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We present a case of an extensive bone marrow infiltrate of poorly differentiated carcinoma, in a 19-year-old male with suspected progression of sinusal undifferentiated carcinoma, after several lines of treatment.

Multiparameter flow cytometry (MFC)-based clonality assessment is a powerful method of diagnosis and follow-up in monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM). However, the relevance of intraclonal heterogeneity in immunophenotypic studies remains poorly understood. The main objective of this work was to characterize the different immunophenotypic subclones in MGUS and MM patients and to investigate their correlation with disease stages. An 8-color MFC proto-col with 17 markers was used to identify the subclones within the neoplastic compartment of 56 MGUS subjects, 151 newly diagnosed MM patients, 30 MM subjects in complete remission with detectable minimal residual disease, and 36 relapsed/refractory MM patients. Two or more clusters were observed in >85% of MGUS subjects, 75% of stage I MM patients, and

Listeria monocytogenes is Gram-positive facultative intracellular pathogen often foodborne and found elsewhere. It is an uncommon cause of illness in the general population. However, it is an important cause of severe infection in neonates, pregnant women, elderly and immunosuppressed patients. Listeriosis has unique preference for pregnant women. Maternal listeriosis is a diagnostic challenge, and intrauterine infection can lead to severe complications such as amnionitis, preterm labor, spontaneous abortion, stillbirth and neonatal sepsis. From 2001 to 2005, 16 patients with L. monocytogenes were identified in this hospital; four (25%) were pregnant women. Clinical and laboratory findings are described. There were 3 preterm deliveries and 1 spontaneous second trimester abortion. Three women with listeriosis had no predisposing factors other than pregnancy. One patient was on immunosupressive drugs for ulcerative colitis. Fever was the most common symptom. Infected neonates were most commonly diagnosed with early-onset listeriosis (two cases) or fetal demise (one case). Pregnancy can be the only risk factor for listeriosis. Listeriosis should be considered during the evaluation of febrile syndrome in pregnancy as this condition can be the only risk factor. Blood and amniotic fluid cultures are useful diagnostic tests. Perinatal complications remains high.

Listeria monocytogenes is Gram-positive facultative intracellular pathogen often foodborne and found elsewhere. It is an uncommon cause of illness in the general population. However, it is an important cause of severe infection in neonates, pregnant women, elderly and immunosuppressed patients. Listeriosis has unique preference for pregnant women. Maternal listeriosis is a diagnostic challenge, and intrauterine infection can lead to severe complications such as amnionitis, preterm labor, spontaneous abortion, stillbirth and neonatal sepsis. From 2001 to 2005, 16 patients with L. monocytogenes were identified in this hospital; four (25%) were pregnant women. Clinical and laboratory findings are described. There were 3 preterm deliveries and 1 spontaneous second trimester abortion. Three women with listeriosis had no predisposing factors other than pregnancy. One patient was on immunosupressive drugs for ulcerative colitis. Fever was the most common symptom. Infected neonates were most commonly diagnosed with early-onset listeriosis (two cases) or fetal demise (one case). Pregnancy can be the only risk factor for listeriosis. Listeriosis should be considered during the evaluation of febrile syndrome in pregnancy as this condition can be the only risk factor. Blood and amniotic fluid cultures are useful diagnostic tests. Perinatal complications remains high.

Congenital syphilis (CS) is an important health problem in Chile, with a rate of 0.25/1,000 live newborn (NB) during year 2004. In 2000, the Chilean Ministry of Public Health recommended to perform a screening in cord blood at the moment of delivery. Instead, the Centers for Disease Control and Prevention guidelines recommend the screening in maternal serum since cord blood has up to 5% of false (-) versus 0.5% of maternal serum, both with respect to the NB serum.Maternal serum and NB cord blood were studied during one year to determine the best screening method at delivery.RPR was performed and positive results were confirmed by treponemic test (immunochromatographyDetermine, ELISA Captia, Ig and IgM, and MHA-Tp). Serologically confirmed patients were evaluated by the specialist to define CS cases.Between June 1999 and August 2000 2,741 binomies were studied; of these, 37 (1.3%) were RPR reactive and 2.704 were non-reactive. In 11 of the 37 reactive cases, mother and NB were RPR reactive (Group I), in 9 cases the NB was RPR reactive and the mother was non-reactive (Group II), and the other 17 were NB non-reactive and mother reactive (Group III). In group I, 7/11 (64%) were true (+)s and 4/11(36%)) false (+)s of RPR. In group II, 9/9 (100%) corresponded to false (+)s of RPR in cord blood, and in group III, 11/17 (65%) corresponded to false (+)s of RPR in maternal blood but 6/17 (35%) were found to be cases of syphilis during pregnancy. Three of them were not treated opportunely and were designed as CS. In total 9 NB corresponded to CS (6 in group I and 3 in group III). If the screening had been performed only in cord blood, three NB with CS would have not been diagnosed.Even when maternal serum has a high rate of false (+)s, it has better sensitivity than cord blood for the diagnosis of CS, thus it is suggested to perform the screening at delivery with maternal serum instead of cord blood samples.

Las malformaciones congénitas son la principal causa de muerte neonatal precoz en nuestro medio; en la mayoría de los casos corresponden a cardiopatías congénitas mayores. Las cardiopatías congénitas tienen una incidencia de 8/1.000 recién nacidos vivos, correspondiendo la mitad de ellas a cardiopatías congénitas mayores. Una de las intervenciones recomendadas para reducir la mortalidad de este grupo de niños es evaluar rutinariamente la anatomía del corazón fetal mediante ecografía obstétrica, para planificar la atención neonatal, de aquellos fetos con cardiopatías congénitas, en el momento y lugar más oportuno. En objetivo de la presente revisión es comprobar si el diagnóstico prenatal de una cardiopatía congénita mejora el pronóstico perinatal respecto de aquellos casos que son diagnosticados post parto. Observamos que el diagnóstico antenatal de cardiopatía congénita, no mejora la sobrevida neonatal, excepto en ciertas cardiopatías congénitas ductus dependientes (transposición de grandes arterias, hipoplasia del corazón izquierdo y coartación de aorta), en que si se ha reportado una mayor probabilidad de sobrevida en el grupo de recién nacidos en los cuales se realizó el diagnóstico en el período prenatal. Recomendamos la evaluación rutinaria del corazón fetal en la ecografía obstétrica habitual, y efectuar ecocardiografía fetal especializada ante la sospecha de alteraciones o en aquellos grupos de mayor riesgo Congenital malformations are the main cause of neonatal death; in most of the cases they correspond to major congenital heart defects. Congenital heart defects have an incidence of 8/1,000 live newborns, corresponding half of them to major congenital heart defects. To reduce the mortality of this group of children routine evaluation of fetal heart anatomy by ultrasound is recommended, allowing neonatal care, of those fetuses with congenital heart defects, at the appropriate time and place. Here we attempt to verify if prenatal diagnosis of a congenital heart defect improves the perinatal outcome compare to postnatal diagnosis. We observed that the prenatal diagnosis of congenital heart defects, does not improve the neonatal outcome, except in certain congenital ductus dependent heart defects (transposition of great vessels, hypoplastic left heart syndrome and aortic coarctation), where a better outcome has been shown for those new born with prenatal diagnosis. We recommend routine evaluation of the fetal heart during prenatal ultrasound, and to carry out fetal echocardiography in high risk groups or when a defect is suspected

El tratamiento de la metrorragia postparto contempla enfoques quirúrgicos conservadores para aquellas pacientes en quienes se desea conservar la fertilidad. En ellas la ligadura de arterias hipogástricas muestra buenos resultados en el control del sangrado, además ha mostrado éxito en lograr embarazos posteriores. Se presenta un caso clínico manejado por los autores y se analiza la literatura disponible

RESUMENStreptococcus agalactiae es el principal agente causal de sepsis neonatal de aparicion precoz con unaincidencia que fluctua entre 1 y 3 por 1000 recien nacidos vivos. Se han entregado pautas dirigidas a reducirlas tasas de sepsis precoz con la administracion de antibioticos intraparto. Se ha propuesto como antibioticode primera eleccion la Penicilina o Ampicilina, y Clindamicina para pacientes alergicos a las primeras, perotambien se ha planteado el uso de Eritromicina o Cefazolina. Se estudia la sensibilidad a estas drogas, en183 cepas de Streptococcus Grupo B, aisladas en 917 embarazadas, al final del tercer trimestre, en regionvaginal y perianal.PALABRAS CLAVES: Streptococcus grupo Beta, antibioticos sensibilidadSUMMARYStreptococcus agalactiae (Grupo B Streptococcus) is the main bacterial agent involved in neonatalsepsis of early onset (1 to 3/1000 live newborns). Has been given standards for reducing the rates ofneonatal sepsis of early onset using antibiotics during labor. Has been proposed as the first choice Penicilinor Ampicilin and Clindamicin for allergic patients. Erythromycin and Cefazolin has been proposed to treatthis patients.This report study sensibilities for this drugs in 183 Group B Streptococcus strains from vaginal andperianal region of 917 pregnant women during the last trimester.KEY WORDS: Group B Streptococcus, antibiotic sensibilities

Introduccion. La Sociedad Internacional de Cefaleas (IHS, International Headache Society) publico en 1988 la 1.a edicion de la clasificacion de las cefaleas. La 2.a edicion se completa en el 2003. Objetivo. Determinar si existen cambios en la incidencia de la cefalea pospuncion lumbar segun la edicion de la IHS. Pacientes y metodos. Prospectivamente se recogieron, entre el 2002 y 2003, 78 pacientes a los que se realizo una puncion lumbar diagnostica, 40 raquianestesias obstetricas y 516 raquianestesias no obstetricas. Se utilizo la 1.a edicion, y tras la aparicion de la 2.a se recodificaron los casos. Resultados. Con la 1.a edicion, la cefalea pospuncion en las punciones diagnosticas fueron 31 de 78 casos (39,7%), y cuando se utilizo la 2.a fueron 10 casos (12,8%). En las pacientes de raquianestesia obstetrica, con la utilizacion de la 1.a edicion, la incidencia de cefalea fue de seis casos de 40 (15%) y cuatro casos con la 2.a (10%). De los pacientes con raquianestesia no obstetrica la incidencia de cefalea fue de 80 (15,5%) de 516 casos con la 1.a edicion de la IHS, y 25 casos (4,85%) con la 2.a. Conclusiones. Se necesita conocer la edicion si se quieren comparar incidencias de cefalea pospuncion entre observadores, ya que las diferencias son ostensibles entre utilizar una u otra edicion. El principal motivo de discrepancia entre las dos ediciones es la asociacion obligada de algun signo acompanante, ya que este no era criterio necesario en la 1.a edicion y si en la 2.a.

BRADYKININ obtained from ox plasma1 and synthetic bradykinin cause intense vasodilatation in many mammalian species. Intravenous injections of bradykinin lower arterial blood pressure in anaesthetized animals. On a molar basis, bradykinin is only ten times less active than acetylcholine and as active as histamine1. Two crude bradykinin-containing extracts from ox plasma—one prepared by us and the other kindly supplied by Prof. Rocha e Silva—were shown to have the typical depressor action in normal rats, but frequently produced a striking hypertensive effect in rats nephrectomized 16–24 hr. before. These results are similar to those obtained with anephrotensin prepared from rat serum2.