Angiosarcoma de cara y cuero cabelludo

Angiosarcoma is an unusual malignancy representing 1-2% of all soft tissues sarcomas. The etiopahogenesis is unclear but some risk factors have been described such us chronic lymphedema, radiation, environmental carcinogens and certain family syndromes. As imaging features are non-specific, the definitive diagnosis requires biopsy with inmunohistochemical techniques. Surgery is the unique curative treatment, but most patients with head and neck angiosarcoma are not suitable for surgical resection as they usually have metastasic disease at the moment of diagnosis.El angiosarcoma es un raro tumor maligno que supone el 1-2% de los sarcomas de partes blandas. Aunque la etiopatogenia no es del todo conocida, se han definido varios factores de riesgo que incluyen el linfedema crónico, antecedentes de radiación, carcinógenos ambientales y determinados síndromes familiares. No hay ningún patrón radiológico patognomónico, por lo que para su diagnóstico es obligada la realización de una biopsia con análisis con técnicas de inmunohistoquímica. El único tratamiento curativo es la cirugía, que puede realizarse en un escaso número de pacientes ya que el diagnóstico suele llegar en estadios avanzados

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective