Síndrome de Allen Master: causa excepcional de abdomen agudo en el embarazo / Allen Master syndrome: exceptional cause of acute abdomen in pregnancy

Se presenta un caso de abdomen agudo en una gestante de 20 semanas, por una torsión anexial. Ante la ausencia de signos ecográficos compatibles con patología en los primeros momentos y el empeoramiento clínico, se solicitó una RMN que permitió la aproximación diagnóstica y facilitó la indicación urgente de cirugía abdominal. En el curso de la laparotomía se diagnosticó una hernia interna del anexo, con marcado componente vascular a través de un defecto del ligamento ancho, que obligó a la anexectomía. Tras el diagnóstico y el tratamiento realizado, la gestación continúa con buenos resultados materno-fetal. Estos orificios han sido presentados excepcionalmente como causa de hernias internas digestivas, urológicas y anexiales, siendo controvertido su origen, congénito, inflamatorio o traumático. Se repasan las pruebas complementarias indicadas en el manejo diagnóstico del dolor abdominal en el embarazo, incluyendo las últimas recomendaciones de la European Society of Urogenital Radiology-ESUR.

A case of acute abdomen in a pregnant 20 weeks is presented with an adnexal torsion. In the absence of pathologic ultrasound signs with in the early stages and clinical worsening, was requested an MRI that allowed the diagnostic approach and the indication for urgent abdominal surgery. During laparotomy was observed an internal adnexal hernia through a defect in the broad ligament, with marked vascular component which forced the adnexectomy. After the diagnosis and treatment performed, the pregnancy continues with good maternal and fetal outcomes. These defects were presented exceptionally as a cause of digestive, urological and adnexal internal hernias. The origin remains controversial, congenital, inflammatory or traumatic. Complementary tests in the diagnostic management of abdominal pain in pregnancy are reviewed, including the latest recommendations of the European Society of Urogenital Radiology-ESUR.

Development of three different neoplasias in a patient in an 18-year period of time.

This study presents a rare case of a patient who developed three different types of neoplasia in an 18-year period of time. The case presents a 31-year-old man with a history of treated Hodgkin's lymphoma in the neck region at the age of 13 years. The patient was admitted at the General Hospital of Nafplio for differential diagnosis of pain in the right subcostal region initiated 1 month before his admission and normochromic, normocytic anaemia. The laboratory examinations lead to the diagnosis of a sarcoma in the cardioesophageal junction. The patient was subjected to total gastrectomy. Nine months later he is admitted with a palpable firm lump in the nipple of the right breast, which suggested a malignant neoplasia. The patient was subjected to modified radical mastectomy. The appearance of three different types of neoplasia in three different organ systems in the same patient and the infrequency of the specific neoplasias individually and in combination present a special interest considering the patient's genetic background and the uniqueness of the case in the international literature.

Efficacy of ibandronate for the treatment of skeletal events in patients with metastatic breast cancer.

Patients with breast carcinoma often develop bone metastases that carry a high risk of complications. A randomized, placebo-controlled trial was conducted to evaluate the efficacy and safety of ibandronate in patients with metastatic bone disease following breast cancer. The primary efficacy end point of the study was the proportion of patients who developed skeletal-related events (SREs, defined as pathologic fracture, spinal cord compression, radiation therapy to bone, change in anti-neoplastic therapy and surgery to bone). Secondary end points included time to first skeletal event, skeletal morbidity rate (events/year) and time to progression of bone lesions. In 150 patients (148 [female symbol] / 2 [male symbol]) with breast carcinoma and bone metastases, treatment with intravenous ibandronate 6 mg over 15 min every 4 weeks for 24 months significantly reduced the proportion of patients who experienced an SRE compared with placebo (36% vs. 48%; P = 0.027). Time to first SRE was also delayed significantly (median 457 vs. 304 days; P = 0.007). Multiple event analysis showed that ibandronate reduced the risk of developing an SRE by 32% (hazard ratio = 0.69; 95% confidence interval 0.42-0.79; P = 0.003). In general, ibandronate was well tolerated with very rare grade 3 or 4 toxicity. In this study, ibandronate was shown to be significantly more effective than placebo as a treatment for metastatic bone disease from breast cancer using multiple end points.

Once-weekly epoetin beta therapy in patients with solid tumours and chemotherapy-induced anaemia: a randomized, double-blind, dose-finding study.

Anaemia is common in patients receiving chemotherapy, causing symptoms that have a major impact on quality of life (QoL). Epoetin beta rapidly increases haemoglobin (Hb) levels and improves QoL in anaemic patients with a variety of tumours. This was a randomized, double-blind, parallel-group, dose-finding study assessing the efficacy and safety of once-weekly epoetin beta in patients with solid tumours receiving chemotherapy. Adult patients with anaemia (Hb < 11 g/dL) were randomized to receive epoetin beta 30,000 IU or 20,000 IU once weekly for 12 weeks. All patients received oral iron supplementation. Haemoglobin levels, transfusion need and QoL [Functional Assessment of Cancer Therapy-fatigue (FACT-F) subscale score] were assessed at regular intervals. Fifty patients were randomized; 30 patients received epoetin beta 30,000 IU once weekly and 20 received 20,000 IU once weekly. Mean (+/- SD) increase in Hb from baseline to week 12 was 1.75 +/- 2.15 g/dL in the 30,000 IU group (P = 0.008 vs. baseline) and 1.04 +/- 1.75 g/dL in the 20,000 IU group (non-significant). Haemoglobin response (increase in Hb >or=2 g/dL from baseline) was observed in 78.3% of patients receiving epoetin beta 30,000 IU and 66.7% receiving epoetin beta 20,000 IU. Improvements in FACT-F subscale score were significantly (P < 0.001) correlated with increases in Hb level. Transfusion use was low during the study in both groups. Both epoetin beta regiments were well tolerated and there were no dose-dependent adverse events. Epoetin beta 30,000 IU once weekly is an effective and well-tolerated treatment of anaemia in patients with solid tumours.

Ibandronate is effective in preventing skeletal events in patients with bone metastases from colorectal cancer.

Patients with metastatic colorectal carcinoma (CRC) often develop bone metastases with a high risk of complications. Ibandronate is a novel single-nitrogen bisphosphonate that has been shown to be effective for treating bone metastases from breast cancer. A randomized, placebo-controlled trial was conducted to evaluate the efficacy and safety of ibandronate in patients with bone metastases from CRC. The primary efficacy end point was the proportion of patients with skeletal-related events (defined as pathologic fracture, spinal cord compression, radiation therapy to bone, change in antineoplastic therapy or surgery to bone). Secondary end points included time to first skeletal event, skeletal morbidity rate (events/year) and time to progression of bone lesions. In 73 patients with CRC, treatment with intravenous ibandronate 6 mg administered via a 15-min infusion significantly reduced the proportion of patients with skeletal events (39% vs. 78% with placebo; P = 0.019) and prolonged the time to first event by at least 6 months (median >279 vs. 93 days with placebo; P = 0.009). Ibandronate also significantly reduced the skeletal morbidity rate (mean 2.36 vs. 3.14 with placebo; P = 0.018) and prolonged time to progression of bone lesions (214 days vs. 81 days with placebo; P = 0.018). Ibandronate was well tolerated with very rare grade 3 or 4 toxicity. Furthermore, the incidence of renal adverse events was comparable with placebo and there were no clinically relevant changes in serum creatinine. Ibandronate provided significant clinical benefits for patients with bone metastases secondary to CRC. These results indicate that ibandronate may be an effective treatment for patients with metastatic bone disease following CRC. Larger studies are required for further assessment.

Headache characteristics and brain metastases prediction in cancer patients.

The aim of this study was to evaluate the headache and other neurological symptoms and signs as guide predictors for the occurrence of brain metastases in cancer patients. We prospectively studied 54 cancer patients with newly appeared headache or with a change in the pattern of an existing headache during the recent months. All patients completed a questionnaire regarding headache's clinical characteristics and existence of accompanying symptoms. They also underwent a detailed neurological, ophthalmologic examination and brain neuroimaging investigation. Brain metastases were diagnosed in 29 patients. Univariate regression analysis showed an association between occurrence of brain metastases and nine clinical symptoms or signs. Multivariate regression analyses emerged only four of them as significant independent predictors. These were: bilateral frontal-temporal headache, more pronounced on the side of metastasis in cases of single metastases, with duration > or =8 weeks, pulsating quality and moderate to severe intensity (OR: 11.9; 95% CI. 2.52-56.1), emesis (OR: 10.2; 95% CI. 2.1-55.8), gait instability (OR: 7.4; 95% CI. 1.75-33.9) and extensor plantar response (OR: 12.1; 95% CI. 2.2-120.7). In conclusion, all cancer patients who manifest the above independent clinical predictors should be highly suspected for appearance of brain metastases and therefore should be thoroughly investigated.

The impact of weekly dosing of epoetin alfa on the haematological parameters and on the quality of life of anaemic cancer patients.

The aim of this study was to evaluate the effectiveness and the impact of once-weekly administration of epoetin alfa (Ea) on the management of anaemia and on the quality of life (QOL) of cancer patients receiving chemotherapy. Eighty cancer patients with life expectancy > or = 24 weeks and haemoglobin (Hb) levels < 10.5 g/dL were studied. After an initial screening of patients' demographic and clinical characteristics, Ea 40000 U once a week was administered over a period of 4 months. In case of patients with Hb level exceeding > 14 g/dL or in case of non-response, the dosage was reconsidered. Every month, data regarding Hb levels, clinical variations, changes in the chemotherapy regimen and transfusion use since the last study visit, were evaluated. The Linear Analogue Scale Assessment scale was used for the evaluation of the QOL. The readmissions to hospital rates (P < 0.002) and the transfusion use rates (P < 0.003) were significantly decreased comparatively with baseline. A mean increase from baseline to the final Hb level (P < 0.001) was established, as well as a significant improvement in the functional ability, energy and in the overall QOL (P < 0.001). In conclusion, the treatment of cancer patients with Ea once-weekly is effective and safe, improving their haematological parameters and QOL.

Spontaneous acute subdural haematoma caused by tension pneumocephalus.

We describe the first case of spontaneous acute subdural haematoma (SASH) caused by tension pneumocephalus in a patient who had undergone surgery for sinusitis followed by meningitis many years previously. The patient presented with a seizure and epistaxis. The haematoma was caused by a torn bridging vein. Tension pneumocephalus has to be added to the list of possible causes for SASH.

Structural cost of shoot modules and its implications on plant potential fitness in a Mediterranean perennial shrub, Retama sphaerocarpa (L.) Boiss.

This paper introduces a methodology to analyse the structural costs on plant potential fitness, empirically exemplified in the hierarchical shoot system of a Mediterranean perennial plant, Retama sphaerocarpa (L.) Boiss. During growing season every year (March-August), the terminal shoot (which is the basic unit of growth) develops inflorescences, flowers and fruits, as well as new shoots (first-, second- and third-order branching shoots) which have the potential to "behave" as terminal shoots in the following year. Different morphological and demographical aspects of the modules within the terminal shoot were measured in 100 terminal shoots selected from different plants of a natural population of R. sphaerocarpa. Complementary samples of 100 shoots of different branching orders were collected to obtain biomass estimations of the terminal shoots. We propose a simple procedure to estimate structural cost (biomass investment) on plant potential fitness (flowering buds) as a methodology for interpreting and comparing the consequences on fitness of different plant growth patterns. The results of this study exemplify how differential allocation patterns among plant structural modules, depending on their position within the shoot system, can be quantified to estimate their influence upon plant potential fitness.

Abceso epidural espinal cervicotoracolumbar con tetraparesia. Buena recuperación tras tratamiento no quirúrgico con antibióticos y dexametasona. Caso clínico y revisión de la literatura / Cervicothoracolumbar spinal epidural abscess with tetraparesis. Good recovery after non-surgical treatment with antibiotics and dexamethasone. Case report and review of the literature

Describimos el tratamiento conservador de un absceso epidural espinal (AEE) causado por escherichia coli y afectando el espacio epidural anterior desde C2 hasta L4 en una paciente diabética y obesa con tetraparesia. Se decribe la respuesta favorable al tratamiento con dexametasona y antibióticos. Revisamos la literatura sobre el tratamiento no quirúrgico de AEE con un especial énfasis en el uso de corticoesteroides (AU)

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Cervicothoracolumbar spinal epidural abscess with tetraparesis. Good recovery after non-surgical treatment with antibiotics and dexamethasone. Case report and review of the literature.

We report the conservative treatment of a spinal epidural abscess (SEA) caused by escherichia coli and affecting the anterior epidural space from C2 to L4 in a diabetic, obese patient presenting with tetraparesis. The favourable clinical response to the administration of dexamethasone and antibiotics is described. We review the literature on non-surgical treatment of SEA with special regard to the use of corticosteroids.

Lymphoma of the breast: clinical and radiologic features with pathologic correlation in 28 patients.

The objective of this study was to determine the clinical and radiologic findings of lymphoma involving the breast, separately evaluating primary and secondary forms. We retrospectively reviewed the medical reports of 28 patients with lymphoma of the breast: 12 patients with primary lymphoma and 16 with secondary lymphoma. In primary lymphoma, mammography revealed a solitary mass (58.3%), multiple unilateral masses (8.3%), unilateral diffuse involvement (25%), and bilateral diffuse involvement (8.3%). The margins of masses were irregular (50%), partially defined (37.5%), and well defined (12.5%). The mean diameter of the masses was 4.6 cm. In secondary lymphoma, mammography revealed multiple masses (56.2%), solitary masses (12.5%), and diffuse unilateral breast involvement (31.2%). Their margins were irregular (18.1%), partially defined (27.2%), and well-defined (54.5%). The mean diameter of the masses was 2.8 cm. Cytologic examination (n = 13) was demonstrative of lymphomatous involvement in all cases. We observed an association between high-grade types of malignancy and a diffuse pattern of radiologic breast involvement. Masses in primary disease tended to have less-defined margins and greater diameters than those observed in secondary cases. Cytologic examination proved to be a useful diagnostic procedure in the evaluation of secondary disease. The involvement of the breast in extranodal lymphomas does not seem to affect the prognosis of the disease.

Biomonitoring of metal deposition in northern Spain by moss analysis.

The results of the first survey carried out in northern Spain to determine atmospheric deposition of metals by analysis of terrestrial mosses, are described. Samples of different mosses, mainly Hypnum cupressiforme and Scleropodium purum, were collected from 134 sampling sites, between 1995 and 1996. Levels of Al, As, Cr, Cu, Fe, Hg, Ni, Pb and Zn, were determined by flame atomic absorption or atomic fluorescence spectrophotometry. Regression analysis was used to compare the capacity of the selected moss species to accumulate the elements, and intercalibration of accumulation in these species was carried out where necessary. Distribution maps were prepared to allow the zones most affected by metal deposition to be identified and to relate this to known sources of contamination: electricity power stations and other industries (e.g. Hg and Ni), edaphic contamination (e.g. Al and Cr) and road traffic (Pb). Background levels of metals in each species were also determined for the study area.

Repicaduras intrahospitalarias con himenópteros / In-hospital re-stinging with hymenoptera

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Tumor de Brenner / Brenner tumor

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[Anatomic considerations in relation to the importance of the external branch of the spinal nerve in surgery on the posterior cervical triangle]. / Consideraciones anatómicas sobre la importancia de la rama externa del nervio espinal en la cirugía del triángulo posterior del cuello.

The integrity of the spinal accessory nerve plays an important role in cervicofacial surgery since the majority of surgical approaches involve this structure. The resection of the spinal accessory nerve leads to the so-called <> mainly due to the denervation of the trapezius. This syndrome is characterised by the onset of regional pain, functional deficit and deformation of the shoulder joint. The anatomy of the accessory nerve is defined in the light of 93 functional neck dissections with particular regard to the following aspects: its relation with the internal jugular vein, its relation with the sternocleidomastoid muscle (ECM) and mastoid tip and its anastomoses with the cervical plexus.

Salvage chemotherapy with paclitaxel, vinorelbine, and cisplatin (PVC) in anthracycline-resistant advanced breast cancer.

The tolerance and the efficacy of the paclitaxel-vinorelbine-cisplatin combination (PVC regimen) was evaluated in 33 patients with anthracycline-resistant stage IV breast cancer, who had disease progression under anthracycline- or mitoxantrone-based chemotherapy. Fourteen (42%) and 19 (58%) patients had primary and secondary resistance to anthracyclines, respectively; 70% had visceral metastases. Patients received vinorelbine (25 mg/m2) followed by paclitaxel (135 mg/m2) in a 3-hour infusion on day 1, and cisplatin (CDDP; 80 mg/m2) on day 2, in a 3-week schedule. A total of 208 chemotherapy courses were administered (median six courses per patient). Grade 3/4 neutropenia occurred in 13 patients (39%), seven of whom were hospitalized for neutropenic fever (5% of the courses). There was no toxic death. Grade 4 thrombocytopenia occurred in two patients (6%) and grade 3 anemia in three patients (9%). Grade 2 and 3 neurosensory toxicity occurred in 11 patients (32%) and two patients (6%), respectively, and grade 3/4 fatigue was observed in four patients (12%). Two (6%) complete and 17 partial responses (52%) (total, 58%; 95% confidence interval, 42%-75%) were documented. Stable disease was observed in eight patients (24%) and progression in six patients (18%). The median duration of response was 6.5+ months. The median survival was 15+ months, and the 1-year survival was 67%. In conclusion, PVC regimen is an active and well-tolerated salvage chemotherapy in patients resistant to anthracycline.

First-line treatment of advanced non-small-cell lung cancer with docetaxel and cisplatin: a multicenter phase II study.

PURPOSE: To evaluate the efficacy and safety of the docetaxel-cisplatin combination in patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Chemotherapy-naïve patients with histologically confirmed, measurable stage IIIB or IV NSCLC, a World Health Organization (WHO) performance status of 0-2 and adequate bone marrow, renal, hepatic and cardiac function were eligible for the study. Patients received docetaxel (100 mg/m2) as an one-hour infusion on day 1 and cisplatin (80 mg/m2) as a 30-min infusion with appropriate hydration on day 2. Granulocyte colony-stimulating factor (G-CSF; 150 micrograms/m2, SC) was given on days 3 to 13. Treatment was repeated every three weeks. RESULTS: Fifty-three patients were enrolled (28 with stage IIIB and 25 with stage IV). One complete and 23 partial responses were observed (overall response rate (OR): 45%; 95% CI: 34.1%-61.8%). The response rate was 57% and 32% in patients with stages IIIB and IV disease (P = NS). The median time to progression was 36 weeks and the median survival 48 weeks; the one-year survival was 48%. Grade 3-4 neutropenia occurred in 23 patients, 15 of whom were hospitalized for neutropenic fever; two patients died of sepsis. Grade 2 neurotoxicity was observed in six patients and grade 3 in five patients; grade 3 fatigue occurred in seven patients, grade 3-4 mucositis in four patients and grade 3-4 diarrhea in six patients. Mild allergic reactions and oedema were observed in five and four patients, respectively. The median dose intensity was 30 mg/m2/week for docetaxel and 24 mg/m2/week for cisplatin, corresponding to 91% and 89% of the specified protocol doses, respectively. CONCLUSIONS: The docetaxel-cisplatin combination is an active regimen in advanced NSCLC, but hematologic toxicity remains high despite the prophylactic use of G-CSF.

Docetaxel (Taxotere) and gemcitabine in the treatment of non-small cell lung cancer: preliminary results.

A phase II study was performed to investigate the tolerance and efficacy of the combination of docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) and gemcitabine in chemotherapy-naive patients with advanced non-small cell lung cancer (NSCLC). To date, 24 patients (five with stage IIIB and 19 with stage IV NSCLC) have been treated according to the protocol: gemcitabine 900 mg/m2 was administered on days 1 and 8 as a 30-minute infusion and docetaxel 100 mg/m2 was administered on day 8 as a 1-hour infusion after appropriate premedication. Granulocyte colony-stimulating factor 150 microg/m2 subcutaneously was given on days 9 to 15. Treatment was repeated every 3 weeks. Grade 3/4 granulocytopenia occurred in seven (29%) patients, and one (4%) of these patients developed febrile neutropenia. Grade 3/4 thrombocytopenia and anemia were observed in three (13%) and one (4%) patient, respectively. Grade 2 neurotoxicity and fatigue occurred in one (4%) patient each. Other toxicities were mild. There were no treatment-related deaths. Eight patients experienced a partial response (53.3%; 95% confidence interval, 28.1% to 78.6%), and stable and progressive disease were documented in two (13%) and five (33%) patients, respectively. The median delivered dose was 600 mg/m2/wk and 33 mg/m2/wk for gemcitabine and docetaxel, respectively. These preliminary data suggest that the docetaxel/gemcitabine combination has significant antitumor activity and is well tolerated in chemotherapy-naive patients with NSCLC. The study is ongoing.