On the structural formula of smectites: a review and new data on the influence of exchangeable cations.

The understanding of the structural formula of smectite minerals is basic to predicting their physicochemical properties, which depend on the location of the cation substitutions within their 2:1 layer. This implies knowing the correct distribution and structural positions of the cations, which allows assigning the source of the layer charge of the tetrahedral or octahedral sheet, determining the total number of octahedral cations and, consequently, knowing the type of smectite. However, sometimes the structural formula obtained is not accurate. A key reason for the complexity of obtaining the correct structural formula is the presence of different exchangeable cations, especially Mg. Most smectites, to some extent, contain Mg2+ that can be on both octahedral and interlayer positions. This indeterminacy can lead to errors when constructing the structural formula. To estimate the correct position of the Mg2+ ions, that is their distribution over the octahedral and interlayer positions, it is necessary to substitute the interlayer Mg2+ and work with samples saturated with a known cation (homoionic samples). Seven smectites of the dioctahedral and trioctahedral types were homoionized with Ca2+, substituting the natural exchangeable cations. Several differences were found between the formulae obtained for the natural and Ca2+ homoionic samples. Both layer and interlayer charges increased, and the calculated numbers of octahedral cations in the homoionic samples were closer to four and six in the dioctahedral and trioctahedral smectites, respectively, with respect to the values calculated in the non-homoionic samples. This change was not limited to the octahedral sheet and interlayer, because the tetrahedral content also changed. For both dioctahedral and trioctahedral samples, the structural formulae improved considerably after homoionization of the samples, although higher accuracy was obtained the more magnesic and trioctahedral the smectites were. Additionally, the changes in the structural formulae sometimes resulted in changing the classification of the smectite.

Invasion history of Harmonia axyridis (Pallas, 1773) (Coleoptera: Coccinellidae) in Ecuador.

Harmonia axyridis is a ladybird extensively used around the world for biological control of agricultural pests. However, it has become invasive in several countries, producing negative ecological and socio-economic impacts. Herein, we review the invasion history of the Harlequin Ladybird Harmonia axyridis (Pallas, 1773) in Ecuador. Although first reported in Ecuador in 2012, museum specimens date back to 2004 and it is currently established across the country, especially along the Andean region. Due to its invasive nature, further studies are urgently needed to evaluate possible impacts of H. axyridis on the Ecuadorian biodiversity and agroindustry.

Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain.

BACKGROUND: Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. METHODS: A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. RESULTS: Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5-11.8) vs 3.4 years (IQR 0.4-9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. CONCLUSIONS: MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.

Poor Sensitivity of Fecal Gluten Immunogenic Peptides and Serum Antibodies to Detect Duodenal Mucosal Damage in Celiac Disease Monitoring.

A lifelong gluten-free diet (GFD) is the only current treatment for celiac disease (CD), but strict compliance is complicated. Duodenal biopsies are the "gold standard" method for diagnosing CD, but they are not generally recommended for disease monitoring. We evaluated the sensitivity and specificity of fecal gluten immunogenic peptides (GIPs) to detect duodenal lesions in CD patients on a GFD and compared them with serum anti-tissue transglutaminase (tTG) IgA antibodies. A prospective study was conducted at two tertiary centers in Spain on a consecutive series of adolescents and adults with CD who maintained a long-lasting GFD. Adherence to a GFD and health-related quality of life were scored with validated questionnaires. Mucosal damage graded according to the Marsh-Oberhüber classification (Marsh 1/2/3) was used as the reference standard. Of the 97 patients included, 27 presented duodenal mucosal damage and 70 had normal biopsies (Marsh 0). The sensitivity (33%) and specificity (81%) of GIPs were similar to those provided by the two assays used to measure anti-tTG antibodies. Scores in questionnaires showed no association with GIP, but an association between GIPs and patients' self-reported gluten consumption was found (p = 0.003). GIP displayed low sensitivity but acceptable specificity for the detection of mucosal damage in CD.

Influencia de la puntuación MELD basal en la eficacia del tratamiento de la hepatitis C con sofosbuvir y simeprevir / Influence of baseline MELD score in the efficacy of treatment of hepatitis C with simeprevir and sofosbuvir

INTRODUCCIÓN: Hay pocos estudios publicados acerca de los factores predictivos de respuesta al tratamiento de la hepatitis C con sofosbuvir y simeprevir. OBJETIVO: Conocer qué factores influyen en la respuesta a simeprevir (SIM) y sofosbuvir (SOF) en pacientes infectados por los genotipos 1 o 4 de la hepatitis C. PACIENTES Y MÉTODOS: Estudio prospectivo observacional de cohortes en 12 hospitales. La efectividad se evaluó con respuesta virológica sostenida (RVS12). RESULTADOS: Se incluyeron 204 pacientes (62,3% varones, edad media 55 años). Ciento ochenta y seis (91,2%) genotipo 1 (60,3% 1b, 25% 1a) y 18 (8,8%) genotipo 4. Ciento treinta y dos (64,7%) cirróticos (87,9% Child A), 33 (16,2%) F3, 31 (15,2%) F2, 8 (3,9%) F0-1. Un 80,8% MELD < 10. Noventa y tres (45,6%) naive. Se asoció ribavirina en 68 (33,3%). Carga viral basal media 2.151.549 UI/ML (DE: 2.391.840). Duración tratamiento 12 semanas en 93,1%. Cuatro suspendieron tratamiento: suicidio, brote psicótico, hiperbilirrubinemia y recurrencia hepatocarcinoma. Ciento noventa (93,1%) alcanzaron RVS12. No hubo diferencias RVS12 en función del genotipo, duración tratamiento, empleo de ribavirina, tratamiento previo, CV y plaquetas basales. En análisis univariante, negatividad carga viral a las 4 semanas (p = 0,042), ausencia de cirrosis (p = 0,021), albúmina basal ≥ 4g/dl (p:0,001) y MELD<10 (p < 0,0001) se asociaron con mayor RVS12. En estudio multivariante solo hubo relación significativa entre puntuación MELD basal < 10 y mayor RVS12 (p < 0,001). CONCLUSIONES: La combinación de simeprevir y sofosbuvir es muy eficaz en pacientes infectados por los genotipos 1 y 4 de la hepatitis C. Es un tratamiento seguro, especialmente en pacientes sin ribavirina. Esta combinación es más efectiva en pacientes con puntuación MELD inferior a 10

INTRODUCTION: There are few published studies on predictors of response to treatment with sofosbuvir and simeprevir in HCV patients. OBJECTIVE: The objective of the study was to analyse possible predictors of response to simeprevir (SMV) and sofosbuvir (SOF) in patients infected with hepatitis C genotypes 1 or 4. PATIENTS AND METHODS: Prospective observational cohort study in 12 hospitals. The primary efficacy endpoint was SVR rate 12 weeks after end of treatment (SVR12). RESULTS: 204 patients (62.3% male, mean age 55 years) were included: 186 (91.2%) genotype 1 (60.3% 1b 25% 1a) and 18 (8.8%) genotype 4. 132 (64.7%) cirrhotic (87.9% Child A), 33 (16.2%) F3, 31 (15.2%) F2, 8 (3.9%) F0-1. 80.8% MELD<10. 93 (45.6%) naive. Ribavirin was added in 68 (33.3%). Mean baseline viral load 2,151,549 IU/ml (SD: 2,391,840). Treatment duration 12 weeks in 93.1%. 4 discontinued therapy: suicide, psychotic attack, hyperbilirubinaemia and liver cancer recurrence. 190 (93.1%) achieved SVR12. There were no differences in SVR12 depending on the genotype, treatment duration, ribavirin use, prior therapy, viral load (VL) or baseline platelets. In univariate analysis, undetectable VL at 4 weeks (p = 0.042), absence of cirrhosis (p = 0.021), baseline albumin ≥ 4g/dl (p = 0.001) and MELD < 10 (p < 0.0001) were associated with higher SVR12. In multivariate analysis, only baseline MELD score < 10 patients had higher SVR12 (p < 0.001). CONCLUSIONS: The combination of simeprevir and sofosbuvir in patients infected with genotype 1 and 4 hepatitis C is highly effective. It is a safe therapy, especially in patients without ribavirin. This combination was more effective in patients with a MELD score below 10

Influence of baseline MELD score in the efficacy of treatment of hepatitis C with simeprevir and sofosbuvir. / Influencia de la puntuación MELD basal en la eficacia del tratamiento de la hepatitis C con sofosbuvir y simeprevir.

INTRODUCTION: There are few published studies on predictors of response to treatment with sofosbuvir and simeprevir in HCV patients. OBJECTIVE: The objective of the study was to analyse possible predictors of response to simeprevir (SMV) and sofosbuvir (SOF) in patients infected with hepatitis C genotypes 1 or 4. PATIENTS AND METHODS: Prospective observational cohort study in 12 hospitals. The primary efficacy endpoint was SVR rate 12 weeks after end of treatment (SVR12). RESULTS: 204 patients (62.3% male, mean age 55 years) were included: 186 (91.2%) genotype 1 (60.3% 1b 25% 1a) and 18 (8.8%) genotype 4. 132 (64.7%) cirrhotic (87.9% Child A), 33 (16.2%) F3, 31 (15.2%) F2, 8 (3.9%) F0-1. 80.8% MELD<10. 93 (45.6%) naive. Ribavirin was added in 68 (33.3%). Mean baseline viral load 2,151,549 IU/ml (SD: 2,391,840). Treatment duration 12 weeks in 93.1%. 4 discontinued therapy: suicide, psychotic attack, hyperbilirubinaemia and liver cancer recurrence. 190 (93.1%) achieved SVR12. There were no differences in SVR12 depending on the genotype, treatment duration, ribavirin use, prior therapy, viral load (VL) or baseline platelets. In univariate analysis, undetectable VL at 4 weeks (p=0.042), absence of cirrhosis (p=0.021), baseline albumin ≥ 4g/dl (p=0.001) and MELD<10 (p<0.0001) were associated with higher SVR12. In multivariate analysis, only baseline MELD score <10 patients had higher SVR12 (p<0.001). CONCLUSIONS: The combination of simeprevir and sofosbuvir in patients infected with genotype 1 and 4 hepatitis C is highly effective. It is a safe therapy, especially in patients without ribavirin. This combination was more effective in patients with a MELD score below 10.

Lectura automatizada de citología de orina: estudio retrospectivo preliminar / Automated cytology readings of urine: a preliminary retrospective study

La lectura automatizada de citología basada en ThinPrep® es una evidente ayuda para el citotécnico y para el patólogo, al identificar campos de interés para ser evaluados. Algunos autores han demostrado la utilidad de la citología líquida ThinPrep® como sustitución del citospin en citología de orina, pero existe muy escasa información acerca de su utilidad. Objetivo. Evaluar la utilidad de la lectura automática de citología, en citología de orina. Material y métodos. Estudio retrospectivo de 180 extensiones de orina. Procesamiento según protocolo con plataforma ThinPrep®, tinción automatizada con teñidor Leica®, lectura manual de la extensión y diagnóstico. Lectura automatizada de citología utilizando Imager® y posterior revisión por los citotécnicos. Resultados. Los resultados fueron clasificados como positivos, negativos, atipia o polioma. La coincidencia diagnóstica fue del 83,9% (Kappa; IC 95%: 0,713 [0,619-0,807]). Todos los casos positivos fueron detectados por el sistema automático. De los 118 casos interpretados previamente como negativos, 97 (82%) fueron reinterpretados como tales. Ningún caso informado previamente como negativo fue interpretado como positivo. La sensibilidad y el valor predictivo negativo del Imager® para la detección de carcinoma en esta serie son del 100%. La especificidad es del 98%, y el valor predictivo positivo, del 91%. El citotécnico revisó 75 de las 180 laminillas (41,7%), la mayoría por atipias (89,6%) y negativos (32,3%). Conclusiones. El uso del Imager® como pre-cribado podría ayudar en la interpretación de la citología de orina. El porcentaje de casos que no precisan de revisión completa podría aumentar con la experiencia del citotécnico (AU)

ThinPrep® Imager system reading method of liquid-based cytology is currently a very helpful tool for both the cytotechnologist and the pathologist. Some authors have shown the usefulness of liquid-based cytology ThinPrep® as a replacement of the citospin in urine cytology. However, there is very little information about its usefulness. Objective. To evaluate the utility of reading urine cytology using ThinPrep® Imager System. Material and methods. A retrospective study of 180 urine cytology smears was carried out. Processing was done according to ThinPrep® platform protocol, automated staining with stainer Leica® and manual reading of the slide and diagnosis, followed by automated reading of cytology using Imager®. Review by cytotechnologists. Results. The results were classified as positive, negative, atypia or polioma. Diagnostic coincidence was 83.9% (Kappa; 95% IC, 0.713 [0,619-0,807]). All positive cases were detected by the automated system. Of the 118 cases previously interpreted as negative, 97 (82%) were reinterpreted as such. None previously reported as negative were interpreted as positive in the study with Imager®. Sensitivity as well as negative predictive value of the Imager® for the detection of carcinoma in this series are 100%. The specificity is 98% and the positive predictive value is 91%. The cytotechnologist reviewed 75/180 slides (41.7%), mostly with atypia (89.6%) or negative (32,3%). Conclusions. The use of the Imager® as a pre-screening method could help in the interpretation of urine cytology and a useful tool for the cytotechnologist. The percentage of cases that do not require complete revision could increase with the experience of the cytotechnologist (AU)

Automated screening of gynecologic cytology: a comparison of results.

OBJECTIVE: To compare the results among conventional gynecologic cytology liquid-based cytology and manual screening and liquid-based cytology automatically screened. STUDY DESIGN: The results of 53,311 cervicovaginal samples, corresponding to 53,311 women of Barcelona, Spain are reviewed. The cases are subdivided into 19,742 conventional cervicovaginal samples; 17,596 liquid-based cytology, manually screened samples; and 15,973 liquid-based automated-screened samples. RESULTS: The automated screening increases the atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion detection, in respect to liquid-based, manual screening and conventional cytology. In the follow-up, automated screening increases the diagnosis of squamous intraepithelial lesion (low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion). CONCLUSION: Automated screening increases detection of all categories and increases the specificity for high-grade squamous intraepithelial lesion.

La carga viral no es un factor pronóstico en LSIL / Viral load is not a prognostic factor in LSIL

Objetivo. Estudiar el valor de la carga viral para predecir la persistencia y/o la progresión en LSIL. Diseño del estudio. Estudio prospectivo. Todos los casos diagnosticados como LSIL en el año 2006, y seguidos a los 6, 12 y 24 meses después del diagnóstico. Método. Citología líquida (ThinPrep®, Hologic, Malborough, MA, EE. UU.) para realizar el estudio citológico. Test de captura de híbridos (HCII-HR, Quiagen, Hilden, Alemania), utilizando el test para determinar la presencia de VPH de alto riesgo. Resultados. De los 102 casos, 87 fueron HPV positivos (85,3%). La persistencia o progresión se observó en el 54% de los casos en el primer control, en el 42,4% en el segundo control y en el 33,3% en el tercer control. No se demostró lesión en el seguimiento en el 46% de los casos en el primer control, en el 57% de los casos en el segundo control y en el 66,7% de los casos en el tercer control. Diecinueve casos progresaron a HSIL: 11 detectados en el primer control, 6 en el segundo y 2 en el tercero. La sensibilidad para HSIL nunca superó el 89%, con una especificidad siempre menor del 40%. Conclusiones. La determinación de la carga viral mediante HC2 en LSIL no es útil para predecir su comportamiento(AU)

Objective. To study the HPV viral load (VL) in the prediction of the persistence and/or progression in LSIL cases. Study design. Prospective study. 102 consecutive cases diagnosed as LSIL in 2006 with follow-ups at 6, 12 and 24 months subsequent to diagnosis. Method. Liquid based cytology (ThinPrep®, Hologic, Malborough, MA, USA), for the cytological study. Hybrid Captute II Test (HCII-HR, Quiagen, Hilden, Germany), for the determination of the presence or absence of High-Risk HPV. Results. 87 of the 102 cases studied were HR-HPV positive (85.3%). The presence or progression was detected in 54%, 42% and 33.35% of the cases in the first, second and third controls respectively. No lesion was demonstrated in 46%, 57% and 66.7% of the cases at first, second and third controls respectively. 19 cases progressed to HSIL; 11 of which were detected on the first control, 6 on the second and 2 on the third. The sensitivity of the VL for detecting HSIL never exceeded 89%, with a specificity always inferior to 40%. Conclusion. The VL determined by the HC2 method is not a useful indicator of prognosis in the follow-up of LSIL cases(AU)

Detection of HPV by in situ hybridization in thin-layer (ThinPrep) cervicovaginal samples.

We have studied an automated in situ hybridization (ISH) method as a possible alternative approach for detecting high-risk human papillomavirus (HPV) in monolayer (ThinPrep) cervico-vaginal samples, comparing the results with those obtained by polymerase chain reaction (PCR) using consensus primers and studying the relationship between the ISH staining pattern and the viral integration in HPV 16-positive cases. Eighty atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) cases were used for our purposes. The patients were monitored through periodic cytologies. ISH with was performed with an automated Ventana System, analysis by PCR was performed with consensus primers and integration of HPV16 was performed by realtime PCR analyzing E2 and E6 genes. Additionally, 27 HSIL cases were also studied to observe the ISH staining patterns. HPV infection was detected by ISH in 21.7% of the ASCUS cases and 55.8% of the LSIL cases. Two distinct staining patterns were observed: multipunctated (MP) and diffuse (DI). In some cases, a mixed pattern (MP + DI) was observed and these cases were considered as MP. The MP pattern increased with the degree of lesion and seemed to have a prognostic value in ASCUS/LSIL cases. The lesion in MP pattern cases persisted throughout the entire study in 77% of cases, whereas in cases with a DI staining pattern, only 41% of them showed persistence of the lesion (p <0.001). No correlation was found between HPV integration and the ISH staining pattern. Given the lower sensitivity and negative predictive value of ISH and its incapacity to demonstrate the integration of high-risk HPV in ASCUS and LSIL cases using liquid-based cytology, we do not recommend this technique for the triage of ASCUS and LSIL cases.

Axillary metastasis in a patient with double neoplasia: a case report.

BACKGROUND: Axillary lymph node metastases in women are most frequently associated with breast cancer. Few cases have been reported to be related to other primary tumors of the breast. Furthermore, emperipolesis, a phenomenon that occurs as a result of the phagocytosis of hematopoietic cells by neoplastic cells, is observed in few tumors. CASE: A 72-year-old woman presenting endometrial and breast cancer developed axillary metastasis 2 months after diagnosis of breast cancer. A fine needle aspiration was performed. A diagnosis of metastasis from endometrial cancer was made on the basis of cytological characteristics. CONCLUSION: The morphologic features in this case (emperipolesis) oriented as axillary metastases from primary endometrial cancer.

Citología en medio líquido (Thin Prep Pap Test). Un año de experiencia / Liquid-based cytology (Thin Prep Pap Test). A one-year experience

Objetivos: Evaluar nuestra experiencia en citología en medio líquido (Thin Prep Pap Test) durante un año, evaluando el seguimiento de las pacientes diagnosticadas. Comparar estos datos con nuestros resultados obtenidos previamente con citología convencional. Sujetos y métodos: Se realizaron 11.150 citologías cervicovaginales, 8.086 convencionales y 3.064 en medio líquido (Thin Prep Pap Test) y se evaluaron los resultados. Se efectuó un seguimiento de las pacientes y una evaluación de éste en los casos diagnosticados como células escamosas atípicas de significado incierto y como lesión escamosa intraepitelial de bajo grado. Resultados: Los resultados obtenidos demuestran un incremento de los diagnósticos en todas las categorías, si bien sólo de forma estadísticamente significativa si evaluamos los resultados en conjunto, no por separado. En cuanto al seguimiento, los resultados son similares en la citología convencional y en el Thin Prep. Conclusiones: La citología en medio líquido incrementa de forma más o menos significativa la detección de las lesiones cervicales preneoplásicas y, por tanto, mejora el rendimiento de la citología cervicovaginal

Objectives: To describe our experience of liquid-based cytology (Thin Prep Pap Test) over a 1-year period by evaluating the follow-up of patients with an abnormal result and to compare the results obtained with the Thin Prep Pap Test with those previously obtained with conventional cytology. Subjects and methods: The results of 11,150 cervico-vaginal pap tests (8,086 conventional tests and 3,064 liquid-based tests [Thin Prep]) were evaluated. The follow-up of patients with a diagnosis of atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) was evaluated. Results: Diagnosis of abnormal results in all categories increased, although this increase was only statistically significant when the results were evaluated as a whole. The results of follow-up were similar with both methods. Conclusions: Liquid-based cytology (Thin Prep Pap Test) substantially increases the detection of preneoplastic cervical lesions and consequently improves the yield of cervico-vaginal cytology

ASCUS sobre células metaplásicas. Significado pronóstico de los cambios citológicos / ASCUS-metaplasic cells. Prognostic significance of celular changes

La predicción de la evolución del ASCUS sigue siendo un tema controvertido. En un intentode hallar aspectos citológicos que permitan predecir dicha evolución hemos evaluado 5 detallescitológicos en células escamosas inmaduras con características de ASCUS sugestivo de lesiónescamosa de alto grado. Ninguno de los detalles evaluados ha mostrado valor predictivo respectoa la evolución de la lesión

Follow-up of patients diagnosed as having ASCUS have no predictable morphological data.We have evaluated 5 aspects of ASCUS affecting immature squamous cells to find out whetherthese details have predictive value. None of these data have statistical significance related tofollow-up of the patients examined

ASCUS sobre células metaplásicas Significado pronóstico de los cambios citológicos / ASCUS-metaplasic cells. Prognostic significance of celular changes

La predicción de la evolución del ASCUS sigue siendo un tema controvertido. En un intento de hallar aspectos citológicos que permitan predecir dicha evolución hemos evaluado 5 detalles citológicos en células escamosas inmaduras con características de ASCUS sugestivo de lesión escamosa de alto grado. Ninguno de los detalles evaluados ha mostrado valor predictivo respecto a la evolución de la lesión

Follow-up of patients diagnosed as having ASCUS have no predictable morphological data. We have evaluated 5 aspects of ASCUS affecting immature squamous cells to find out whether these details have predictive value. None of these data have statistical significance related to follow-up of the patients examined

ASCUS y control citológico / ASCUS and quality control in cytology

Objetivo: Establecer un mecanismo de control de calidad lo más efectivo posible para las citologías diagnosticadas como ASCUS. Material y método: Revisión de las citologías cérvico-vaginales diagnosticadas como ASCUS durante los años 1995 a 1999 ambos inclusive. Reevaluación por dos citotécnicas diferentes al azar, sin datos clínicos. Reevaluación de las discrepancias por el citopatólogo. Estudio estadístico. Revisión de la Literatura. Resultados: Índice de concordancia entre citotécnicas: 80 por ciento. Índice de concordancia del citopatólogo: 84,5 por ciento. Todos los casos considerados como negativos mostraron desaparición de la lesión en el seguimiento. Los cambios asentados sobre células metaplásicas y en mujeres peri y post-menopáusicas son los casos con mayores discrepancias. Discusión: Nuestros resultados muestran una concordancia para el diagnóstico de ASCUS mayor que la reportada en la Literatura. Creemos que este método, si bien es más laborioso que otros publicados en la Literatura, es mejor por cuanto unifica criterios entre el personal que trabaja en un Laboratorio de Citopatología, y permite evaluar los casos en relación al seguimiento de las pacientes (AU)

Escleredema de Buschke / Scleredema of Buschke

Presentamos un caso de escleredema en una mujer obesa de 54 años. Refería tener los síntomas desde la niñez y a los 42 años de edad fue diagnosticada de diabetes mellitus tipo 2 insulinodependiente. La paciente mejoró parcialmente con un riguroso control de su diabetes, pérdida de peso e inclusión en un programa de rehabilitación. (AU)

Mixedema generalizado del adulto con evolución a coma mixedematoso / Generalized myxedema in an adult leading to myxedema coma

Describimos un caso de mixedema generalizado en una mujer de 70 años de edad. Como consecuencia de una infección pulmonar la paciente sufrió una grave descompensación, con evolución fatal a coma mixedematoso. Queremos destacar la baja incidencia de esta presentación clínica del hipotiroidismo, así como su mal pronóstico (AU)

Terapia endovascular del sistema nervioso cedntral factibilidad de su aplicación en nuestro medio

Se estudiaron 28 pacientes portadores de lesiones neurovasculares complejas, tales como fístulas arteriovenosas, malformaciones arteriovenosas, aneurismas gigantes y tumores hipervasculares, los cuales fueron tratados mediante técnicas endovasculares. Se evaluaron los hallazgos clínico radiológicos, así como la estrategia, materiales embólicos, resultados y complicaciones ded la embolización, demostrándose la factibilidad de: 1) Acceder por vía endovascular mediante microcatéteres al interior de lesiones neurovasculares complejas. 2) Realizar una evaluación angiográfica superselectiva de las mismas. 3) Colocar por vía endovascular y en el seno de estas lesiones, agentes terapéuticos trombogénicos con resultados curativos, coadyuvantes a la cirugía o paliativos con un mínimo de morbilidad