Fallo hepático por intoxicación con producto casero elaborado con anís estrellado y anís verde en lactante de 4 meses / Liver failure secondary to poisoning by a homemade product made of star and green anise in a 4-month-old infant

Las intoxicaciones en edad pediátrica representan una causa frecuente de consulta en urgencias hospitalarias. Los productos elaborados con hierbas pueden resultar tóxicos para el lactante. Se han descrito ampliamente las propiedades neurotóxicas del anís estrellado (Illicium verum), producto clásicamente empleado para el tratamiento del cólico del lactante. La presentación de fallo hepático agudo por consumo de infusiones elaboradas con hierbas de anís es excepcional en nuestro entorno. Se describe el caso de un lactante de 4 meses con hipertransaminasemia, coagulopatía grave, hipoglucemia no cetósica, acidosis metabólica moderada y síntomas neurológicos con crisis convulsivas y nistagmo. Tras descartar etiología infecciosa, metabólica y autoinmune y realizar una anamnesis cuidadosa, la familia refería haber administrado al paciente durante los últimos dos meses una infusión diaria con anís estrellado y anís verde (Pimpinella anisum). Es de gran importancia resaltar el grave riesgo de administrar infusiones de hierbas caseras en el lactante (AU)

Intoxications in pediatric age represent a frequent cause of visit to the hospital emergency unit. Herb-made products can be toxic for the infant. The neurotoxic properties of the star anise (Illicium verum) have been widely described, although it is a classic product used to treat the infantile colic. Hepatic failure due to the consumption of anise herb elaborated infusions is presented as an exceptional finding in our environment. A case of a 4-month-old infant with hypertransaminasemia, severe coagulopathy, non ketotic hypoglycemia, moderated metabolic acidosis and neurologic symptoms such as seizures and nistagmus is described. After discarding infectious, metabolic and autoimmune etiology and through a meticulous anamnesis, the family referred having administered in the last two months a daily star anise and green anise (Pimpinella anisum) infusion to the patient. It is important to emphasize the serious risk of administering homemade herb infusions to infants (AU)

Liver failure secondary to poisoning by a homemade product made of star and green anise in a 4-month-old infant.

Intoxications in pediatric age represent a frequent cause of visit to the hospital emergency unit. Herb-made products can be toxic for the infant. The neurotoxic properties of the star anise (Illicium verum) have been widely described, although it is a classic product used to treat the infantile colic. Hepatic failure due to the consumption of anise herb elaborated infusions is presented as an exceptional finding in our environment. A case of a 4-month-old infant with hypertransaminasemia, severe coagulopathy, non ketotic hypoglycemia, moderated metabolic acidosis and neurologic symptoms such as seizures and nistagmus is described. After discarding infectious, metabolic and autoimmune etiology and through a meticulous anamnesis, the family referred having administered in the last two months a daily star anise and green anise (Pimpinella anisum) infusion to the patient. It is important to emphasize the serious risk of administering homemade herb infusions to infants.

Hidatidosis torácica con invasión del canal vertebral / Hydatid thoracic spinal canal invasión

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[Immunohistochemistry and surgical approaches in solitary fibrous tumor of the pleura]. / Inmunohistoquímica y vías de abordaje en el tumor fibroso pleural.

Solitary fibrous tumor of the pleura (SFTP) is a rare, benign, slow-growing neoplasm that arises from the submesothelial cells of the pleura. Usually, resection of the tumor and adjacent structures are sufficient for resolution. Nowadays, videothoracoscopy (VTC) allows adequate access for the surgical treatment of these tumors. CD34 antigen positivity is a differential feature with mesothelioma. We present our experience with 15 patients with SFTP (nine women and six men) who underwent surgical resection in the last 12 years (10 thoracotomies, one sternotomy and four VTC). Only four patients were symptomatic at diagnosis. In our opinion, VTC is a less invasive diagnostic and therapeutic approach than thoracotomy that provides an adequate approach for the resection of SFTP in selected patients. Because of the malignant potential of this tumor, long-term follow-up is mandatory.

Inmunohistoquímica y vías de abordaje en el tumor fibroso pleural / Inmunohistochemistry and surgical approaches in solitary fibrous tumor of the pleura

El tumor fibroso pleural (TFP) es una neoplasia benigna poco frecuente, de crecimiento lento, que se origina a partir de las células submesoteliales de la pleura. Habitualmente, la resección del tumor y de las estructuras adyacentes, si están afectadas, suele ser suficiente para su resolución. Actualmente, la videotoracoscopia (VTC) permite un acceso adecuado para el tratamiento de estos tumores. La positividad para CD34 es un rasgo diferencial con el mesotelioma. Se presentan 15 casos de TFP (9 mujeres y 6 varones) intervenidos en nuestro servicio en los últimos 12 años (10 toracotomías, 1 esternotomía y 4 mediante VTC). Sólo 4 casos presentaron síntomas al diagnóstico. Se plantea la VTC como un método diagnóstico y terapéutico, menos invasivo que la toracotomía, que permite un abordaje adecuado para la resección del TFP, en casos seleccionados. El seguimiento a largo plazo es obligado, dado su potencial maligno (AU)

Solitary fibrous tumor of the pleura (SFTP) is a rare, benign, slow-growing neoplasm that arises from the submesothelial cells of the pleura. Usually, resection of the tumor and adjacent structures are sufficient for resolution. Nowadays, videothoracoscopy (VTC) allows adequate access for the surgical treatment of these tumors. CD34 antigen positivity is a differential feature with mesothelioma. We present our experience with 15 patients with SFTP (nine women and six men) who underwent surgical resection in the last 12 years (10 thoracotomies, one sternotomy and four VTC). Only four patients were symptomatic at diagnosis. In our opinion, VTC is a less invasive diagnostic and therapeutic approach than thoracotomy that provides an adequate approach for the resection of SFTP in selected patients. Because of the malignant potential of this tumor, long-term follow-up is mandatory (AU)

Carcinoma insular de tiroides. Una neoplasia poco frecuente pero agresiva / Insular carcinoma of the thyroid. An uncommon but aggressive neoplasm

El carcinoma insular de tiroides es una entidad infrecuente, denominada así por Carcangiu et al, en 1984, cuando describió su característica anatomía patológica. Desde un punto de vista morfológico, y también clínico, se le considera en una posición intermedia entre el carcinoma diferenciado de tiroides, papilar o folicular, y el indiferenciado o anaplásico. No obstante, la mayoría de los autores lo consideran una entidad independiente y aparte. Su pronóstico es peor que el del carcinoma tiroideo clásico, y la mayoría de los autores recomienda un tratamiento enérgico, que en algunos casos puede proporcionar supervivencias prolongadas. Presentamos a 2 pacientes que, tras el tratamiento de un tumor primario, sufrieron recidiva, que fue tratada, pero con una evolución diferente (AU)

Insular carcinoma of the thyroid is an infrequent entity, named in 1984 by Carcangiu when he described its characteristic histology. Clinically and morphologically it is considered to be in an intermediate position between well-differen-tiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. However, most authors believe it to be an independent entity. The prognosis of this tumor is worse than that of classic carcinoma of the thyroid, and most authors advise aggressive therapy, which in some cases can achieved prolonged survival. We describe 2 patients who experienced recurrence after treatment for the primary tumor. The recurrences were treated but the clinical courses differed (AU)

[Thoracic surgery]. / Cirugía torácica.

Thirty-two patients with shock wave lesions to the chest who did not require invasive ventilatory support were treated. The Injury Severity Score (median 13), the pO2/FiO2 ratio (350) and lung injury severity (Murray score 1.25) were analyzed. Symptoms, mainly chest pain, depended on the severity of barotrauma and respiratory distress. All the lesions developed in the first 24 hours and most patients (75%) presented lung contusion. Although patients with lung contusion had greater intra- and extrathoracic comborbidity, differences in comparison with those without lung contusion were not significant, except in length of hospital stay (13 days vs 5.5 days; p = 0.008). Costal fractures were found in 12 patients (37%), mostly in the first 3 ribs and 60% of the patients had reduction of the upper thoracic contour (traumatic apical thoracoplasty). Outcomes were satisfactory with no mortality.

Cirugía Torácica / Thoracic Surgery

Nuestro servicio trató a 32 pacientes con traumatismo torácico por onda expansiva que no necesitaban soporte ventilatorio invasivo. Se analizan el Injury Severity Score (mediana de 13), la relación presión parcial de oxígeno/fracción inspiratoria de oxígeno (mediana de 350) y la gravedad de la lesión pulmonar observada (mediana de 1,25 en el índice de Murray). La clínica, dominada por el dolor torácico, dependió de la intensidad del barotrauma y del distrés respiratorio. Todas las lesiones aparecieron en las primeras 24 h y la mayoría de los pacientes (75%) presentaban contusión pulmonar. Aunque los pacientes con contusión pulmonar presentan mayor comorbilidad, intra y extratorácica, las diferencias no son significativas respecto a los que no la tienen, salvo en la estancia hospitalaria (13 frente a 5,5 días; p = 0,008). Aparecieron fracturas costales en 12 pacientes (37%), la mayoría en las 3 primeras costillas y en el 60% de los casos con disminución del contorno torácico superior (toracoplastia traumática apical). La evolución ha sido satisfactoria, sin mortalidad (AU)

Thirty-two patients with shock wave lesions to the chest who did not require invasive ventilatory support were treated. The Injury Severity Score (median 13), the pO2/FiO2 ratio (350) and lung injury severity (Murray score 1.25) were analyzed. Symptoms, mainly chest pain, depended on the severity of barotrauma and respiratory distress. All the lesions developed in the first 24 hours and most patients (75%) presented lung contusion. Although patients with lung contusion had greater intra- and extrathoracic comborbidity, differences in comparison with those without lung contusion were not significant, except in length of hospital stay (13 days vs 5.5 days; p = 0.008). Costal fractures were found in 12 patients (37%), mostly in the first 3 ribs and 60% of the patients had reduction of the upper thoracic contour (traumatic apical thoracoplasty). Outcomes were satisfactory with no mortality (AU)

[Insular carcinoma of the thyroid. An uncommon but aggressive neoplasm]. / Carcinoma insular de tiroides. Una neoplasia poco frecuente pero agresiva.

Insular carcinoma of the thyroid is an infrequent entity, named in 1984 by Carcangiu when he described its characteristic histology. Clinically and morphologically it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. However, most authors believe it to be an independent entity. The prognosis of this tumor is worse than that of classic carcinoma of the thyroid, and most authors advise aggressive therapy, which in some cases can achieved prolonged survival. We describe 2 patients who experienced recurrence after treatment for the primary tumor. The recurrences were treated but the clinical courses differed.