Linfoma extranodal NK de celulas T tipo nasal: reporte de caso / Extranodal NK/T cell lymphoma, nasal type: report of case

El linfoma extranodal de c‚lulas T/NK tipo nasal es una entidad rara, cuya etiolog¡a est  asociada al virus Epstein-Barr, su comportamiento agresivo (20% de sobrevida a 5 a¤os) y es predominante en hombres. Se manifiesta por una lesi¢n tumoral mediofacial destructiva de vasos y necrosis prominente. El diagn¢stico es cl¡nico e inmunohistopatol¢gico y se caracteriza por una marcada agiocentricidad y necrosis tisular, acompa¤ada de infiltrado inflamatorio de linfocitos, histiocitos, c‚lulas plasm ticas y a veces eosfin¢filos. Su inmunofenotipo caracter¡stic es CD2(+), CD56(+), CD3 epsilon (+), CD3 superficie (-), CD7(-), CD16(-), CD30 +/-. A pesar de ser radiosensible, tiene un mal pron¢stico, generalmente, como consecuencia de complicaciones del tratamiento. Se reporta un caso representativo de linfoma extraodal de c‚lulas T/NK tipo nasal de una paciente mujer de 58 anos procedente de Cusco.

Nasal T-cell and natural killer (NK) cell extranodal lymphoma is a rare entity whose etiology is associated with Epstein-Barr, has an aggressive behavior (20% 5-year survival), predominantly in men. Expressed by a midface destructive lesion tumoral of vessels and prominent necrosis. diagnosis is clinical and immunohistochemical is characterized by a marked angiocentricity, and tissular necrosis accompanied by inflamatory infiltrate of lymphocytes, histiocytes, plasma cells and sometimes eosinophils. Its characteristic inmunophenotype is CD2(+), CD56(+), CD3 epsilon (+), CD3 superficie (-), CD7(-), CD16(-), CD30 +/-. Despite being radiosensitive, generally has a poor prognosis due to treatment complications. We report a representative case of nasal T-cell and natural killer cell extranodal lymphoma of a female patient of 58 years from Cusco.

Cutaneous manifestations of internal malignancies in a tertiary health care hospital of a developing country.

In a public hospital in Lima, Peru, 24 patients with 16 types of paraneoplastic dermatoses were identified by data collection. The most frequent dermatosis was dermatomyositis (four patients). The other dermatoses were malignant acanthosis nigricans, palmoplantar keratoderma, bullous dermatoses, lymphomatoid papulosis, edematous scarring vasculitic panniculitis, Norwegian scabies, primary systemic amyloidosis, necrolytic migratory erythema, infective dermatitis, pancreatic panniculitis, generalized pruritus, Lesser-Trelat syndrome, and acquired ichthyosis. Most of these paraneoplastic dermatoses were diagnosed before (45.8%) or at the time of (38.5%) the diagnosis of the underlying malignancy. The most frequent underlying malignancies were lymphoma, adenocarcinomas of the upper digestive tract, and malignant neoplasms of the pancreas. The average age of the patients was 47.0 ± 16.9 years and the length of the disease since diagnosis was 13.7 months. The mortality rate was 75%. Paraneoplastic dermatoses are rare dermatologic entities that are difficult to diagnose. Surveillance is also hampered when patients do not have easy access to health care centers due to financial and geographical issues. However, when identified, they might facilitate the early diagnosis of an associated tumor and contribute to increase the surveillance of patients.

Cutaneous manifestations of internal malignancies in a tertiary health care hospital of a developing country / Manifestações cutâneas de doenças malignas em um hospital terciário de um país em desenvolvimento

In a public hospital in Lima, Peru, 24 patients with 16 types of paraneoplastic dermatoses were identified by data collection. The most frequent dermatosis was dermatomyositis (four patients). The other dermatoses were malignant acanthosis nigricans, palmoplantar keratoderma, bullous dermatoses, lymphomatoid papulosis, edematous scarring vasculitic panniculitis, Norwegian scabies, primary systemic amyloidosis, necrolytic migratory erythema, infective dermatitis, pancreatic panniculitis, generalized pruritus, Lesser-Trelat syndrome, and acquired ichthyosis. Most of these paraneoplastic dermatoses were diagnosed before (45.8 percent) or at the time of (38.5 percent) the diagnosis of the underlying malignancy. The most frequent underlying malignancies were lymphoma, adenocarcinomas of the upper digestive tract, and malignant neoplasms of the pancreas. The average age of the patients was 47.0 ± 16.9 years and the length of the disease since diagnosis was 13.7 months. The mortality rate was 75 percent. Paraneoplastic dermatoses are rare dermatologic entities that are difficult to diagnose. Surveillance is also hampered when patients do not have easy access to health care centers due to financial and geographical issues. However, when identified, they might facilitate the early diagnosis of an associated tumor and contribute to increase the surveillance of patients.

Em um hospital público em Lima, Peru, 24 pacientes com 16 tipos de dermatoses paraneoplásicas foram identificados por meio de coleta de dados. A dermatose mais frequente foi dermatomiosite (quatro pacientes). As outras dermatoses foram acantose maligna, queratodermia palmoplantar, dermatoses bolhosas, papulose linfomatóide, cicatriz edematosa, paniculite e vasculite, escabiose norueguesa, amiloidose sistêmica primária, eritema necrolítico migratório, dermatite infecciosa, paniculite pancreática, prurido generalizado, sinal de Leser-Trelat e ictiose adquirida. Grande parte dessas dermatoses foi diagnosticada antes (45,8 por cento) ou no momento (38,5 por cento) do diagnóstico do tumor subjacente. Os tumores malignos mais frequentes foram linfoma, adenocarcinomas do trato digestivo superior e neoplasias malignas do pâncreas. A idade média dos pacientes foi de 47.0 ± 16.9 anos e a duração da doença desde o diagnóstico foi de 13,7 meses. A taxa de mortalidade foi de 75 por cento. Dermatoses paraneoplásicas são condições dermatológicas raras de difícil diagnóstico. O controle também é prejudicado quando pacientes não têm acesso fácil à centros de saúde por questões financeiras ou geográficas. No entanto, quando identificadas, elas podem facilitar o diagnóstico precoce de um tumor associado e contribuir para um aumento do controle dos pacientes.

Facial porokeratosis: A series of six patients.

Porokeratosis is a disorder of epidermal keratinization characterized by annular plaques with an atrophic centre and hyperkeratotic edges, and includes a heterogeneous group of disorders that are mostly inherited in an autosomal dominant fashion. Facial porokeratosis is rare and is not well documented. We present six cases of facial porokeratosis seen over a period of 15 years in a hospital in Lima, Peru. In most of the cases, porokeratosis was found in younger women without any significant past medical history. Oral isotretinoin showed moderate improvement in two of our patients.

Satisfacción laboral y factores asociados en personal asistencial médico y no médico de un hospital nacional de Lima-Perú / Job satisfaction and associated factors in physicians and not physicians in a national hospital in Lima, Peru

Objetivo: Determinar la satisfacción laboral y factores asociados en personal asistencial médico y no médico del Hospital Nacional Dos de Mayo (HNDM). Métodos: Estudio transversal. La muestra fue obtenida mediante muestreo aleatorio simple y estuvo constituida por personal asistencial médico y no médico (enfermería, obstetricia y técnico de enfermería) que laboraba en los pabellones de hospitalización, consultorios externos, servicios de emergencias (adultos, niños y gestantes) del HNDM entre enero y marzo de 2007. La muestra fue conformada en el grupo de médicos por 75 personas, en el grupo de enfermeros y obstetras por 65 personas y en el grupo de técnicos de enfermería por 87 personas. Se procedió a la aplicación de una encuesta anónima que valoró la satisfacción laboral y posibles factores asociados en personal asistencial médico y no médico. Los cálculos fueron realizados con un nivel de confianza del 95%. Resultados: El 22.7% del personal médico se encontraba satisfecho con su trabajo, la satisfacción en el grupo compuesto por enfermeras y obstetras fue del 26.2%; mientras que en el personal técnico de enfermería, la satisfacción laboral fue del 49.4%. El análisis multivariado mostró que en el personal asistencial médico del HNDM los factores asociados a satisfacción laboral fueron la adecuada higiene y limpieza de los ambientes de trabajo (p=0.003) y el tener adecuada relación con sus jefes de servicio (p=0.023). Los factores asociados a satisfacción en personal asistencial de enfermería y obstetricia fueron la adecuada carga laboral (p=0.003) y las adecuadas oportunidades de promoción y ascenso (p=0.006); mientras que, en el personal asistencial técnico fueron la satisfacción con el salario mensual (p<0.001) y con la supervisión ejercida sobre ellos (p<0.001). Conclusiones: Existe un bajo porcentaje de satisfacción laboral en personal asistencial médico...

Objective: To determine job satisfaction and associated factors related to health and not health workers from the Hospital Nacional Dos de Mayo (HNDM). Methods: The sample was obtained by simple random sampling and consisted of personal medical and nonmedical care (nursing, midwifery and nurse technicians) who worked in hospital wards, outpatient, emergency services (adults, children and pregnant women) of HNDM between January and March 2007. The sample consisted of physicians in the group of 75 people in the group of nurses and midwives per 65 people in the group of nursing technicians by 87 people. We proceeded to the implementation of an anonymous survey that assessed the job satisfaction and personal factors associated in medical and nonmedical care. The calculations were performed with a confidence level of 95%. Results: 22.7% of the medical staff was satisfied with his work, satisfaction in the group consisting of nurses and midwives was 26.2%, while in the nursing staff, job satisfaction was 49.4%. Multivariate analysis showed that the care doctor HNDM factors associated with job satisfaction were the proper hygiene and cleanliness of the work environment (p = 0.003) and having a proper relationship with their department heads (p = 0.023). Factors associated with personal satisfaction in nursing and midwifery care were appropriate workload (p = 0.003) and adequate opportunities for promotion and advancement (p = 0.006), whereas in the technical assistance staff were satisfaction with the salary month (p <0.001) and with the supervision exercised over them (p <0.001). Conclusions: There is a low percentage of staff job satisfaction in medical and nonmedical care of HNDM which is lower than that reported in international literature. Factors associated with satisfaction differ markedly in the medical and nonmedical.

Enfermedad de bowen palmar / Bowen disease of the palms

La enfermedad de Bowen es una forma de carcinoma escamocelular de la piel y de la mucosa que afecta pacientes adultos mayores de 60 años siendo raros los casos reportados antes de los 30 años. Se caracteriza por una placa escamosa de crecimiento lento y progresivo principalmente en áreas expuestas a radiación solar como cabeza, cuello y tronco. Se presenta el caso de un paciente de 20 años con lesión en palma de mano que se inicia hace 10 años, en quien se diagnostica Enfermedad de Bowen, recibe tratamiento con imiquimod con evolución favorable.

BowenÆs disease is a form of squamous cellcarcinoma of the skin and mucosa that affects adults over 60 reported cases being rare before age 30. It is characterized by scaly plaque slow and progressive growth mainly in areas exposed to solar radiation as the head, neck and trunk. A case of a patient of 20 years with palm of hand injury that started at 10 years, who was diagnosed with BowenÆs disease, treated with Imiquimod with favorable results.

Linfoma cutáneo primario de células grandes anaplásicas CD30+ / Cutaneous CD30+ Anaplastic Large-Cell Lymphoma

El linfoma primario cutáneo de células grandes anaplásicos, es un trastorno linfoproloiferativo que afecta principalmente a adultos, caracterizado por presentar tumores solitarios o localizados, que en la histopatología muestra un infiltrado de células CD30+ y tener buen pronóstico. Se presenta el caso de un paciente de 52 años con lesiones tumorales en miembro inferior izquierdo de 1 año de evolución.

Primary cutaneous lymphoma anaplastic large cell, is a lymphoproliferative disorder characterized by affect adult patients with solitary or localized tumors, the histopathology shows an infiltration of CD30 + cells and have a good prognosis. We report a male of 52 years with tumors in the left lower limb of 1 year of evolution.

Depósitos cutáneos generalizados como manifestación inicial de gota / Widespread cutaneous deposits as the initial manifestation of gout

Los tofos son depósitos de cristales de urato monosódico con localización típica periarticular. Aparecen en pacientes con hiperuricemia de varios años de evolución, aunque en casos infrecuentes, pueden ser la manifestación inicial de la gota. Presentamos un caso inusual de gota severa sin historia diagnóstica previa ni presencia de ataques agudos. El paciente había desarrollado múltiples nódulos grandes, en ubicaciones poco comunes, que incluían plantas, pubis y espalda.

Tophi are deposits of monosodium urate crystals, they are typically located in periarticular sites. Usually they apeer in patients who have had hyperuricemia over many years, although in rare cases, tophi may be the initial manifestation of the gout. We present an unusual case ofsevere gout without prior diagnostic history or presence of acute attacks. The patient developed large, multiple nodules in many uncommon locations including plants, pubis and back.