Diagnóstico prenatal de trombohematoma subcoriónico masivo (mola de Breus) / Prenatal diagnosis of massive subchorionic thrombohematoma (Breus mole)

El trombohematoma subcoriónico masivo o Mola de Breus, por ser éste el autor que lo describió por primera vez en abortos, es un hematoma subcorial de al menos 1 cm de grosor que ocupa al menos, el 50% de la superficie fetal. Suele asociar una alta morbimortalidad fetal y perinatal, en forma de abortos, retraso del crecimiento intrauterino, muerte intrauterina, desprendimiento de placenta normalmente inserta y recién nacidos de bajo peso, generalmente pretérminos. Esta entidad debe diferenciarse de otros procesos que pueden asentar bajo la placa corial, hacia la superficie fetal como: corioangioma, depósitos de fibrina y trombosis del espacio intervelloso. Se han intentado postular mecanismos que pudieran causar dicha circunstancia, sin que por el momento podamos definir factores de riesgo médicos que claramente predispongan a padecer esta entidad. El objetivo de describir estos dos casos clínicos diagnosticados en 2013 es resaltar que, gracias a la sospecha ecográfica de un trombohematoma subcoriónico masivo, podemos estudiar la pieza de placenta y membranas tras la finalización de la gestación, con lo que obtendríamos así la confirmación anátomo-patológica, de otra manera esta información podría perderse.

The massive subchorionictrombo hematoma or Breus's Mola, this was the author who first described it in miscarriages, is a subchorionic hematoma at least 1 cm in thickness which occupies at least 50% of the fetal surface. Usually associated with high fetal and perinatal morbidity and mortality, as miscarriages, intrau-terine growth retardation, stillbirth, placental abruption and low birth weight, preterm generally. This entity should be distinguished from other processes that can seat under the chorionic plate to the fetal surface as chorioangioma, fibrin deposition and thrombosis intervillous space. They have tried to apply mechanisms that could cause such a circumstance, but for now we don't define medical risk factors that predispose clearly suffer from this entity. In order to describe these two cases diagnosed in 2013 is to emphasize that thanks to the sonographic suspicion of a massive subchorionic trombohematoma, can study the piece of placenta and membranes after the end of pregnancy, so it would provide pathologic confirmation, otherwise this information could be lost.

Banda suburetral libre de tensión transobturadora versus single-incision sling para el tratamiento de la incontinencia urinaria de esfuerzo: seguimiento a 2 años / Transobturator tape versus single-incision sling for the treatment of stress urinary incontinence

Objetivos: Determinar la tasa de curación objetiva/subjetiva y complicaciones del tratamiento de incontinencia urinaria de esfuerzo con banda suburetral transobutadora y single-incision sling. Métodos: Estudio retrospectivo de pacientes operadas de incontinencia urinaria de esfuerzo (hipermovilidad uretral) con banda suburetral transobturadora (n: 37) y single-incision sling (n: 44) entre enero-2012 y enero-2015. Si se asociaba corrección de prolapso de órganos pélvicos, se colocaba banda transobturadora (TVT-O/ TOT) con internación. Si no precisaba corregir prolapso, se insertaba single-incision sling ambulatoriamente. Las evaluaciones fueron al mes, 6 meses y 1 año. El contacto a 2 años fue telefónico. De 37 bandas transobturadoras completaron seguimiento 35 a 1 año y 26 a 2 años. De 44 single-incision sling, completaron seguimiento 42 a 1 año y 19 a 2 años. Resultados: La edad media para transobturadoras fue superior: 65±9,7 vs 58,2±11,3 (p=0,005). Transobturadoras demostraron más prolapso asociado: 87,8% vs 63,3% (p=0,042) y mayor tiempo quirúrgico (minutos): 81,07±31,27 vs 36,79±11,09 (p=0,000). Hubo mayor morbilidad en transobturadoras, sin diferencias significativas. La continencia al año fue: 80% transobturadoras vs 83% single-incision sling (p=0,706) y a 2 años: 84% vs 79% (p=0,623). Se encontraban satisfechas al año: 80% transobutradoras vs 85,7% single-incision sling (p=0,586) y a 2 años: 88,5% vs 78,9% (p=0,512). Conclusiones: Single-incision sling presentan tasas de éxito y satisfacción similares a bandas transobturadoras, con menor morbilidad, coste y tiempo operatorio, pudiendo ser de primera elección cuando no exista prolapso sintomático asociado.

Objectives: To determine objective and subjective cure rate and complications of stress urinary incontinence treatment with transobturator tape and single-incision sling. Methods: We performed a retrospective study including patients diagnosed of stress urinary incontinence, treated surgically either with transobturator tape (n: 37) or with single-incision sling (n: 44), between January 2012 and January 2015. If pelvic organ prolapse was associated, transobturator route was preferred requiring patient hospitalization. If this correction was not needed, we performed single-incision sling, as an ambulatory procedure. Follow up visits were scheduled at 1, 6, 12 months after surgery and a telephone interview at 24 months. Results: Mean age was higher in transobturator group: 65±9.7 vs 58.2±11.3 (p=0.005). A statistically significant difference between the two groups was found in operating time (minutes): 81.07±31.27 vs 36.79±1.09 (p=0.000) and pelvic prolapse associated: 87.8% vs 63.3% (p=0.042). Morbidity rate was higher in the transobturator group, but without significance. After 1 year follow-up, there were no significant differences between the transobturator and the single-incision groups regarding continence (80% vs 83%; p=0.706) and satisfaction (80% vs 85.7%; p=0.586). We found similar results at 24 months telephonic interview. Conclusions: Single-incision slings are comparable to transobturator tapes in 12 and 24 months success rates and satisfaction, with significantly less morbidity, costs and operating time, becoming first line option when no pelvic prolapse is associated.

Head and neck cancer. An aetiopathogenetic study of non-endemic lymphoepithelioma.

An aetiopathogenetic analysis of non-endemic nasopharyngeal carcinoma (NPC) in European and Southern American patient groups was performed. Specifically, the study sought to determine the proportion of Epstein-Barr Virus (EBV)-positive tumour cells in NPC patients in two very different populations (Europe and South America) in areas not associated with a high incidence of NPC. Clinical data (age, sex and onset of clinical disease) were also analyzed. A total of 50 NPC samples, 24 from a European hospital (EH) and 26 from two South American hospitals (SAH), were included. Nuclear staining for Epstein-Barr virus-encoded small RNA (EBER) was performed by in situ hybridization (ISH). Latent membrane protein 1 (LMP1) expression was measured by immunohistochemical (IHC) analysis. A higher incidence of NPC was observed in patients > 40 years of age in EH; in SAH, by contrast, the incidence was higher in patients aged ≤ 40 years. Cervical lymph node metastasis was detected in 31 patients (of whom 84.6% were from SAH). A total of 72% of samples were EBERpositive; the incidence of EBER positivity was greater in type 3 NPCs. EBV was detected in a large proportion of epithelial cells in samples from both EH and SAH (75% vs. 69.2%, respectively). An association was found between EBER detection in lymphocytes and patient origin (p = 0.0001). LMP1 expression was detected in 64% of patients. ISH for the detection of EBER is the most sensitive technique for demonstrating EBV in tumour tissue. The incidence of EBV was not significantly greater in either of the study populations, but was significantly higher in patients with type 3 NPC. Definitive histological diagnosis of NPC was reached earlier in EH than in SAH, where metastases were more frequently diagnosed, suggesting that the disease had reached a more advanced stage by the time treatment was started.

High dose rate brachytherapy (HDR-BT) in locally advanced oesophageal cancer. Clinic response and survival related to biological equivalent dose (BED).

INTRODUCTION: Ninety percent of oesophageal cancers are locally advanced at diagnosis, and treatment yields discouraging results. High dose rate brachytherapy (HDR-BT) permits an increment of local doses without a significant increment of toxicity. The goal of our study is to compare different HDR-BT fractions and assess global survival (GS) and cause-specific survival (CSS). MATERIAL AND METHODS: Twenty-six patients were treated for locally advanced oesophageal cancer with chemotherapy concomitant with conformal three-dimensional radiotherapy (C3DR) from January 1994 to December 2000. Of this group, 96.2% were males, mean age 63.08 years; the most frequent location was medium third, for 50% of cases. Eighty-four percent of cases were G2-3 epidermoid carcinomas. The administration consisted of 44.2 Gy with C3DR and 5 applications of HDR-BT of 500 cGy each. RESULTS: Actuarial GS and CSS at 5 years is 10.18% and 12.96%, a mean survival of 25.68 and 29.14 months respectively. The following factors (C3DR total dose, fraction dose and total dose of HDR-BT, number of applications, active length of application, total dose of C3DR plus HDR-BT, and BED of HDR-BT) are evaluated to find if they have an influence on treatment response, GS and actuarial CSS. The only result that yields statistical significance, in univariant analysis, is the active length in HDR-BT, thus for a greater active length of application, a minor response is obtained and GS diminishes (p=0.05). We grouped BT fractions on biological equivalent dose (BED) into: <28, 28-33 and >33 Gy; mean survival and GS at 5 years increases with BED>or=28 Gy (p=0.016). CONCLUSION: Tumour response increases (complete and partial) when BED on HDR-BT is increased, regardless of the fraction employed. A BED higher than 28 Gy yields a significant increase of mean survival and GS at 5 years (p=0.016).

Tremorgenic mycotoxins produced by strains of Penicillium spp. isolated from toxic Poa huecu parodi.

Seventeen strains of Penicillium spp. have been isolated from Poa huecu Parodi from the Zapala zone, exhibiting toxicity to sheet. The following strains have been identified: P. crustosum, cyclopium, notatum, palitans, puberulum, verrucosum, viridicatum and Penicillium spp. The toxigenic capacity of the strains was studied after growing them under suitable conditions. Toxins produced were analysed by thin layer chromatography (TLC). Penitrem A (PA) and Penitrem B (PB) neurotoxins were identified and quantitated in twelve strains; verruculogen (VERR) and fumitremorgen B (FTB) being present in one of them. The effect of these mycotoxins was studied in mice. Neurological symptoms characteristic of the intoxication by tremorgenic toxins and similar to those observed in sheep suffering from 'huecu's disease' were observed. The possible role of these toxins as causative agents of 'huecu's disease' is discussed.

Effect of aflatoxin B1 on resistance induced by Bordetella bronchiseptica vaccine in rabbits.

The effects of aflatoxin B1 on the development of the immune response to oil-adjuvanted Bordetella bronchiseptica vaccine and on acquired resistance to bacterial challenge were studied in rabbits. The doses of aflatoxin used were insufficient to produce clinical intoxication. Rabbits were randomly assigned to three groups, each having six animals: control (T), vaccinated (V), and vaccinated plus aflatoxin (VA) at 0.05 mg/kg daily per os. Groups V and VA were vaccinated twice, and the three groups were subsequently challenged with virulent B. bronchiseptica. The average weight gain at weekly intervals was significantly reduced in group VA, and no statistically significant differences were found in the titers of agglutinating antibodies between groups V and VA. There were significant differences between groups V and VA in the extent and severity of the pneumonic process, group VA being most affected. Results indicated that agglutinating antibody titers were not related to the level of protection in the latter group. Other mechanisms, such as alveolar macrophage activity and cell-mediated immunity, were implicated in the impairment of the acquired resistance in rabbits subclinically intoxicated with aflatoxin.

[Determination of aflatoxins and toxicogenic fungi in mixed feed for poultry]. / Determinación de aflatoxinas y hongos toxicogénicos en alimentos balanceados para aves.

The presence of aflatoxins was determined in 155 samples of chicken feeds, as well as their fungal contamination. Aflatoxins were detected in 3 of the analized samples; one of them contained 1620 micrograms/kg, a highly dangerous amount for chickens. The amount found in the remaining 2 samples was 30 micrograms/kg. A study of toxigenic fungus showed a prevalence of 69.3% of Aspergillus flovus: 72.4% of this percentage corresponded to aflatoxins producing strains. The prevalence of Aspergillus ocraceus was 18.6%; ten per cent of it corresponded to ochratoxin A producing strains. Chicken feeds are an adequate substratum for the formation of aflatoxins; this was demonstrated by raising the humidity contents of initially negative samples, which contained toxigenic Aspergillus flavus spores. The danger of storing chicken feeds under certain humidity and temperature conditions was demonstrated.

Determinación de aflatoxinas y hongos toxicogénicos en alimentos balanceados para aves. / [Determination of aflatoxins and toxicogenic fungi in mixed feed for poultry]

The presence of aflatoxins was determined in 155 samples of chicken feeds, as well as their fungal contamination. Aflatoxins were detected in 3 of the analized samples; one of them contained 1620 micrograms/kg, a highly dangerous amount for chickens. The amount found in the remaining 2 samples was 30 micrograms/kg. A study of toxigenic fungus showed a prevalence of 69.3

of Aspergillus flovus: 72.4

of this percentage corresponded to aflatoxins producing strains. The prevalence of Aspergillus ocraceus was 18.6

; ten per cent of it corresponded to ochratoxin A producing strains. Chicken feeds are an adequate substratum for the formation of aflatoxins; this was demonstrated by raising the humidity contents of initially negative samples, which contained toxigenic Aspergillus flavus spores. The danger of storing chicken feeds under certain humidity and temperature conditions was demonstrated.

Determinación de aflatoxinas y hongos toxicogénicos en alimentos balanceados para aves / [Determination of aflatoxins and toxicogenic fungi in mixed feed for poultry]

The presence of aflatoxins was determined in 155 samples of chicken feeds, as well as their fungal contamination. Aflatoxins were detected in 3 of the analized samples; one of them contained 1620 micrograms/kg, a highly dangerous amount for chickens. The amount found in the remaining 2 samples was 30 micrograms/kg. A study of toxigenic fungus showed a prevalence of 69.3

of this percentage corresponded to aflatoxins producing strains. The prevalence of Aspergillus ocraceus was 18.6

; ten per cent of it corresponded to ochratoxin A producing strains. Chicken feeds are an adequate substratum for the formation of aflatoxins; this was demonstrated by raising the humidity contents of initially negative samples, which contained toxigenic Aspergillus flavus spores. The danger of storing chicken feeds under certain humidity and temperature conditions was demonstrated.