Fibrohistiocitoma maligno óseo tras degeneración de enfermedad de Paget Caso clínico y revisión de la literatura

El fibrohistiocitoma maligno óseo es un tumor de estirpe mesenquimal poco frecuente, pero de alta agresividad. Se suele presentar de forma primaria, aunque a veces lo hace sobre lesiones previas en el hueso. Puede ser difícil de diferenciar histológicamente de otros tumores, pero es una entidad propia desde el punto de vista anatomopatológico. Presentamos un paciente con enfermedad de Paget que desarrolló un fibrohistiocitoma maligno óseo en el fémur sobre el hueso pagético. Fue tratado mediante desarticulación de cadera. No se usó quimioterapia como tratamiento coadyuvante debido a su avanzada edad y situación basal. A los 18 meses se encuentra asintomático y sin signos de recurrencia. Se hace una revisión de la literatura acerca de este tumor.Malignant fibrous histiocytoma of bone is a rare but highly agressive mesenchimal tumor. It usually arises as a primary tumor but sometimes it can be associated with pre-existing bone abnormalities. Histologically it can be missdiagnosed with other tumors. We report a case of malignant fibrous histiocytoma of bone in the femur in a patient with Paget's disease treated by hip desarticulation. We didn't use chemotherapy because his elderly status. At 18 months follow up, the patient is symptom-free and neither local recurrence nor metastasis have been found. A review of the literature has been carried out

Pseudoaneurisma de la arteria geniculada superior lateral secundaria a artroplastia de rodilla: Aportación de un caso

El pseudoaneurisma es una complicación infrecuente en la cirugía ortopédica de rodilla. Los pocos casos descritos generalmente están en relación con cirugía artroscópica. Presentamos un caso de pseudoaneurisma de la arteria geniculada superolateral secundario a artroplastia de rodilla en un varón de 69 años. El diagnóstico se realizó mediante arteriografía. Se trató con éxito mediante hemostasia y resección química.Pseudoaneurysm is an uncommon complication in knee orthopaedic surgery. There are few cases reported an most of them are secondary to arthroscopic techniques. We report a case of pseudoaneurysm of the superolateral genicular artery after knee arthroplasty in a 69-year-old-man. The diagnosis was made with arteriographay, and treatment was a successful hemostasia and surgical resection

Evaluación funcional en ancianos intervenidos de fractura de cadera

Estudio observacional prospectivo en pacientes mayores de 65 años intervenidos de fractura de cadera. El objetivo fue conocer la evolución funcional de los pacientes a los tres meses del alta hospitalaria, identificar variables relacionadas con dicha recuperación funcional, describir la mortalidad e institucionalización asociadas al proceso. Se analizaron variables demográficas como edad, sexo, convivencia. Otros aspectos registrados fueron: comorbilidad, deterioro cognitivo, capacidad para caminar, nivel de dependencia según índice de Barthel, institucionalización y mortalidad. Se recogió la información al ingreso y a los 3 meses del alta. El 89,6% de la muestra, fueron mujeres, la edad media fue de 83,56 años. El 40% de los pacientes recuperaron la independencia previa registrándose una mortalidad del 16,7% así como una leve progresión hacia la institucionalización. La capacidad funcional y el deterioro cognitivo del paciente, previos a la fractura condicionan su recuperación funcional y dependencias posteriores

Immune thrombotic thrombocytopenic purpura in older patients: Results from the Spanish TTP Registry (REPTT)

Immune thrombotic thrombocytopenic purpura (iTTP) is an ultra-rare disease that seldom occurs in the elderly. Few reports have studied the clinical course of iTTP in older patients. In this study, we have analysed the clinical characteristics at presentation and response to therapy in a series of 44 patients with iTTP ≥60 years at diagnosis from the Spanish TTP Registry and compared them with 209 patients with <60 years at diagnosis from the same Registry. Similar symptoms and laboratory results were described in both groups, except for a higher incidence of renal dysfunction among older patients (23% vs. 43.1%; p = 0.008). Front-line treatment in patients ≥60 years was like that administered in younger patients. Also, no evidence of a difference in clinical response and overall survival was seen in both groups. Of note, 14 and 25 patients ≥60 years received treatment with caplacizumab and rituximab, respectively, showing a favourable safety and efficacy profile, like that observed in patients <60 years.Peer reviewe

Correlation between resistance mechanisms in Staphylococcus aureus and cell wall and septum thickening

Ana Bel&eacute;n Garc&iacute;a,1 Jos&eacute; Manuel Vi&ntilde;uela-Prieto,1 Laura L&oacute;pez-Gonz&aacute;lez,1 Francisco Javier Candel1,2 1Department of Clinical Microbiology, Hospital Cl&iacute;nico San Carlos, Complutense University, Madrid, Spain; 2Health Research Institute, Hospital Universitario San Carlos, Madrid, Spain Purpose: The aim of the present study is to examine cell wall and septum thickening of methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), and methicillin- and linezolid-resistant S. aureus (MLRSA) isolates by transmission electron microscopy to correlate the association of resistance mechanisms with major changes in the morphology of membrane or septum.Materials and methods: MSSA, MRSA, and MLRSA strains obtained from clinical samples of an outbreak that occurred in 2010 at the Intensive Care Unit of our Hospital were thawed and sown at 37&deg;C in blood agar overnight. After that, they were washed, pelleted, and treated with a fixer solution. Pellets were dehydrated and finally embedded in resin. Transmission electron microscopy was used to characterize cell wall and septum thickening in all isolates. The comparison between the measurements obtained for each group was performed by a Kruskal&ndash;Wallis test and a post hoc Dunn&ndash;Bonferroni&rsquo;s pairwise comparison method.Results: Differences in cell wall and septum thickness were statistically significant (P&lt;0.001 and P&lt;0.001, respectively) between the three groups. Moreover, significant differences were detected in wall and septum thickness between the MSSA and MRSA strains (P&lt;0.001 and P&lt;0.001, respectively) and between the MSSA and MLRSA strains (P&lt;0.001 and P&lt;0.001, respectively) but not between the MRSA and MLRSA strains (P=0.386 and P=0.117).Conclusion: In this analysis, we correlate the resistance mediated by alterations in the cell membrane of S. aureus (methicillin-resistant, for example) with a greater thickness of the wall or septum. The resistance added to linezolid did not determine significant changes in the characteristics of the wall or septum with respect to those strains resistant only to methicillin. Keywords: linezolid-resistant S. aureus, vancomycin intermediate S. aureus, VISA, protein synthesis inhibitor antibiotics, TE

Manejo no quirúrgico de hematoma subdural intra-craneal tras anestesia espinal complicada

El hematoma subdural (SDH) es una complicación evolutiva rara, documentada y de riesgo vital en los cuadros de cefalea post punción subdural (PDPH). Presentamos un caso de esta rara complicación resuelto con un parche de sangre autóloga epidural y tratamiento conservador, sin precisar evacuación quirúrgica

Identification of an Evolutionarily Conserved Ankyrin Domain-Containing Protein, Caiap, Which Regulates Inflammasome-Dependent Resistance to Bacterial Infection

Many proteins contain tandemly repeated modules of several amino acids, which act as the building blocks that form the underlying architecture of a specific protein-binding interface. Among these motifs and one of the most frequently observed is ankyrin repeats (ANK), which consist of 33 amino acid residues that are highly conserved. ANK domains span a wide range of functions, including protein–protein interactions, such as the recruitment of substrate to the catalytic domain of an enzyme, or the assembly of stable multiprotein complexes. Here, we report the identification of an evolutionarily conserved protein, that we term Caiap (from CARD- and ANK-containing Inflammasome Adaptor Protein), which has an N-terminal CARD domain and 16 C-terminal ANK domains and is required for the inflammasome-dependent resistance to Salmonella Typhimurium in zebrafish. Intriguingly, Caiap is highly conserved from cartilaginous fish to marsupials but is absent in placental mammals. Mechanistically, Caiap acts downstream flagellin and interacts with catalytic active Caspa, the functional homolog of mammalian caspase-1, through its ANK domain, while its CARD domain promotes its self-oligomerization. Our results therefore point to ANK domain-containing proteins as key inflammasome adaptors required for the stabilization of active caspase-1 in functionally stable, high molecular weight complexes

Proinflammatory Signaling Regulates Hematopoietic Stem Cell Emergence

Hematopoietic stem cells (HSCs) underlie the production of blood and immune cells for the lifetime of an organism. In vertebrate embryos, HSCs arise from the unique transdifferentiation of hemogenic endothelium comprising the floor of the dorsal aorta during a brief developmental window. To date, this process has not been replicated in&nbsp;vitro from pluripotent precursors, partly because the full complement of required signaling inputs remains to be determined. Here, we show that TNFR2 via TNF? activates the Notch and NF-?B signaling pathways to establish HSC fate, indicating a requirement for inflammatory signaling in HSC generation. We determine that primitive neutrophils are the major source of TNF?, assigning a role for transient innate immune cells in establishing the HSC program. These results demonstrate that proinflammatory signaling, in the absence of infection, is utilized by the developing embryo to generate the lineal precursors of the adult hematopoietic system

Supplementary Material for: Endovascular Treatment of Distal Internal Carotid Artery Occlusions with Retrievable Stents

<b><i>Background:</i></b> Acute stroke due to distal intracranial internal carotid artery (ICA) occlusion has a poor natural history. Outcome in patients who receive intravenous tissue plasminogen activator (tPA) is also unsatisfactory. The objective of this study is to evaluate the effectiveness and safety of endovascular treatment with retrievable stents in these patients. <b><i>Methods:</i></b> Data from a prospective register of patients with acute stroke treated with an endovascular procedure in a single centre were analysed. <b><i>Results:</i></b> A total of 20 patients with distal ICA occlusion were collected. Mean baseline National Institutes of Health Stroke Scale score was 18. Eight cases (40%) had received previous intravenous tPA. Mean time from stroke to recanalization was 393 min. Retrievable stents with proximal occlusion and aspiration were used in all cases. In 3 patients, 2 retrievable stents were used simultaneously. Complete recanalization (thrombolysis in cerebral infarction 2b/3) was accomplished in 85% of cases. A favourable clinical outcome (modified Rankin Scale score 0-2) was achieved in 13 patients (65%). Mortality occurred in 2 cases (10%). <b><i>Conclusions:</i></b> Endovascular treatment of patients with distal ICA occlusion seems safe and effective. Retrievable stents may be the treatment of choice, although randomized clinical trials are necessary. The use of 2 retrievable stents at the same time could be an alternative technique useful in thrombi of larger size