Ischemic hepatitis secondary to cardiac tamponade, a rare cause / Hepatitis isquémica secundaria a taponamiento cardiaco, una causa poco frecuente.

Ischemic hepatitis (IH) is a rare entity, usually associated with hypoperfusion secondary to low cardiac output (congestive heart failure, acute myocardial infarction or dilated cardiomyopathy), followed in frequency by respiratory insufficiency and sepsis. A 49-year-old man presented at the emergency room with progressive dyspnea and hypotension, objectifying a significant increase in transaminases (aspartate transferase 5.550 U / L, alanine transferase 3.826 U / L) and LDH (10.375 U / L). Liver Doppler ultrasound was normal. The echocardiogram confirmed the suspected diagnosis of massive pericardial effusion. Cardiac tamponade is a rare cause for this clinical picture. In the case of our patient, rapid diagnosis and urgent pericardiocentesis led to his prompt recovery.

[Hepatocellular carcinoma in Navarre: study of characteristics and evolution in clinical practice]. / El hepatocarcinoma en la Comunidad Foral de Navarra: estudio de características y evolución en la práctica clínica habitual.

BACKGROUND: Hepatocellular carcinoma generally arises in a cirrhotic liver. The aim of screening is to improve survival. The aims of our study are to determine the characteristics and evolution of hepatocellular carcinoma and the effect of screening on survival, in clinical practice in Navarre. METHODS: Prospective and retrospective study of 111 patients diagnosed with hepatocellular carcinoma in public hospitals in Navarre between January 2009 and January 2015. Epidemiological, clinical, analytical, radiological characteristics, tumour staging, treatment and evolution were analyzed. Survival was compared between patients subjected to screening and those not. RESULTS: Mean age was 67 years. The patients (84.7%) were mainly male and 85.6% had cirrhosis. The most frequent aetiology was alcohol consumption (40.7%). 62.2% were diagnosed in early stages, 15.3% in intermediate and 22.5 % in advanced or terminal stages. 4.5% received transplants, 21.6% received surgical resection, 23.4% were treated with abla-tion techniques, 10.8 % with chemoembolization, 5.4% with radiembolization, 2.7% with embolization, 13.5 % with sorafenib and 18% symptomatically. Only 32 patients (28.8%) were subjected to screening. No statistical differences were found in survival depending on surveillance (32 month versus 34; p = 0.971). CONCLUSIONS: In Navarre, hepatocellular carcinoma generally appears against a background of cirrhosis, and alcohol is the most frequent aetiology. Hepatocellular carcinoma is diagnosed most frequently in early stages and out of screening practi-ces. Screening was not associated to better survival.

[Ductal regeneration in vanishing bile duct syndrome in Hodgkin's lymphoma]. / Recuperación ductular en el síndrome de los conductillos biliares evanescent en paciente con linfoma de Hodgkin.

We present the case of a 17-year-old male patient with Hodgkin's lymphoma (nodular sclerosis) in the mediastinum. During the postoperative period treatment with erythromycin was started and the patient developed progressive jaundice and cholestasis. Treatment modified for the lymphoma was initiated, which achieved complete remission and subsequent improvement and resolution of the cholestasis. Histological study of the liver revealed massive loss of bile ducts. After resolution of the cholestasis, consecutive biopsies revealed ductal proliferation. The present report therefore illustrates a case of ductopenia or vanishing bile duct syndrome (VBDS) with ad integrum regeneration of the bile ducts simultaneous with lymphoma remission. Because the 2 possible causes, erythromycin toxicity and Hodgkin's lymphoma, occurred simultaneously, the etiology of the VBDS cannot be definitively established.

[Giant esophageal hematoma: possible association with low-dose aspirin]. / Hematoma esofágico gigante: posible relación con dosis pequeñas de aspirina.

Esophageal hematoma is a rare entity that usually presents as acute thoracic pain. It may occur spontaneously or in association with an underlying disease or direct esophageal damage. The presence of coagulation disorders plays an important role in the development of hematoma. We describe the case of a female patient treated with low-dose aspirin who was diagnosed through emergency gastroscopy. We also review the literature and discuss possible causes, findings in diagnostic tests and treatment.

[Inflammatory bowel disease and amyloidosis]. / Enfermedad inflamatoria intestinal y amiloidosis.

Secondary (AA) amyloidosis is a rare but serious complication of longstanding inflammatory bowel disease that can affect the patient's prognosis more than the underlying disease. Although early diagnosis of this complication is becoming more frequent, its effective treatment continues to pose a challenge to the clinician. We present two cases of Crohn's disease complicated by secondary amyloidosis after two years, and describe their outcome.

[Brunner gland hamartoma and anisakiasis: etiologic association?]. / Hamartoma de glándulas de Brunner y anisakiasis: una asociación etiológica?

Brunner's gland hamartoma is a rare duodenal tumor generally localized in the duodenal bulb. Normally assymptomatic, it might cause upper gastrointestinal bleeding or intestinal obstruction. The diagnosis is based on upper gastrointestinal endoscopic or barium examination findings, and its treatment includes surgical or endoscopic resection, with an optimum prognosis. We present the case of a 59-year-old woman who was admitted to the hospital with an upper gastrointestinal bleeding picture. Endoscopic examination showed an ulcerated polyp in duodenal bulb which was cut with polipectomy wire. Histological slides showed a parasitic granuloma within a Brunner's gland hamartoma. Skin prick test and specific IgE determination were positive for Anisakis. Up to our knowledge, this association has never been described before.

Asymptomatic gastroduodenal anisakiasis as the cause of anaphylaxis.

A great number of parasites have been reported in fish, but only a few of them are capable of infecting human beings. Anisakiasis or anisakidosis is caused by sea nematodes of the genus Anisakis, with the main implicated species being Anisakis simplex. Infection with Anisakis causes a wide spectrum of clinical manifestations, ranging from symptoms related to the upper and occasionally lower digestive tract to allergic manifestations, mainly urticaria and anaphylaxis. We report a case of asymptomatic gastroduodenal anisakiasis presenting as severe anaphylaxis.

[Chronic non granulomatous ulcerative jejunitis]. / Yeyunoileítis ulcerative crónica no granulomatosa.

Chronic non granulomatous ulcerative jejunoileitis a very infrequentity characterized by malabsorption and ulcerations of the small intestine which usually involve the jejunum and ileum. A case of a woman diagnosed with malabsorption syndrome requiring laparotomy due to worsening of a picture of malabsorption and the presence of stenosis and ileal ulceration, demonstrating villous atrophy and lymphoplasmocytic infiltration in the histology compatible with this disease is presented.