Extrauterine leiomyomatosis, the great mimicker.

OBJECTIVES: Describe the radiographic features of the different forms of extrauterine leiomyomatosis. CONCLUSIONS: Leiomyomas with a rare growth pattern occur most often in women of reproductive age and with a history of hysterectomy. Extrauterine leiomyomas present a greater diagnostic challenge because they may mimic malignancies, and serious diagnostic errors may result.

Leiomiomatosis extrauterina, la gran simuladora / Extrauterine leiomyomatosis, the great mimicker

Objetivos: Definir el concepto de leiomiomatosis extrauterina y describir sus formas de aparición. Realizar una revisión de los hallazgos radiológicos de los distintos tipos de leiomiomatosis extrauterina a partir de casos de nuestro centro. Conclusiones: La leiomiomatosis extrauterina es una entidad rara, típica de mujeres premenopáusicas histerectomizadas. Conocer los hallazgos radiológicos de esta patología permite incluirla en el diagnóstico diferencial de una masa pélvica, una enfermedad peritoneal o una invasión vascular de aspecto tumoral.(AU)

Objectives Describe the radiographic features of the different forms of extrauterine leiomyomatosis. Conclusions: Leiomyomas with a rare growth pattern occur most often in women of reproductive age and with a history of hysterectomy. Extrauterine leiomyomas present a greater diagnostic challenge because they may mimic malignancies, and serious diagnostic errors may result.(AU)

Hallazgos en imagen en los tumores mucinosos de abdomen y pelvis / Imaging findings for mucinous tumors of the abdomen and pelvis

El objetivo de este artículo es describir los hallazgos en imagen de los tumores mucinosos de abdomen y pelvis que, por su composición, comparten características radiológicas independientemente del órgano de origen. Debido al alto contenido hídrico del moco, generalmente muestran un aspecto similar al agua en la ecografía, la tomografía computarizada y la resonancia magnética. Otra característica común de los tumores productores de mucina es la frecuente presencia de calcificaciones. La rotura de estas lesiones con acumulación de material mucinoso en la cavidad peritoneal da lugar al pseudomixoma peritoneal. La importancia de la identificación de las neoplasias mucinosas radica en el diferente manejo, pronóstico y evolución clínica con respecto a las no mucinosas; en función de su localización anatómica y las características de imagen, la actitud varía desde el seguimiento a la cirugía radical en combinación con quimio y/o radioterapia

This article aims to describe the imaging findings for mucinous tumors of the abdomen and pelvis, which have a similar appearance on imaging tests regardless of the organ in which they develop. Due to the high water content of mucus, the appearance of these tumors is generally similar to that of water on ultrasonography, computed tomography, and magnetic resonance imaging. Another common feature of mucin-producing tumors is that calcifications are often present. The rupture of these lesions and accumulation of mucinous material in the peritoneal cavity gives rise to pseudomyxoma peritonei. It is important to identify mucinous tumors because they have a different prognosis and clinical course than non-mucinous tumors and require different management. Depending on their anatomic location and their imaging characteristics, the treatment approach varies from follow-up to radical surgery together with chemotherapy or radiotherapy or both

Imaging findings for mucinous tumors of the abdomen and pelvis. / Hallazgos en imagen en los tumores mucinosos de abdomen y pelvis.

This article aims to describe the imaging findings for mucinous tumors of the abdomen and pelvis, which have a similar appearance on imaging tests regardless of the organ in which they develop. Due to the high water content of mucus, the appearance of these tumors is generally similar to that of water on ultrasonography, computed tomography, and magnetic resonance imaging. Another common feature of mucin-producing tumors is that calcifications are often present. The rupture of these lesions and accumulation of mucinous material in the peritoneal cavity gives rise to pseudomyxoma peritonei. It is important to identify mucinous tumors because they have a different prognosis and clinical course than non-mucinous tumors and require different management. Depending on their anatomic location and their imaging characteristics, the treatment approach varies from follow-up to radical surgery together with chemotherapy or radiotherapy or both.

[Recurring neuromyelitis without optic neuritis: a case report]. / Neuromielitis recidivante sin neuritis optica: a proposito de un caso.

INTRODUCTION: Neuromyelitis optica, or Devic's disease, is an inflammatory, demyelinating disease of the central nervous system that selectively affects the optic nerves and the spinal cord, with a high rate of relapses. Anti-aquaporin-4 (AQP4) antibodies are a highly specific marker for this condition. CASE REPORT: A 66-year-old female with longitudinally extensive dorsal transverse myelitis with complete remission following steroidal treatment and later acute relapse, with palsy in one limb. The differential diagnoses considered included a spinal tumour and arteriovenous malformation of the spinal cord. Being positive for AQP4 was the decisive factor in the final diagnosis. CONCLUSIONS: Early detection of anti-AQP4 antibodies together with appropriate immunotherapy can be the key to a better prognosis. An early diagnosis is essential to be able to start treatment at an early stage and thus prevent relapses and severe sequelae.

Estudio mediante técnicas de imagen no invasivas del síndrome de atrapamiento de la arteria poplítea. A propósito de dos casos / Noninvasive imaging of popliteal artery entrapment syndrome: a report of two cases

El síndrome de atrapamiento de la arteria poplítea es una causa de claudicación e isquemia de miembros inferiores en adultos jóvenes. Se debe a una compresión arterial extrínseca secundaria a una anomalía congénita en la relación anatómica entre la arteria poplítea y las estructuras musculotendinosas vecinas. El síndrome de atrapamiento de la arteria poplítea provoca un microtrauma vascular crónico y progresivo con ateromatosis y formación de trombos. Un diagnóstico preciso y precoz es crucial para una planificación quirúrgica adecuada que evite complicaciones graves (AU)

Popliteal artery entrapment syndrome is a cause of lower limb claudication and ischemia in young adults. This syndrome is due to extrinsic arterial compression secondary to a congenital anomaly in the anatomic relations between the popliteal artery and its neighboring musculotendinous structures. Popliteal artery entrapment leads to chronic, progressive vascular microtrauma with atheromatosis and thrombus formation. Accurate early diagnosis is crucial to enable appropriate surgical planning and avoid complications (AU)

[Noninvasive imaging of popliteal artery entrapment syndrome: a report of two cases]. / Estudio mediante técnicas de imagen no invasivas del síndrome de atrapamiento de la arteria poplítea. A propósito de dos casos.

Popliteal artery entrapment syndrome is a cause of lower limb claudication and ischemia in young adults. This syndrome is due to extrinsic arterial compression secondary to a congenital anomaly in the anatomic relations between the popliteal artery and its neighboring musculotendinous structures. Popliteal artery entrapment leads to chronic, progressive vascular microtrauma with atheromatosis and thrombus formation. Accurate early diagnosis is crucial to enable appropriate surgical planning and avoid complications.

Diuretic induced hyponatraemia in elderly hypertensive women.

Diuretics are recommended as first-line antihypertensive treatment in elderly patients. Although attention is usually paid to prevent hypokalaemia with diuretic therapy, risk of hyponatraemia is often ignored. We performed this study to characterise hypertensive patients at increased risk to develop hyponatraemia. We reviewed charts of hypertensive patients hospitalised in Chaim Sheba Medical Center for hyponatraemia from 1990 to 1997. Patients with other causes of hyponatraemia were excluded. The General Practice Maccabi database was used to estimate age and sex distribution of patients prescribed diuretics for hypertension. We identified 180 hypertensive patients (149 F, 31 M; mean age 76.4 +/- 9.2 years) hospitalised because of hyponatraemia. Across all age groups, odds ratio (OR) to develop hyponatraemia was three times higher for women vs men (OR 3.10, 95% confidence interval (CI): 2.07-4.67). One hundred and sixty-two patients (90%) were older than 65 years. Patients of both sexes older than 65 years were 10 times (and if they were older than 75 years 16 times) more likely to develop hyponatraemia than those younger than 65 years (OR 9.87, 95%, CI: 5.93-16.64). Most patients (74.5%) used a thiazide-based diuretic; only 10% used a low dose (<25 mg/day). In 37% of patients diuretics were used for more than 1 year before hyponatraemia developed. Diuretic-induced hyponatraemia may be insidious and appear even after prolonged diuretics use. Elderly women seem to be at particularly high risk. In this population diuretic use should be associated with close monitoring of sodium and potassium levels.

Case report: increased insulin sensitivity in tumor hypoglycemia in a diabetic patient: glucose metabolism in tumor hypoglycemia.

A 58-year-old man, with primary hemochromatosis, cirrhosis, and diabetes mellitus treated with insulin developed hepatoma. As the tumor grew, he lost his dependence on insulin therapy and experienced episodes of hypoglycemia. His response to infuse insulin was studied using the euglycemic clamp technique. Insulin was infused at rates of 1 and 10 mu/kg/min. The insulin dose response curve was shifted to the left and at plasma insulin levels of 72 microU/ml, steady-state glucose consumption was 9.6 mg/kg/min, 50% more than in normals, and nearly three times greater than that in other cirrhotics. The insulin clearance rate was 4417 m1/m2/min, almost five and six times more than in normals and cirrhotics, respectively. Basal hepatic glucose production was 3.6 mg/kg/min, two and three times higher than in normal and in cirrhotic subjects, respectively. The decrease in amino acid during hyperinsulinemia was more than 30% higher than in normal and other cirrhotics. IFG-I and II levels were not elevated in this patient. Increased insulin sensitivity and increased insulin clearance and serum amino acid decrease in response to insulin in vivo, suggest that insulin responsive tissues are at last partially responsible for tumor hypoglycemia. The increased glucose disposal rate probably accounted for the disappearance of the diabetes.