Fibrosarcoma primario de ovario. Reporte de una neoplasia inusual / Primary ovarian fibrosarcoma. Report of an unusual neoplasm

Introducción: El fibrosarcoma ovárico es un tumor maligno del estroma ovárico muy infrecuente, con pocos casos reportado en la literatura. Principales síntomas o hallazgos clínicos: Mujer de 56 años posmenopáusica, con sangrado vaginal escaso de varios días de evolución y dolor en fosa ilíaca derecha sin fiebre ni clínica digestiva. La exploración ginecológica era normal.Diagnósticos principales, intervenciones terapéuticas y resultados: La ecografía transvaginal mostró un endometrio homogéneo, un mioma de 2,4×1cm y una lesión sólido-quística heterogénea de tabiques gruesos de 6,4×6,8cm en el ovario izquierdo. El estudio histológico intraoperatorio se informó como: neoplasia sólida sospechosa de malignidad. Se le realizó histerectomía más doble anexectomía, omentectomía y linfadenectomía. Histológicamente la neoplasia estaba constituida por células fusiformes dispuestas en láminas y fascículos entrecruzados con apariencia difusa en espiga, con atipia nuclear moderada, áreas de necrosis y focos de hemorragia. Se identificaron 12 mitosis por 10 campos de gran aumento. Inmunohistoquímicamente las células fueron positivas para inhibina, actina 1A4, vimentina, calretinina, CD56 y CD99. El índice proliferativo con Ki-67 fue del 25%. El diagnosticó definitivo fue: fibrosarcoma primario de ovario. Un año después, la paciente se encontraba libre de enfermedad sin ninguna terapia adyuvante y continúa en seguimiento. Conclusión: El fibrosarcoma de ovario es una neoplasia maligna excepcional de mal pronóstico. En la actualidad, los tratamientos y factores pronósticos del fibrosarcoma ovárico siguen siendo discutibles. El presente caso destaca el importante papel del estudio intraoperatorio y la inmunohistoquímica para su correcto diagnóstico.(AU)

Introduction: Ovarian fibrosarcoma is an extremely rare malignant ovarian stromal tumor, with few cases reported in the literature. Main symptoms and/or clinical findings: A 56-year-old posmenopausal woman with scant vaginal bleeding of several days’ duration and pain in the right iliac fossa without fever or digestive symptoms. The gynecological examination was normal. Main diagnoses, therapeutic interventions and results: Transvaginal ultrasound showed a homogeneous endometrium, a 2.4×1cm myoma, and a heterogeneous solid-cystic lesion with thick septa measuring 6.4×6.8cm in the left ovary. An intraoperative histological study was performed, which was reported as: solid neoplasm suspicious of malignancy. Hysterectomy plus double adnexectomy, omentectomy, and lymphadenectomy were performed. Histologically, the neoplasm was made up of spindle cells arranged in sheets and intertwined fascicles with a diffuse spike-like appearance, with moderate nuclear atypia, areas of necrosis and hemorrhage foci; 12 mitoses were identified for every 10 high-power fields. Immunohistochemically the cells were positive for inhibin, actin 1A4, vimentin, calretinin, CD56 and CD99. The proliferative rate with Ki-67 was 25%. The definitive diagnosis was: primary ovarian fibrosarcoma. One year later, the patient is free of the disease without any adjuvant treatment and continues to be followed up. Conclusion: Ovarian fibrosarcoma is an exceptional malignancy with a poor prognosis. Currently, the treatments and prognostic factors for ovarian fibrosarcoma are still the subject of debate. This case highlights the important role of the intraoperative study and immunohistochemistry for its correct diagnosis.(AU)

Tumor uterino que recuerda a los tumores de los cordones sexuales del ovario (UTROSCT): un caso clinicopatológico / Uterine tumour resembling ovarian sex cord tumours (UTROSCT): A clinicopathological case

Introducción: El tumor uterino que recuerda al tumor de los cordones sexuales del ovario (UTROSCT) es un tumor muy infrecuente de histogénesis incierta, incluido en la actual clasificación de tumores del estroma endometrial de la Organización Mundial de la Salud. Principales síntomas y/o hallazgos clínicos: Mujer de 48 años, sin antecedentes de interés, acudió a consulta por hipermenorreas en los últimos ciclos. La exploración ginecológica era normal. Diagnósticos principales, intervenciones terapéuticas y resultados: El estudio ecográfico mostró una lesión nodular submucosa de 26×21mm. Se le realizó histeroscopia diagnóstica, identificándose un mioma submucoso no accesible para extirpación ambulatoria. Se llevó a cabo histeroscopia quirúrgica procediéndose a miomectomía con asa de diatermia. Histológicamente se observó tejido muscular liso masivamente infiltrado por células de poco citoplasma con diferenciación glandular positivas con citoqueratinas, interpretándose como fragmentos de pared miometrial infiltrados por carcinoma. Se le realizó estudio de extensión e histerectomía. En la pieza quirúrgica no se identificó neoplasia residual. Se revaluó la biopsia previa y se amplió el estudio inmunohistoquímico, observándose positividad para marcadores de los cordones sexuales, epiteliales y musculares lisos. Ante estos hallazgos, el diagnóstico definitivo fue UTROSCT. Conclusión: El UTROSCT muestra generalmente un comportamiento benigno. Sin embargo, se considera de potencial maligno incierto, debido a que presenta una baja tasa de recurrencias y metástasis excepcionales. Desde el punto de vista histopatológico es importante reconocer esta entidad, ya que su histológica es variada imitando una amplia gama de tumores tanto benignos como malignos, por lo que es necesario realizar estudio inmunohistoquímico para su correcto diagnóstico.(AU)

Introduction: Uterine tumour resembling ovarian sex cord tumour (UTROSCT) is a very rare tumour of uncertain histogenesis, included in the current classification of endometrial stromal tumours of the World Health Organization. Main symptoms and/or clinical findings: 48-year-old woman with no history of interest, consulted for hypermenorrhoea in recent cycles. The gynaecological examination was normal. Main diagnoses, therapeutic interventions, and results: The ultrasound study showed a submucosal nodular lesion of 26×21mm. A diagnostic hysteroscopy was performed, identifying a submucosal myoma not accessible for outpatient removal. Surgical hysteroscopy was performed, proceeding to myomectomy with loop diathermy. Histologically, smooth muscle tissue was observed massively infiltrated by cells with scant cytoplasm and positive glandular differentiation for cytokeratins, interpreted as fragments of the myometrial wall infiltrated by carcinoma. An extension study and hysterectomy were performed. No residual neoplasia was identified in the surgical piece. A previous biopsy was re-evaluated and an immunohistochemical study was extended, showing positivity for sexual cord, epithelial, and smooth muscle markers. Given these findings, the definitive diagnosis was UTROSCT. Conclusion: UTROSCT generally shows benign behaviour. However, it is considered to be of uncertain malignant potential, due to its low rate of recurrence and rare metastases. From the histopathological point of view, it is important to recognize this entity, since its histology is varied, mimicking a wide range of tumours, both benign and malignant, making it necessary to perform an immunohistochemical study for its correct diagnosis.(AU)

Computational study of the interplay between intermolecular interactions and CO2 orientations in type I hydrates.

Carbon dioxide (CO2) molecules show a rich orientation landscape when they are enclathrated in type I hydrates. Previous studies have described experimentally their preferential orientations, and some theoretical works have explained, but only partially, these experimental results. In the present paper, we use classical molecular dynamics and electronic density functional theory to advance in the theoretical description of CO2 orientations within type I hydrates. Our results are fully compatible with those previously reported, both theoretical and experimental, the geometric shape of the cavities in hydrate being, and therefore, the steric constraints, responsible for some (but not all) preferential angles. In addition, our calculations also show that guest-guest interactions in neighbouring cages are a key factor to explain the remaining experimental angles. Besides the implication concerning equation of state hydrate modeling approximations, the conclusion is that these guest-guest interactions should not be neglected, contrary to the usual practice.

[Vulvar squamous cell carcinoma in young women with HPV negative]. / Carcinoma epidermoide de vulva en mujer joven con VPH negative.

BACKGROUND: The vulvar cancer is the fourth more frequent neoplasia after the endometrial, cervix and ovarian cancer. Normally, it has been related to old women of ages from 70 to 80 years old. Rarely, it has been detected cases in adult or young women. However, its incidence has been increased in the last years and in more early years. It is for this change in the incidence and its appearance in early years why a possible etiology has been looked for, opening different hypothesis that go from that related to the HPV to those that study an inflammatory chronic process as the basis for the carcinogenesis. CLINICAL CASE: In this article, it has been presented the case of a woman who is 34 years old with negative VPH that made her debut with epidermoid carcinoma of the vulva moderately different and on purpose of the case, we do a revision of the literature existent. CONCLUSIONS: Vulvar cancer diagnosed in young women as in older, but with different trends, risk factors and natural history. The case reported here escapes the theories studied so far so needed new lines of inquiry to investigate this form of presentation young woman, without HPV infection.

Revisiting the thermodynamic modelling of type I gas-hydroquinone clathrates.

Under specific pressure and temperature conditions, certain gaseous species can be engaged in a host lattice of hydroquinone molecules, forming a supramolecular entity called a gas hydroquinone clathrate. This study is devoted to the thermodynamic modelling of type I hydroquinone clathrates. The gases considered in this work are argon, krypton, xenon, methane, nitrogen, oxygen and hydrogen sulphide. The basic van der Waals and Platteeuw model, which is, for example, not able to predict well the phase equilibrium properties of such clathrates at high temperature, is modified and extended by considering first the solubility of the guest in solid HQ and then the mutual interactions between the gaseous molecules inside the clathrate structure (i.e. guest-guest interactions). Other improvements of the basic theory, such as the choice of the reference state, are proposed, and a unique set of thermodynamic parameters valid for all the studied guests are finally calculated. Very good agreement is obtained between the model predictions and the experimental data available in the literature. Our results clearly demonstrate that the highest level of theory is necessary to describe well both the triphasic equilibrium line (where the HQ clathrate, the native hydroquinone HQα and the gas coexist), the occupancy of the guest in the clathrate, and the intercalation enthalpy.

Understanding the Phase Behavior of Tetrahydrofuran + Carbon Dioxide, + Methane, and + Water Binary Mixtures from the SAFT-VR Approach.

The high-pressure phase diagrams of the tetrahydrofuran(1) + carbon dioxide(2), + methane(2), and + water(2) mixtures are examined using the SAFT-VR approach. Carbon dioxide molecule is modeled as two spherical segments tangentially bonded, water is modeled as a spherical segment with four associating sites to represent the hydrogen bonding, methane is represented as an isolated sphere, and tetrahydrofuran is represented as a chain of m tangentially bonded spherical segments. Dispersive interactions are modeled using the square-well intermolecular potential. In addition, two different molecular model mixtures are developed to take into account the subtle balance between water-tetrahydrofuran hydrogen-bonding interactions. The polar and quadrupolar interactions present in water, tetrahydrofuran, and carbon dioxide are treated in an effective way via square-well potentials of variable range. The optimized intermolecular parameters are taken from the works of Giner et al. (Fluid Phase Equil. 2007, 255, 200), Galindo and Blas (J. Phys. Chem. B 2002, 106, 4503), Patel et al. (Ind. Eng. Chem. Res. 2003, 42, 3809), and Clark et al. (Mol. Phys. 2006, 104, 3561) for tetrahydrofuran, carbon dioxide, methane, and water, respectively. The phase diagrams of the binary mixtures exhibit different types of phase behavior according to the classification of van Konynenburg and Scott, ranging from types I, III, and VI phase behavior for the tetrahydrofuran(1) + carbon dioxide(2), + methane(2), and + water(2) binary mixtures, respectively. This last type is characterized by the presence of a Bancroft point, positive azeotropy, and the so-called closed-loop curves that represent regions of liquid-liquid immiscibility in the phase diagram. The system exhibits lower critical solution temperatures (LCSTs), which denote the lower limit of immiscibility together with upper critical solution temperatures (UCSTs). This behavior is explained in terms of competition between the incompatibility with the alkyl parts of the tetrahydrofuran ring chain and the hydrogen bonding between water and the ether group. A minimum number of unlike interaction parameters are fitted to give the optimal representation of the most representative features of the binary phase diagrams. In the particular case of tetrahydrofuran(1) + water(2), two sets of intermolecular potential model parameters are proposed to describe accurately either the hypercritical point associated with the closed-loop liquid-liquid immiscibility region or the location of the mixture lower- and upper-critical end-points. The theory is not only able to predict the type of phase behavior of each mixture, but also provides a reasonably good description of the global phase behavior whenever experimental data are available.

Molecular dynamics simulation of CO2 hydrates: Prediction of three phase coexistence line.

The three phase equilibrium line (hydrate-liquid water-liquid carbon dioxide) has been estimated for the water + carbon dioxide binary mixture using molecular dynamics simulation and the direct coexistence technique. Both molecules have been represented using rigid nonpolarizable models. TIP4P/2005 and TIP4P/Ice were used for the case of water, while carbon dioxide was considered as a three center linear molecule with the parameterizations of MSM, EPM2, TraPPE, and ZD. The influence of the initial guest occupancy fraction on the hydrate stability has been analyzed first in order to determine the optimal starting configuration for the simulations, paying attention to the influence of the two different cells existing in the sI hydrate structure. The three phase coexistence temperature was then determined for a pressure range from 2 to 500 MPa. The qualitative shape of the equilibrium curve estimated is correct, including the high pressure temperature maximum that determines the hydrate re-entrant behaviour. However, in order to obtain quantitative agreement with experimental results, a positive deviation from the classical Lorentz-Berthelot combining rules must be considered.

Lack of clinical therapeutic benefit of antidepressants is associated overall activation of the inflammatory system.

Despite the evidence of an association between depression and increased inflammatory markers, still little is known in relation to the most severe cases of the disorder i.e., those who fail to respond to antidepressants. We have assessed the cytokine profile and cortisol levels in 21 healthy controls (HC) and 19 medicated patients with depression with treatment-resistance (TRD) moderately ill. As an initial exploratory analysis, we have also related cytokine profile to the patient's clinical treatment outcome after an inpatient admission. Cytokine profile was measured in the serum by the Cytokine Array I kit (Randox). Plasma cortisol was carried out using a commercially available for the IMMULITE system. When compared to healthy controls, depressed patients had higher levels of cortisol, IL-6, IL-10, but lower levels of IL-4 and VEGF. Our exploratory analysis showed subjects who did not go on to respond to the inpatient admission treatment package had lower levels of MCP-1, and a trend toward lower levels of VEGF. Taking together, these data suggest that lack of clinical therapeutic benefit of antidepressants is associated with overall activation of the inflammatory system.

Development of a new type of high pressure calorimetric cell, mechanically agitated and equipped with a dynamic pressure control system: application to the characterization of gas hydrates.

A novel prototype of calorimetric cell has been developed allowing experiments under pressure with an in situ agitation system and a dynamic control of the pressure inside the cell. The use of such a system opens a wide range of potential practical applications for determining properties of complex fluids in both pressurized and agitated conditions. The technical details of this prototype and its calibration procedure are described, and an application devoted to the determination of phase equilibrium and phase change enthalpy of gas hydrates is presented. Our results, obtained with a good precision and reproducibility, were found in fairly good agreement with those found in literature, illustrate the various interests to use this novel apparatus.

Carcinoma de trompa de Falopio: revisión de casos en el Hospital General Universitario de Albacete / Primary fallopian tube carcinoma. Review of cases. Hospital General Albacete

Introducción: El carcinoma de trompa de Falopio primario (CTFP) constituye la neoplasia maligna menos frecuente del aparato genital femenino. Su incidencia es mayor entre la cuarta y la sexta década de la vida. Debido a su baja prevalencia y a su sintomatología inespecífica, el diagnóstico de esta enfermedad raramente se realiza antes de la cirugía. Objetivo: El principal objetivo de esta revisión ha sido conocer la forma de presentación y evolución del CTFP. Para ello se han analizado los casos de CTFP ocurridos en el Hospital General Universitario de Albacete desde el año 2000. Material y métodos: Hemos realizado un estudio descriptivo retrospectivo que incluye una serie de 5 casos de CTFP tratados en nuestro centro. Resultados: La edad media de las pacientes en el momento del diagnóstico es de 55 años. El síntoma más frecuente ha sido la hemorragia genital. En una de las pacientes, a pesar de que el diagnóstico de CTFP se realiza de manera post-operatoria, se sospechó un CTFP con las pruebas diagnósticas previas a la cirugía. El examen histopatológico reveló 3 casos de adenocarcinomas de tipo seroso y 2 de tipo endometrioide. La citología de líquido peritoneal fue positiva en el 80% de los casos. En cuanto al estadio clínico, 2 pacientes se encontraban en estadio I, 2 en estadio II y sólo un caso en estadio III. El seguimiento medio de estas pacientes ha sido de 31 meses, produciéndose recidiva en 3 de los 5 casos, a nivel local, dentro del primer año tras el diagnóstico. Conclusiones: ElCTFP, aunque es una entidad rara, no podemos olvidarlo ante una paciente con hidromenorrea, dolor abdominal, masa anexial y alteraciones citológicas cervicovaginales y/o endometriales (AU)

Introduction: Primary fallopian tube carcinoma (PFTC) is the rarest of all gynecologic cancers. It frequently occurs between fourth and sixth decade of life. Because of its low prevalence and its unspecific symptoms, PFTC is rarely diagnosed before surgery. Objetive: The main objective of this study is to analyze the patients who were diagnosed of PFTC in the General Hospital of Albacete between 2000 and 2009. Material and methods: We present a retrospective descriptive study involving 5 patients with PFTC treated in our hospital. Results: The average age of the patients at the moment of diagnosis is 55 years. The most frequent symptom has been the vaginal bleeding. In one of the patients, although the diagnosis of PFTC was done postoperative, we suspected PFTC with the preoperative study. Histopathological examination revealed 3 cases of serous adenocarcinoma and 2 cases of endometroid adenocarcinoma. Peritoneal cytology was positive in 80% of the cases. As far as the surgical staging is concerned, 2 patients were diagnosed in stage I, 2 patients in stage II and only one patient in stage III. The average follow has been 31 months, appearing recurrence in 3 of the 5 cases during the first year, as a local recurrence. Conclusion: Although PFTC is a very rare malignancy, it should be suspected in a patient with vaginal bleeding, abdominal pain, adnexal mass and abnormalities of cervical or endometrial cytologies (AU)

[Parotid gland's tumors in children]. / Tumores de parótida en niños.

The tumors of the salivary glands are infrequent in children, and parotid gland is involved in 80% of them. When a salivary gland tumor is present, the chance of malignancy is greater in the child than in the adult. We reviewed 8 cases identified in patients aged 14 years and younger in our hospital, analyzing its antecedents, signs and symptoms, histological features, diagnosis, treatment and evolution. All the patients displayed preauricular painless, non-inflammatory and slow-growing masses to an age between 10 months and 14 years. Four or them were pleomorphic adenomas, two haemangiomas, one epidermal cysts and one myoepithelial carcinoma. We emphasize the exceptional nature of the carcinoma for its rareness and for the high degree of malignancy expressed. We made a fine needle aspiration biopsy in four cases but they were conclusive only in three. All were treated by surgical resection of the tumour except for the myoepithelial carcinoma and the recurrent pleomorphic adenoma that were treated by total parotidectomy. The malignant tumours of the parotid gland are clinically indistinguishable of the benign ones, thus when any palpable mass appears in the zone of the parotid gland, an accurate diagnosis should be made without delay. The treatment of choice is the surgical excision with wide margins, being other adjuvant treatments less useful to this age than in the adult age.

Tumores de parótida en niños / Parotid gland´s tumors in children

Los tumores de glándulas salivares son infrecuentes en niños, afectando el 80% a la parótida y presentando una mayor proporción de malignidad que en adultos. Revisamos 8 casos en menores de 15 años tratados en nuestro hospital, atendiendo a sus antecedentes, expresividad clínica, tipo tumoral, diagnóstico, tratamiento empleado y seguimiento. Todos debutaron con masa parotídea asintomática y de crecimiento lento a una edad entre 10 meses y 14 años. Cuatro fueron adenomas pleomorfos, dos angiomas capilares, un quiste epidérmico y un carcinomamioepitelial. Destacamos la excepcionalidad del carcinoma por su rareza y por el alto grado de malignidad expresado. Se realizó punción-aspiración con aguja fina en cuatro pacientes, siendo concluyente sólo en tres. En todos se practicó tumorectomía, excepto en el carcinoma mioepitelialy en uno de los adenomas pleomorfos recidivado, en los que se realizó parotidectomía total. Los tumores malignos de la parótida son clínicamente indistinguibles de los benignos, por lo que ante toda masa palpable en la zona parotídea deberíamos establecer un diagnóstico sin demora. El tratamiento de elección es la exéresis quirúrgica con márgenes amplios, siendo otros tratamientos coadyuvantes poco útiles en niños (AU)

The tumors of the salivary glands are infrequent in children, and parotid gland is involved in 80% of them. When a salivary gland tumor is present, the chance of malignancy is greater in the child than in the adult. We reviewed 8 cases identified in patients aged 14 years and younger in our hospital, analyzing its antecedents, signs and symptoms, histological features, diagnosis, treatment and evolution. All the patients displayed preauricular painless, non-inflammatory and slow-growing masses to an age between 10 months and 14 years. Four of them were pleomorphic adenomas, two haemangiomas, one epidermal cysts and onemyoepithelial carcinoma. We emphasize the exceptional nature of the carcinoma for its rareness and for the high degree of malignancy expressed. We made a fine needle aspiration biopsy in four cases but they were conclusive only in three. All were treated by surgical resection of the tumour except for the myoepithelial carcinoma and the recurrent pleomorphic adenoma that were treated by total parotidectomy. The malignant tumours of the parotid gland are clinically indistinguishable of the benign ones, thus when any palpable mass appears in the zone of the parotid gland, an accurate diagnosis should be made without delay. The treatment of choice is the surgical excision with wide margins, being other adjuvant treatments less useful to this age that in the adult age (AU)

Positive thyroid transcription factor 1 staining strongly correlates with survival of patients with adenocarcinoma of the lung.

This study investigated the relation between positive thyroid transcription factor 1 (TTF1) staining and survival of patients affected by primary adenocarcinoma (ADC) of the lung. Pathological tissue from consecutive ADC patients was collected from 2002 to 2004. The anti-TTF1 antibody (8G7G3/1, dilution of 1/200) was used. Thyroid transcription factor 1 staining was assessed for each tumour as positive or negative. Probability of survival was estimated by Kaplan-Meier and difference tested by log-rank test. A Cox's regression multivariate analysis was carried out. In all, 106 patients were studied (66% male, 69% PS0-1, 83% with stage III or IV). Tumours expressed positive TTF1 staining in 66% of cases. Multivariate analysis demonstrated an independent lower risk of death for patients whose tumour expresses positive TTF1 staining (HR = 0.51, 95% CI 0.30-0.85; P = 0.01) and higher grade of differentiation (HR = 0.40, 95% CI 0.24-0.68; P = 0.001). In conclusion, positive TTF1 staining strongly and independently correlates with survival of patients with primary ADC of the lung.

CYFRA 21-1 level predicts survival in non-small-cell lung cancer patients receiving gefitinib as third-line therapy.

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) as gefitinib emerged as an accepted treatment in second- or third-line setting in NSCLC. However, clinical surrogate markers of EGFR-TKI activity in NSCLC patients remain to be identified and we studied the prognostic value of CYFRA 21-1 in this setting. Serum samples from 53 patients with NSCLC receiving gefitinib after failure of at least a platinum-containing regimen were prospectively collected from January 2002 to December 2003. Multivariate analysis demonstrated an independent negative impact on survival for a level of CYFRA 21-1 higher than 3.5 ng ml(-1) (HR=2.45, 95% CI 1.13-5.29; P=0.02). In conclusion, CYFRA 21-1 is a tool available to predict the survival of NSCLC patients receiving gefitinib as third-line therapy in an independent manner. In case of a CYFRA 21-1 level higher than 3.5 ng ml(-1), treatment with gefitinib needs further evaluation giving its relative poor effect on survival.

[Survey on the treatment of hospitalised community-acquired lower respiratory tract infections]. / Enquête sur la prise en charge thérapeutique des malades hospitalisés pour infection respiratoire basse communautaire.

OBJECTIVES: The assessment of treatment habits regarding community-acquired lower respiratory tract infections and comparison with current national recommendations. METHOD: Prospective survey of treatment habits. Patients hospitalised for community-acquired pneumonia in the department of internal medicine, the department of neurology and the department of respiratory diseases (127 beds) at the Sainte-Marguerite Hospital in Marseilles were included. We studied the socio-economical context, the presence of severity factors, the analysis of risk factors, the antibiotic treatments prescribed (type, route of administration, duration) and the outcome of the patients. RESULTS: From November 2001 to February 2002, 98 patients with community-acquired pulmonary infections were included (61 men with a mean age of 72.5 years). The treatment of these patients conformed to guidelines in 79 cases. In 19 cases, the prescription did not conform (unjustified bi-therapy in 8 patients; absence of bi-therapy in suspected cases of intra-cellular bacteria in 4 patients; insufficient dose in 2 patients; and non-adapted antibiotherapy in 5 patients). CONCLUSION: In the study conditions, the management of community-acquired pneumonia in the hospital most often conformed to current guidelines. Nevertheless, efforts made for initial and continued medical training together with the wide circulation of the guidelines must be continued.

[Benign hair-follicle derived eyelids tumors in adults]. / Tumores palpebrales benignos derivados de los folículos pilosos en adultos.

PURPOSE: Benign eyelid neoplasms derived from hair follicles are frequently misdiagnosed, including pilomatricoma, trichoepithelioma, trichilemmoma, trichoblastoma and inverted follicular keratosis. METHODS: We reviewed 17 tumors seen in the last 9 years, between 1992 and 2002. Excisional biopsy constituted the treatment in all cases. RESULTS: The mean age was 44.5 years (range 13-80 years). Ten were women and 7 men. Pilomatricoma and trichoepithelioma accounted for 76.5% of all neoplasms. All trichoepitheliomas were found as solitary tumors and no patient had a history of familial trichoepithelioma. The remaining neoplasms (23.5%) were trichilemmomas, trichoblastoma and inverted follicular keratosis. No patient recurred locally and there were no malignant transformations after a mean follow-up of 3.1 years. The most frequent hair follicle neoplasms in our series was pilomatricoma (9 cases). CONCLUSIONS: Benign hair follicle neoplasms are rare in the eyelid. Most can simulate a basal cell carcinoma when evaluation is based on clinical evidence alone, and only the pilomatricoma may resemble a benign neoplasm. Thereby they must be excised with free surgical margins. All excised eyelid lesions should be sumitted for histopathologic examination because it is not possible to obtain 100% accuracy in diagnosing eyelid tumors.

Tumores palpebrales benignos derivados de los folículos pilosos en adultos / Benign hair-follicle derived eyelids tumors in adults

Objetivo: Los tumores palpebrales benignos que derivan de los folículos pilosos con frecuencia son mal diagnosticados clínicamente. Este grupo incluye el pilomatricoma, el tricoepitelioma, el tricolemoma, el tricoblastoma y la queratosis folicular invertida. Métodos: Revisamos 17 tumores de este tipo, que hemos tratado entre 1992 y 2000. Su excisión quirúrgica fue su tratamiento en todos los casos. Resultados: La edad media fue de 44,5 años (rango 13-80 años). Diez fueron mujeres y 7 hombres. Los pilomatricomas y los tricoepiteliomas constituyeron el 76,5 por ciento del total de este tipo de tumores. Todos los tricoepiteliomas se presentaron de forma aislada y sin antecedentes familiares. El resto (23,5 por ciento) fueron tricolemomas, un tricoblastoma y una queratosis folicular invertida. Ninguno tuvo recurrencia local y por tanto ninguno hizo una transformación maligna tras una media de 3,1 años de seguimiento. El más frecuente de este tipo de tumores en nuestra serie fue el pilomatricoma (9 liomas se presentaron de forma aislada y sin antecedentes familiares. El resto (23,5 por ciento) fueron tricolemomas, un tricoblastoma y una queratosis folicular invertida. Ninguno tuvo recurrencia local y por tanto ninguno hizo una transformación maligna tras una media de 3,1 años de seguimiento. El más frecuente de este tipo de tumores en nuestra serie fue el pilomatricoma (9 casos).Conclusiones: Los tumores benignos palpebrales derivados de los folículos pilosos son infrecuentes. Pueden ser confundidos con un carcinoma de células basales cuando nos basamos sólo en la exploración clínica y únicamente los pilomatricomas pueden semejar una lesión benigna. Deben ser reseca casos).Conclusiones: Los tumores benignos palpebrales derivados de los folículos pilosos son infrecuentes. Pueden ser confundidos con un carcinoma de células basales cuando nos basamos sólo en la exploración clínica y únicamente los pilomatricomas pueden semejar una lesión benigna. Deben ser resecados con márgenes de seguridad, y todas las lesiones deben ser estudiadas histopatológicamente para confirmar el diagnóstico, ya que es imposible obtener un 100 por ciento de correlación clínico-patológica en el diagnóstico de los tumores palpebrales (AU)