Vólvulo primario de intestino delgado en el adulto / Primary volvulus of the small intestine in adult

El vólvulo de intestino delgado primario es una condición en la cual existe una torsión de la totalidad o de un segmento del intestino delgado y su mesenterio, sin encontrarse malrotación intestinal, bridas adquiridas o congénitas o cualquier otra condición que facilite que se produzca el vólvulo. En el adulto generalmente ocurre en un segmento del intestino medio. Se presentan 4 casos de vólvulo primario del intestino delgado en el adulto, operado en el Servicio de Urgencia de la Clínica Alemana. Por su escasa frecuencia en nuestro medio, este cuadro presenta una importante dificultad diagnóstica. En todos los casos destaca en su presentación clínica, el comienzo agudo de dolor abdominal de gran intensidad, que no guarda relación con los hallazgos del examen clínico y con escasa repercusión en los estudios complementarios. Los cuatros pacientes fueron sometidos a intervención quirúrgica

Osteomalacia hipofosfémica adquirida post-trasplante renal: una causa de osteoporosis grave / Hypophosphatemic osteomalacia adquiared post renal transplantation: a cause of severe osteoporosis

Renal osteodystrophy improves after renal transplantation but, after the procedure, other forms of bone disease emerge. We report a male patient that received a renal allograft four years before, who consulted for low back pain secondary to multiple vertebral compression fractures. The patient had good renal function, a parathormone independent hyperphosphaturia, normal 25-OH cholecalciferol, increased urinary hydroxyproline, decreased osteocalcin, reduced bone density and a bone biopsy revealing osteomalacia. The diagnosis of hypophosphemic osteomalacia was reached and treatment with phosphates and ergocalciferol was started but, despite this, the patient suffered a new fracture 2 years later. Two mechanisms can produce hypophosphatemia after a renal transplantation: a parathormone excess due to the previous renal failure, that disappears during the first year after the transplantation or a derangement in renal phosphate transport that can be due to a generalized proximal tubule solute transport derangement (Fanconi syndrome), parathormone hypersensitivity or to an idiopathic hyperphosphaturia. Despite a good treatment, bone mass is not recovered and there is a high fracture risk. Mineral metabolism must be closely monitored after a renal allograft and its alterations must be quickly treated

Linfoma primario cerebral post trasplante renal: comunicación de un caso y revisión de la literatura / Primary brain lymphoma post renal transplantation: report of a case and literature review

We report a 30 years old male, presenting eight years after a kidney transplant with intracraneal hypertension and two hyperdense masses detected in a brain CAT scan, whose histopathological study revealed a giant cell immnunoblastic lymphoma. The patient was successfully treated with chemo and radiotherapy and after 18 months of follow up there is no evidence of tumoral relapse. Immunocompromised patients specially transplant recipients, had a several fold higher incidence of malignant tumors, specially primary lymphomas of the central nervous system. These are generally of B type, are associated to Epstein Barr virus and have a high mortality. Cancer must be considered in the differential diagnosis of masses of uncertain origin in transplant recipients

Glomeruloesclerosis focal y segmentaria en el trasplante renal / Focal segmental glomeruloesclerosis in renal transplantation

In 179 patients subjected to 186 renal tranplants, 30 renal biopsies were performed due to the presence of a proteinuria over 3.5 g/24 h or due to a reduction in glomerular filtration rate. Six of these biopsies, coming from 5 patients, disclosed morphological alterations compatible with focal segmental glomerulosclerosis. Five of these were due to recurrence of the primary disease (in 4 patients) and in all, massive proteinuria appeared from 1 to 23 days after transplantation. Two patients with three transplants evolved to renal failure and required dialysis in a period 12 months as a mean. The third patient, developed a nephrotic syndrome without renal failure and died 14 months after the renal transplant due to stroke. In the fourth patient, the nephrotic syndrome disappeared 38 days after the transplant and remained with minimal proteinuria until his last follow up visit two years later. The primary disease of the fifth patient is unknown, the nephrotic syndrome appeared 68 months after the transplant and remitted spontaneously in 2 months. The renal biopsy showed focal and segmental lesions with partial effacement of epithelial foot processes. It is concluded that focal segmental glomerulosclerosis recurrence in renal transplant occurs with aerly massive proteinuria and frequently leads to renal failure and graft loss in no more than two years