Sarcoma de Ewing extraesquelético subcutáneo primario / PNET. Reporte de caso y revisión de la literatura / Primary subcutaneous extraskeletal Ewing's sarcoma (PNET). A case report and literatura review

Resumen La familia de tumores del Sarcoma de Ewing (ES) es un grupo poco habitual de neoplasias malignas que pueden localizarse en regiones: óseas como extraóseas. El tumor neuroectodérmico primitivo (PNET), muestra más diferenciación neuronal que el Sarcoma de Ewing (ES) y rara vez se presenta en piel y tejidos subcutáneos. Ocasionalmente se presenta como un cáncer de piel primario, que tiene como características clínicas: una tumoración superficial, en promedio mide 2-3 cm, de consistencia blanda, móvil y algunas veces dolorosa. Los lugares más afectados son espacios paravertebrales, extremidades inferiores, cabeza, cuello y pelvis. Describimos el caso de un varón de 13 años, con 2 tumores superficiales en cuero cabelludo, el examen histológico presentaba una proliferación de células de pequeño tamaño, basófilas, monomorfas; con perfil inmunohistoquímico FLI1 positivo, compatible con PNET.

Summary Ewing´s sarcomas are a less common malignant neoplasms that can be located both in skeletal and extra skeletal areas. The primitive neuroectodermic tumor (PNET) shows more neuronal differentiation than Ewing´s sarcoma and rarely invades the skin and soft tissues. This tumor occasionally presents as a primary skin cancer which has distinctive features such as a superficial tumor with a 2-3 cm, soft, mobile and eventually painful. Most affected areas of the body are paravertebral spaces, lower limbs, head, neck and pelvis. We report here the case of a 13 year old male presenting with 2 superficial tumors located on the scalp, the histo pathological examination revealed a proliferation of small, basophilic and monomorphic cells that showed FLI1 positive immunohistochemistry pattern compatible with PNET.

Relación bidireccional de las patologías cutáneas con los trastornos mentales / Bidirectional relationship of the skin pathologies with mental disorders

La Psicodermatología, o Medicina Psicocutánea, es el resultado de la fusión de dos grandes especialidades médicas: psiquiatría y dermatología. La psiquiatría implica el diagnóstico y tratamiento de los trastornos mentales, mientras que la dermatología es responsable del diagnóstico y tratamiento de las enfermedades de la piel y sus apéndices. El dermatólogo debe ser consciente de esta correspondencia y considerar la constante interacción entre las enfermedades psiquiátricas y cutáneas, siendo ésta relación bidireccional. Hasta un tercio de los pacientes ambulatorios de dermatología tienen un problema psiquiátrico importante que complica su afección cutánea. La consulta dermatológica será relevante, al abordar y tratar las patologías psiquiátricas, como la depresión y/o la ansiedad, que son más frecuentes.

Psychodermatology, or psychocutaneous medicine, is the result of the merger of two major medical specialties: psychiatry and dermatology. Psychiatry involves the study of mental disorders, while dermatology is responsible for the diagnosis and treatment of skin diseases and their appendices.The dermatologist must be aware of this correspondence and consider the constant interaction between psychiatric and skin diseases, this relationship being bidirectional. Up to one third of outpatients in dermatology have a significant psychiatric problem that complicates their skin condition. The dermatological consultation will be relevant, when addressing and treating psychiatric pathologies, such as depression and / or anxiety, which are more frequent.

Clinical and Practical Use of Calcimimetics in Dialysis Patients With Secondary Hyperparathyroidism.

CKD and CKD-related mineral and bone disorders (CKD-MBDs) are associated with high cardiovascular and mortality risks. In randomized clinical trials (RCTs), no single drug intervention has been shown to reduce the high mortality risk in dialysis patients, but several robust secondary analyses point toward important potential beneficial effects of controlling CKD-MBD-related factors and secondary hyperparathyroidism. The advent of cinacalcet, which has a unique mode of action at the calcium-sensing receptor, represented an important step forward in controlling CKD-MBD. In addition, new RCTs have conclusively shown that cinacalcet improves achievement of target levels for all of the metabolic abnormalities associated with CKD-MBD and may also attenuate the progression of vascular and valvular calcifications in dialysis patients. However, a final conclusion on the effect of cinacalcet on hard outcomes remains elusive. Tolerance of cinacalcet is limited by frequent secondary side effects such as nausea, vomiting, hypocalcemia and oversuppression of parathyroid hormone, which may cause some management difficulties, especially for those lacking experience with the drug. Against this background, this review aims to summarize the results of studies on cinacalcet, up to and including the publication of the recent ADVANCE and EVOLVE RCTs, as well as recent post hoc analyses, and to offer practical guidance on how to improve the clinical management of the most frequent adverse events associated with cinacalcet, based on both currently available information and personal experience. In addition, attention is drawn to less common secondary effects of cinacalcet treatment and advisable precautions.

Prácticas de utilización de plaguicidas en agricultores en el distrito de Huaral-Perú, noviembre 2005 / Pesticide use practices in farmers in the district of Huaral-Peru, November 2005

Objetivo: Describir las prácticas de utilización de plaguicidas en los agricultores del distrito de Huaral. Material y Métodos: Estudio transversal. Se realizó un muestreo por conveniencia de agricultores asistentes a las reuniones del mes de noviembre de las comisiones de regantes Chancay Bajo, La Esperanza, Huando y Chancay Alto (Huaral û Perú). Para la recolección de datos se elaboró y validó una encuesta que se aplicó mediante entrevista. Resultados: Se incluyó 119 agricultores con edad promedio de 50.5 años. El 44.9% de los insecticidas usados eran de uso restringido en el país siendo el más usado Metamidofos. Las prácticas inadecuadas más frecuentes fueron, antes de la fumigación la protección personal incorrecta (54.6%) y la mezcla de diferentes insecticidas durante la preparación (74.4%); durante la fumigación la protección personal incorrecta (51.3%); y después de la fumigación el inadecuado desecho de plaguicida sobrante (53.3%). Se halló relación significativa entre recibir capacitación y uso correcto de protección personal durante la fumigación (p=0.043), además de asociación entre uso de insecticidas restringidos con la práctica de mezcla de insecticidas (p=0.009) y con protección personal incorrecta durante la preparación(p=0.003). Conclusiones: Las prácticas inadecuadas en el uso de plaguicidas son bastante frecuentes en el grupo de agricultores entrevistados. La capacitación es un factor favorable de buenas prácticas mientras que el uso de insecticidas restringidos se constituiría en un marcador de prácticas inadecuadas.

Objective: To describe the pesticide utilization practices among agricultural workers in the district of Huaral. Materials and Methods: This is a transversal study. We carried out a convenient sample among farmers who attended to the meetings of the Irrigation Committee of Chancay Bajo, La Esperanza, Huando and Chancay Alto in November. In order to collect information, we elaborated and validated a questionnaire which was applied in an interview. Results: We included 110 farmers aged 50.5 years old on average. A 44.9% of the pesticides used were restricted in our country, being the most used Metamidofos. The most frequent inadequate practices were: Before the fumigation: defective personal protection (54.6%) and the mixing of different insecticides during the preparation (74.4%); during the fumigation: defective personal protection (51.3%); after the fumigation: inadequate dumping of remaining pesticide (53.3%). We found a significant relation (x2; p=0.043) between receiving training and a correct personal protection use during the fumigation. Also, the connection between restricted pesticides use and the practice of mixing insecticides (p=0.009) and the defective personal protection during the preparation (p=0.003). Conclusions: Inadequate pesticide use practices are quite frequent among the interviewed farmers. Training is a favorable factor for good practices while restricted pesticides use are becoming as a marker of defective practices.