[Histiocytic necrotizing lymphadenitis: report of three cases]. / Tumor cervical por enfermedad de Kikuchi: Una entidad clínica a la que no estamos habituados. Caso clínico.

Histiocytic necrotizing lymphadenitis (HNL), also known as Kikuchi 5 disease is a rare condition of unknown etiology. Patients present with cervical lymph node enlargement, fever and malaise. The diagnosis is made by excision biopsy. However, this entity must be distinguished from both reactive processes and malignant tumors such as lymphoma. The clinical course is self limited with spontaneous resolution within a few months. We report three patients with the disease. A 37 year-old woman with a 4 months history of a painless submaxillary mass of 2.5 cm diameter, attached to the deep tissues of the neck. The mass was excised and the biopsy report was HNL. After 26 months of follow up, the patient is asymptomatic. A 30 year-old woman with a history of 2 months of a painless lateral cervical mass and aspiration biopsy was reported as suspicious for lymphoma. An excision biopsy was performed, that was reported as HNL. In both patients, lymphoma was ruled out by immunohistochemistry. A 33 year-old woman with a 3 weeks history of an asymptomatic lateral cervical mass. Biopsy was reported as HNL. This condition must be included in the differential diagnosis of cervical asymptomatic masses. The clinician must be aware of it to avoid long-term, costly treatments.

Tumor cervical por enfermedad de Kikuchi: Una entidad clínica a la que no estamos habituados. Caso clínico / Histiocytic necrotizing lymphadenitis: Report of three cases

Histiocytic necrotizing lymphadenitis (HNL), also known as Kikuchi 5 disease is a rare condition of unknown etiology. Patients present with cervical lymph node enlargement, fever and malaise. The diagnosis is made by excision biopsy. However, this entity must be distinguished from both reactive processes and malignant tumors such as lymphoma. The clinical course is self limited with spontaneous resolution within a few months. We report three patients with the disease. A 37 year-old woman with a 4 months history of a painless submaxillary mass of 2.5 cm diameter, attached to the deep tissues of the neck. The mass was excised and the biopsy report was HNL. After 26 months of follow up, the patient is asymptomatic. A 30 year-old woman with a history of 2 months of a painless lateral cervical mass and aspiration biopsy was reported as suspicious for lymphoma. An excision biopsy was performed, that was reported as HNL. In both patients, lymphoma was ruled out by immunohistochemistry. A 33 year-old woman with a 3 weeks history of an asymptomatic lateral cervical mass. Biopsy was reported as HNL. This condition must be included in the differential diagnosis of cervical asymptomatic masses. The clinician must be aware of it to avoid long-term, costly treatments.

Reconstrucción de lesiones de extremidad inferior con Colgajo de Arteria Sural Superficial, experiencia de 10 años / Reconstruction of lower extremity lesions with superficial sural artery flap: a ten-year experience

La cobertura de heridas complejas en extremidades inferiores es un desafío de difícil manejo. Se realizó un estudio retrospectivo, analizando el resultado y las complicaciones en el uso del colgajo sural a pedículo distal para cobertura de defectos de extremidad inferior. Material y Método: Revisión de fichas clínicas de todos los pacientes sometidos a colgajo sural en los Hospitales Militar y Trabajador de Santiago entre los años 1995 y 2005, analizando características epidemiológicas, técnica quirúrgica y complicaciones del procedimiento. Resultados: Colgajos surales totales: 40 casos. Etiología de lesión: Fracturas: 33 casos (82,5%), heridas complejas (infectadas, inestables) 4 casos (10%), desforrramiento: 2 casos (5%) y quemadura: 1 caso (2,5%). En 20 casos no hubo complicación, y dentro de las complicaciones se encontraron necrosis parcial: 8 casos (20%), infección: 5 casos (12,5%), epidermolísis: 4 casos (10%) y seroma en 3 casos (7,5%). No se reportaron casos de necrosis total. Conclusión: El colgajo sural a pedículo distal es una alternativa válida de cobertura en lesiones complejas de extremo distal de extremidad inferior, con complicaciones de manejo aceptables, y con buen resultado a largo plazo.

Background: The covering of complex wounds of lower extremities is a difficult challenge. Aim: To analyze the results and complications on the use of sural flaps with distal pedicle for the covering of lower extremity defects. Material and Methods: We reviewed the clinical records of all the patients that had sural flaps between 1995 and 2005 at the Military Hospital and Workers Hospital of Santiago, Chile. We analyzed the epidemiologic characteristics, surgical techniques and complications of the procedure. Results: We found 40 cases of sural flaps. The etiology of the lesions were fractures in 33 cases (82.5%), complex wounds: four cases (10%), skin tearing and muscle laceration in 2 cases (5%) and burns 1 case (2.5%). In 20 cases there were no complications. Eight cases had partial necrosis (20%), five had infections (12.5%), four had epidermolysis and three had a seroma (7.5%). There were no reports of total necrosis. Conclusions: Sural flaps with a distal pedicle are a valid alternative for the covering of complex wounds of the distal portion of lower extremities, with a low rate of complications and good long term results.

Genetic polymorphisms of CYP2D6, CYP1A1 and CYP2E1 in the South-Amerindian population of Chile.

Polymorphisms of cytochrome P450 genes show pronounced interethnic variation and have not been previously studied in the South-Amerindian population, which probably has an Asian origin. Therefore, a similar distribution of allelic and haplotype frequencies of cytochrome P450 genes to Asian populations might be expected in South-Amerindians. We analysed the allelic frequencies and haplotype distribution for CYP2D6, CYP1A1 and CYP2E1 genes in the South-Amerindian population of Chile (Mapuche, n = 84) by Southern blot or polymerase chain reaction-restriction fragment length polymorphism. Similar allelic frequencies and haplotype distribution for the CYP2E1 gene between Mapuches and Asian populations were observed. Frequencies of the two major functional CYP2D6*1 and CYP2D6*2 alleles and the CYP2D6*5 null allele were similar to most populations world-wide. The alleles CYP2D6*3 and *9, absent in Asians, were not found in Mapuches. The CYP2D6*4 allelic group, uncommon in Asian populations, had a low frequency in Mapuches (0.036). However, the CYP2D6*10 allele (Ch1, Ch2 and J), highly frequent in Asians (0.33-0.50), had a very low frequency (0.018) in our study population. In addition, the presence of the common Chinese 44 kb XbaI fragment of CYP2D6 (0.19-0.31 in Asians) was not detected in South-Amerindians. Interestingly, high frequencies for the rare m2 and Val alleles of the CYP1A1 gene were found in Mapuches (0.821 and 0.91, respectively), and the rare Val/m2 haplotype was significantly higher in Mapuches (0.748) than in Asians (0.24) (P < 0.01). The frequency of this haplotype in Mapuches is the highest frequency reported to date. The population studied was in Hardy-Weinberg equilibrium for these polymorphisms. The major differences between Mapuches and Asians were for CYP2D6*10 and CYP1A1 allelic frequencies, as well as the absence of the common Chinese 44 kb XbaI fragment of CYP2D6. These differences might be interpreted as a consequence of genetic drifts caused by a founder effect in the settlement of South-Amerindians, or genetic selection caused by dietary or environmental factors.

Genetic epidemiology of cholesterol cholelithiasis among Chilean Hispanics, Amerindians, and Maoris.

BACKGROUND & AIMS: The etiology of cholesterol gallstones is multifactorial, with interactions of genes and the environment. The hypothesis that aborigine cholesterol lithogenic genes are widely spread among Chileans, a population with a high prevalence of gallstones, was tested. METHODS: Medical history and anthropometric measurements were obtained and abdominal ultrasonography was performed in 182 Mapuche Indians, 225 Maoris of Easter Island, and 1584 Hispanics. Blood groups, DNA, lipids, and glucose were analyzed. The Amerindian Admixture Index and mitochondrial DNA (mtDNA) assessed the ethnicity and degree of racial admixture. RESULTS: Amerindian Admixture Index was 0.8 in Mapuches and 0.4 in Hispanics. All Mapuches, 88% of Hispanics, but none of Maoris had Amerindian mtDNA haplotypes. Age- and sex-adjusted global prevalence of gallstone disease was higher in Mapuches (35%) than in Hispanics (27%) and Maoris (21%). Compared with Hispanics, the youngest group of Mapuches had the greatest corrected risk of gallstones: odds ratios of 6.0 in women and 2.3 in men. In contrast, the gallstone risk in Maoris was lower compared with Hispanics: odds ratios of 0.6 for women and 0.5 for men. CONCLUSIONS: Cholesterol lithogenic genes appear widely spread among Chilean Indians and Hispanics. They could determine the early formation of gallstones and explain the high prevalence of gallbladder diseases among some South American populations.

[Gallbladder polyps. 2d Consensus Workshop of the Chilean Hepatology Association]. / Pólipos vesiculares. Segundo taller de consenso de la asociatión chilena de hepatología.

During a workshop, hepatologists analyzed and gave recommendations about gallbladder polyps. They arrived to the following agreements: gallbladder polyps of less than 10 mm should be followed with ultrasonography at 3, 6 and 12 months if there is no enlargement. If there is enlargement, a cholecystectomy should be performed. Polyps larger than 10 mm should be subjected to cholecystectomy.

Apolipoprotein E polymorphism in patients with acute pancreatitis.

We have shown that patients with previous acute pancreatitis (AP) may have an abnormal catabolism of chylomicron remnants (CMR). Because apoprotein E (Apo E) genetic polymorphism has an important influence on CMR clearance, we compared frequency distribution of Apo E phenotypes in 52 patients with AP, 109 patients with gallstones, and 110 control subjects. Apo E phenotypes were detected by isoelectric focusing and immunoblotting. After adjusting for differences in age and gender, fasting triglyceride level was comparable between the study groups. The frequency distribution of Apo E phenotypes was not different between the three study groups and it was in Hardy-Weinberg equilibrium. The gene frequency for Apo E2 was 0.212, 0.273, and 0.243 in AP, gallstone, and control group, respectively. For Apo E3 it was 0.701, 0.627, and 0.674, and for Apo E4 0.090, 0.100, and 0.083 in the same groups, respectively. Differences were not statistically significant (chi 2). In conclusion, the abnormal catabolism of CMR in patients with AP is not attributable to Apo E polymorphism. An alternative explanation may be sought in the activity of the recently identified hepatocytic Apo E receptor [LDL-related receptor protein (LRP)].

Pregnancy and cholelithiasis: pathogenesis and natural course of gallstones diagnosed in early puerperium.

Several recent reports have indicated an increased prevalence of gallstones in association with pregnancy. If these reports are true, the early puerperium should be a favorable time to detect the disease in its initial stages and follow its natural course. Accordingly, the gallbladder was examined by ultrasound in 980 women during the immediate postpartum period and in 150 nulliparous, age-matched healthy volunteers. Gallstones were detected in 12.2% of the puerperal women and in 1.3% of the control group. In 70 patients who had stones in a functioning gallbladder, 22 (31%) had had attacks of biliary colic. The history of pain was more common in patients with stones greater than 10 mm in diameter. Forty-one women with small stones (< 10 mm) were followed clinically and ultrasonographically for between 6 and 24 (mean = 8.7) mo. All remained pain-free, and in twelve subjects (29%) the stones disappeared. Gallbladder bile was examined in 11 normal volunteers (controls) immediately after delivery and in 19 women with small stones 39 +/- 6 days postpartum. Bile was saturated with cholesterol in the controls and was unsaturated in patients with gallstones. We conclude that in our population pregnancy is a very important pathogenetic factor favoring gallstone formation. Attacks of biliary colic appear early and frequently in young Chilean women with this disease. Unexplained disappearance of small stones frequently occurs: in some cases it is likely to be the result of spontaneous dissolution because bile becomes unsaturated within a few weeks of delivery.

[Correlation between ultrasound and pathology of the gallbladder]. / Correlacion entre la ecotomografia y la anatomia patologica de la vesicula biliar.

Ultrasound is a sensible and specific method for the diagnosis, study of natural course and follow up of medical treatment of gallstones. Thus it is important to specify the concordance between echographic and pathological findings of the gallbladder. Ninety one patients were subjected to an ultrasound gallbladder examination immediately before elective surgery and the excised organ was pathologically examined right after the operation. The number and size of stones, the diameters and wall thickness of the gallbladder and the presence of polyps and septa were compared with both methods. The correlation was fair for the number or size of the stones considered separately; however the correct diagnosis of both parameters was obtained in only a third of the cases. Diameters of the gallbladder were underestimated by ultrasound; wall thickness measurement showed a very good correlation with both methods. No correlation was found for polyps or septa. Although ultrasound is excellent for the diagnosis of gallstones, its precision, is insufficient to determine the exact number and size of the stones.

[Epidemiology and natural history of biliary calculi. Implication for clinical management]. / Epidemiologia e historia natural de la litiasis biliar. Implicancias para el manejo clinico de la enfermedad.

The knowledge of the epidemiology of cholesterol gallstones is mainly descriptive in Chile. Prevalence data has been gathered from several autopsy studies. The prevalence in these studies is similar to the prevalence determined in a cholecystographic study in a sample of the population of Santiago: 51% of women and 17% of men harbor gallstones, or have been cholecystectomized. The risk factors of the disease are well known and include sex, age, obesity, pregnancy, female sex hormones and hypotriglyceridemic drugs, there is scarce data on the natural history of gallstone disease. In this article we review the present knowledge of both the epidemiology and natural history of gallstones. In addition, we present some specific questions related to the potential identification of environmental and genetic risk factors in epidemiological studies. It is stressed that the knowledge of the natural history of gallstone disease is critical for the appropriate rational management of silent gallstones.

Separation and quantitation of cholesterol carriers in native bile by ultracentrifugation.

The vesicular and micellar carriers of biliary cholesterol were isolated and quantitated from native bile by a simple and short isopyknic ultracentrifugal method. The method was designed to decrease the potential pitfalls of classic ultracentrifugation: osmotic effects of the centrifugation media and hydrostatic pressure effects generated in the centrifuge tube. This was accomplished by using metrizamide as an inert centrifugation medium for isopyknic separation and a vertical rotor. The buoyant density of vesicles isolated from human native bile varied between 1.010 and 1.030 gm/ml, as determined in preformed bile-metrizamide density gradients after 285 min of centrifugation. When 16% metrizamide was directly dissolved in bile, its density increased to 1.060 gm/ml. After 120 min of centrifugation, it was found that more than 95% of total vesicular cholesterol floated at the top of the centrifuge tube. This fraction appeared as one or two white opalescent bands. The present ultracentrifugal method was validated by gel filtration chromatography. It was found that more than 95% of vesicular cholesterol migrated to the top 0.4 ml of the centrifuge tube after the short-run centrifugation. Approximately 5% of total biliary cholesterol present in the vesicular fractions was in fact solubilized in mixed micelles as assessed by gel filtration chromatography. Although the proportion of vesicles and micelles estimated with the present ultracentrifugal method is in the range reported by other authors using the more common chromatographic method, we believe that our method has two major advantages. First, it eliminates the dilutional effect of buffers necessary for gel filtration chromatography.(ABSTRACT TRUNCATED AT 250 WORDS)

[Distribution of the infection by Camallanus corderoi (Nemata: Spiruroidea) in different autochthonous hosts and localities of the Valdivia river basin, Chile]. / Distribución de la infección por Camallanus corderoi (Nemata: Spiruroidea) en distintos hospedadores autóctonos y sectores de la cuenca del río Valdivia, Chile.

Six hundred and thirty nine autochthonous fish were examined in 1986-1987 in search for Camallanus corderoi infection on different biotopes from Valdivia River basin (between 39 degrees 30'-40 degrees 00'S, 73 degrees 30'-71 degrees 45'' W). Brachigalaxias bullocki, Galaxias maculatus, Galaxias platei, Aplochiton taeniatus, Cheirodon australe, Basilichthys australis and Cauque mauleanum are new hosts for C. corderoi. Infection by C. corderoi in fish is acquired by ingestion of infected copepods and prevalence and intensity of infection showed differences between host fish and biotopes. In general, infrapopulations of C. corderoi showed overdispersion in different hosts.

[Diabetes mellitus in chronic alcoholic liver damage]. / Diabetes mellitus en el daño hepatico cronico alcoholico.

We performed an oral glucose tolerance test and measured serum insulin levels in 38 patients with chronic alcoholic liver damage. A diabetic curve was obtained in 34% of subjects both obese and non obese. Insulin levels were elevated in comparison with normal subjects in all patients. The Turner index [(serum insulin x 100)/(blood sugar--30]) was lower than normal at all points of the GTT, suggesting a decreased insulin secretion in relation to serum glucose level. Blood glucose level at 120 min was correlated to age, serum bilirubin and prothrombin time. Thus, chronic liver damage is a risk factor for diabetes mellitus. The alteration of carbohydrate metabolism is correlated to the severity of liver disfunction. The initial pathogenic factor may be hyperinsulinism and resistance to insulin, followed by decreased secretion of the hormone.

Rapid isolation of vesicular and micellar carriers of biliary lipids by ultracentrifugation.

A simple, rapid, and new method has been developed to isolate and to quantitate the vesicular carrier of biliary lipids by isopycnic ultracentrifugation. The method combines the use of Metrizamide, as an inert centrifugation media to change the density of bile for isopycnic separation of vesicles, and a vertical rotor, to decrease both the time of centrifugation and the pressure of the hydrostatic column in the ultracentrifuge tube. Vesicles harvested from bile-Metrizamide density gradients were identified by negative staining electron microscopy. The buoyant densitites of biliary vesicles varied between 1.010 and 1.030 g/ml. The diameter of vesicles in fractions with d less than 1.020 g/ml was 82 +/- 10 nm and in fraction with d approximately 1.030 g/ml was 57 +/- 8 nm. Gel filtration chromatography with Ultrogel AcA 34 was used to validate the quantitive isolation of vesicles by the ultracentrifugal method. In experiments with bile-Metrizamide continuous preformed density gradients, greater than 93% of vesicular cholesterol was found in fractions with d less than 1.030 g/ml after 285 min of centrifugation at 50,000 rpm in a VTi vertical rotor (Beckman Instruments, Inc.). When 16% Metrizamide was dissolved in bile and centrifuged for 120 min, greater than 96% of total vesicular cholesterol was found in the top 0.4 ml of the 5-ml centrifuge tube, as assessed by gel filtration chromatography. This fraction contained less than 8% of cholesterol carried in micelles, as assessed by gel filtration chromatography. The variation coefficient of this short ultracentrifugal method to isolate biliary vesicles was 4.6%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Biliary lipid secretion in men with cholelithiasis]. / Secreción de lípidos biliares en hombres con colelitiasis.

Supersaturation of bile is indispensable for the appearance of cholesterol gallstones; it can be due to hypersecretion of cholesterol or to hyposecretion of bile acids and phospholipids. In a previous study we demonstrated cholesterol hypersecretion in Chilean women with gallstones. To elucidate the secretory defect in male patients we studied two groups of young men with normal body weight and a functioning gallbladder: four individuals with cholesterol gallstones and six healthy volunteers. The bile acid pool size and the secretory rate of bile acids and phospholipids were similar in controls and gallstone patients. On the other hand, cholesterol output was higher in the gallstone group. This study confirms the importance of biliary cholesterol hypersecretion as a major factor in the pathogenesis of gallstone disease in Chile.

Influence of legume intake on biliary lipids and cholesterol saturation in young Chilean men. Identification of a dietary risk factor for cholesterol gallstone formation in a highly prevalent area.

Chileans and North American Indians have one of the highest prevalence rates of cholesterol gallstones in the world. The most common theory to explain this has been the operation of some as yet undefined genetic risk factor in these populations. Searching for some common environmental factor for gallstones in Chileans and North American Indians, we found that beans and other legumes are common foods consumed by both populations. In this study we tested the hypothesis that legume intake may favor the production of biliary cholesterol supersaturation. We studied 20 young men subjected to a diet containing 120 g/day of legumes and a control diet without legumes for a period of 1 mo each. Both diets supplied identical quantities of energy, carbohydrates, protein, total fat, fiber, and cholesterol. Low-density lipoprotein cholesterol concentration decreased by 16% (p less than 0.001) after the legume diet. Biliary cholesterol saturation increased in 19 of the 20 subjects; the mean of the group markedly increased from 110% to 169% (p less than 0.001) after the legume diet. These results are consistent with the hypothesis that legume intake is a potential risk factor for cholesterol gallstone disease.