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El cáncer de mama en coraza constituye una de las formas clínicas de presentación de las metástasis cutáneas del cáncer mamario. Es de aparición poco frecuente, sobre todo, en el sexo masculino. Se presenta el caso de un paciente de sexo masculino, de 74 años de edad, de color de piel negra, con antecedente de diabetes e hipertensión arterial que acudió a consulta de mastología provincial por presentar desde hacía algunos meses dolor discreto y unas lesiones pruriginosas en la mama derecha. Además de otros exámenes se le realizó biopsia escisional de pequeño fragmento de la lesión con estudio por parafina que informó metástasis cutánea de un carcinoma mamario en coraza según su forma de presentación clínica. Se muestra el caso porque no se localizó ninguna publicación en la provincia Cienfuegos ni en el país de un caso en el sexo masculino, por lo cual se considera de interés para el personal médico la publicación de este reporte.

Neuroectodermal tumors are the main cause of mediastinal tumors. Of these, the ganglioneuroma is the most benign and the least frequent, with an incidence of 1 in 100,000 children. It occurs predominantly in childhood with a mean presentation at age seven. Most of these tumors are asymptomatic and diagnosed incidentally. The 43 % of them showing intrathoracic manifestation and located in the sympathetic ganglia of the posterior mediastinum. Imaging studies provide advantages for the location, size and extent of the tumor. These tests are of great benefit to the surgeon. The prognosis is generally favorable, which is a sign of good prognosis when it appears after five years of age and when it is located in the posterior mediastinum. The case of a patient who underwent thoracoscopy with total resection of the tumor, with a favorable evolution during her follow-up is presented. This patient was diagnosed with a ganglioneuroma in the posterior mediastinum. A literature review was carried out regarding this case. This report is presented because ganglioneuroma is a rare benign tumor in children.

La mastectomía reductora de riesgo, también conocida como mastectomía profiláctica, consiste en extirpar la mayor cantidad de tejido posible de una mama sana para reducir el riesgo potencial de desarrollar cáncer. Se presenta el caso de una paciente de 30 años de edad, de color de piel negra, multípara y con antecedentes de padecer desde muy joven enfermedad macroquística de mamas. A esta paciente se le había realizado mastectomía subcutánea bilateral 10 años atrás a causa de enfermedad macroquística y que no tuvo posibilidad de implantes en esa ocasión, lo que le acarreó cicatrices inestéticas y secuelas psicológicas. La paciente acudió al Servicio de Cirugía Plástica del Princess Marina Hospital de Botswana en África solicitando corrección estética. Con la intervención se logró una mama armónica, aunque pequeña, con tejidos autólogos, sin complicaciones mayores y con la perspectiva para aumento de volumen mamario futuro con tejidos autólogos. En esta paciente la reconstrucción estética fue una opción necesaria y a su vez efectiva dado su contexto socioeconómico. Se presenta el caso por lo interesante que resulta este tipo de intervención realizada por especialistas cubanos en su colaboración médica en un país africano.

Sars-Cov-2, is a virus belonging to the coronaviridae family, responsible for the pandemic that has been plaguing the world since December 2019, which produces the infectious disease called COVID-19. This disease is expressed in more than half of the cases in a mild and even asymptomatic way, however, in a non-negligible number of patients it manifests itself in its most severe form, with multiple complications, and can even cause death. Along with respiratory complications, cardiovascular complications are present mainly in those patients who require admission to intensive care units, which make medical management difficult, as well as entail a worse prognosis. The case of a 70-years-old patient with a history of apparent health, who was admitted with respiratory symptoms and who, after performing the polymerase chain reaction technique with reverse transcriptase in real time, was positive for the Sars-Cov virus. -2, it was decided to transfer him to the Playa Girón Heroes Specialized Ambulatory Center, where he was hospitalized in the Intensive Care Unit for 6 days and died mainly as a result of cardiovascular complications is presented. The aim of this research is to present the case of a patient who suffered from respiratory symptoms as an initial presentation of the infection, for which a real-time polymerase chain reaction was performed, which was positive for SARS-CoV- 2.

Nasal reconstruction was born in India, 3000 years before our era. Nasal reconstruction has followed three basic lines: the Indian method, using the median frontal flap; the French method with the lateral cheek flap; and the Italian method with the brachial flap. Flaps allow the reconstruction of defects by restoring nasal shape and function. The classic method for reconstructing the ala nasal is the nasolabial flap. The nasolabial flap has specific characteristics in terms of location, size, circulatory pattern, vascularization, innervation, and function. We present two cases of patients treated at the Princess Marina Hospital in Botswana in Africa, who required inverted nasolabial flaps for the reconstruction of their nasal wings. After the application of the procedure, the affected nasal wing was recovered, returning functionality, harmony, symmetry and order in both cases in relation to the contralateral wing in the absence of complications. The inverted nasolabial flap is useful to restore the contour of the nasal wing, as well as to support the wing and to shape the nasal floor. This flap can have a minimum of complications if the structures are handled gently and the sutures are handled without tension. That cases are presented because of how interesting this type of intervention is, carried out by Cuban specialists in their medical collaboration in an african country.

Colon tumors are the third leading cause of cancer death in Cuba. Incarcerated colon tumors in umbilical hernias are rare. They are more often distinguished in inguinal hernias than in umbilical ones. The most significant symptoms are: asthenia, weight loss, alterations in the stool and abdominal pain. They usually present as a palpable mass that is difficult to reduce. The diagnostic method par excellence is the colon by enema and surgical treatment. The most common histopathological variety is adenocarcinoma. The case of an elderly patient who came to the clinic due to fatigue, weight loss and dark stools it is presented. The physical examination revealed an umbilical hernia. Complementary and diagnostic imaging studies were performed. A possible digestive tract tumor was determined. An emergency surgical procedure was performed. The aim of this report is to characterize a case of an incarcerated colon hepatic flexure tumor in an umbilical hernia due to its infrequent location.

La enfermedad de Paget de la mama se encuentra entre las llamadas formas especiales del cáncer de mama. Su incidencia es de solo el 1 al 1,5 % del total de los cánceres mamarios que se diagnostican. Fundamentalmente aparece en mujeres en la quinta o sexta décadas de la vida. Se considera extremadamente rara en su forma bilateral. Se presenta el caso de una paciente de 32 años de edad que acudió a consulta provincial de mastología por presentar lesiones escamosas en el complejo areola pezón de ambas mamas, más acentuadas en la derecha. Se le realizó biopsia con aspiración con aguja fina y se diagnostica enfermedad mamaria de Paget bilateral. La enfermedad de Paget de la mama es una enfermedad de rara aparición y en el caso que se presenta aparecen dos características pocos comunes, el tratarse de una paciente joven y la localización bilateral de la enfermedad, lo cual hace de más valor su publicación para conocimiento del personal médico dedicado a la atención de estas afecciones.

Paget's disease of the breast is among the so-called special forms of breast cancer. Its incidence is only 1 to 1.5 % of all breast cancers that are diagnosed. It mainly appears in women in the fifth or sixth decade of life. It is considered extremely rare in its bilateral form. The case of a 32-years-old female patient of urban origin who attended the provincial mastology clinic for presenting scaly lesions in the nipple areola complex of both breasts, more accentuated on the right side. She underwent a fine needle aspiration biopsy and was diagnosed with bilateral Paget's disease of the breast. Paget's disease of the breast is a disease of rare appearance throughout the world and in the case that it occurs, two uncommon characteristics appear, the fact that it is a young patient and the bilateral location of the disease, which makes it more valuable its publication for the knowledge of medical personnel dedicated to the care of these conditions.

The pleuropericardial cyst is a rare lesion with a benign clinical course in most cases, which is detected incidentally on the chest radiograph. They are approximately 3 to 8 cm in diameter. The incidence of pleuropericardial cyst has been estimated at one per 100,000 cases and represents between 5 and 10 % of mediastinal tumors. A greater number of them are congenital, but some acquired due to infectious, inflammatory or traumatic etiology have been described. Imaging and choice studies are essential in its diagnosis. It is presented a case of a male patient with clinical symptoms of decompensated heart failure who attended the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos where a chest X-ray was indicated. A simple and contrasted chest tomography and right lung and abdominal field ultrasound were also performed. A predominantly right large pleuropericardial cyst, large pericardial effusion, pleural effusion and small ascites were diagnosed. This report is presented due to the importance on imaging studies in the diagnosis of mediastinal disorders, due to their accuracy, to achieve an adequate conduct to follow when imposing a treatment and monitoring of patients affected with this pathology.

Prader-Willi syndrome is a rare genetic disease, characterized by hypothalamic-pituitary anomalies, which presents with severe hypotonia during the neonatal period and the first two years of life, with hyperphagia with a high risk of developing morbid obesity in childhood and adulthood; as well as learning difficulties and serious behavioral and / or psychiatric problems. A 17-years-old patient with white skin color is presented. The main manifestations of the patient showed: deviation of the palpebral fissure and alterations in the diameter, small hands and feet, obesity, hypogenitalism, diabetes mellitus, muscular dysfunction, mental deficiency, short stature, among others. The clinical criteria and results of complementary studies were compatible with the diagnosis of Prader-Willi syndrome. This case is presented because it is necessary to describe the clinical and genetic characteristics of patients with Prader-Willi syndrome, since it is a rare genetic disease with important compromise for the future life of those who suffer from it.

Cystic fibrosis or mucoviscidosis is the most common genetic disease in the Caucasian race characterized by thickening of secretions due to abnormal ion transport of epithelial cells, manifested with pancreatic insufficiency, progressive lung disease, alteration in the secretion of electrolytes in sweat, azoospermia in males and decreased fertility in females. Treatment of cystic fibrosis is primarily symptomatic. A case of a two-and-a-half-month-old infant who began to present vomiting, scattered and scaly irregular erythematous lesions on the skin on the face, chest, limbs, anal and genital region, in addition to presenting little weight gain is presented. For these reasons it was decided to admit her for study and treatment. A physical examination, complementary tests, of the cardiovascular system was performed. A diagnosis of cystic fibrosis and gastroesophageal reflux was made. This case is presented for describing the clinical and laboratory characteristics of a patient with atypical presentation of cystic fibrosis. Skin alterations as a presenting sign of cystic fibrosis are rare and only fewer than 30 cases have been reported in the medical literature.

The aplasia complexion congenital it is a pathology that a heterogeneous group of clinical present forms from the moment of the birth comprises. It is characterized for the absence of all the capes of the skin at the organism's some zones and his most frequent presentation is in the scalp, being rare in all fours. It can be of exogenous or genetic origin. His etiology consists fundamentally in a premature defect of differentiation of the embryo and it correlates multiple causes itself could have accompanied in some cases of malformations another levels. Several forms of treatment, conservative and surgical treatment exist. The intervention of a multi-disciplinary team for his satisfactory evolution becomes necessary. The complexion presents a case with aplasia itself congenital in both inferior members that is diagnosed just after the birth and that you receive medical and surgical treatment, obtentions proven to be satisfactory for the patient from the functional and esthetic point of view of all fours. You encounter this case because in a general way the aplasia the complexion has very low incidence for what the presentation of this report that the affection localized in the inferior members has proves to be important.

Congenital aplasia cutis is a rare and heterogeneous disorder, with an estimated incidence of 1-3 cases per 10,000 births. It can appear in isolation or as part of several polymalformative syndromes, observing autosomal recessive and autosomal dominant inheritance patterns. Its treatment is controversial and will depend on the size, location, degree of involvement of the underlying structures and risk of potentially fatal complications. Three cases are presented with a diagnosis of congenital aplasia cutis, with different degrees of affectation, whose healing occurred in utero. A bibliographic review was carried out regarding the presentation of three clinical cases, the first 2 with a congenital aplasia cutis without associated malformation and the third with a bone defect and other associated malformations. This series of cases is presented due to the rare and heterogeneous nature of this condition.

The ganglioneuroma is a benign primitive neuroectodermal tumor, which derives from the ganglia of the sympathetic system and is composed of mature Schwann cells, ganglion cells, and nerve fibers. A rare neck tumor, in a female pediatric patient with a history of cervical tumor mass for two years is presented. In the imaging studies performed, a heterogeneous solid lesion with punctate calcifications was diagnosed, compressing adjacent bone and vascular structures. To obtain histology, an ultrasound-guided core needle biopsy was performed, and the diagnosis of cervical ganglioneuroma was informed by pathological anatomy. Due to the low incidence of ganglioneuroma as a tumor variety, and in turn, the rare cervical location in a small percentage of patients, the present research aims to enrich the national and international scientific literature, providing a new case that serves as the basis for future research, respecting the ethical principles of health research.

La neurocisticercosis es una infección del sistema nervioso central provocada por la ingestión accidental de huevos de Taenia Solium, constituyendo la parasitosis más frecuente del propio sistema. Es un problema común en muchos países latinoamericanos, asiáticos y africanos; en áreas endémicas, es considerada la principal etiología de las epilepsias de inicio tardío. Se presenta el caso de un paciente de 39 años de edad, de sexo masculino, con historia de alteraciones del comportamiento y varias crisis convulsivas desde hacía un año atrás. Por este motivo fue trasladado al Hospital Militar Principal de Luanda e ingresado en el Servicio de Psiquiatría con diagnóstico presuntivo de neurosis histérica. Al mes de su egreso fue remitido nuevamente esta vez en el Servicio de Neurología del propio hospital. Se le realizó examen físico, se le indicaron complementarios y se le realizó rayos X de tórax y tomografía que mostraron imágenes sugestivas de neurocisticercosis activa. Se le indicó tratamiento farmacológico y fisioterapia. Lugo de ochenta días el paciente fue egresado, consciente, orientado, asintomático. El objetivo de la presentación es llamar la atención a especialistas que cumplen colaboración en diferentes partes del mundo al ser una enfermedad extremadamente rara en Cuba y a la que se deben enfrentar con cierta frecuencia en otras latitudes.

Neurocysticercosis is an infection of the central nervous system caused by the accidental ingestion of eggs of Taenia Solium, constituting the most frequent parasitosis of the system itself. It is a common problem in many Latin American, Asian and African countries; in endemic areas, it is considered the main etiology of late-onset epilepsies. The case of a 39-year-old male patient with a history of behavioral disorders and several seizures for a year is presented. For this reason he was transferred to the Main Military Hospital of Luanda and admitted to the Psychiatry Service with a presumptive diagnosis of hysterical neurosis. A month after his discharge, he was referred again this time to the Neurology Service of the hospital itself. A physical examination was performed, supplementary tests were indicated, and a chest X-ray and tomography were performed, which showed images suggestive of active neurocysticercosis. Pharmacological treatment and physiotherapy were indicated. After eighty days, the patient was discharged, conscious, oriented, and asymptomatic. The objective of the presentation is to draw the attention of specialists who collaborate in different parts of the world as it is an extremely rare disease in Cuba and which they must face with certain frequency in other latitudes.

Pleural mesotheliomas are primary mesothelial cell tumors. Lining the pleural cavity, they are closely related to asbestos exposure. They have a low incidence and poor prognosis. A 46-years-old patient, white-skinned, who attended the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos due to pain in the back and shoulders, fever, and weight loss is presented. The physical examination revealed an abolished vesicular murmur in the lower 1/3 of the right lung. The chest X-ray and CT scan showed a medium to large right pleural effusion and pleural thickening. Histological studies indicated that the lesion was compatible with epithelioid variant pleural mesothelioma. The patient is maintained with cytostatic treatment and follow-up in consultation. The objective of this study is to describe the case of a patient with malignant pleural mesothelioma, admitted to the Internal Medicine Service of the Dr. Gustavo Aldereguía Lima General University Hospital of Cienfuegos.

Primitive epidermoid carcinoma is considered the rarest breast tumor, with an incidence that represents only 0.04 to 0.075 % of all malignant tumors of this location. It is a variety of metaplastic carcinoma made up of keratinizing pavement cells. The case presented is a 65-year-old white male patient, resident in the Abreus municipality, Cienfuegos province who attended the province's mastology clinic for presenting a 5 cm tumor in the upper external quadrant of the right breast, two months in evolution. Exeresis of the tumor was performed and a report of the biopsy was received with the result of poorly differentiated squamous cell carcinoma. Currently the patient is followed in consultation and is free of metastases. Due to the unusual nature of the case, its publication is decided. This report is presented as the first male patient to undergo surgery for squamous cell carcinoma of the breast in the Cienfuegos province.

El carcinoma epidermoide primitivo está considerado el tumor más raro de la mama, con una incidencia que representa solo del 0,04 al 0,075 % de todos los tumores malignos de esta localización. Es una variedad de carcinoma metaplásico constituido por células pavimentosas queratinizantes. Se presenta el caso de un paciente de sexo masculino, de 65 años, de color de piel blanca, residente en el municipio Abreus, provincia Cienfuegos, que acudió a la consulta de mastología de la provincia por presentar una tumoración de 5 cms. en el cuadrante superior externo de la mama derecha, de dos meses de evolución. Se realizó exéresis de la tumoración y se recibió informe de la biopsia con el resultado de carcinoma epidermoide poco diferenciado. Actualmente el paciente se sigue en consulta y está libre de metástasis. Por lo inusual del caso se decide su publicación. Se presenta este reporte por ser el primer paciente de sexo masculino, operado de carcinoma epidermoide de mama en la provincia Cienfuegos.

Marfan syndrome is an autosomal dominant genetic disorder, with a prevalence of 1 every 5,000-10,000 newborns, so it is classified as an uncommon disease. It affects multiple organs and systems; its prognosis is marked by the cardiovascular involvement. Multidisciplinary follow-up of these patients allows the timely diagnosis of complications and improves their quality of life. Two cases with Marfan syndrome and other associated diseases are presented. A literature review was carried out regarding the report of 2 teenager clinical cases with suggestive phenotypic characteristics, the first case with an associated arachnoidocele and the second case with Gilbert's disease.

Foundation: there is an increase in couple infertility and female endocrine causes are among the main reasons. Objective: to describe the behavior of endocrine female infertility in patients studied at the Territorial Center for Human Reproduction of Cienfuegos. Method: a descriptive series of case studies was conducted in which all women treated for endocrine infertility from January 2012 to January 2013 were included. The variables analyzed were age, personal pathological history, type of bleeding, obstetric history, nutritional assessment, hirsutism, goiter, galactorrhea, acanthosis nigricans, time and type of infertility. A database, using SPSS program was created and processed for further analysis. Descriptive statistics, frequencies and percentages were applied. Results: the predominant age group was 30 to 34 years old and 9.4 % had a personal pathological history of obesity, almost half had oligomenorrhea 33.6 % of them were overweight and on physical examination 34.3 % of the patients showed acanthosis nigricans. The largest number of women attended with less than 3-year infertility was 50.4 %. Secondary infertility was 66.4 % and according to the endocrine diagnosis, hyperprolactinemia was the most representative with 38.7 %. Conclusions: endocrine infertility occurred mainly in overweight women; with a secondary, less than 3-year time infertility and hyperprolactinemia was the most representative.

Diffuse B-cell lymphoma is the most common type of non-Hodgkin lymphoma in adults characterized by its aggressiveness and wide location. The first sign of its presence is a rapidly growing mass of lymph nodes. The case of a 64-year-old patient is presented, with a pathological history of arterial hypertension, ex-smoker, who was admitted because for 3 months she had increased volume of the left lateral region of the neck. Clinical studies, imaging, aspiration cytology, medullogram and spinal biopsy and lymph node biopsy allowed diagnosis and staging to begin treatment with cyclophosphamide, doxorubicin, vincristine and prednisone plus the monoclonal antibody rituximab according to the protocol for these tumors. Two months after treatment, the reduction of ganglionic masses had been achieved. The case is presented because it is of interest to specialists and training personnel.

Mucinous thyroid carcinomas are very rare and in some cases may appear in association with other tumors, but it does not represent a true primary thyroid carcinoma. A case of a 66-year-old white-skinned patient of rural origin is presented with a history of suffering from ischemic heart disease and arterial hypertension, for which she was undergoing medical treatment. He went to the office with an increase neck volume in the anterior region for several months, accompanied by malaise, gallop rhythm and sometimes dysphagia to solid foods. On the physical examination a tumor was found which occupied almost the entire right lobe, corresponding to a nodule of approximately 4 cm. in diameter, mobile with swallowing. The objective of this work is to present the surgical treatment performed to a patient affected by a thyroid gland mucinous carcinoma. Due to the low frequency of this entity, its publication is considered of interest to scientific staff.

La enfermedad de Castleman es un raro padecimiento con igual frecuencia en ambos sexos, que puede aparecer a cualquier edad. Se caracteriza por crecimiento de tumores benignos del tejido linfático, localizados con mayor frecuencia en mediastino, estómago y cuello y son menos frecuentes en axila, pelvis y páncreas. Histológicamente se describen 3 variedades: la hialinovascular, la plasmocelular y la mixta. Se presenta el caso de un paciente de 13 años de edad, con antecedentes de microesferocitosis congénita e infección por citomegalovirus, con ingresos frecuentes por síndrome febril prolongado, el último ocurrió a los 11 años donde apareció aumento de tamaño de las cadenas ganglionares a predominio de ganglios intraabdominales. Se realizó estudio histológico que informó enfermedad de Castleman con afectación ganglionar difusa, además de hepatitis crónica reactiva. Actualmente el paciente se mantiene con seguimiento ambulatorio con control hematológico y ultrasonido abdominal, así como tratamiento con vitaminoterapia. Se presenta este reporte por la baja prevalencia de este tipo de tumor en el Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos.

La púrpura de Shönlein-Henoch es una vasculitis de la infancia caracterizada por una púrpura palpable no trombocitopénica y manifestaciones sistémicas, acompañadas de dolor abdominal, sangrado gastrointestinal, glomerulonefritis, artritis y artralgias. Está relacionada con patologías desencadenantes como las infecciones y las picaduras de insectos. Se presenta el caso de un niño de 4 años de edad, que presentaba cuadros alérgicos de rinitis y urticaria. Se le había diagnosticado una trombocitopenia inmune primaria de evolución crónica. A pesar del empleo de diferentes alternativas de tratamiento, recurrió con trombocitopenia muy severa, asociada a cuadro de púrpura y lesiones maculo-papulares y urticarianas. Los complementarios realizados, a excepción del conteo de plaquetas, estuvieron en rangos normales. La evolución fue satisfactoria en un periodo de tres semanas. Se presenta el caso porque es una forma atípica de esta enfermedad.

El síndrome de sensibilidad a drogas con eosinofilia y síntomas sistémicos es una reacción de hipersensibilidad que se desencadena por múltiples drogas, tales como antibióticos, antiinflamatorios, anticonvulsivantes que ocurre en el 2,2 % de los pacientes hospitalizados. Su importancia radica en la alta mortalidad, que puede alcanzar hasta un 30 %. Se presenta el caso de un niño de 5 años, con antecedentes de epilepsia diagnosticada, tratada con carbamazepina, que al corto tiempo de iniciar tratamiento anticonvulsivante evolucionó con fiebre de 11 días. Posteriormente aparecieron lesiones cutáneas eritematosas maculopapulares pruriginosas. Se ingresó con el diagnostico de síndrome febril prolongado. Los exámenes de laboratorio revelaron eosinofilia, elevación de pruebas hepáticas y de proteína C reactiva. Se planteó síndrome de sensibilidad a drogas inducido por carbamazepina, tras resultado de la biopsia de piel se suspende el anticomicial, remitiendo así el cuadro, con normalización de eosinófilos y función hepática. El paciente evolucionó sin fiebre y en buen estado general. Se presenta este caso por la baja prevalencia de este síndrome en el Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos.

Drug reaction syndrome with eosinophilia and systemic symptoms is a reaction of hypersensitivity which triggers due to multiple drugs such as antibiotics, anti-inflammatory, anti-convulsants which occur in 2,2 % of admitted patients. Its importance is related in the high mortality that can achieve 30 %. A case of a 5 year old boy with antecedents of diagnosed epilepsy, treated with carbamazepine, who short time after starting the treatment had fever for 11 days. Posteriorly cutaneous erythematous pruritic maculopapular skin lesions appeared. He was admitted with the diagnosis of prolonged febrile syndrome. Laboratory test showed eosinophilia, elevation of liver tests and C-reactive protein. A syndrome of drug sensitivity was considered induced by carbamazepine, after the result of skin biopsy anti-comicial is suspended thus improving the condition, with normalization of eosinophils and liver function. The patient progressed without fever and good general condition. The case is presented due to the low prevalence of this syndrome in the University Pediatric Hospital Paquito González Cueto. Cienfuegos.

Shönlein-Henoch purpura is a common vasculatis in childhood, characterized by a non-trombocytopenic palpable purpura and systemic manifestations, accompanied by abdominal pain, gastro-intestinal bleeding, glomerulonephritis, arthritis and arthralgias. It is the most common of diseases due to disturbances in the vascular component in children. It is related to triggering pathologies as infections and insect bites. A case of a 4 year old boy is presented who presented allergic episodes of rhinitis and urticaria. He had been diagnosed with an chronic primary inmmune thrombocytopenia. In spite of the different treatment approaches, the patient had a severe thrombocytopenia, associated to purpura and macolu-papular lesions and uticaria. Lab tests, with the exception of platelet count, were within the normal limits. The progress was satisfactory in a three week period.

Las tumoraciones de ovario de naturaleza maligna son poco frecuentes en edades pediátricas. Los disgerminomas son tumores relativamente raros y constituyen alrededor del 2 % de todos los canceres ováricos, sin embargo, representan aproximadamente la mitad de los tumores malignos de células germinales. Se presenta el caso de una paciente de 14 años de edad, con antecedentes de displasia esquelética generalizada, que acudió con dolor abdominal y masa palpable en hipogastrio. Los exámenes de imagenología informaron que la tumoración estaba bien encapsulada y que presentaba aspecto sólido. Se asoció a la elevación de marcadores tumorales séricos por lo que se realizó excéresis del tumor y estudio anatomopatológico que concluyó el caso como disgerminoma puro del ovario derecho limitado al órgano. Su relativa escasa frecuencia nos permite comunicar el presente reporte de un disgerminoma en paciente en edad pediátrica portadora de una displasia esquelética.

El cáncer de vesícula biliar es poco frecuente. Su pronóstico está relacionado con la detección temprana y el grado de penetración de la neoplasia en la pared vesicular. Este carcinoma presenta elevada mortalidad, por lo que realizar el diagnóstico precoz es una necesidad imperiosa. Se presenta el caso de un paciente de 81 años de edad con antecedentes patológicos personales de diabetes mellitus tipo II e hipertensión arterial bajo tratamiento regular medicamentoso. Este paciente ingresó en el Servicio de Medicina Interna pues desde hacía un mes presentaba un cuadro de aumento de volumen abdominal e ictericia generalizada, acompañada de dolor moderado en hipocondrio derecho de aparición postprandial inmediato que aliviaba con la administración de analgésicos habituales. El último mes se acompañó de vómitos escasos, astenia marcada, pérdida del apetito, disnea intensa permanente y tos húmeda con expectoración amarillenta, se constató ascitis de moderada cuantía. La gravedad del paciente no permitió avanzar en el estudio de su caso. La necropsia concluyó con diagnóstico de carcinoma primario de células escamosas de vesícula biliar, entidad esta que constituye una rareza en nuestro medio, razón por la que se realiza la presentación del caso.

Cancer in the gallbladder is infrequent. Its prognosis is related to the early detection and the degree of its penetration in the bladder wall. This carcinoma presents a high mortality therefore early diagnosis in a vital need. A case of an 81 year old patient is presented, with antecedents of type II diabetes mellitus and high blood pressure on permanent drug treatment. The patient was admitted to the internal medicine ward due to an increase of abdominal volume and generalized icterus, accompanied by a mild pain over the right hypochondria which appeared immediately after eating and relived with common analgesics. During the last month it was accompanied by a few vomits, marked asthenia, loss of appetite, intense and permanent dyspnea, and productive cough with yellowish expectoration and a moderate ascites. The severity of the illness did not allow finishing the case study. Clinical necropsy confirmed a diagnosis of primary gallbladder squamous cell carcinoma. This medical condition is an odd in our context reason for which the case is presented.

Several disorders in the structure and morphology of the mammary gland have been described as a result of variations of its development regulating mechanism. It may be found anomalies in number, size, form and location. Among the most frequent congenital anomalies, regarding number, supernumerary breast and regarding location abnormal breast tissue. Both may be the basis for malignant tumors and in a higher frequency the abnormal breast tissue. The abnormal or ectopic breast tissue may present with different forms. It is presented a case of a 48 year old woman from health area 4 at the Cienfuegos municipality who had an abnormal breast tissue on the left axillary, with a secretory orifice from which milk is secreted during pregnancy. Due to the low frequency occurrence of this disease, the publication of this case is considered of scientific interest.

High altitude pulmonary edema occurs in patients who were for some days in cities at the sea level and go back to altitudes over 2,500 mosl. This edema is secundary to a pulmonary maladjustment which leads to a significant hypoxia. It is presented a case of a 15 year old girl who after being in the Ecuadorian coast returned to the mountains at Guamote canton. The objective of this report is to know the pathophisiology, diagnostic and therapeutic approach of high altitute pulmonary edema since it is a frequent condition in children of the region and it is unknown by many health professionals. Most of the times it is under diagnosed or confused with other pathologies which present with respiratory failure.

La actinomicosis pulmonar es una enfermedad bacteriana infrecuente. Se presenta el caso de un paciente de 17 años de edad, procedente del África, con antecedentes de diabetes mellitus y malnutrición proteico-energética, atendido por médicos cubanos de misión en ese continente. El paciente presentó un absceso submandibular en la región lateral izquierda de la cara, posterior a varias manipulaciones odontológicas, con extensión a la porción superior anterior del tórax, trayecto fistuloso a este nivel y presencia de adenopatías en el cuello. Se realizó estudio de la lesión e inició tratamiento con antibióticoterapia, pero el cuadro no remitió y aparecieron nuevos síntomas, que junto a los exámenes imagenológicos sugirieron un proceso neumónico o neoplasia. Se decidió efectuar punción con aspiración por aguja fina que estableció el diagnóstico de actinomicosis pulmonar. Se instauró tratamiento antibiótico de elección con lo que se observó mejoría clínica y radiológica. Por ser una entidad que tiene una presentación clínica muy variada, pues puede simular desde un cuadro infeccioso banal hasta una neoplasia, y ser poco frecuente su localización en el pulmón, se decidió la presentación del caso.

El insulinoma es un tumor poco frecuente, originado en las células beta de los islotes de Langerhans, y caracterizado por la secreción incontrolada y excesiva de insulina, que da lugar a hipoglucemias después del ayuno prolongado o el ejercicio físico. Como parte de su tratamiento quirúrgico, el manejo anestésico es un desafío para el anestesiólogo, debido a las dificultades para mantener niveles normales de glucemia. Se presenta el caso de una paciente portadora de insulinoma, en la cual se realizó un control de la glucemia capilar durante la cirugía, cada diez minutos, lo que permitió mantener el nivel de glucemia dentro de la normalidad. Con la aplicación de anestesia general endotraqueal balanceada, se obtuvieron resultados satisfactorios en el procedimiento quirúrgico, el cual fue guiado por ultrasonido transoperatorio.

La sarcoidosis es una enfermedad sistémica de etiología desconocida en la que se han implicado agentes infecciosos, polvos inorgánicos o sustancias orgánicas; caracterizada por la presencia de una inflamación granulomatosa no necrotizante con acumulación de linfocitos CD4+ y monocitos en los tejidos afectados. Se presenta el caso de un paciente que acudió al Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos refiriendo tos seca, febrícula, opresión torácica y ligera pérdida de peso de tres meses de evolución, que no cedían, a pesar de recibir tratamiento en su área de salud. Luego de realizarle varios estudios se diagnosticó una sarcoidosis pulmonar, enfermedad granulomatosa sistémica y proliferativa cuya etiología permanece en el anonimato. La biopsia continúa siendo la base para el diagnóstico definitivo. Por ser esta una entidad difícil de explicar y entender, además de ser escasamente diagnosticada en nuestro medio se decide presentar este caso clínico.

Breast cancer in men is a rare and infrequent disease, which occurs in a very small proportion with respect to different types of cancers. Such entity is the 0.2 to 1.5 % of all malignant tumors in men. Imaging studies have a very precise diagnostic value in these entities. It is presented the case of a male patient with apparent healthy history who comes the consultation due to palpating a "ball" in the left breast, this patient went to the Imaging Department for conducting a mammography as well performing a study with oblique craniocaudal views and a middle lateral of both nipples. Breast ultrasonography showed a nodular, homogeneous image. It was made a referral to multidiscipline breast consultation with surgical possibilities for the tumor. Due to the infrequent appearance of this entity in men, it is decided to make this case report.

Diseases mimicking a stroke are a major health problem for a large number of hospitals. This paper aims at presenting a disease that has a stroke-like presentation. The case of a 46-year-old man admitted to the stroke unit with a clinical and radiological diagnosis of cerebral infarction is presented. The patient developed fever and a serious deterioration of consciousness. Changes on computed tomography consistent with a brain abscess were observed. Broad-spectrum antibiotics were administered and a follow-up tomography was performed. Once the treatment was completed, the clinical and radiological suspicion of a brain abscess was confirmed.

Las alteraciones cromosómicas son más frecuentes en la pareja infértil que en la población general. Entre pacientes con infertilidad se ha descrito una incidencia global del 2,1 % y 6 % en mujeres y varones respectivamente, la mayor incidencia se observa en varones con azoospermia entre los que se alcanza hasta un 16 %. Las inversiones pericéntricas están entre los reordenamientos cromosómicos balanceados más usuales, con una frecuencia de un 1-2 %. Se presenta el caso de un paciente que fue atendido en el Centro Territorial de Reproducción Asistida de Cienfuegos, para estudio de una infertilidad de dos años de evolución. Se le realizó estudio citogenético y se diagnosticó una inversión pericéntrica del cromosoma 1 46, XY, inv (1) (p13 q32). Es indiscutible la importancia que cobra el estudio citogenético en varones con alteraciones seminales severas, porque al hacer este diagnóstico se pueden identificar los pacientes con riesgo de trasmitir esta alteración a su descendencia.

Hereditary hemorrhagic telangiectasia is an autosomal dominant disorder of the walls of the blood vessels that become tortuous and dilated. Clinically, patients with this disease develop recurrent bleeding, which may occur spontaneously or following minor trauma. We present the case of a 68-year-old male patient who was admitted due to an upper gastrointestinal bleeding and diagnosed with Rendu-Osler-Weber disease. After application of treatment, the patient recovered and was discharged from the hospital.

Las anomalías dentomaxilofaciales representan un problema de salud bucal que se ha incrementado en las últimas décadas. Determinar y tratar los factores causales que las originan, en edades tempranas, es un reto para los estomatólogos y especialmente para los ortodoncistas. Se presenta el caso de una paciente de 39 años que acudió a consulta con diastema central superior de 9 milímetros. Al examen clínico se detectó enfermedad periodontal, anomalías de la oclusión, exóstosis óseas y torus mandibulares. Se remitió a la consulta multidisciplinaria de especialidades estomatológicas en la que se trazó un plan de tratamiento donde, se determinó controlar la enfermedad periodontal. Luego de una exitosa cirugía se colocó aparatología ortodóncica fija y se cerró el diastema hasta 3 milímetros. Se terminó de cerrar utilizando resina fotopolimerizable y se colocó un aparato removible tipo Hawley como contención por un periodo de 5 años para mantener el tratamiento realizado.

Pellagroid dermatitis is a condition resulting from the deficiency of niacin and/or tryptophan that causes dermatological, gastrointestinal and neurological symptoms. It is very rare in our country, a fact that motivated us to present this case. The patient was a 49-year-old white man diagnosed with pellagroid dermatitis. He also suffered from hypothyroidism, alcohol dependence and had poor eating habits due to his frequent drinking. He had a medical history of hypertension and presented cutaneous manifestations of pellagroid dermatitis. The erythematous and scaly manifestations were located on the back of both arms. They resembled scalded skin; some had an ulcerated and blistered center and were similar to those in the neck, deltoid region and other sites exposed to sunlight. The lesions were permanently cured after vitamin therapy and skin protection from solar radiation.

The use of anti-inflammatory glucocorticoids may be necessary during pregnancy to treat some maternal conditions. Its effects in pregnant women are virtually the same as those described in the general adult population. Avascular necrosis is the death of bone tissue due to the interruption of the blood supply, and is mainly associated with the use of high-dose corticosteroids for long periods. We present the case of a 21-year-old patient at 34 weeks’ gestation admitted to the Intensive Care Unit of the Enrique Cabrera Hospital because of decompensated hypertension, obesity and congenital adrenal hyperplasia treated with suppressive doses of steroids. Subsequently, she was diagnosed with an avascular necrosis of both femoral heads. Iatrogenic Cushing’s syndrome resulting from all these factors was found. The newborn developed a seborrheic dermatitis of the scalp. The purpose of this presentation is to describe the side effects of the chronic use of glucocorticoids in pregnant women.

The Phyllodes Tumor is an infrequent mammary fibroepithelial neoplasia, with an epithelial benign component and a mesenquimal component that can be benign or malignant; it only represents 0.3 to 0.4 % of all of the mammary tumours. The case of a 50 year old female sex patient with Phyllodes tumour of the mamma of benign nature is presented. For the infrequent of this disease, it is considered valuable to publish this case.

La enfermedad de Paget de la mama es poco frecuente, representando solamente el 1 a 1,5 % del total de los cánceres mamarios que se reportan, y que algunos autores la consideran una forma especial de cáncer de mama, y otros solo una extensión de un carcinoma intraductal que alcanza el pezón. Tiene dos formas clínicas de presentación: la eczematosa y la ulcerativa. Se presenta el caso de una paciente de sexo femenino, de 67 años de edad, con una enfermedad de Paget de la mama derecha con forma clínica ulcerativa. Por lo poco frecuente de esta enfermedad, se considera de valor para el personal médico dedicado a la atención de las enfermedades de las mamas, el reporte de este caso.

La migraña está considerada como un factor de riesgo para los ictus isquémicos en adultos jóvenes, especialmente del sexo femenino en edad fértil. El pronóstico es bueno con bajo riesgo de recurrencia. A pesar de los criterios establecidos para el tratamiento del infarto migrañoso, no siempre se cumplen estrictamente, permitiendo cierta flexibilidad en dicho tratamiento. Se presenta el caso de una paciente con antecedentes de migraña con auras, que sufre un infarto cerebral isquémico en el curso de una crisis migrañosa. El ictus se manifestó como una hemiparesia derecha, con trastornos sensitivos y lenguaje disártrico. Los estudios de laboratorio fueron normales y el infarto cerebral fue detectado en la resonancia magnética, en territorio de la arteria cerebral media izquierda. La paciente tuvo evolución favorable sin secuelas.

Acquired long QT syndrome results from secondary causes and can be caused by more than 100 non-antiarrhythmic drugs. Cardiac arrest due to Torsades de pointes induced by drugs causing prolonged QT syndrome is a rare but potentially fatal event, even in hospitals. The case of a 47-year-old patient diagnosed with non-Hodgkin lymphoma admitted to the hematology department of the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos is presented. The patient had been previously treated with anthracyclines and developed episodes of palpitations and syncope later. The treatment included monitoring the patient, avoiding other QT prolonging agents and administrating magnesium sulfate and potassium chloride with a proper maintenance of the fluid and acid-base balance. The presentation of this case aims at motivating interest in new reports on the subject and establishing a direct causal relationship through the evidence provided by new experiences.

Una de las enfermedades ginecológicas que altera la calidad de vida de las mujeres, afectando sus relaciones de pareja, familiares, laborales, y de reproducción, lo constituye la endometriosis. Se presenta un caso que a nuestro juicio lo hace acreedor de la condición de insólito; ya que debuta en una mujer de mediana edad, aparece en una localización poco frecuente, y otro aspecto singular lo constituye, que no se encontró al realizar la laparoscopia foco alguno de endometriosis en la cavidad abdominal.

La celulitis química es la reacción de los tegumentos como respuesta a la administración de sustancias tóxicas, que provocan una reacción inflamatoria aguda que evoluciona hacia el absceso o la necrosis. Esta es una patología que no se presenta con frecuencia en el Servicio de Ortopedia y Traumatología del Hospital Clínico Quirúrgico Joaquín Albarrán de La Habana. Se presenta el caso de un paciente que acudió a nuestra institución con aumento de volumen en ambos miembros superiores a nivel de los bíceps y tríceps, y con marcada necrosis en la piel acompañada de lesiones de adenopatías axilares, una de ellas abscedada, debido a una celulitis química. Se indicó antibiótico previo a la realización de cultivos y antibiograma y curas locales bajo anestesia, en estos momentos se observan las lesiones en fase de curación.

Primary cutaneous CD 30+ anaplastic large cell lymphoma is part of the spectrum of primary cutaneous CD30 + lymphoproliferative disorders, together with lymphomatoid papulosis. Its frequency is less than 0.5 x 100 000 inhabitants per year. It accounts for a very small proportion of non-Hodgkins lymphomas. The case of an 80-year-old female patient whose diagnosis was established in 2006 because of lesions on the face and neck is presented. The lesions continued to grow in an exaggerated fashion lately leading to deformity of her face. She was admitted due to neurological manifestations unrelated to the lesions. The presentation of this case is necessary because it requires performing differential diagnosis in clinical practice. Given its rarity, it is of interest to the medical community, especially trainees.