Hematoma hepático subcapsular espontáneo en gestantes / Spontaneous subcapsular hepatic hematoma in pregnant patients

El hematoma hepático subcapsular espontáneo (HHSE) en gestantes, con o sin historia previa de preeclampsia, eclampsia o síndrome HELLP, es una enfermedad poco frecuente durante la gestación y el puerperio (1/45.000-1/225.000 embarazos). Su importancia para el anestesiólogo radica en que asocia una elevada morbimortalidad materna (60-86% y 39%) y neonatal (42%). Tras la sospecha clínica, el diagnóstico de certeza se establece mediante diversas pruebas de imagen; sin embargo, en la mayoría de los casos el diagnóstico del HHSE es un hallazgo casual intraoperatorio asociado a un compromiso materno o fetal. Hoy en día la actuación obstétrica y anestésica ante un HHSE no está estandarizada y depende de su integridad, la estabilidad hemodinámica materna, así como el periodo gestacional en el momento del diagnóstico. La posibilidad de una hemorragia aguda crítica con necesidad de transfusión masiva hace recomendable disponer de protocolos actualizados del tratamiento de la hemorragia obstétrica, adecuándolos a las peculiaridades clínicas de estas pacientes. Tras la fase aguda se debe prestar atención a las complicaciones tromboembólicas.(AU)

Spontaneous subcapsular hepatic hematoma (SSHH) with or without previous history of preeclampsia and/or HELLP syndrome represents a very rare pathological condition in pregnancy and postpartum (1/45,000-1/225,000 pregnancies). Its importance for the anesthesiologist lays in its association with high morbidity and mortality for the mother (60-86%, 39%) and newborn (42%). After a high clinical suspicion, the certainty clinical diagnosis is settled by different imaging techniques. However, in most cases the diagnosis of SSHH is a casual intraoperative finding associated to a maternal or fetal compromise. Nowadays the obstetric and anesthetic management of a SSHH is not standardized and depends on its integrity, hemodynamic stability and the gestational period when diagnosed. The possibility of an acute critic hemorrhage with necessity of massive transfusion, makes advisable to provide updated protocols for the treatment of obstetric hemorrhage, adapting them to the clinical peculiarities of these patients. After the acute phase, close attention should be kept on thromboembolic complications.(AU)

Spontaneous subcapsular hepatic hematoma in pregnant patients.

Spontaneous subcapsular hepatic hematoma (SSHH) with or without previous history of preeclampsia and/or HELLP syndrome represents a very rare pathological condition in pregnancy and postpartum, (1/45,000-1/225,000 pregnancies). Its importance for the anesthesiologist lays in its association with high morbidity and mortality for the mother (60-86%, 39%) and newborn (42%). After a high clinical suspicion, the certainty clinical diagnosis is settled by different imaging techniques. However, in most cases the diagnosis of SSHH is a casual intraoperative finding associated to a maternal or foetal compromise. Nowadays the obstetric and anaesthetic management of a SSHH is not standardized and depends on its integrity, hemodynamic stability and the gestational period when diagnosed. The possibility of an acute critic haemorrhage with necessity of massive transfusion, makes advisable to provide updated protocols for the treatment of obstetric hemorrhage, adapting them to the clinical peculiarities of these patients. After the acute phase, close attention should be kept on thromboembolic complications.

Absceso pulmonar por Pseudomonas aeruginosa en paciente / No disponible

En los pacientes inmunodeprimidos, entre las causa más frecuentes de absceso pulmonar se encuentra la Pseudomonas aeruginosa. Para el diagnóstico etiológico de absceso pulmonar necesitamos que la radiografía de tórax muestre un infiltrado con cavitación superior a 2 cm y que exista documentación microbiológica que determinará la elección del tratamiento antibiótico adecuado. En el caso de que el absceso sea por P. aeruginosa, resultará más complicado porque los antibióticos empíricamente indicados no suelen ir dirigidos específicamente a esta bacteria. Presentamos un caso de una paciente de 78 años con esclerosis sistémica y neumopatía intersticial no específica en tratamiento inmunosupresor que presentó un absceso pulmonar por P. aeruginosa de instauración brusca y de evolución tórpida

In the inmunocompromised patients, among the most common cause of lung abscess stand out Pseudomonas aeruginosa. For a etiologic diagnosis of lung abscess we need the thorax radiograph to show a pulmonary infiltrate with a cavitatiom with a depth of at least 2 cm and microbiological documentation, which will define which is the best antibiotic therapy. If the lung abscess is caused by the bacteria P. aeruginosa, its treatment will be more difficult because empirically recommended antibiotics barely target this bacteria. We present a 78-years-old female patient with systemic sclerosis and nonspecific interstitial pneumonia, who is receiveing an immunosuppressive treatment. She was diagnosed with a P. aeruginosa lung abscess which had a sudden onset and a bad evolution

[Pulmonary MALT lymphoma and paraneoplastic syndromes]. / Lymphome du MALT pulmonaire et syndromes paranéoplasiques.

INTRODUCTION: Primary pulmonary lymphoma is a rare disease; diagnosis is often delayed because of atypical clinical presentation and slow progression. OBSERVATION: A 42-year-old woman consulted because of haemoptysis. Chest CT-scan showed multiple nodular calcified masses. A lung biopsy led to the diagnosis of pulmonary amyloidosis with pulmonary MALT lymphoma (mucosa-associated lymphoid tissue). The patient developed two paraneoplastic syndromes: a hypertrophic osteoarthropathy and mucinosis. CONCLUSION: Multiple nodular amyloidosis can be a mode of presentation for pulmonary lymphoma. Paraneoplastic syndromes must be systematically considered and can help in early diagnosis of the disease and its relapse.

[Paucisymptomatic presentation of an allergic bronchopulmonary aspergillosis]. / Une aspergillose broncho-pulmonaire allergique de présentation pauci-symptomatique.

Clinical atypical presentations of rare lung disease can cause a diagnostic issue. In this case report, allergic bronchopulmonary aspergillosis is not like in the traditional form of severe asthma but is revealed by a persistent cough. CT scan and biological examinations should be prescribed when there is doubt in confirming the diagnosis. Diagnostic and therapeutic management should be done early in this disease to avoid complications such as bronchiectasis.

Upper-limb muscular electrical stimulation driven by EEG-based detections of the intentions to move: a proposed intervention for patients with stroke.

This study proposes an intervention for stroke patients in which electrical stimulation of muscles in the affected arm is supplied when movement intention is detected from the electroencephalographic signal. The detection relies on the combined analysis of two movement related cortical patterns: the event-related desynchronization and the bereitschaftspotential. Results with two healthy subjects and three chronic stroke patients show that reliable EEG-based estimations of the movement onsets can be generated (on average, 66.9 ± 26.4 % of the movements are detected with 0.42 ± 0.17 false activations per minute) which in turn give rise to electrical stimuli providing sensory feedback tightly associated to the movement planning (average detection latency of the onsets of the movements was 54.4 ± 287.9 ms).

[Comparison of home-based and outpatient, hospital-based, pulmonary rehabilitation in patients with chronic respiratory diseases]. / La réhabilitation respiratoire : évaluation de deux types de prise en charge, ambulatoire versus domicile.

INTRODUCTION: The comprehensive care and personalized pulmonary rehabilitation (PR) of patients with chronic respiratory disease is effective regardless of the place of performance. The objective of this prospective observational study was to compare two types of care in an outpatient rehabilitation center, versus a home-based PR. METHODS: Two hundred and eighty-six patients were supported : 137 patients were included in outpatients (age : 61.2±10.8years, BMI: 28.7±7.1), 149 in home-based PR (age: 62.9±12years, BMI: 26.1±6.6). The choice between outpatient and home was a function of distance from the center and the patient's wishes. The outpatient care was done in groups of six, four times a week for 6weeks. At home she was single, once a week for 8weeks with continued physical activity independently of the other days a week depending on individual action plan. The therapeutic education programs and psycho-social support were identical in both structures. The assessment included assessment of exercise tolerance test in 6minutes stepper (TS6), anxiety and depression and quality of life. RESULTS: There were no incidents or accidents during the PR in the two structures. The exercise intolerance was significantly higher in patients TS6 home (332.9±154.8 versus 460.2±137.9 counts, P<0.01). All the parameters studied, except for HAD score in the center, were improved significantly (P<0.001) after the course. The evolution of the different scores was not significantly different between the ambulatory versus home. CONCLUSION: The PR of chronic respiratory unselected patients is as safe and effective at home or in outpatient center on exercise tolerance and quality of life. Home-based PR is an alternative to outpatient care as long as all activities, physical training, therapeutic education and psychosocial support, are achieved.

[Colorectal polyps: update on diagnosis]. / Pólipos colorectales: actualización en el diagnóstico.

Histological diagnosis determines the clinical behavior of colorectal polyps. Recently new types of polyps have been described and the classification has become wider and more complex. Our aim is update the current concepts in the knowledge of colorectal polyps.

Pólipos colorectales: actualización en el diagnóstico / Colorectal polyps: update in the diagnosis

El diagnóstico histológico de los pólipos colorrectales determina la conducta que tomará el médico especialista con el paciente. Con la aparición de nuevos pólipos en los últimos años, la clasificación histológica se ha tornado más compleja y amplia. Nuestro objetivo es actualizar los conceptos en el diagnóstico histológico de pólipos de colon de una manera clara y de fácil comprensión, especialmente para gastroenterólogos y patólogos.

Histological diagnosis determines the clinical behavior of colorectal polyps. Recently new types of polyps have been described and the classification has become wider and more complex. Our aim is update the current concepts in the knowledge of colorectal polyps.

Incremento de linfocitos intraepiteliales en pacientes con sindrome de intestino irritable / Increase of intraepithelial lymphocytes in patients with irritable bowel syndrome

Diversos trabajos reportan aumento en el número de linfocitos intraepiteliales (LIE), mastocitos y células enterocromafines en pacientes con Sindrome de Intestino Irritable (SII). Muchos de estos hallazgos se basan en el uso de inmunohistoquímica que son de poca disponibilidad en hospitales generales. El objetivo del presente trabajo es estudiar los hallazgos histológicos en la biopsia de colon sólo con histoquimica en pacientes con SII comparándolos con un grupo sin SII. Fueron incluidos 25 pacientes: 16 (64%), con criterios diagnósticos de SII y 9 (36%), sin SII. Se encontró un mayor número de LIE en el grupo de SII (p=0,002). Un grupo de pacientes con criterios Roma III (41,9%) presentó LIE en el rango de Colitis Linfocitica por lo que fueron excluidos de este estudio. No se encontró diferencia estadísticamente significativa en el número de mastocitos, células enterocromafines y eosinofilos.

Several studies have shown increased numbers of intraepithelial lymphocytes (IEL), mast cells, enterochromaffin cells in colonic mucosa of patients with Irritable Bowel Syndrome (IBS). Many of these findings are based is based on immunohistochemistry results, which is not available in general hospitals. Our objective is to study the histological findings observed in colon biopsies from patients with IBS compared with a group without IBS, using only histochemistry. Twenty five (25) patients were included: 16 with IBS and 9 without IBS. We found increased numbers of IEL in patients with IBS (p=0,002). A group of patients with IBS(41.9%) who fulfilled histological criteria for lymphocytic colitis were excluded. There was no significant difference in mast cells, enterochromaffin cells or eosinophils.

[Increase of intraepithelial lymphocytes in patients with irritable bowel syndrome]. / Incremento de Linfocitos Intraepiteliales en Pacientes con Sindrome de Intestino Irritable.

Several studies have shown increased numbers of intraepithelial lymphocytes (IEL), mast cells, enterochromaffin cells in colonic mucosa of patients with Irritable Bowel Syndrome (IBS). Many of these findings are based is based on immunohistochemistry results, which is not available in general hospitals. Our objective is to study the histological findings observed in colon biopsies from patients with IBS compared with a group without IBS, using only histochemistry. Twenty five (25) patients were included: 16 with IBS and 9 without IBS. We found increased numbers of IEL in patients with IBS (p=0,002). A group of patients with IBS (41.9%) who fulfilled histological criteria for lymphocytic colitis were excluded. There was no significant difference in mast cells, enterochromaffin cells or eosinophils.

Low serological positivity in patients with histology compatible with celiac disease in Perú.

OBJECTIVE: To study the frequency of positive serology for celiac disease (CD) in patients with duodenal biopsies suggestive of this disease. MATERIAL AND METHODS: Cross sectional study. We included patients with duodenal biopsies histologically compatible with CD and antigliadin, antiendomysial and IgA antitransglutaminase antibodies. We defined a "case" of CD if there was a positive biopsy and either antiendomisial or antitransglutaminase positive antibodies. RESULTS: Thirty one patients were included in our study. Six were antiendomysial positive and 5 antitransglutaminase positive while the antigliadin was positive in 14 cases. Therefore, out of 31 patients only 10 had a serology compatible with CD and only one had positive both antibodies, antiendomysial and antitransglutaminase. CONCLUSIONS: a) We have found that most of the duodenal biopsies compatible with CD are not diagnosed with positive serology; and b) we found a low correlation between serological diagnostic tests.

Baja frecuencia de positividad serológica en pacientes con biopsias histológicamente compatibles con enfermedad celiaca en Perú / No disponible

Objetivo: estudiar la frecuencia de positividad de las pruebasserológicas en pacientes con biopsias compatible con enfermedadceliaca.Material y métodos: estudio transversal. Se incluyeron pacientescon biopsia duodenal histológicamente compatible con enfermedadceliaca y determinación de anticuerpos antigliadina, antiendomisioy antitransglutaminasa IgA. Definimos como caso deenfermedad celiaca a quienes tuvieran biopsia positiva y anticuerposantiendomisio y/o antitransglutaminasa positivos.Resultados: 31 pacientes fueron incluidos de los cuales 6 fueronantiendomisio positivo, 5 fueron antitransglutaminasa positivoy antigliadina fue positivo en 14. Por lo tanto de 31 pacientes concambios histológicos compatibles con enfermedad celiaca sólo 10tuvieron serología diagnóstica. Sólo uno de los pacientes tuvo positividadtanto para antitransglutaminasa como para antiendomisio.Conclusiones: a) encontramos que la mayoría de biopsias deduodeno con un cuadro histológico sugerente de enfermedad celiacano se corresponden con serología diagnóstica de esta enfermedad;b) encontramos baja coincidencia en la positividad serológicaentre antiendomisio y antitransglutaminasa(AU)

Objective: to study the frequency of positive serology for celiac disease (CD) in patients with duodenal biopsies suggestive of this disease. Material and methods: cross sectional study. We included patients with duodenal biopsies histologically compatible with CD and antigliadin, antiendomysial and IgA antitransglutaminase antibodies. We defined a “case” of CD if there was a positive biopsy and either antiendomisial or antitransglutaminase positive antibodies. Results: thirty one patients were included in our study. Six were antiendomysial positive and 5 antitransglutaminase positive while the antigliadin was positive in 14 cases. Therefore, out of 31 patients only 10 had a serology compatible with CD and only one had positive both antibodies, antiendomysial and antitransglutaminase. Conclusions: a) we have found that most of the duodenal biopsies compatible with CD are not diagnosed with positive serology; and b) we found a low correlation between serological diagnostic tests(AU)

[Inflamatory polyps of the colon an evaluation]. / Polipos inflamatorios de colon: reporte de casos y revisión de literatura.

AIM: We report our experience with Inflammatory Polyps of the Colon. METHODS: Retrospective study including all polyps diagnosed at the Arias Stella Pathology Institute, Lima in the year 2008. Inflammatory polyps were diagnosed as polyp composed of reactive epithelium without dysplasia, inflamed granulation tissue. RESULTS: We found 887 polyps of which 2.3% were inflammatory polyps. One out of three were located in the sigmoid colon, and 63% had no underlying colonic disease. CONCLUSION: Inflammatory polyps are rare among colonic polyps and most patients have no accompanying colonic disease.

Pólipos Inflamatorios de Colon Reporte de Casos y Revision de Literatura / Inflamatory polyps of the colon an evaluation

OBJETIVOS: Reportar nuestra experiencia con los pólipos inflamatorios de colon. METODOLOGIA: Estudio retrospectivo que incluyó todos los pólipos colónicos diagnosticados en el Instituto Arias Stella, Lima en el año 2008. Los pólipos Inflamatorios fueron definidos como todo pólipo compuesto por criptas distorsionadas tapizadas porepitelio sin displasia, tejido de granulación e inflamación. RESULTADOS Encontramos 887 pólipos de los cuales los pólipos Inflamatorios (20) representaron el 2,3 por ciento, del total 30 por ciento de ellos se presentaron en colon sigmoides y la mayoría (63 por ciento) no presentaron patología concomitante. CONCLUSIÓN Los pólipos Inflamatorios son raros entre los pólipos colónicos y la mayoría de los pacientes no tienen patología colónica acompañante.

AIM: We report our experience with Inflammatory Polyps of the Colon. METHODS: Retrospective study including all polyps diagnosed at the Arias Stella Pathology Institute, Lima in the year 2008. Inflammatory polyps were diagnosed as polyp composed of reactive epithelium without dysplasia, inflamed granulation tissue. RESULTS: We found 887 polyps of which 2.3 per cent were inflammatory polyps. One out of three were located in the sigmoidcolon, and 63 per cent had no underlying colonic disease. CONCLUSION: Inflammatory polyps are rare among colonic polyps and most patients have no accompanying colonic disease.

[Colon biopsy--histological characteristics in different types of chronic colitis]. / Biopsia de colon: características histológicas en diferentes tipos de colitis crónica.

In the last few years a variety of new forms of chronic colitis have been described with defined histological characteristics. It is important both for the gastroenterologists and pathologists to be acquainted with this new clinic pathological entities. The present article is a review of the anatomo-pathological characteristics of the different types of colitis.

Biopsia de Colon: Características Histológicas en diferentes tipos de Colitis Crónica / Biopsy of Colon: histological features in different types of Chronicle Colitis

En los últimos años han aparecido diferentes tipos de colitis con características histológicas definidas. Es importante que tanto el gastroenterólogo como el patólogo estar actualizados respecto a estas nuevas entidades clínico-patológicas. El presente trabajo es un artículo de revisión sobre las características histopatológicas de los diferentes tipos de colitis.

In the last few years a variety of new forms of chronic colitis have been described withdefined histological characteristics. It is important both for the gastroenterologists andpathologists to be acquainted with this new clinic pathological entities.The present article is a review of the anatomo-pathological characteristics of the differenttypes of colitis.

Inmunoexpresión de p53 y ciclina D1 en adenomas de vesícula biliar / No disponible

Introducción: el adenoma de vesícula biliar es una neoplasiainfrecuente, cuya relación con el adenocarcinoma es poco conocida,aunque algunos autores han propuesto que la mayoría de adenomasno degeneran en adenocarcinomas, debido a que ambaslesiones presentan vías moleculares diferentes.Material y métodos: el presente trabajo es un estudio transversalque compara las características moleculares del adenoma yadenocarcinoma de vesícula biliar, mediante la medición inmunohistoquímicade la expresión de las proteína p53 y ciclina D1(ambas reguladoras del ciclo celular) en 12 enfermos de cada grupo.Resultados: encontramos una mayor expresión de p53 enlos adenocarcinomas (83,3%) que en los adenomas (16,6%) siendoesta diferencia estadísticamente significativa usando el test dechi cuadrado (p = 0,003), mientras que la expresión de ciclina D1en ambos grupos fue similar.Conclusión: consideramos que nuestros resultados indicanque la alteración en el p53 es un paso importante en el desarrollode los adenocarcinomas de vesícula biliar, mientras que en el desarrollode los adenomas, la alteración del p53 sería poco trascendente.Por otro lado, la sobreexpresión de ciclina D1 sería un mecanismomolecular común a ambas lesiones

Introduction: gallbladder adenomas are infrequent neoplasmswhose relation to adenocarcinoma is not well understood.It has been suggested that adenomas and adenocarcinomas followdifferent molecular pathways.Material and methods: this is a comparative, cross-sectionalstudy in which we compared p53 and D1 cyclin expression inadenomas and adenocarcinomas of the gallbladder.Results: we included 12 cases in each group. Expression ofp53 occurred in 83.3% of adenocarcinomas and in 16.6% ofadenomas (p = 0.003). D1 cyclin was expressed in a similar numberof adenomas and adenocarcinomas.Conclusion: our results support the hypothesis that p53 is animportant step in the pathogenesis of adenocarcinomas but not ofadenomas of the gallbladder. D1 cyclin is apparently a commonpathway involved in the genesis of both tumors (AU)

[E-cadherin molecular expresion in the diffuse and intestinal types of gastric adenocarcinoma. A report from Lima, Peru]. / E-cadherina: expresión molecular en carcinomas de estómago de tipo difuso y tipo intestinal. Estudio realizado en Lima, Perú.

OBJECTIVE: Signet ring carcinoma of the stomach is well known to be more aggressive and infiltrating than adenocarcinoma. Different studies have proposed that signet ring cell carcinoma would be more infiltrating because of the loss of E-cadherin expression, this cadherin is a class of protein cell membrane protein which plays an important role in cell-adhesion. METHODS: We carried out a transversal comparative study, in order to measure the E-cadherin expression in 10 cases of signet ring cell and in 10 cases of adenocarcinoma, with help of immunohistochemistry. RESULTS: We found a bigger expression of E-cadherin in adenocarcinomas (100%) than signet ring cell carcinoma (40%), this difference was significative using Fisher test (p = 0,011). The loss of E-cadherin would explain the bigger infiltrating capacity in comparison to adenocarcinoma.