally of cranial nerve nuclei, pontine nuclei and reticular neurons was found. In the brainstem, astrocytes were hypertrophic with abnormal nuclei and there was microglial proliferation in zones where chromatolysis was found. The possibility that free radicals derived from the adulterated oil and cytotoxic complexes formed by mast-cell granules and eosinophil peroxidases might have been involved in the pathogenesis is discussed. The toxic oil was rich in linoleic acid which, by forming an excess of arachidonic acid, might have played an additional role in the pathogenesis of the lesions.

Pathology of a new toxic syndrome caused by ingestion of adulterated oil in Spain.

The Toxic Syndrome (TS) caused by ingestion of adulterated rapeseed oil in Spain is a new disease of multisystemic character whose aetiology and pathogenesis remains unknown. The most prominent pathological feature is a peculiar non-necrotizing vasculitis, that affects mainly the intima and involves vessels of every type and size in practically every organ. The TS begins with an acute clinical picture with pleuropneumopathy, fever, headaches, exanthems and eosinophilia. In these early clinical phases the main pathological findings were observed in the lungs and consisted of intense pulmonary interstitial oedema with scanty inflammatory mononuclear infiltrates. Ultrastructural study revealed hydropic degeneration of pneumocytes types I and II with desquamation of type I. The patients in this phase died of respiratory failure, later deaths were due to thromboembolic complications. Later still the patients developed a neuromuscular syndrome, sclerodermiform skin lesions and severe weight loss and died predominantly of infectious complications and respiratory failure. The anatomopathological picture in the peripheral nerves was that of inflammatory neuropathy with a lymphocytic perineuritis that led to perineural fibrosis with secondary axonal degeneration. The muscle presented an interstitial inflammatory myopathy at first followed by a neurogenic muscular atrophy. The skin lesions in the late phases consisted in dermal or dermal and subdermal fibrosclerosis, with vasculitis of the small arteries in the lower dermis. The salivary glands and pancreas showed vasculitis and interstitial inflammation which progressed to interstitial fibrosis and parenchymal atrophy.