Fascie de sátiro por cuernos cutáneos. Presentación de una paciente

Cutaneous horn is a tumor lesion characterized by a disorder of keratinisation of the epithelium. It is associated with multiple causes and may be related to lesions of marked malignancy. Clinical diagnosis is based on the history and physical examination of the lesion. However, the anatomo-histological study is of vital importance to rule out malignancy. The reported case was very interesting as a 35-year-old female patient showed, bilaterally, two separate cutaneous horns on the forehead, which gave her a satyr or imp face. Exeresis of the lesions was performed, with a safety margin of 0.5 cm and plasty of the area with local flaps. Histologic examination of surgical specimens was conducted and it confirmed the diagnosis of cutaneous horns.  El cuerno cutáneo es una lesión tumoral que se caracteriza por un trastorno de la queratinización del epitelio, se asocia a múltiples causas y puede estar en relación con lesiones de marcada malignidad. El diagnóstico clínico se apoya en la anamnesis y el examen físico de la lesión; no obstante, el estudio anatomohistológico cobra vital importancia para descartar una enfermedad maligna en correspondencia. El caso que se presenta posee una connotada curiosidad al aparecer, de forma bilateral, sendos cuernos cutáneos en la región frontal de una paciente femenina de 35 años, lo que le da una fascie de sátiro o diablillo. Se realizó la excéresis de las lesiones con un margen de seguridad de 0.5cm y plastia de la zona con colgajos locales, además se efectuó el estudio histológico pertinente a las piezas quirúrgicas y se confirmó el diagnóstico de cuernos cutáneos

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