ABSTRACT
Mesenteric or retroperitoneal actinomycosis is an extremely rare disease. The international databases have revealed only 10 cases affecting the mesenterium and another 52 cases affecting the retroperitoneum. We report a 78-year-old female who was admitted with complaints of abdominal pain. Laboratory examination revealed anemia and the clinical examination revealed an irregular mass in the abdomen. Ultrasound and computed tomography (CT) scans showed a solid mass in the mesenteric-retroperitoneal region. Biopsy of the nonresectable mass revealed the presence of chronic inflammation in the mesenteric area with Actinomyces colonies. The patient was treated with oral amoxicillin, 500 mg every 6 hours for 6 months. The symptoms disappeared, but the mesenteric-retroperitoneal mass remains, but smaller in size. Based on the review of the literature and the case reported here, we conclude that mesenteric-retroperitoneal actinomycosis is difficult to diagnose by means of noninvasive techniques as it can masquerade as a malignant process. An accurate diagnosis is always obtained in a histological or microbiological examination, often requiring surgical intervention. Treatment with penicillin has proven to be effective.
Subject(s)
Actinomycosis/diagnosis , Mesentery/microbiology , Retroperitoneal Space/microbiology , Actinomycosis/diagnostic imaging , Actinomycosis/drug therapy , Aged , Amoxicillin/therapeutic use , Diagnosis, Differential , Female , Humans , Penicillins/therapeutic use , Tomography, X-Ray ComputedABSTRACT
Introducción. La elastasa polimorfonuclear es una proteasa localizada en los lisosomas de los leucocitos polimorfonucleares que se libera como mecanismo de defensa para eliminar los productos de degradación tisular en el lugar de la inflamación. En este trabajo se evalúa la utilidad de la determinación de la elastasa como factor pronóstico en pacientes con pancreatitis aguda. Pacientes y método. Se realiza un estudio prospectivo sobre la utilidad de la medida de la elastasa en una serie de 31 pacientes con pancreatitis aguda. Se les efectuó, dentro de los primeros 3 días del ingreso hospitalario, la determinación de hemograma, bioquímica, elastasa polimorfonuclear y proteína C reactiva, además de la evaluación clínica -mediante criterios de Ranson- como grave y leve. Resultados. Se ha encontrado una serie de 7 pacientes con una elastasa media (ñ DE) de 301 ñ 277 µg/l y proteína C reactiva de 14,3 ñ 17,1 mg/dl, que se asocian a una evolución tórpida. En los otros 24 pacientes, la elastasa fue 109 ñ 115 µg/l, y proteína C reactiva de 4,84 ñ 5,87 mg/dl, presentando una evolución favorable. Conclusiones. Existen diferencias significativas entre los dos grupos en ambos parámetros. Tanto la elastasa polimorfonuclear como la proteína C reactiva, junto con otros datos clínicos y el recuento leucocitario, constituyen unos parámetros útiles para diferenciar las pancreatitis agudas graves de las leves (AU)
Subject(s)
Female , Male , Humans , Leukocyte Elastase/analysis , Leukocyte Elastase/pharmacokinetics , Leukocyte Elastase/metabolism , Leukocyte Elastase , C-Reactive Protein/analysis , C-Reactive Protein/pharmacokinetics , C-Reactive Protein/metabolism , C-Reactive Protein , Leukocyte Count/methods , Leukocyte Count/instrumentation , Pancreatitis, Acute Necrotizing/complications , Pancreatitis, Acute Necrotizing/diagnosis , Pancreatitis, Acute Necrotizing/blood , Pancreatic Elastase/analysis , Pancreatic Elastase/metabolism , Pancreatic Elastase , Clinical Enzyme Tests/methods , Clinical Enzyme Tests , Clinical Enzyme Tests/trends , Prospective Studies , Prognosis , Amyloid/analysis , Amyloid/metabolism , Haptoglobins/analysis , Haptoglobins/metabolism , Ceruloplasmin/analysis , Ceruloplasmin/metabolism , Leukocytes/metabolism , Risk FactorsABSTRACT
We present two cases of inguinoscrotal hernia that contains stomach, both associated with a chronic obstructive pulmonary disease; one of them is shown with a intermittent gastric obstruction syndrome, the other being a radiological finding in a patient with dispeptic symptoms. The first one died of a respiratory infection, before operation, and the second refused operation because of his scarce symptomatology. A review of the literature shows 60 cases reported including our cases.
