Derrame pleural masivo como forma de presentación de un tumor de Krukenberg. Linfangitis carcinomatosa secundaria / Massive pleural effusion as a form of presentation of a Krukenberg tumor. Secondary carcinomatous lymphangitis

Presentamos el caso clínico de una paciente joven que acudió a Urgencias por disnea, objetivándose en la radiografía de tórax un derrame pleural derecho masivo y en la ecografía transvaginal, efectuada tras el hallazgo de un test de embarazo positivo, una masa ovárica. En la TC toraco-abdominal se observó, además, un engrosamiento de la mucosa gástrica, que fue valorado mediante gastroscopia, siendo la biopsia positiva para adenocarcinoma de células en anillo de sello. Ante estos hallazgos se confirmó el diagnóstico de tumor de Krukenberg, entidad poco frecuente con una forma de presentación también excepcional en forma de falso síndrome de Meigs. Una vez iniciado el tratamiento sistémico la paciente presentó, como una complicación de su enfermedad de base, hallazgos compatibles con una linfangitis carcinomatosa, que condicionó la necesidad de oxigenoterapia domiciliaria

We present the clinical case of a young patient who came to the emergency department due to dyspnea, showing a massive right pleural effusion on the chest radiograph and an ovarian mass on the transvaginal ultrasound, performed after the finding of a positive pregnancy test. In the thoraco-abdominal CT scan, a thickening of the gastric mucosa was also observed, which was valued by gastroscopy, with a positive biopsy for adenocarcinoma of cells in the signet ring. Given these findings, the diagnosis of Krukenberg tumor was confirned, a rare entity with an exceptional form of presentation in the form of false Meigs syndrome. Once the systemic treatment was begun the patient presented, as a complication of the underlying disease, findings compatible with a carcinomatous lymphangitis, which conditioned the need for home oxygen therapy

Manejo de la anemia perioperatoria en paciente con aloanticuerpos programada para esofagectomía / Management of peri-operative anaemia in a patient with rare alloantibodies scheduled for oesophagectomy

Describimos el manejo de una paciente programada para esofagectomía por neoplasia a la que durante el proceso de reserva de hemoderivados le fueron detectados aloanticuerpos, que prácticamente imposibilitaban la obtención de sangre compatible. El manejo de la anemia perioperatoria («patient blood management») se debe realizar rutinariamente en los pacientes quirúrgicos con riesgo de transfusión. Esta estrategia se ha considerado como una de las medidas a tener en cuenta en la rehabilitación multimodal quirúrgica o programa de recuperación intensificada

A description is presented on the management of a patient with an oesophageal neoplasm scheduled for oesophagectomy. Alloantibodies were detected during a blood components reservation procedure, which made it almost impossible to obtain compatible blood. Peri-operative anaemia management or "Patient Blood Management" should be routinely performed in all patients at transfusion risk. This strategy has been considered as one of the actions to bear in mind in fast-track surgery or enhanced recovery after surgery

Management of peri-operative anaemia in a patient with rare alloantibodies scheduled for oesophagectomy. / Manejo de la anemia perioperatoria en paciente con aloanticuerpos programada para esofagectomía.

A description is presented on the management of a patient with an oesophageal neoplasm scheduled for oesophagectomy. Alloantibodies were detected during a blood components reservation procedure, which made it almost impossible to obtain compatible blood. Peri-operative anaemia management or "Patient Blood Management" should be routinely performed in all patients at transfusion risk. This strategy has been considered as one of the actions to bear in mind in fast-track surgery or enhanced recovery after surgery.

Síndrome de piernas inquietas e hipotiroidismo / Restless legs syndrome and hypothyroidism

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Determination of non-steroidal anti-inflammatory drugs in urine by the combination of stir membrane liquid-liquid-liquid microextraction and liquid chromatography.

A stir membrane liquid phase microextraction procedure working under the three-phase mode is proposed for the first time for the determination of six anti-inflammatory drugs in human urine. The target compounds are isolated and preconcentrated using a special device that integrates the extractant and the stirring element. An alkaline aqueous solution is used as extractant phase while 1-octanol is selected as supported liquid membrane solvent. After the extraction, all the analytes are determined by liquid chromatography (LC) with ultraviolet detection (UV). The analytical method is optimized considering the main involved variables (e.g., pH of donor and acceptor phases, extraction time, stirring rate) and the results indicate that the determination of anti-inflammatory drugs at therapeutic and toxic levels is completely feasible. The limits of detection are in the range from 12.6 (indomethacin) to 30.7 µg/L (naproxen). The repeatability of the method, expressed as relative standard deviation (RSD, n = 5) varies between 3.4% (flurbiprofen) and 5.7% (ketoprofen), while the enrichment factors are in the range from 35.0 (naproxen) to 72.5 (indomethacin).