Respuesta favorable a rituximab de un linfoma primario de anejos oculares / Favourable response to rituximab by an ocular adnexal primary lymphoma

CASO CLÍNICO: Mujer de 70 años que presenta un linfoma B marginal extranodal que afecta a la glándula lagrimal y la conjuntiva. Se indica tratamiento con rituximab, con buena respuesta inmediata. A los 5 meses se observa la aparición de proliferación linfoide del mismo tipo en la conjuntiva del ojo contralateral. Durante 5 años de seguimiento sin medidas adicionales la paciente mantiene buen estado general, sin afectación en otras zonas. DISCUSIÓN: Rituximab es una opción terapéutica en casos de linfoma de anejos oculares de bajo grado

CASE REPORT: A 70-year-old woman who presented with an extranodal marginal zone B-cell lymphoma in lacrimal gland and conjunctiva. Initial treatment with rituximab yielded an immediate good response. Five months later she showed lymphoid proliferation in her contralateral conjunctiva. Although no additional treatment was performed, the patient has been free of systemic symptoms and recurrences. DISCUSSION: Rituximab is a quite good therapeutic agent in low grade adnexal lymphoma

Favourable response to rituximab by an ocular adnexal primary lymphoma. / Respuesta favorable a rituximab de un linfoma primario de anejos oculares.

CASE REPORT: A 70-year-old woman who presented with an extranodal marginal zone B-cell lymphoma in lacrimal gland and conjunctiva. Initial treatment with rituximab yielded an immediate good response. Five months later she showed lymphoid proliferation in her contralateral conjunctiva. Although no additional treatment was performed, the patient has been free of systemic symptoms and recurrences. DISCUSSION: Rituximab is a quite good therapeutic agent in low grade adnexal lymphomas.

EBV, HCMV, HHV6, and HHV7 screening in bone marrow samples from children with acute lymphoblastic leukemia.

Acute lymphoblastic leukemia (ALL) is the most common cancer in childhood worldwide and Mexico has reported one of the highest incidence rates. An infectious etiology has been suggested and supported by epidemiological evidences; however, the identity of the involved agent(s) is not known. We considered that early transmitted lymphotropic herpes viruses were good candidates, since transforming mechanisms have been described for them and some are already associated with human cancers. In this study we interrogated the direct role of EBV, HCMV, HHV6, and HHV7 human herpes viruses in childhood ALL. Viral genomes were screened in 70 bone marrow samples from ALL patients through standard and a more sensitive nested PCR. Positive samples were detected only by nested PCR indicating a low level of infection. Our result argues that viral genomes were not present in all leukemic cells, and, hence, infection most likely was not part of the initial genetic lesions leading to ALL. The high statistical power of the study suggested that these agents are not involved in the genesis of ALL in Mexican children. Additional analysis showed that detected infections or coinfections were not associated with prognosis.

Allergy and acute leukaemia in children with Down syndrome: a population study. Report from the Mexican inter-institutional group for the identification of the causes of childhood leukaemia.

BACKGROUND: Allergies have been described as protective factors against the development of childhood acute leukaemia (AL). Our objective was to investigate the associations between allergy history and the development of AL and acute lymphoblastic leukaemia (ALL) in children with Down syndrome (DS). METHODS: A case-control study was performed in Mexico City. The cases (n=97) were diagnosed at nine public hospitals, and the controls (n=222) were recruited at institutions for children with DS. Odds ratios (OR) were calculated. RESULTS: Asthma was positively associated with AL development (OR=4.18; 95% confidence interval (CI): 1.47-11.87), whereas skin allergies were negatively associated (OR=0.42; 95% CI: 0.20-0.91). CONCLUSION: Our findings suggest that allergies and AL in children with DS share biological and immune mechanisms. To our knowledge, this is the first study reporting associations between allergies and AL in children with DS.

Cytological features of ossifying fibromyxoid tumor of soft parts.

A case of ossifying fibromyxoid tumor (OFMT) evaluated during an intraoperative pathological consultation is presented. The patient, a 70-year-old woman was being followed because of a tumor in the left buttock. Cytological smears were obtained after scrapping the tumoral cut surface and revealed a myxoid background with fragments composed of a denser, fibrillar metachromatic stroma with accompanying round to oval tumoral nuclei and no vessels. Single cells were predominantly monomorphic with a round to oval morphology and scarce cytoplasm. The most relevant feature of the tumor was its peripheral, plaque-like, calcified consistency. The review of the cytological descriptions of four cases revealed similar findings that can be presumed as those of a low-grade myxoid tumor of round to oval cells. A specific recognition of OFMT based solely on cytological features seems difficult. However, when such features are coupled with characteristic radiological findings (peripheral calcification) this entity must be considered.

Cytological features of lung adenocarcinoma with massive lymphocyte infiltration.

Adenocarcinoma with massive lymphocyte infiltration is a rare pulmonary neoplasm with few reported cases. It seems to have a better outcome than conventional adenocarcinomas, but it is still not clear if it constitutes a specific clinicopathological entity. We report a case in which cytological studies were available. The small size of the tumor, abundant lymphocyte population, well-differentiated morphology of the neoplasm and scarcity of atypical cells resulted in a difficult cytological diagnosis. This entity should be considered when evaluating pulmonary lesions with abundant lymphocytes. Not all carcinomas with prominent lymphoid stroma show the high-grade, pleomorphic morphology of lymphoepithelioma-like carcinomas.

Impact of liver steatosis on the correlation between liver stiffness and fibrosis measured by transient elastography in patients coinfected with human immunodeficiency virus and hepatitis C virus.

We assessed the effect of different hepatic conditions such as fibrosis, steatosis and necroinflammatory activity on liver stiffness as measured by transient elastography in HIV/HCV-coinfected patients. We studied all consecutive HIV/HCV-coinfected patients who underwent liver biopsy and elastography between January 2007 and December 2008. Liver fibrosis was staged following METAVIR Cooperative Study Group criteria. Steatosis was categorized according to the percentage of affected hepatocytes as low (≤10%), moderate (<25%) and severe (≥25%). A total of 110 patients were included. Fibrosis was distributed by stage as follows: F0, n = 13; F1, n = 47; F2, n = 29; F3, n = 18; and F4, n = 3. Liver biopsy revealed the presence of hepatic steatosis in 68 patients (low to moderate, n = 53; and severe n = 15). By univariate regression analysis, fibrosis, necroinflammatory activity, and the degree of steatosis were correlated with liver stiffness. However, in a multiple regression analysis, steatosis and fibrosis were the only independent variables significantly associated with liver stiffness. With a cut-off of 9.5 kPa to distinguish patients with F ≤ 2 from F ≥ 3, elastography led to a significantly higher number of misclassification errors (25%vs 5%; P = 0.014), most of which were false positives for F ≥ 3. Our study suggests that the correlation between liver stiffness and fibrosis as estimated by transient elastography may be affected by the presence of hepatic steatosis in HIV/HCV-coinfected patients.

Lymphoma associated chromosomal abnormalities can easily be detected by FISH on tissue imprints. An underused diagnostic alternative.

BACKGROUND: Fluorescence in situ hybridisation (FISH) is useful for detecting specific chromosomal abnormalities in various tumours. In lymphomas, diagnosis is frequently made using paraffin wax embedded tissue. However, FISH performed under these conditions presents potential technical problems and difficulties in interpretation. AIMS: To show that FISH using tissue imprints and cytopreps or alternatively, bone marrow (BM) smears, constitutes an easy and rapid strategy to overcome these constraints. METHODS: The study comprised 46 patients with lymphoma. Sixty nine tissue imprints, cytopreps, or BM smears were analysed by FISH. Dual colour, dual fusion FISH probes were used to detect the t(8;14), t(11;14), and t(14;18) translocations, whereas a dual colour breakapart FISH probe was used to detect chromosomal translocations involving the BCL6 gene. RESULTS: Tissue imprints and cytopreps were successfully hybridised in all 52 cases, whereas hybridisation was successful in 16 of 17 archival BM smears. All patients could be analysed to identify either the presence or absence of chromosomal translocations. CONCLUSIONS: The use of tissue imprints, cytopreps, or BM smears to identify chromosomal abnormalities by FISH is a rapid and useful ancillary approach for diagnostic purposes. Therefore, it could be used on a routine basis whenever fresh samples are available.

Santa Teresa de Jesús y los cuidados de enfermería / Saint Teresa of Avila and nursing cares

Revisamos los escritos que la insigne mística y escritora del Siglo de Oro Español, Santa Teresa de Jesús, llevó a cabo acerca de la melancolía, dedicando una atención especial a los cuidados de enfermería que la santa preconiza para esta enfermedad mental (AU)

[Analysis of prescriptions of antibiotics for acute respiratory infections at a health center]. / Análisis de la prescripción de antibióticos en las infecciones respiratorias agudas de un centro de salud.

OBJECTIVE: To analyse the prescription of antibiotics for acute respiratory infections (ARI) at our Health Centre. DESIGN: An observational crossover study. SETTING: Primary Health care. San Gregorio de Telde Health Centre, Gran Canaria. PATIENTS AND PARTICIPANTS: Systematic random sampling of 368 clinical cases with ARI. 196 women (53.26%) and 172 men (46.73%), with an average age of 33.26 +/- 1.97. MEASUREMENTS AND MAIN RESULTS: Antibiotics were prescribed for 42.66% of ARI. Family doctors used them less than general ones (38.67% against 63.04%, p < 0.0001), and on the afternoon lists they were used less than in the morning (33.82% against 52.35%, p < 0.001). In chronically ill patients they were used less than symptomatic treatment (42.16% against 57.83%, p < 0.001). There were no significant differences found between their use and the appearance of complications (37.5% with Antibiotherapy against 62.5% without it) or successive consultations (45.16% with antibiotics against 54.83% without them). They were used more in those aged over 60 (48.97%) and in those who attended less (51.56%). Average cost per patient treated with Antibiotherapy was 2,508.48 +/- 258.80 pesetas against 694.28 +/- 78.67 pesetas for the patient treated symptomatically (p < 0.0005). CONCLUSIONS: We are using Antibiotherapy inadequately in our field. We propose that quality control studies to detect and correct problems of this type should be undertaken. In our case corrective measures with a later reevaluation should be applied.