Oral discoid lupus erythematosus. Diagnostic considerations apropos of a case

The study and presentation of a typical case of discoid lupus erythematosus with oral lesions in a 30-years old woman, without visceral manifestations at present, was the motive for a revision and updating of the concepts of etiology, differential diagnosis, treatment and prognosis of this disease. The authors emphasize the importance of the clinical and evolving aspect of the lesions, long-term development, as well as the response to treatment (an antimalarial synthesis, applied systematically and infiltrates with betamethasone solution) in order to reach valid diagnostic conclusions. It is important in the anatomopathological study to include the atrophic zones of the central portion of the discoid lesion.     

Craniotomy guided by computed tomography with three dimensional reconstruction: technical note

OBJECTIVE: Searching usefulness of computed tomography with three dimensional reconstruction in planning accurate cranial approaches to treat subcortical lesions. METHOD: Eight patients with neoplastic subcortical convexity-based lesions were surgically treated following spatial coordination obtained with three dimensional computed tomography reconstruction (CT 3D). RESULTS: Accurate approaches were accomplished, allowing a safe and optimized removal of neoplasms in all cases. CONCLUSION: The study manifests the benefits of CT 3D in planning suitable craniotomies, avoiding incongruous approaches.     

Takotsubo cardiomiopathy. A rare cause of cardiogenic shock simulating acute myocardial infarction

Takotsubo Cardiomiopathy is a rare cause of acute left ventricular aneurysm, in the absence of coronariopathy, only recently described in world literature. Symptoms may be similar to those from acute myocardial infarction with typical thoracic pain. The image of dumbbell or Takotsubo (a device used in Japan to capture octopus) suggestive ventricular ballooning is characteristic of that new syndrome and there is usually the disappearing of dyskinetic movement up to the 18th day from the beginning of the symptoms, in average.     

Delayed myelination in children with developmental delay detected by volumetric MRI

Delayed acquisition of developmental motor and cognitive milestones is a common clinical expression of many etiological processes. Imaging exams of developmentally delayed children often show no structural brain alterations despite suspicion of brain maturation delay. MRI studies increasingly suggest that white matter myelination finely reflects the progression in functional brain maturation. In this volumetric MRI study, we sought to evaluate whether developmental delay in children with normal conventional MRI exams is associated with reduced myelinated white matter. A total of 100 children (mean age, 4.4 years) with developmental delay and 50 normally developing age-matched control children underwent 3-D MRI to measure the volume of myelinated white matter. Patients showed a significant reduction in the relative content of myelinated white matter (accounting for 19.8% of brain volume in patients and 21.4% in control subjects, P = 0.005). The observed difference was equivalent to a 3.2-year myelination delay. Although the whole hemispheres were invariably symmetrical, the volume of myelinated white matter was asymmetrical in 30% of patients and 10% of control subjects (P = 0.006). We conclude that volumetric assessment of white matter may reveal a reduction in brain myelination beyond early childhood in developmentally delayed children showing normal brain appearance. This finding further emphasizes the view of white matter myelination as an indicator of functional brain maturation.     

Prognostic significance of p53 expression in oral squamous cell carcinoma without neck node metastases

Background. Aberrations of the p53 gene and overexpression of its protein are widely recognized markers of malignancy including oral squamous cell carcinomas. This study was performed to evaluate the relationship of immunoexpression of p53 protein in series of 91 squamous cell carcinomas of the oral cavity with clinicopathologic parameters and to investigate whether p53 immunoexpression might influence the clinical outcome of the disease. Methods. From a group of 287 consecutive patients, 91 surgically treated ones were randomly selected. P53 protein expression was investigated by means of immunohistochemistry. Clinical and histopathologic data were gathered, and the patient survival was analyzed. Results. Of the oral carcinomas, 52.7% (n = 48) overexpressed p53, using a threshold of 10% stained cell nuclei. There was a negative correlation of p53 immunoexpression with a histologic grade of differentiation (r = ?0.236, p = .06) but not with clinical variables. Overall survival rate was 59% at 5 years. In univariate analysis, tumor size, node status, and advanced clinical stage were significantly associated with shortened overall survival. In patients without neck node metastases, p53 showed a strong correlation with survival (p = .01). In multivariate analysis performed only on N0 patients, tumor extension and p53 immunoexpression were found to be the only independent prognostic parameters with relative risks of 1.9 and 4.3, respectively. Conclusions. A strong relationship was observed between p53 immunoexpression and poor prognosis in patients with oral squamous cell carcinomas without neck node metastases. © 2004 Wiley Periodicals, Inc. Head Neck 26: 22–30, 2004     

Tracking methicillin-resistant Staphylococcus aureus clones during a 5-year period (1998 to 2002) in a Spanish hospital

Three hundred seventy-five consecutive methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates recovered between 1998 and 2002 at the Nuestra Señora de Candelaria University Hospital in Tenerife, Spain, were analyzed by molecular fingerprinting techniques to determine MRSA clonal types and their prevalence over time. After determining antibiotic susceptibility, we used SmaI-digested genomic DNA separated by pulsed-field gel electrophoresis (PFGE) to characterize MRSA isolates and to establish PFGE types. Additionally, several selected isolates representative of each major PFGE type were tested by multilocus sequence typing (MLST) and by a multiplex PCR method capable of identifying the structural type of the staphylococcal cassette chromosome mec (SCCmec), generating the corresponding sequence type (ST)-SCCmec types. Results of PFGE, supported by those of MLST and SCCmec typing, allowed us to identify six MRSA clones within the five major PFGE types and document temporal shifts in the prevalence of these MRSA clones from 1998 to 2002. Four of the clones were the pandemic “Iberian” (designated ST247-MRSA-IA), EMRSA-15 (ST22-MRSA-IV), EMRSA-16 (ST36-MRSA-II), and the so-called pediatric (ST5-MRSA-IV) clones, while the other two (ST125-MRSA-IVA and ST146-MRSA-IVA) clones could be derived from the pediatric one. The most striking temporal shift in the dominance of MRSA clones was the replacement of the multidrug-resistant and highly epidemic Iberian clone by the so-called British EMRSA-16 clone during the 5-year surveillance period. Our results are in accordance with previously stated findings showing the worldwide hospital dominance of relatively few pandemic and presumably virulent MRSA clones. We report for the first time the detection in Spain of the British EMRSA-15 and pediatric clones, as well as the abrupt replacement of the Iberian by the EMRSA-16 as the major MRSA clone.Staphylococcus aureus is the causal agent of most staphylococcal pathologies and is currently a versatile microbial pathogen that has evolved resistance to all antibiotic classes. It is associated with serious community-acquired and nosocomial diseases, although most life-threatening S. aureus infections are hospital acquired (4, 8). Its high level of adaptation to hospital environments has been deeply facilitated by the acquisition of methicillin resistance, an evolutionary step that converted S. aureus to methicillin-resistant S. aureus (MRSA), one of the most common nosocomial pathogens nowadays (19). MRSA emerged with the introduction of an exogenous DNA element into its genome, the staphylococcal cassette chromosome mec (SCCmec), which carries the methicillin resistance mecA gene (16). Recent data shows that acquisition of SCCmec has occurred on multiple occasions and that at least five different methicillin-sensitive S. aureus phylogenetic lineages acquired the element (29). Four main structural types of SCCmec, which differ in size and composition, have been described for S. aureus (14, 15, 20).Genetic studies using molecular typing methods have shown that most hospital-acquired MRSA infections worldwide are due to any of the so-called epidemic MRSA (EMRSA). These EMRSA clones present great fitness to hospital environments and, consequently, are established in many hospitals and have spread internationally (7). This situation highlights the importance of monitoring the distribution and routes of dissemination of such EMRSA clones at both levels, within hospitals and between distant locations (24). With this purpose, several molecular techniques and an international common nomenclature have been applied to track EMRSA (10, 27). Pulsed-field gel electrophoresis (PFGE) is considered the “gold standard” for establishing clonal relationships at the local level, but its detection capacity seems to make it also too discriminative for global comparisons (5, 31). By contrast, multilocus sequence typing (MLST) has been verified as an adequate method for long-term and global epidemiological studies (11, 48). Combination of MLST with SCCmec typing permits the unambiguous assignment of collections of MRSA isolates to known or new MRSA clones (10).The aim of this study was to identify MRSA clones circulating in the Nuestra Señora de Candelaria University Hospital (HUNSC), Tenerife, Spain, and to track shifts in their prevalence during a 5-year period (1998 to 2002). For this purpose, we used a combination of different molecular typing methods, including PFGE, MLST, and SCCmec typing.