Elimination of Human Papillomavirus and Cervical Pathological Microbiota with Photodynamic Therapy in Women from Mexico City with Cervical Intraepithelial Neoplasia I.

Cervical carcinoma (CC) is the second cause of cancer death in Mexican women. It starts with premalignant lesions known as Intraepithelial Cervical Neoplasia (CIN) that can develop due to infection by Human Papillomavirus (HPV) and other microorganisms. Current CIN therapy involves invasive methods that affect cervix integrity and fertility; we propose the use of photodynamic therapy (PDT) as a strategy with few side effects. In this work, the effectiveness of PDT for CIN I, HPV and pathogenic vaginal microbiota elimination in 29 women of Mexico City with CIN I, CIN I + HPV and HPV diagnosis was determined. After 6 months of PDT application, HPV infection was eliminated in 100% of the patients (P < 0.01), CIN I + HPV in 64.3% (P < 0.01) and CIN I in 57.2% (P > 0.05). PDT also eliminated pathogenic microorganisms: Chlamydia trachomatis in 81% of the women (P < 0.001) and Candida albicans in 80% (P < 0.05), without affecting normal microbiota since Lactobacillus iners was eliminated only in 5.8% of patients and the opportunistic Gardnerella vaginalis in 20%. These results show that PDT was highly effective in eradicating HPV and pathogenic microorganisms, suggesting that PDT is a promising therapy for cervical infections.

Effectiveness of Photodynamic Therapy in Elimination of HPV-16 and HPV-18 Associated with CIN I in Mexican Women.

This study aimed to determine the effectiveness of photodynamic therapy (PDT), using δ-aminolevulinic acid (5-ALA), in the elimination of premalignant cervical lesions in Mexican patients with human papillomavirus (HPV) infection and/or cervical intraepithelial neoplasia (CIN). Thirty women diagnosed with CIN I and/or positive for HPV participated in the study. Topical 6% 5-ALA in gel form was applied to the uterine cervix; after 4 h, the lesion area was irradiated with a light dose of 200 J cm-2 at 635 nm. This procedure was performed three times at 48-h intervals. Clinical follow-up was performed at 3, 6, and 12 months after the initial PDT administration, by colposcopy, cervical cytology, histopathological analysis, polymerase chain reaction, and hybrid capture. Of HPV-infected patients without evidence of CIN I, 80% cleared the infection, while HPV associated with CIN I was eliminated in 83% of patients (P < 0.05). At 12 months, CIN I had regressed in 57% of patients, although this response was not statistically significant. PDT using 6% 5-ALA is concluded to be effective in eliminating HPV infection associated or not with CIN I.

[Anomalous origin of the left coronary artery from the opposite breast. Pathological case]. / Origen anómalo de la arteria coronaria izquierda del seno opuesto. Caso anatomopatológico.

BACKGROUND: Anomalous origin of the left coronary artery from right coronary sinus ACAOS is characterized because the left main coronary artery anomalously originates from the right sinus of valsalva aortic coronary and whose journey can follow four different paths to the left side of the heart. CASE REPORT: A 73 years old men, who was admitted at the hospital for chest pain of oppressive type, intensity 10/10 with irradiation to left arm and neck, accompanied by diaphoresis and nausea. The diagnosis was an ischemic syndrome acute coronary undergo therapy thrombolytic, the evolution was not satisfactory due to different complications that led to the death. CONCLUSIONS: The diagnosis of anomalous coronary artery left the opposite breast origin (ACAOS), is established basically through methods of diagnostics as computed cardiac angiography or cardiac catheterization as part of the approach of an acute coronary ischemic syndrome that allow to establish the morphological characteristics of coronary as the different anatomic variants and their characteristics with respect to adjacent structures.

Introducción: el origen anómalo de la arteria coronaria izquierda del seno coronario derecho (ACAOS) se caracteriza porque la arteria coronaria principal izquierda se origina anómalamente del seno de valsalva aórtico coronario derecho y cuyo trayecto puede seguir cuatro diferentes caminos hacia el lado izquierdo del corazón. Caso clínico: masculino de 73 años de edad, que ingresó al hospital por dolor precordial de tipo opresivo, intensidad 10/10 con irradiación a brazo izquierdo y cuello, acompañado de diaforesis y nausea. El diagnóstico fue de un síndrome isquémico coronario agudo sometido a terapia trombolítica Su evolución posterior fue no satisfactoria debido a diferentes complicaciones que lo llevaron a la muerte. Conclusiones: el diagnóstico del origen anómalo de la arteria coronaria izquierda del seno opuesto (ACAOS), se establece únicamente a través de métodos de diagnósticos como la angiotomografía computada cardiaca o un cateterismo cardiaco como parte del abordaje de un síndrome isquémico coronario agudo que permiten establecer las características morfológicas de las arterias coronarias como las diferentes variantes anatómicas y sus características particulares respecto a las estructuras adyacentes.

[Two clinical cases of sporadic lymphangioleiomyomatosis]. / Linfangioleiomiomatosis esporádica. Dos casos clínicos.

Lymphangioleiomyomatosis (LAM) is a rare lung disease of unknown etiology, described since 1918 associated with tuberous sclerosis complex (TSC-LAM) and are reported sporadically (S-LAM). It is classified within the group of interstitial lung diseases (ILD) and currently the European Respiratory Society (ERS) has published guidelines for diagnosis and treatment. The objective is to evaluate the clinical presentation of two patients, evolution, management, and review of current treatment. Both patients admitted in our hospital for examination, presenting with spontaneous pneumothorax. Their CT scan shows characteristic cystic lesions and thoracotomy with lung biopsy was performed because lack of expansion and to confirming the diagnosis. Despite the controversy about the optimal management of these patients, there is evidence about the use of progesterone routinely in patients with rapid deterioration of respiratory function when it was provided for a period of at least 12 months. Due to the rareness of the disease, it requires a patient registry to evaluate the use of experimental drugs or include them in research protocols to improve their prognosis.

[Acute myocardial infarction due to pheochromocytoma]. / Infarto agudo del miocardio relacionado con feocromocitoma.

BACKGROUND: pheochromocytoma is a neuroendocrine tumor that secretes high levels of catecholamines and it is able to exert serious cardiovascular effects. The cardiac involvement is the most frequent, with reported conditions such as transient myocardial dysfunction, acute coronary syndrome and ventricular arrhythmias. CLINICAL CASE: we reported a 36 year-old woman without cardiovascular history. She presented with an adrenergic crisis after surgery leading to acute heart failure and acute myocardial infarction. The electrocardiogram showed an ST-segment elevation and positive enzymatic curve, motion alterations in echocardiography and ventriculography without coronary arteries lesions. She was screened for secondary hypertension protocol with a 24 hour urine free catecholamine sample that was clearly elevated. Abdomen computed tomography and magnetic resonance imaging showed a tumor located in the right adrenal gland and she underwent surgical resection. CONCLUSIONS: pheochromocytoma has different clinical presentations that may delay the diagnosis. Early recognition of catecholamine-induced cardiomyopathy and adequate management reduces morbidity and mortality.