Squamous cell carcinoma of the pinna: which histological features could be used to predict prognosis?

Squamous cell carcinoma (SCC) that originates in the pinna is thought to have a high risk of metastases (up to 16%) compared with under 5% for cutaneous SCC at any other site, and histological features of the primary tumour may provide evidence for further surveillance or treatment. To identify any association between histological features and the risk of metastases we made an electronic search of the histopathological records at the University Hospital Southampton NHS Foundation Trust for all patients who presented with auricular SCC from 2007-2012. Inclusion criteria included origin in the pinna, complete two-year follow up, and no history of immunosuppressive treatment. We looked for histopathological features that were thought to be relevant to metastases. We studied specimens from 192 patients, four of whom developed metastases (2%), each with involved lymph nodes. Perineural invasion and local recurrence were significantly associated with increased risk of metastases (p<0.001 and p=0.006). The overall metastatic rate was much lower than those reported in other studies, and factors other than histological features alone may explain the results. We suggest that although some histological features were significantly associated, they do not predict a high enough risk of metastatic disease to provide evidence for further surveillance or elective lymphadenopathy.

First description of gastrointestinal nematodes of Barbary sheep (Ammotragus lervia): the case of Camelostrongylus mentulatus as a paradigm of phylogenic and specific relationship between the parasite and its ancient host.

The gastrointestinal helminth fauna of 24 Barbary sheep or Aoudad (Ammotragus lervia sahariensis) maintained in the Parque de Rescate de la Fauna Sahariana (PRFS, CSIC, Almeria, Spain) was analyzed. Most animals (87.5 %) were parasitized, and multiple infections were highly present. The following species were identified: Camelostrongylus mentulatus, Teladorsagia circumcincta, Marshallagia marshalli, Ostertagia ostertagi, O. leptospicularis, O. lyrata, Haemonchus contortus, Teladorsagia trifurcata, Trichostrongylus vitrinus, T. colubriformis, T. probolorus, T. capricola, Nematodirus spathiger, N. abnormalis, N. filicollis, N. helvetianus, Trichuris spp. and Skrjabinema ovis. Teladorsagia circumcincta was the most prevalent nematode in abomasum (52.6 %) followed by C. mentulatus (50 %). However, this latter nematode had the greater mean intensity and abundance. In the small intestine, T. colubriformis and T. vitrinus had the highest prevalence (36.4 %); the last one showed also the greater mean intensity and abundance. It should be emphasized the presence of Skrjabinema ovis (prevalence 39.1 %) in the large intestine, showing the greater mean abundance and intensity, although with a low values. Camelostrongylus mentulatus could be the most primitive nematode of the family trichostrongylidae recovered in this study; attending to its high prevalence, mean abundance and mean intensity, the possible specificity between this parasite and the Aoudad is discussed.

[Kaposi sarcoma associated with systemic corticosteroid therapy]. / Sarcoma de Kaposi asociado a corticoterapia sistémica.

Kaposi sarcoma (KS) was first described in 1872 by Moritz Kaposi. Its epidemiology is suggestive of an infectious disease and in 1994 Chang and coworkers identified DNA sequences corresponding to a previously unidentified herpes virus--human herpes virus 8 (HHV-8)--in AIDS-associated KS biopsies. It is now believed that the presence of HHV-8 is a necessary condition but not sufficient on its own to cause KS. Other factors such as immunosuppression should also be considered and it is known that immunosuppressive therapy increases the risk of KS. We describe a patient who developed KS after prolonged prednisone therapy for temporal arteritis.

Sarcoma de Kaposi asociado a corticoterapia sistémica / Kaposi sarcoma associated with systemic corticosteroid therapy

El sarcoma de Kaposi (SK) fue descrito por Moritz Kaposi en 1872. Las características epidemiológicas del SK apuntan a una probable causa infecciosa. Se han identificado fragmentos de ADN que corresponden a un virus herpes no identificado previamente, el virus herpes humano tipo 8, en biopsias de SK asociado a sida. Se considera un factor necesario pero no suficiente, siendo conveniente tener en cuenta otros factores como la inmunosupresión. Los tratamientos inmunosupresores se asocian con un mayor riesgo de desarrollar SK. Describimos el caso de un paciente que desarrolló SK tras recibir tratamiento prolongado con prednisona con motivo de la arteritis de la temporal que padecía

Kaposi sarcoma (KS) was first described in 1872 by Moritz Kaposi. Its epidemiology is suggestive of an infectious disease and in 1994 Chang and coworkers identified DNA sequences corresponding to a previously unidentified herpes virus--human herpes virus 8 (HHV-8)--in AIDS-associated KS biopsies. It is now believed that the presence of HHV-8 is a necessary condition but not sufficient on its own to cause KS. Other factors such as immunosuppression should also be considered and it is known that immunosuppressive therapy increases the risk of KS. We describe a patient who developed KS after prolonged prednisone therapy for temporal arteritis

Bullous pemphigoid triggered by influenza vaccination? Ecological study in Galicia, Spain.

BACKGROUND: Influenza vaccination has been suggested to be a trigger for bullous pemphigoid (BP). In our area most new patients with BP are admitted to hospital. OBJECTIVES: To detect a difference in the rate of admissions to hospital for BP during population influenza vaccination programmes, which are mainly targeted at individuals aged 65 years or older, start in the last week of September and last for 2 months. METHODS: An ecological study in Galicia, north-west Spain (1997-2005), restricted to people aged 65 years or older. Using Poisson regression, results were controlled for mean age of admission and percentage of the population vaccinated each year. RESULTS: There were 29 admissions registered during 'vaccination periods' (i.e. approximately 10 weeks per year, including the period of vaccination and two further weeks), and 158 during nonvaccination periods (the rest of the year). The incidence rate ratio of admissions for BP in vaccination vs. nonvaccination periods was 0.85 (95% confidence interval 0.57-1.27, P = 0.43). CONCLUSIONS: Our data do not support the hypothesis of influenza vaccination being an important trigger for severe BP on a population level.

Vacunas del virus del papiloma humano: prevención y tratamiento del cáncer de cérvix / Human papillomavirus vaccines: prevention and treatment of cervical cancer

Objetivo: Describir la situación del cáncer de cérvix, su diagnóstico, relación con el virus del papiloma humano (HPV) y conocer el estado actual de las vacunas frente al virus. Metodología: Artículo de revisión. Se consultaron algunas bases de datos electrónicas (Medline, Cochrane Library, Lilacs, TRIP database, SUMSearch, ACP Journal Club, Healths Evidence Bulletins), páginas web del CDC, US Preventive Task Force, OMS, National Cancer Institute, etc., los resúmenes de la 20ª Conferencia Internacional del Papilomavirus y las referencias bibliográficas de los artículos seleccionados. Además se contactó con expertos. Se revisó por pares la calidad de la evidencia publicada sobre eficacia y seguridad de las vacunas. Epidemiología: La infección por el HPV es la principal causa del cáncer cervical. Se conocen más de 100 tipos de HPV, diferenciados en virus de alto o bajo riesgo en virtud de su potencial carcinógeno. Cada año se diagnostican en el mundo alrededor de 500.000 casos de cáncer y cerca de 280.000 mujeres fallecen por su causa, el 80 por ciento en países en vías de desarrollo, siendo el segundo tumor maligno más frecuente tras el cáncer de mama. Diagnóstico del cáncer de cérvix: La citología cervical o prueba de Papanicolau permite identificar a mujeres que presentan un estadio premaligno y alto riesgo de desarrollar cáncer cervical. La Sociedad Americana del Cáncer recomienda iniciar la citología cervical tres años después de la primera relación sexual y siempre antes de los 21 años y repetirla cada año. La combinación de citología y la prueba HPV DNA alcanzan un alto valor predictivo negativo (cerca del 100 por ciento) para la detección de HSIL. Vacunas profilácticas: Aún no comercializadas, en fase III de investigación. Los resultados disponibles hasta el momento muestran una elevada inmunogenicidad y tolerabilidad para todas ellas y, concretamente, la HPV-16 L1 VLP presenta una alta eficacia en la prevención de la infección persistente. Vacunas terapéuticas: Se han realizado ensayos clínicos en fase I y II frente a proteínas oncogénicas virales. Los resultados de estos estudios nos indican que son vacunas seguras, pero los datos respecto a su inmunogenicidad no son concluyentes (AU)

[Anomalous systemic arterial supply to the lower lobe of the right lung: a rare finding]. / Vascularización anómala sistémica del lóbulo inferior del pulmón derecho: una patología infrecuente.

Vascularization of a segment or lobe of the lung from a systemic artery is a rare anomaly. The lower left lobe is usually involved and clinical presentation typically includes hemoptysis, chest pain, exercise-related dyspnea or murmurs. Some patients are asymptomatic and discovery is fortuitous. Diagnosis depends on images, with angiography and, most recently, helicoid CT scan proving most useful. Treatment is nearly always surgical, with or without prior embolization of the anomalous vessel.We report the case of a 31-year-old man with anomalous systemic arterial supply to the lower right lobe discovered while we examined a pulmonary node that appeared benign. The location was unusual. We discuss diagnostic procedures and assess the relation between this condition and lung sequestration and hypogenetic lung syndrome.

Vascularización anómala sistémica del lóbulo inferior del pulmón derecho: una patología infrecuente / Anomalous systemic arterial supply to the lower lobe of the right lung: a rare finding

La vascularización a partir de una arteria sistémica de un segmento o lóbulo pulmonar es una anomalía muy poco frecuente, que afecta con preferencia al lóbulo inferior izquierdo y se presenta generalmente con clínica de hemoptisis, dolor torácico, disnea de esfuerzo o descubrimiento de un soplo. Algunos casos son asintomáticos y el hallazgo es casual. El diagnóstico se basa en pruebas de imagen, obteniéndose los mejores resultados con estudios angiográficos y, más recientemente, con la tomografía computarizada helicoidal. El tratamiento es en casi todos los casos quirúrgico, con o sin embolización previa del vaso anómalo. Aportamos el caso de un varón de 31 años con vascularización anómala del lóbulo inferior derecho, hallazgo casual durante el estudio de un nódulo pulmonar de características radiológicas de benignidad. Se trata de una localización infrecuente de la anomalía. Se detallan los procedimientos diagnósticos y se valora la relación de esta entidad con el secuestro pulmonar y el síndrome del pulmón hipogenético (AU)

Experiencia de gestión y coordinación sanitaria interinstitucional en una situación excepcional. El encierro en iglesias de Barcelona

Se describe la experiencia de atención sanitaria a los inmigrantes encerrados en iglesias de Barcelona en huelga de hambre entre los meses de enero y febrero de 2001.El objetivo principal es dar a conocer los diversos aspectos de esta experiencia, dado lo que tienen de inusual aunque en una realidad de presencia creciente de inmigrantes en nuestra sociedad. Más de 600 inmigrantes se encerraron a finales de enero en varias iglesias de Barcelona, en reivindicación de su regularización, y se declararon en huelga de hambre. La huelga de hambre duró 15 días, y finalizó tras un preacuerdo con la Delegación del Gobierno, aunque persistieron en el encierro, que ha durado 47 días, hasta la concreción del preacuerdo, y sin incidencias importantes. Fue necesaria la atención sanitaria para dar respuesta a las demandas de los inmigrantes, dada la huelga de hambre y para difundir recomendaciones y pautas que atenuasen los riesgos para la salud de este colectivo. La situación de hacinamiento y la aparición de un caso de tuberculosis pulmonar bacilífera requirieron actuaciones de saneamiento y de vigilancia epidemiológica. Tanto el dispositivo asistencial como el epidemiológico y de salud pública hicieron confluir a los servicios sanitarios públicos con los de organizaciones sin ánimo de lucro y personas voluntarias, en una gestión conjunta y coordinada que demostró ser eficaz, ágil y efectiva. El reto que continúa para los servicios sanitarios es el seguimiento de los casos atendidos y mantener los servicios adecuados para las diversas comunidades presentes en nuestra sociedad, en la línea de atención que ya se viene prestando, y con nuevos recursos y conocimientos (AU)

Catalysis of the silica sol-gel process by divalent transition metal bis(acetylacetonate) complexes.

Transition metal bis(acetylacetonate) complexes of Co(II), Ni(II), Cu(II), and Zn(II) have been found to be active catalysts for the sol-gel process. The catalytic activity of these complexes decreases in going from Co(II) to Zn(II) and is highest for the acetylacetonate ligand system. 29Si NMR studies show that the complexes act primarily as condensation catalysts and are, in that regard, similar to Brønsted bases such as hydroxide. Mechanistically, however, they appear to differ significantly from hydroxide in how they induce condensation. This is revealed in the catalyst concentration dependence, which is 1/2 order for the metal complexes and 1st order in hydroxide. Differences are also apparent in the thermochemical parameters that indicate that the metal complexes act to increase the entropy of the transition state leading to condensation. The catalytic activity is proportional to the degree of ligand dissociation of the metal complex, and experiments suggest that the active catalytic species is specifically the first dissociation product, MII(acac)+.

[Thoracic hydatidosis. Our experience in the last 15 years]. / Hidatidosis torácica. Nuestra experiencia en los últimos quince años.

Hydatidosis in Spain has been a relevant public health problem which has been partly solved due to the implementation of different preventive programs. In this work the thoracic hydatidosis cases diagnosed at our hospital during the last 15 years are reported. Forty patients with thoracic hydatidosis are analyzed. Most of them had pulmonary hydatidosis (32), 14 had liver and lung cysts, and in eight cases of thoracic hydatidosis there was no pulmonary involvement; eight patients had been operated previously because of hydatidosis. A discussion follows of the epidemiologic, clinical and radiologic characteristics, as well as laboratory data, endobronchial changes, diagnostic cost/effectiveness of bronchoscopy when performed, and results after surgery. To remark the high percentage of complicated hydatidosis and uncommon locations, seven cases of multiple hydatidosis (two of them with cardiac involvement), five cases had hepato-thoracic communication, three with chest wall involvement, and one with exclusive cardiac involvement, as well as one case of calcified pulmonary hydatidosis. In most patients (37), treatment was surgery with a low number of complications at post-surgery (3). Three relapses were noted at follow-up.

Anti-hepatitis C virus epidemiological study in two dialysis centers in Florence.

We studied the prevalence and incidence of anti-hepatitis C virus (HCV) antibodies in 350 patients during 15 months and looked for some risk factors. We found a significant correlation between anti-HCV positivity and length of dialysis treatment and treatment in more than one center. We propose some prophylactic rules.

Cytomegalovirus encephalitis in a non-immunocompromised patient: CSF diagnosis by in situ hybridization cells.

Cytomegalovirus (CMV) encephalitis in immunologically normal patients is rarely reported in the literature. CMV infection was diagnosed by viral DNA probe techniques on CSF cells in a 32-year-old, immunologically normal male presenting with a severe clinical picture due to encephalitis. Administration of ganciclovir was followed by an immediate improvement in the patient's condition. More sensitive techniques for CMV detection could allow to discover more cases of CMV encephalitis in non-immunocompromised patients than previously recognized.