Influencia de la tiroiditis linfocitaria crónica en el pronóstico de pacientes con carcinoma papilar de tiroides / Influence of chronic lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma

Introducción: Algunos estudios atribuyen a la tiroiditis linfocitaria crónica (TLC) asociada al carcinoma papilar de tiroides (CPT) un efecto protector o de buen pronóstico; otros sugieren que sería un factor de riesgo para el desarrollo de recurrencias. Objetivo: Determinar la influencia de la TLC en el pronóstico de pacientes con CPT. Métodos: De un total de 406 CPT operados por un mismo cirujano (JLN), se seleccionaron 140 CPT que cumplieron los siguientes criterios de inclusión: pacientes operados con tiroidectomía total con criterio curativo y diagnóstico histológico de CPT variedad usual, sin tratamientos quirúrgicos previos y con seguimiento mínimo de 5 años. El diagnóstico de CPT y TLC lo realizó un mismo anatomopatólogo. Se definieron como factores de mal pronóstico, la edad ?45 años, el sexo masculino, los tumores grandes (>40 mm), los ganglios metastásicos al momento del diagnóstico de CPT, la multifocalidad tumoral y la invasión extratiroidea. Resultados: Se diagnosticaron histológicamente 51 (36.4%) CPT asociados con TLC y 89 (63.6%) sin TLC. Ninguno de los factores considerados mostró diferencias estadísticamente significativas entre los pacientes con y sin TLC (P=NS). Las tasas de recurrencia (3.6%) y muerte (2.1%) también fueron similares en ambos grupos (P=NS). Conclusión: La coexistencia de CPT y TLC es elevada y concordante con algunas publicaciones, pero la TLC no produjo ningún impacto sobre el pronóstico (recurrencia) de los pacientes. Aquellos que recurrieron y fallecieron presentaron 3 o más factores de mal pronóstico, sin que la TLC fuese un factor determinante del pronóstico.

Introduction: Some articles attribute a protect effect of chronic lymphocytic thyroiditis (CLT) on the prognostic outcome of patients with papillary thyroid carcinoma (PTC); others suggest it as a risk factor of PTC recurrences. Objective: To determine the influence of CLT on the prognostic outcome of patients with PTC. Methods: From 406 PTC patients surgically treated by a same surgeon (JLN), which received radioactive iodine ablative dosis, 140 PTC patients were selected that followed the following criteria: patients who underwent a total thyroidectomy for curative purpose, with histological diagnosis of pure PTC, without previous related surgeries, with a minimal 5-year follow-up. PTC and CLT histological diagnosis were performed by a same pathologist. Bad prognosis factors were defined: ?45 years old, male sex, big tumors (>40 mm), metastatic nodes at PTC diagnosis, multifocality and extrathyroideal extension. Results: 51 (36.4%) were found associated with CLT and 89 (63.6%) showed only pure PTC. No factors showed significantly statistical differences between patients with and without CLT (P=NS). Recurrence (3.6%) and death (2.1%) rates were similar in both groups, too (P=NS). Conclusion: Coexistence of CLT and PTC is high and it coincides with other experiences, but CLT did not cause any impact on the prognostic outcome (recurrence and/or death) of patients with PTC. Patients who had recurrence or died showed at least three risk factors, but CLT did not a bad prognosis factor.

Systemic infection caused by Trichosporon asahii in a patient with liver transplant.

Trichosporon species are emerging pathogens capable of causing severe infections in immunocompromised patients. In this paper, we report a case of systemic infection in a liver transplant patient caused by Trichosporon asahii to show the etiologic agent's aggressiveness and poor therapeutic results with the different antifungals employed.

The utility of the C-peptide in the phenotyping of patients candidates for pancreas transplantation.

It is not unusual for simultaneous pancreas and kidney transplantation (SPK) to be performed in patients with type 2 diabetes (T2D), clinically classified as having type 1 diabetes (T1D). C-peptide determination is useful to identify these patients. We describe the prevalence and characteristics of patients with C-peptide levels >3 ng/mL, classified with T2D in 172 patients referred for SPK from 1998-2006. Nine patients (5.2%) fulfilled this criteria (mean free C-peptide 9.08 ng/mL) and were older at diabetes onset (23.5 vs. 12 yr, p < 0.001) and at assessment (42.2 vs. 37.6 yr, p = 0.047) with shorter time between diabetes onset and renal failure (17.8 vs. 22.7 yr, p = 0.3) compared with T1D patients (mean free C-peptide 0.24 ng/mL). In our experience the prevalence of T2D in candidates for SPK is not negligible. Despite some clinical differences with T1D these T2D patients can phenotypically be confounded with T1D in the absence of C-peptide determination.

[Abdominal bleeding due to spontaneous mesenteric vein rupture]. / Hemoperitoneo secundario a la rotura espontánea de la vena mesentérica.

UNLABELLED: Hepatic cirrhosis is the leading cause of portal hypertension and is usually associated with the development ofsplacnic varices. Variceal intraabdominal rupture is a rare cause of hemoperitoneum. A case of spontaneous mesenteric vein rupture is reported. CLINICAL CASE: 43-year-old man with hepatic cirrhosis (Child-Pugh C stage) and previous bleeding of esophageal varices, admitted to hospital because of orthostatic hypotension episodes (positive tilt test) and abdominal distention. Laboratory: anemia, low platelet count and abnormal coagulation tests. CT scan showed abdominal fluid. Exploratory laparotomy was performed and 3 liters of blood were found into the abdominal cavity. The mesenteric vein had a ruptured variceal dilatation with intermitent jet bleeding. No organ abnormalities were found. Repair of the dilated vein was performed. The patient evolved well and was dismissed from hospital ten days after admittance. OBJECTIVE: To present a case in which a rare cause of intraabdominal bleeding, usually associated with high mortality rate, is follawed by a good clinical evolution.

Hemoperitoneo secundario a la rotura espontánea de la vena mesentérica / Abdominal bleeding due to spontaneous mesenteric vein rupture

La cirrosis hepática es la principal causa de hipertensión portal y se asocia con el desarrollo de venas esplácnicas varicosas. La rotura de várices intraabdominales es una causa rara de hemoperitoneo. Se presenta el caso de hemoperitoneo espontáneo por rotura de vena mesentérica superior varicosa. Caso clínico: varón de 43 años con antecedentes de cirrosis alcohólica (estadio C de Child-Pugh) y múltiples internaciones por hemorragia digestiva variceal. Consulta por episodios sincopales y distensión abdominal. Al examen físico se presento: vigil, orientado, hipotenso, con tilt test positivo, distensión abdominal, estigmas cutáneos de hepatopatía crónica. Laboratorio: anemia, plaquetopenia, rolongación de los tiempos de coagulación. TAC de abdomen: líquido libre en cavidad peritoneal. Laparotomía exploradora: se extraen tres litros de sangre de cavidad abdominal. Se visualiza vena mesentérica superior varicosa con una zona en forma de pezón que muestra punto de sangrado en jet, intermitente. No se evidenció daño de otro órgano. Se procedió a la rafia de la lesión lográndose hemostasia. El paciente evolucionó favorablemente abandonando el hospital 10 días después del ingreso. Objetivo: presentar un paciente con una causa poco común de hemoperitoneo y remarcar la buena evolución, ya que este tipo de patología suele tener alta mortalidad.

Hepatic cirrhosis is the leading cause of portal hypertension and is usually associated with the development of splacnic varices. Variceal intraabdominal rupture is a rare cause of hemoperitoneum. A case of spontaneous mesenteric vein rupture is reported. Clinical case: 43 year old man with hepatic cirrhosis (Child-Pugh C stage) and previous bleeding of esophageal varices, admitted to hospital because of orthostatic hypotension episodes (positive tilt test) and abdominal distention. Laboratory: anemia, low platelet count and abnormal coagulation tests. CT scan showed abdominal fluid. Exploratory laparotomy was performed and 3 liters of blood were found into the abdominal cavity. The mesenteric vein had a ruptured variceal dilatation with intermitent jet bleeding. No organ abnormalities were found. Repair of the dilated vein was performed. The patient evolved well and was dismissed from hospital ten days after admittance. Objective: To present a case in which a rare cause of intraabdominal bleeding, usually associated with high mortality rate, is follawed by a good clinical evolution.

Hemoperitoneo secundario a la rotura espontánea de la vena mesentérica / Abdominal bleeding due to spontaneous mesenteric vein rupture

La cirrosis hepática es la principal causa de hipertensión portal y se asocia con el desarrollo de venas esplácnicas varicosas. La rotura de várices intraabdominales es una causa rara de hemoperitoneo. Se presenta el caso de hemoperitoneo espontáneo por rotura de vena mesentérica superior varicosa. Caso clínico: varón de 43 años con antecedentes de cirrosis alcohólica (estadio C de Child-Pugh) y múltiples internaciones por hemorragia digestiva variceal. Consulta por episodios sincopales y distensión abdominal. Al examen físico se presento: vigil, orientado, hipotenso, con tilt test positivo, distensión abdominal, estigmas cutáneos de hepatopatía crónica. Laboratorio: anemia, plaquetopenia, rolongación de los tiempos de coagulación. TAC de abdomen: líquido libre en cavidad peritoneal. Laparotomía exploradora: se extraen tres litros de sangre de cavidad abdominal. Se visualiza vena mesentérica superior varicosa con una zona en forma de pezón que muestra punto de sangrado en jet, intermitente. No se evidenció daño de otro órgano. Se procedió a la rafia de la lesión lográndose hemostasia. El paciente evolucionó favorablemente abandonando el hospital 10 días después del ingreso. Objetivo: presentar un paciente con una causa poco común de hemoperitoneo y remarcar la buena evolución, ya que este tipo de patología suele tener alta mortalidad.(AU)

Hepatic cirrhosis is the leading cause of portal hypertension and is usually associated with the development of splacnic varices. Variceal intraabdominal rupture is a rare cause of hemoperitoneum. A case of spontaneous mesenteric vein rupture is reported. Clinical case: 43 year old man with hepatic cirrhosis (Child-Pugh C stage) and previous bleeding of esophageal varices, admitted to hospital because of orthostatic hypotension episodes (positive tilt test) and abdominal distention. Laboratory: anemia, low platelet count and abnormal coagulation tests. CT scan showed abdominal fluid. Exploratory laparotomy was performed and 3 liters of blood were found into the abdominal cavity. The mesenteric vein had a ruptured variceal dilatation with intermitent jet bleeding. No organ abnormalities were found. Repair of the dilated vein was performed. The patient evolved well and was dismissed from hospital ten days after admittance. Objective: To present a case in which a rare cause of intraabdominal bleeding, usually associated with high mortality rate, is follawed by a good clinical evolution.(AU)