[Exogenous lipoid pneumonia and anorexia nervosa: a case report].

Exogenous lipoid pneumonia is a rare entity with non-specific clinical presentation. Early diagnosis is key to prevent pulmonary fibrosis in cases of chronic exogenous lipoid pneumonia . Here, we present the diagnostic process in a 51-year-old female with chronic cough and yellow sputum, no fever nor signs of infection. The computerized axial tomography scan showed alveolar infiltrates in both lungs. We performed a bronchoalveolar lavage and collected a yellowish material, but no clear result were obtained from its analysis. Cryobiopsy of lung tissue was key for the diagnosis of exogenous lipoid pneumonia . This may be related to the chronic anorexia nervosa that the patient suffers, associated with purgative habits. After identifying the cause of the symptoms, the patient is recovering, changing her habits, and has no cough nor sputum.

Neumonía lipoidea exógena y anorexia nerviosa: caso clínico / Exogenous lipoid pneumonia and anorexia nervosa: a case report

La neumonía lipoidea exógena es una entidad infrecuente y con una presentación clínica inespecífica. Su diagnóstico temprano es clave para prevenir la fibrosis pulmonar que produce su cronificación. Presentamos el proceso diagnóstico de una paciente de 51 años, con clínica de tos con expectoración amarillenta, sin síntomas de infección ni fiebre, de larga evolución. En latomografía axial computarizada se observaron infiltrados pulmonares bilaterales de tipo alveolar. Se realizó un lavado broncoalveolar en el que se obtuvo un material amarillento de origen desconocido, que no permitió alcanzar ninguna conclusión clara. La criobiopsia pulmonar fue la prueba clave que llevó al diagnóstico de neumonía lipoidea exógena, en probable relación con la anorexia con hábito purgativo que la paciente sufría de forma crónica. Hallado el origen del problema, la paciente se encuentra actualmente en proceso de recuperación y cambio de hábitos, sin tos ni expectoración.(AU)

Exogenous lipoid pneumonia is a rare entity with non-specific clinical presentation. Early diagnosis is key to prevent pulmonary fibrosis in cases of chronic exogenous lipoid pneumonia . Here, we present the diagnostic process in a 51-year-old female with chronic cough and yellow sputum, no fever nor signs of infection. The computerized axial tomography scan showed alveolar infiltrates in both lungs. We per-formed a bronchoalveolar lavage and collected a yellowish material, but no clear result were obtained from its analysis. Cryobiopsy of lung tissue was key for the diagnosis ofexogenous lipoid pneumonia . This may be related to the chronic anorexia nervosa that the patient suffers, associated with purgative habits. After identifying the cause of the symptoms, the patient is recovering, changing her habits, and has no cough nor sputum.(AU)

Proton pump inhibitor-responsive oesophageal eosinophilia correlates with downregulation of eotaxin-3 and Th2 cytokines overexpression.

BACKGROUND: The molecular basis and effects of proton pump inhibitor (PPI) therapy on PPI-responsive oesophageal eosinophilia (PPI-REE) and eosinophilic oesophagitis (EoE) remain unknown. AIM: To compare symptom-histological and cytokine gene expression in PPI-REE and EoE patients, at baseline and after specific treatment. METHODS: In consecutive adult patients with an EoE phenotype (dysphagia/food impaction, typical endoscopic findings and > 15 eos/HPF), gene expression of eotaxin-3, IL-13, and IL-5 were determined in distal and proximal oesophagus, at baseline and after omeprazole 40 mg b.d. for 8 weeks. PPI-REE was defined by clinicohistological response. PPI nonresponders (EoE) were offered treatment with topical steroids. RESULTS: Fifty three patients were re-evaluated on PPI therapy. 23 patients (43%) had PPI-REE and 30 patients (57%) had EoE. At baseline, eotaxin-3/IL-13/IL-5 gene expression was indistinguishable between EoE and PPI-REE, excepting increased IL-5 expression in proximal oesophagus (12.54 vs. 57, P = 0.029). PPI therapy significantly decreased eotaxin-3/IL-13 in PPI-REE, at both oesophageal sites (P ≤ 0.008), and IL-5 in distal (P = 0.016), but not in proximal oesophagus. Patients with steroid-responsive EoE also showed a significant decrease in eotaxin-3/IL-5 expression at both oesophageal sites. In EoE patients, initial PPI trial significantly decreased distal oesophageal eosinophilia (63.78 to 41.79 eos/HPF, P = 0.025) and led to symptom remission in 16%, but did not influence Th2 markers. CONCLUSIONS: Baseline cytokine gene expression in PPI-REE was nearly indistinguishable from EoE. PPI therapy significantly downregulated oesophageal eotaxin-3/Th2-cytokine gene expression in PPI-REE, similarly to that seen in steroid-responsive EoE. A subset of EoE patients showed clinicohistological improvement on PPI therapy.

Loss of TCR-beta F1 and/or EZRIN expression is associated with unfavorable prognosis in nodal peripheral T-cell lymphomas.

Nodal peripheral T-cell lymphoma (nodal PTCL) has an unfavorable prognosis, and specific pathogenic alterations have not been fully identified. The biological and clinical relevance of the expression of CD30/T-cell receptor (TCR) genes is a topic under active investigation. One-hundred and ninety-three consecutive nodal PTCLs (89 angioimmunoblastic T-cell lymphomas (AITL) and 104 PTCL-unspecified (PTCL-not otherwise specified (NOS)) cases) were analyzed for the immunohistochemical expression of 19 molecules, involving TCR/CD30 pathways and the associations with standard prognostic indices. Mutually exclusive expression was found between CD3 and TCR-beta F1 with CD30 expression. Taking all PTCL cases together, logistic regression identified a biological score (BS) including TCR molecules (TCR-beta F1 and EZRIN) that separates two subgroups of patients with a median survival of 34.57 and 5.20 months (P<0.001). Multivariate analysis identified BS and the prognostic index for PTCL (PIT) score as independent prognostic factors. This BS maintained its significance in multivariate analysis only for the PTCL-NOS subgroup of tumors. In AITL cases, only a high level of ki67 expression was related to prognosis. A BS including molecules involved in the TCR signaling pathway proved to be an independent prognostic factor of poor outcome in a multivariate analysis, specifically in PTCL-NOS patients. Nevertheless, validation in an independent series of homogeneously treated PTCL patients is required to confirm these data.

Resultados de la biopsia selectiva de ganglio centinela combinada con la localización radioguiada de tumores invasivos no palpables de mama. Técnica de SNOLL / No disponible

Objetivo: La biopsia selectiva del ganglio centinela mediante inyección intralesional de un radiocoloide, combinado con la localización radioguiada de tumores no palpables de mama en el mismo acto quirúrgico se denomina técnica de SNOLL. El objetivo de nuestro estudio es mostrar la factibilidad y sencillez para realizar la técnica en un hospital provincial de 2º nivel dotado con Servicio de Medicina Nuclear, comparando nuestros resultados con las publicaciones de referencia. Métodos: Entre enero 2007 y marzo 2008 se incluyeron 20 pacientes consecutivas diagnosticadas de carcinoma no palpable de mama. Se realizó inyección intratumoral de un nanocoloide- Tc99 de albúmina (0,2 ml, 37MBq) guiada por ecografía o estereotaxia seguida de linfogammagrafía e instilación subareolar de colorante azul patente (2 ml). Tras identificación del ganglio centinela se detectó y extirpó la lesión mamaria mediante uso de sonda detectora de rayos gamma. Se verificaron radiológicamente todos los especímenes extirpados. Resultados: Se obtuvo al menos un ganglio centinela mediante marcaje radiactivo en 19 pacientes (95%). En un paciente el ganglio centinela se detectó únicamente mediante colorante. La localización radioguiada y extirpación de la lesión primaria se consiguió en todos los casos. En dos casos (10%), los márgenes se encontraban afectos (< 2 mm) por enfermedad in situ extensa asociada. 4 pacientes presentaron ganglio centinela positivo. Conclusiones: Las conclusiones de nuestra serie se encuadran en las publicadas hasta la fecha, otorgando a la técnica de SNOLL mejores resultados que la localización con guía metálica y confirmando la factibilidad de la misma en cualquier centro con recurso a Medicina Nuclear(AU)

Introduction: The SNOLL technique results of the combination of radioguided occult lesion localization (ROLL) and sentinel node mapping with a single radiotracer injection in the management of non-palpable breast cancer. The aim of this study was to evaluate the feasibility of this technique in a second-level hospital with a nuclear medicine department and compare our results with the reference publications. Methods: From January 2007 to March 2008, lymphoscintigraphy was performed in 20 consecutive patients with non-palpable breast cancer after the intratumoral injection of albumin nanocolloid-Tc99 (0.2 ml, 37 MBq) guided by stereotaxis or ultrasound. Under general anaesthesia, a subareolar injection of blue dye was performed. After sentinel lymph node biopsy, the gamma-ray detection probe was used for radioguided removal of the breast tumor. All the breast lesions were identified on X-ray control of the surgical specimen. Results: Al least one sentinel node was removed in 19 patients (95%). In one patient, the sentinel node was only detected by blue dye. Radioguided surgery of the breast tumor was successfully achieved in all patients. In two cases (10%), in situ carcinoma was present close to the margins of the surgical specimen (< 2 mm) and further re-excision was therefore performed. Axillary dissection was accomplished in 4 patients with sentinel node metastases. Conclusions: The findings of our study are consistent with those published to date, showing the advantage of SNOLL technique over the wire-guided localization of non-palpable breast cancer and confirming its feasibility in any center with a reference nuclear medicine department(AU)

Proteomic analysis of human mesenchymal stromal cells derived from adipose tissue undergoing osteoblast differentiation.

BACKGROUND AIMS: Stem cells derived from human adipose tissue (ASC) have the capacity for renewal, are easily obtained and have plasticity properties that allow them to differentiate into several cell types, including osteoblast cells. With the aim of understanding the issue of the osteogenic process and finding reliable biomarkers in cells undergoing the osteogeneic differentiation process, this work took advantage of a proteomic approach to identify proteins involved in osteogenesis. METHODS: For this purpose, ASC were analyzed under three conditions: S0, in the absence of stimulation; S1, with 2 weeks of osteogenic medium stimulation; and S2, with 4 weeks of osteogenic medium stimulation. The identification of ASC was carried out by flow cytometry using antibodies specific to known undifferentiated stem cell-surface markers. Cell viability, enzymatic activity, mineral deposition, collagen structure and production and gene analyzes were evaluated for each condition. RESULTS: Phenotypic modifications were observed during the in vitro osteogenic differentiation process by two-dimensional (2-D) differential image gel electrophoresis (DIGE). The proteins were identified by mass espectrometry in tandem (MS/MS) analyzes using Matrix-assisted laser desorption/ionization with TOF/TOF is a tandem mass spectrometry method where two time-of-flight mass spectrometers are used consecutively (MALDI-TOF/TOF). A total of 51 differentially expressed proteins was identified when comparing the three observed conditions. Sixteen different spots were identified in the S0 stage compared with S2, while 28 different spots were found in S2 compared with S0. S1 expressed seven different spots compared with S0 and S2. CONCLUSIONS: These findings suggest the involvement of several proteins directly related to the osteogenic pathway, which can be used to improve understanding of the osteogenic process.