Linfoma de células B de alto grado de malignidad con morfología blastoide durante el embarazo: reporte de un caso / High-grade malignant B-Cell lymphoma with blastoid during pregnancy: a case report

Resumen ANTECEDENTES: Durante el embarazo es más común el linfoma de Hodking que el no Hodking; afecta, en promedio, a mujeres de 30 años (18-44 años) y más. Suele diagnosticarse alrededor de las 28 semanas de embarazo y está documentado que puede llegarse al término. Los esquemas de tratamiento pueden iniciarse en el posparto inmediato o, incluso, antes. La incidencia mundial del linfoma no Hodking es de 0.8 por cada 100,000 mujeres; se desconoce la supervivencia durante el embarazo. CASO CLINICO: Paciente de 34 años, con antecedentes obstétricos de tres embarazos, una cesárea y un aborto y el embarazo actual en curso de las 29 semanas, referida de la ciudad de Colima debido a un reporte de BI-RADS 3 en el ultrasonido de mama y un nódulo mamario palpable, con evidencia de múltiples tumoraciones en la zona hepática, esplénica y peripancreática. La biopsia tomada de las zonas de la lesión reportó: linfoma de células B de alto grado de malignidad, con morfología blastoide y expresión de C-MYC y BCL2. Además, la paciente se encontró con: anemia, dolor abdominal, múltiples nódulos hepáticos y adenopatías abdominales. Se decidió la interrupción del embrazo a las 30 semanas, con la obtención de un recién nacido, sin complicaciones. Enseguida se inició el tratamiento con rituximab-etopósido-prednisolona-vincristina-ciclofosfamida-doxorrubicina (R-EPOCH) con adecuada adaptación por la paciente. CONCLUSION: Puesto que la información bibliográfica de linfoma y embarazo es escasa el caso aquí reportado es relevante por su aporte. La atención multidisciplinaria favorecerá siempre el pronóstico de las pacientes.

Abstract BACKGROUND: Hodking's lymphoma is more common during pregnancy than non-Hodking's lymphoma; it affects, on average, women aged 30 years (18-44 years) and older. It is usually diagnosed around 28 weeks of pregnancy and is documented to be carried to term. Treatment regimens can be initiated in the immediate postpartum period or even earlier. The worldwide incidence of non-Hodking's lymphoma is 0.8 per 100,000 women; survival during pregnancy is unknown. CLINICAL CASE: 34-year-old patient, with obstetric history of three pregnancies, one cesarean section and one abortion and the current pregnancy in progress at 29 weeks, referred from the city of Colima due to a report of BI-RADS 3 on breast ultrasound and a palpable breast nodule, with evidence of multiple tumors in the hepatic, splenic and peripancreatic area. Biopsy taken from the lesion areas reported: high grade malignant B-cell lymphoma, with blastoid morphology and expression of C-MYC and BCL2. In addition, the patient was found to have: anemia, abdominal pain, multiple hepatic nodules and abdominal adenopathies. It was decided to terminate the pregnancy at 30 weeks, with the delivery of an uncomplicated newborn. Rituximab-Etoposide, Prednisone, Vincristine, Cyclophosphamide, and Doxorubicin (R-EPOCH) therapy was started immediately with adequate adaptation by the patient. CONCLUSION: Since bibliographic information on lymphoma and pregnancy is scarce, the case reported here is relevant for its contribution. Multidisciplinary care will always favor the prognosis of patients.

Influence of Epoch Length and Recording Site on the Relationship Between Tri-Axial Accelerometry-Derived Physical Activity Levels and Structural, Functional, and Hemodynamic Properties of Central and Peripheral Arteries.

Background: It remains to be established to what extent physical activity (PA) levels among individuals are independently associated with deviations from the "optimal" state of the arterial system. Accelerometers have been proposed as means to obtain reliable, objective, and more comprehensive data of PA. Decisions at the time of data collection/processing could influence the association between accelerometry-derived indices and arterial properties. Objectives: (i) To identify to what extent the strength of association between arterial properties and accelerometer-derived indices depend on the recording site and/or the epoch length; (ii) to determine whether some arterial characteristics (hemodynamic vs. structural vs. functional) or regions (elastic vs. transitional vs. muscular arteries; central vs. peripheral) have higher levels of association with accelerometry-derived indices. Methods: Physical activity (PA), cardiovascular risk factors (CRFs), and cardiovascular properties were evaluated in 60 volunteers (general population; age: 23-62 years; women: 43%). PA was measured daily for 7 days (free-living situation; triaxial-accelerometers ActiGraph-GT3X+; hip and wrist; "Worn-to-wrist" option) and raw data was converted at epoch lengths of 1, 5, 10, 30, and 60-s. PA-related energy expenditure, daily time in moderate-to-vigorous PA, steps/minute, and counts-per-minute for vector magnitude were calculated. The cardiovascular evaluation included hemodynamic (central and peripheral pressure), structural (diameters and intima-media thickness), and functional (local and regional stiffness) parameters of carotids, femoral, and brachial arteries, and carotid-femoral and carotid-radial pathways. Arterial z-scores were obtained using age-related equations derived from healthy participants not exposed to CRFs (n = 1,688; age: 2-84 years; female: 51.2%) to evaluate at which degree each parameter deviates from the "optimal" value. Methods: In general, hip recordings outperformed those obtained on the wrist regarding the strength of association with arterial parameters. Accelerometer-derived indices and their association with arterial properties vary depending on the recording site and epoch length. PA indices are stronger associated with functional (local) than structural variables and with central than peripheral arteries. Conclusions: Regardless of the PA index, there were independent associations with central artery characteristics, which reinforces that these territories would be the most related to PA levels. Differences in data acquisition and processing could lead to differences in conclusions when addressing the association between accelerometer-derived indices and the cardiovascular system.

Histeria, femineidad y locura en los tiempos del otro que no existe / Hysteria, feminity and folly in the epoch of the non existing other

Este trabajo realiza un recorrido por diversas referencias teóricas para intentar situar la especificidad de las llamadas locuras en las mujeres entre histeria y femineidad; así mismo se sitúa cómo la lógica de estas responde a ciertas coordenadas subjetivas estructurales que a su vez están tomadas por los puntales que estructuran la época y sus avatares.

This paper examines various theoretical references to put into place the specificity of so-called follies in women, between hysteria and femininity. It places, as well, how their logic responds to certain subjective structural coordinates, taken in turn by the coordinates that structure our time and its avatars.

Los efectos de la época actual en la tramitación de la crisis de la pubertad, abordaje psicoanalítico de pacientes con patología orgánica en el hospital general / The effects of the current epoch on the processing time of the crisis of puberty. A psychoanalytical approach of patients with organic pathology in the general hospital

En el presente trabajo, nos preguntamos acerca de la aparición de patología orgánica que afecta los órganos reproductores en el momento de la pubertad ­ adolescencia, a partir de la práctica clínica de orientación psicoanalítica desarrollada en el marco del Programa de la Facultad de Psicología en el Hospital de Clínicas que tiene lugar en dicho Hospital y que concierne a las investigaciones PROINPSI "La adolescencia y el déficit en los procesos de simbolización" y "La incidencia de la época actual en el déficit de los recursos subjetivos para la elaboración psíquica en la pubertad" ­en proceso de aprobación-. La maduración biológica que da inicio a la pubertad-adolescencia, implica la posibilidad de la reproducción sexuada que Freud plantea como ligada a la muerte puesto que el viviente se reproduce y muere. En nuestro trabajo realizamos un planteo acerca de cómo se presenta lo real en aquel los casos donde la respuesta frente a la castración es el rechazo, y que tiene como consecuencia, desde la perspectiva psicoanalítica, la enfermedad del órgano facilitado. Se trata de un punto forclusivo que no implica necesariamente el rechazo del significante del Nombre del Padre.

In the present work we wonder about the appearance of organic pathology that affects reproductive organs during puberty ­ adolescence, from the psychoanalytically oriented clinical practice developed under the Program of the School of Psychology of the University of Buenos Aires in the Hospital de Clinicas. This program takes place in this Hospital and it concerns the PROINPSI (Program for the Promotion of Research of the School of Psychology of the University of Buenos Aires) investigation projects: "Adolescence and the deficit in the processes of symbolization" and "The incidence of the current epoch in the deficit of subjective resources for the psychic processing in puberty". The biological maturation which initiates puberty ­ adolescence, implies the possibility of sexual reproduction. Freud says that sexual reproduction is linked to death because the living being reproduces and dies. In this paper, we try to propound how the real is presented in those cases in which the answer to castration is rejection, which, from the psychoanalytic perspective, has the disease of the provided organ as a consequence. It is a foreclusive response which does not necessarily implies the rejection of the Name-of-the-Father signifier.

La propensión al principio de placer en la época actual y sus efectos en la salida de la adolescencia / The propensity to the pleasure principle in the current epoch and its effects on the exit from adolescence

Partiendo de un caso clínico, y haciendo una lectura del mismo desde los trabajos de Sigmund Freud y Jacques Lacan, los autores presentan a la adolescencia como un momento del ciclo vital en donde se ponen en juego para el sujeto operaciones simbólicas que determinarán su posibilidad de advenir adulto. Para esto se consideran las particularidades que presenta la época actual en lo concerniente a los modos de satisfacción y los ideales propuestos. La operatividad de la metáfora paterna se torna crucial para ligar al adolescente, en tanto sujeto adulto a advenir, a la comunidad en el amor y el trabajo.

Utilizing a clinical case, and reading it with a base on Sigmund Freud and Jacques Lacan's work, the authors present adolescence as a moment in the life cycle where the symbolic operations brought into play will determine the subject's ability to become an adult. For this purpose, the peculiarities of the current epoch regarding the ways to satisfaction and the ideals proposed are to be considered. The operativeness of the paternal metaphor becomes crucial to bind the adolescent, as an adult subject to be, to the community within love and work.

Tratamiento de pacientes con linfomas no Hodgkin asociados a SIDA: experiencia del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán / Treatment of non-Hodgkin's lymphoma associated with acquired immnodeficiency syndrome (AIDS) at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Antecedentes: La supervivencia de los pacientes con linfomas no Hodgkin asociados al Síndrome de Inmunodeficiencia Adquirida (SIDA) ha mejorado con el uso de antirretrovirales y de quimioterapia menos tóxica. Material y métodos: El objetivo del estudio fue mostrar los resultados del tratamiento de los pacientes con linfomas no Hodgkin y SIDA. Se estudiaron nueve pacientes de manera retrospectiva. Se analizó la supervivencia global y libre de enfermedad mediante curvas de Kaplan-Meier; además de sus características generales. Resultados: El tratamiento recibido fue a base de etopósido, prednisona, vincristina, doxorrubicina y ciclofosfamida (DA-EPOCH). Los pacientes tuvieron supervivencia global de 18 meses, una supervivencia libre de enfermedad de 13 meses, una mediana de seguimiento de 16 meses con respuestas completas en ocho de nueve pacientes. Conclusiones: Se observó una adecuada repuesta a tratamiento en este grupo de enfermos reflejada en una mayor supervivencia global.

BACKGROUND: Survival in patients with acquired immunodeficiency syndrome (AIDS) related non-Hodgkin's Lymphoma has improved with the use of High Active Antiretroviral Therapy (HAART) and less toxic chemotherapy. MATERIAL AND METHODS: Clinical characteristics and outcome among patients treated for AIDS related non-Hodgkin's Lymphoma are described. Nine patients were studied retrospectively. Overall survival (OS) and Free Disease Survival (FDS) using a Kaplan-Meier model were analyzed. RESULTS: Patients received (DA-EPOCH) etoposide, prednisone, vincristine, doxorubicin and cyclophosphamide. The overall Survival was 18 months and 13 month Free Disease Survival with a median follow-up of 16 months showing full response in 8/9 patients was observed. CONCLUSIONS: A very satisfactory treatment response in this group of patients expressed as an increased Overall Survival was noted.

Propagação vegetativa de Platanus AcerIfolia Ait.: (I) efeito de tipos fisiológicos das estacas e épocas de coleta no enraizamento de estacas

The aim of this work was to evaluate the effect of the physiological type of the cutting on rooting of Platanus acerifolia Ait. cuttings collected at different times. The treatments followed a 4 x 4 factorial scheme, involving four physiological types of the cuttings (hardwood, basal semi-herbaceous, middle semi-herbaceous, and thin basal semi-herbaceous), and four different times of the cuttings collection (September/95, January/96, March/96, and July/96). The cuttings were rooted in pots containing as substrate a mixture of medium sand + carbonised rice husk, 1:1 v/v, both washed. The experiment was conducted during 110 days under intermittent artificial mist conditions. The results indicate that the best time to collect cuttings to get rooting is in July, and basal semi-herbaceous cutting shows the best percentage on rooting.

O objetivo desse trabalho foi avaliar os efeitos do tipo fisiológico da estaca e da época de coleta no enraizamento de estacas de Platanus acerifolia Ait. Os tratamentos consistiram de uma combinação bifatorial (4 x 4), representados por quatro tipos fisiológicos de estacas de ramos ("de ano", "do ano" basal, "do ano" mediana e "do ano" basal fina) e quatro épocas de coleta (setembro/95, janeiro/96, março/96 e julho/96). A estaquia foi realizada em vasos contendo como substrato uma mistura de areia média e casca de arroz carbonizada (1:1, v/v), ambas lavadas. O experimento foi conduzido por 110 dias em casa de vegetação com sistema de microaspersão intermitente. A melhor época de coleta das estacas para o enraizamento é em julho e as estacas de ramos "do ano" basais apresentam o maior potencial de enraizamento.

Propagação vegetativa de Platanus AcerIfolia Ait.: (I) efeito de tipos fisiológicos das estacas e épocas de coleta no enraizamento de estacas

The aim of this work was to evaluate the effect of the physiological type of the cutting on rooting of Platanus acerifolia Ait. cuttings collected at different times. The treatments followed a 4 x 4 factorial scheme, involving four physiological types of the cuttings (hardwood, basal semi-herbaceous, middle semi-herbaceous, and thin basal semi-herbaceous), and four different times of the cuttings collection (September/95, January/96, March/96, and July/96). The cuttings were rooted in pots containing as substrate a mixture of medium sand + carbonised rice husk, 1:1 v/v, both washed. The experiment was conducted during 110 days under intermittent artificial mist conditions. The results indicate that the best time to collect cuttings to get rooting is in July, and basal semi-herbaceous cutting shows the best percentage on rooting.

O objetivo desse trabalho foi avaliar os efeitos do tipo fisiológico da estaca e da época de coleta no enraizamento de estacas de Platanus acerifolia Ait. Os tratamentos consistiram de uma combinação bifatorial (4 x 4), representados por quatro tipos fisiológicos de estacas de ramos ("de ano", "do ano" basal, "do ano" mediana e "do ano" basal fina) e quatro épocas de coleta (setembro/95, janeiro/96, março/96 e julho/96). A estaquia foi realizada em vasos contendo como substrato uma mistura de areia média e casca de arroz carbonizada (1:1, v/v), ambas lavadas. O experimento foi conduzido por 110 dias em casa de vegetação com sistema de microaspersão intermitente. A melhor época de coleta das estacas para o enraizamento é em julho e as estacas de ramos "do ano" basais apresentam o maior potencial de enraizamento.