Síndrome de Behçet como diagnóstico diferencial de las úlceras genitales / Behçet's syndrome: Differential diagnosis with genital ulcers

La presencia de una úlcera genital inespecífica es el signo guía de diversas entidades clinicopatológicas. Las enfermedades de transmisión sexual son la causa más frecuente y conocida. Sin embargo, las úlceras genitales además de origen infeccioso pueden ser manifestación de una neoplasia, o de una enfermedad sistémica con afectación genital, como el síndrome de Behçet, que incluye en sus criterios diagnósticos las úlceras genitales recidivantes. Presentamos el caso de una paciente diagnosticada de síndrome de Behçet, entidad a considerar ante un cuadro de úlceras genitales de repetición

A nonspecific genital ulcer can be the first manifestation of several diseases. The best-known and most frequent cause of these ulcers is sexually transmitted diseases. Nevertheless, genital ulcers can also be a manifestation of a neoplasm or a systemic disease with genital involvement, such as Behc¸et syndrome, in which one of the diagnostic criteria is relapsing genital ulcers. We present the case of a patient diagnosed with Behc¸ et’s syndrome, an entity that should be included in the differential diagnosis of patients with recurrent genital ulcers

[Adrenal gland myelolipoma: radiological view]. / Mielolipoma suprarrenal: una visión radiológica.

OBJECTIVE: To report a case of adrenal myelolipoma in a female patient with a history of arterial hypertension and increased plasma aldosterone levels. METHODS: Evaluation by CT and ultrasound, and anatomopathological analysis were performed. RESULTS: The CT and ultrasound scans showed a fat-containing adrenal mass. The patient underwent surgery. Histological analysis of the surgical specimen demonstrated a myelolipoma, a benign tumor composed in varying proportions of adipose and hematopoietic tissue. CONCLUSIONS: A diagnosis of adrenal myelolipoma must be considered when a fat-containing adrenal mass is demonstrated by ultrasound, CT or MRI.

[ST-segment and myocardial enzymes evolution during myocardial infarction after fibrinolysis therapy and its relation with postinfarction angina, Killip class and mortality in intensive unit care]. / Evolución del segmento ST y las enzimas cardíacas en el infarto agudo de miocardio con fibrinólisis y su relación con la angina postinfarto, el índice de Killip y la mortalidad durante el ingreso en cuidados intensivos.

INTRODUCTION: The prognostic value of enzyme peaks, the sum of the ST segment and reperfusion arrythmias during myocardial infarction remains unclear. AIM: The aim of this study was to relate the early enzymatic peaks, the sum of the ST segment and reperfusion arrythmias after thrombolytic therapy with postinfarction angina, Killip class and mortality during the acute phase of myocardial infarction. PATIENTS AND METHODS: Of 187 patients receiving fibrinolytic therapy, 169 were consecutively and prospectively included in the study. The following myocardial enzymes were determined: CK, MB, TGO, LDH. Electrocardiograms were performed prior to and 2, 6, 12 and 24 hours after the administration of the fibrinolytic drug. RESULTS: The mean age of the patients was 60.12 +/- 11.3 years, with 138 (81.7%) being males. Myocardial infarction was anterior in 74 (43.7%) and inferior in 95 cases (56.3%). Reperfusion arrythmias were observed in 65 cases (38.5%). One hundred thirty-one (77.5%) were Killip class I, 12 (7.1%) presented postinfarction angina, and 8 (4.7%) died. A peak was observed in MB at 6 hours in cases of anterior myocardial infarction and the sum of the ST segment decreased less than 50% in the first 2 hours. No statistically significant correlation was observed between the enzymatic peaks, the reperfusion arrythmias, Killip class, postinfarction angina or early mortality. The greater the ST segment sum, the greater the severity according to the Killip class. On multivariate analysis no model was found to be related to postinfarction angina. However, age was related to mortality and sex and age were associated with heart failure. CONCLUSIONS: In our population, the variables studied were not found to be useful to determine the prognosis during the early phase of acute myocardial infarction.

[Intestinal tuberculosis, a difficult suspected diagnosis]. / Tuberculosis intestinal, un difícil diagnóstico de presunción.

Intestinal tuberculosis (ITB) is an always difficult clinical diagnosis; we must keep in mind it in the diagnosis of patients with abdominal pain, even without concomitant lung involvement. Seven patients with ITB were revised. Five patients were male and two female, with a mean age of 45 years; all of them presented abdominal pain. Ileocecal region was involved in 71.4% of the cases. Only one patient showed old specific pulmonary lesions radiologically. Neoplasia was the most frequent clinical presumption. ITB diagnosis was made only in one case, as first possibility. Histopathological examination revealed caseous granulomas in all the cases, with acid-alcohol resistant bacilli in 71.4% of them. We want to underline the need of thinking about ITB, in the clinical evaluation of in specific abdominal pain, above all in immunosuppressed patients, and to emphasize the importance of histopathologic findings in the final diagnosis of this entity.

Tuberculosis intestinal, un difícil diagnóstico de presunción / Intestinal tuberculosis, difficult clinical diagnosis

La tuberculosis intestinal (TBI) es un diagnóstico clínico siempre difícil que es necesario tener en cuenta al valorar cuadros de dolor abdominal, incluso sin afectación pulmonar concomitante. Revisamos siete casos de TBI, en cinco varones y dos mujeres, con una edad media de 45 años; todos se presentaron como dolor abdominal. La localización pricipal fue íleo-cecal (71,4%). En un enfermo se documentó radiografía de tórax anormal por tuberculosis pulmonar antigua. El diagnóstico de presunción más frecuente fue el de neoplasia y sólo en un caso se pensó en TBI como primera posibilidad. Se llegó al diagnóstico final tras el estudio histopatológico, en el que se observaron granulomas caseificantes en todos los casos, con bacilos ácido-alcohol resistentes en el 71,4%. Queremos subrayar la necesidad de pensar en TBI, al valorar cuadros de dolor abdominal, sobre todo en inmunodeprimidos y destacar la importancia del estudio anatomopatológico en el diagnóstico final de estos enfermos (AU)

[An intimal sarcoma of the pulmonary artery. An immunohistochemical study]. / Sarcoma intimal de la arteria pulmonar. Estudio inmunohistoquímico.

Pulmonary artery intimal sarcomas tend to be presented with symptoms of pulmonary thromboembolism and grow regionally, with little capacity to metastasize. They probably originate from subendothelial cells, that become myofibroblasts. Knowledge of it is important to establish a presurgery diagnosis, with the possibility of a total resection, the only useful treatment until now. We report a case of a pulmonary artery primary sarcoma, in a 73 year old woman, admitted with hemoptysis and pleuritic chest pain, who died ten days after. Autopsy revealed an intraluminal mass at the pulmonary artery trunk, without regional nor distance involvement. Microscopic study showed a pleomorphic tumor with spindle and epithelioid cells, positive for actin, desmin and vimentin. All these data support the diagnosis of primary intimal sarcoma of the pulmonary artery. We want to emphasize the myogenic differentiation of the tumor, uncommon in previously reported cases.

[Extramedullary anaplastic plasmacytoma]. / Plasmocitoma anaplásico extramedular.

A case of extramedullary plasmacytoma of the maxillary sinus, locally aggressive, in a 65 years old man is presented. Clinical diagnosis of adenocarcinoma was suspected but the pathological study showed an anaplastic morphology, with little plasmacytic differentiation and lack of stain with cytokeratins and epithelial membrane antigen (EMA), immunohistochemical marker of plasmatic cells, among others. Definitive diagnosis was based on light chain restriction and lack of multiple myeloma.

[Primary round-cell liposarcoma of the bladder]. / Liposarcoma de células redondas primario de vejiga urinaria.

OBJECTIVE: To report a rare case of primary round cell liposarcoma of the urinary bladder. METHODS: A case of primary round cell liposarcoma of the urinary bladder in an 80-year-old female with hematuria is presented. The patient had a large, solid, non-circumscribed bladder tumor of 6.5 cms. The radiological, histological and immunohistochemical findings are discussed. RESULTS: The neoplasm was composed of isolated lipoblasts among numerous small round cells that were positive for S-100 and vimentin, and a high proliferation rate was demonstrated by Ki-67. The patient died 10 months after the histologic diagnosis. CONCLUSION: Primary liposarcoma of the urinary bladder is a very rare tumor with a poor prognosis that usually presents as a large tumor mass.

[Squamous cell carcinoma of the prostate. Presentation of a case and review of the literature]. / Carcinoma de próstata de células escamosas. Presentación de un caso y revision de la literatura.

Presentation of one case report of squamous cells prostate carcinoma. This type of prostate tumour accounts for 0.5-1% of all prostate neoplasias and presents clinical and evolutive aspects that are different from those of prostate adenocarcinoma with a poor response to any therapy and a very poor prognosis relative to adenocarcinoma. A literature review is included.

[Tension pneumothorax as a complication of colonoscopy]. / Neumotórax a tensión como complicación de colonoscopia.

The appearance of complications is not frequent following lower gastric endoscopy, and even less so in those which carry the risk of death. Within the low incidence, perforation is the second in frequency of appearance, following hemorrhage. Herein we present the case of a patient who developed acute respiratory failure on developing hypertensive pneumothorax secondary to colon perforation during therapeutic colonoscopy. The mechanism of production, the clinical manifestations and the treatment of this complication are reviewed.

[Miliary tuberculosis. Autopsy study of 29 cases]. / Tuberculosis miliar. Estudio autópsico de 29 casos.

A retrospective anatomoclinic study of 29 cases of miliary tuberculosis, selected from 2.808 necropsies carried out at Hospital Central de Asturias between 1971 and 1994, is described. Fifty eight per cent of the patients were older than 50 years. Predisposing factors were identified in 80%: diabetes, alcoholism, chronic hepatopaty, silicosis, chronic renal failure, immunessupresive treatment and malignant neoplasms. A premorten correct clinical diagnosis were done in 8 cases (27.5%) and were suspected in 4 (13.7%). Typical miliary radiologic pattern was established in 17%. The more frequently affected organs were lungs (100%), liver (82%), spleen (75%), lymphatic nodes (55%) and bone marrow (41%). Early diagnosis and treatment is nowadays more difficult because of increasing of cryptic tuberculosis, involvement of resistant organs (pancreas), new predisposing factors (chronic renal failure), new risk groups (AIDS) and lack of demonstrative clinical and radiologic findings, so is necessary to maintain suspect of this disease always in mind.