Diagnóstico y tratamiento endocrinológico de las lesiones del área selar en la edad pediátrica

IntroductionSellar masses are an heterogeneous group of lesions, both in nature and management. Not all of them require surgery.ObjectivesTo describe the presenting symptoms of sellar masses and endocrine abnormalities occurring during follow-up. To emphasize the significance of endocrine assessment, and to identify lesions amenable to hormonal treatment.Patients and methodsA retrospective review of the records of children under 14 years of age referred to our center for sellar lesions during 12 years. Data collected included sex, age, nature of lesion, clinical presentation, size, treatment, and endocrine abnormalities.ResultsForty-five patients (25 females) aged 7.2 ± 4.1 years (range 0.25-13.5) were enrolled. Follow-up time was 6.2 ± 3.7 years. Lesion nature was known in 39 cases, 4 of which were successfully treated at the Endocrinology Department: 3 prolactinomas (with dopamine agonist) and one thyrotroph cell hyperplasia (with levothyroxine). The most common presenting symptoms were neurological and/or visual (25/45), followed by endocrine conditions (13/45). Duration of endocrine and neuro-ophthalmic symptoms was 12.6 ± 18.2 months and 2.6 ± 4.9 (P = .012), respectively. Some endocrine condition was found in 24/45 patients at the initial evaluation and in 37/45 patients at the end of follow-up.ConclusionsManagement of sellar lesions requires a multidisciplinary effort. Endocrine tests are indispensable to identify lesions amenable to hormonal treatment. Endocrine disorders usually occurred before neurological and ophthalmological symptoms, and their identification may therefore allow for earlier diagnosis. Hormone assessment should be regularly performed during follow-up.     

A malignus melanoma immunterápiájának lehetoségei

Despite their well-documented immunogenicity, malignant melanomas belong to the most aggressive tumor types. A potential explanation for this is the suboptimal activation of tumor infiltrating T cells. In order to boost immune responses against tumors, a variety of treatment modalities have been tested in animal models and in clinical setting. Antigen-nonspecific approaches (e.g., IFN-alpha and IL-2), as well as active specific immunotherapeutical modalities based on the use of autologous or allogeneic tumor cell-save been investigated in clinical trials of melanoma. The identification of melanoma-associated antigens has opened new avenues in antigen-specific immunotherapy. A promising alternative for the delivery of different forms of melanoma antigens is the application of dendritic cells, the most potent antigen presenting cells capable of eliciting efficient T-cell response. Beside active immunotherapy, immune response against melanoma antigens could be increased through the adoptive transfer of tumor infiltrating lymphocytes or antigen specific T-cell clones. The most important conclusion that can be drawn from the results of published immunotherapy studies is that these modalities are able to induce durable complete tumor regressions,mostly with reasonable toxicity; however, generally only in a minority of patients. This points to the importance of appropriate patient selection, with regard to the expression of the targeted antigens and HLA molecules, as well as to the general immunocompetence of the patients. A crucial and still unsolved question is monitoring immune activation during treatment, although there are promising new tools that could prove useful in this respect. The presence of tumor-reactive CTL in the circulation or in the tumors does not guarantee an efficient immune response. It is important to assess if these T cells are in an activated and functional state. Finally, in several single target antigen-based clinical studies a therapy-induced immunoselection of antigen-negative clones, leading to disease progression, was observed. This could be overcome with the use of antigen cocktails or whole tumor approaches. A better understanding of the mechanisms of action of immunotherapeutical modalities may enhance the success rate of these strategies.     

Análisis ecológico de las comunidades liquénicas de la Catedral de León (España)

Ecological analysis of Leon Cathedral lichen communities (Spain).A study of the lichen communities present on Leon Cathedral showed there to be 39 species present, mainly crustose forms of the Teloschistaceae and Lecanoraceae. Two lichen communities were found on calcareous stonework and on highly nitrified habitats. Species distribution depends mainly on nitrophytism, hygrophytism, photophytism and pH indexes, and to a lesser extent on angle of inclination, exposure and substrate type.     

Inquérito epidemiológico com paracoccidioidina e histoplasmina em área agrícola de café em Ibiá, Minas Gerais, Brasil.

An epidemiological survey in an endemic area for paracoccidioidomycosis in Ibiá town, Minas Gerais state, Brazil was carried out. For this, we used a standard form for each household and intradermal antigens of histoplasmin and paracoccidioidin. Out of 194 individuals, 109(56%) were engaged in the survey showing reactivity of 44% and 49.5% for these antigens respectively. The reactivity to paracoccidioidin was observed in 50% of children below ten years. Individuals who revealed reactivity to paracoccidiodin with prior history of coffee growing activities, and those reporting the grain collection as the main work, showed statistically significant association p = 0.0092, p = 0.0007 and p = 0,01 respectively. These results could suggest that activities related to coffee crops, may favour the transmission of Paracoccidioides brasiliensis, specially among the grain collectors. In addition, the reactivity for histoplasmin antigen, suggest that this region is endemic for both fungi.     

Diagnóstico microbiológico de las micosis invasoras

The prognosis of invasive fungal infections (IFI) depends on the speed of diagnosis and treatment. Conventional diagnostic methods are of low sensitivity, laborious and too slow, leading to the need for new, faster, and more efficient diagnostic strategies.There are several techniques for diagnosing a candidemia that are faster than the conventional blood culture (BC). Once yeast growth in BC is detected, species identification can be speeded up by mass spectrometry (30 minutes), commercialised molecular techniques (60-80 minutes) or fluorescent in situ hybridization (90 minutes). The combined detection of biomarkers (antimicellium, mannan and anti-mannan or β-glucan) has shown to be of greater use than their individual use. Commercialised nucleic acid amplification techniques (Septifast®, T2Candida®) are very reliable alternatives to BC. The detection of the capsular antigen of Cryptococcus, by means of latex agglutination or immuno-chromatography, is a valuable technique for cryptococcosis diagnosis.Direct microscopic examination and culture of representative specimens is used for the conventional diagnosis of IFI by filamentous fungi. Detection of galactomannan and β-glucan are considered diagnostic criteria for probable invasive aspergillosis and probable IFI, respectively, despite the lack of specificity of the latter. The detection of fungal volatile organic compounds in breath is an interesting diagnostic strategy in pulmonary infections. Although widely used, nucleic acid detection techniques are not considered diagnostic criteria for IFIs caused by moulds in consensus documents, due to their lack of standardisation. However, they are the only alternative to culture methods in invasive infections by Scedosporium/Lomentospora, Fusarium, zygomycetes, or dematiaceous fungi.