Púrpura trombocitopénica trombótica, lupus eritematoso sistémico y tratamiento de rescate con ciclofosfamida / Thrombotic thrombocytopenic purpura, systemic lupus erythematosus and rescue treatment with cyclophosphamide

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Resolución de seudoquiste pancreático tras Pancreatitis aguda grave con nutrición enteral continua en el yeyuno / Resolution of pancreatic pseudocysts after acute Pancreatitis with continuous jejunal feeding

Presentamos un caso de Pancreatitis aguda de etiología enólica complicada con seudoquiste pancreático, que evolucionó favorablemente con nutrición enteral con fórmula monomérica administrada a través de sonda nasoyeyunal. Se discuten las indicaciones de soporte nutricional, las vías de administración de la nutrición (nutrición enteral frente a nutrición parenteral), el lugar de infusión y el tipo de fórmula de la nutrición enteral en la Pancreatitis aguda complicada (AU)

[A cholesterol embolism during heparin treatment]. / Embolismo de colesterol durante el tratamiento con heparina.

The cholesterol embolization is a rare complication of atherosclerosis. A direct implication of the treatment with anticoagulants in the etiology of the disease has been questioned, and now such therapy is considered more as an adjuvant factor with angiographic procedures than as a cause. A 60-year-old patient with an ischemic cardiomyopathy presented cholesterol embolization syndrome, confirmed by cutaneous biopsy histologic examination during treatment with heparin. Spontaneous evolution was favourable and only limited amputation of the lower limbs were required. The authors think that cholesterol emboli have a direct relationship to the treatment with heparin in this case, there being no other causes to justify its appearance.

[Acute human immunodeficiency virus infection associated with facial diplegia]. / Infección aguda por el virus de la inmunodeficiencia humana asociada a diplejia facial.

We describe the case of a 21-year-old parenterally drug-addict man, who presented an acute and self-limited disease, temporarily associated to seroconversion against the human immunodeficiency virus. During his evolution, the patient developed aseptic meningitis and facial diplegia. Two lymphatic ganglions were histopathologically and sequentially studied during the third and sixth week of the disease, showing an intense follicular depletion in the first sample, which reverted towards a pattern of follicular hyperplasia in the second one.

[Influence of arterial pressure and plasma renin activity on tubular reabsorption of sodium]. / Influencia de la presión arterial y de la actividad de renina plasmática sobre la reabsorción tubular de sodio.

BACKGROUND: With the aim of confirming the possible existence of an increase in the fractional proximal reabsorption of sodium in the development of essential hypertension, the tubular dynamics of sodium were compared by the lithium clearance technique in a group of hypertensive patients and controls. METHODS: Following a week of drug suspension 186 patients with slight or moderate essential hypertension and 37 normal subjects with homogeneous sodium ingestion were studied. A clearing period of 90 minutes prior to the administration of a tracing doses of lithium was considered to calculate the fractional proximal and distal reabsorption of sodium in terms of glomerular filtration. In addition to global comparison of the measurements, the hypertensives were classified and compared according to mean arterial pressure (MAP) and percentages of plasma renin activity (PRA). RESULTS: No differences were found in tubular dynamics of sodium between hypertensive and normotensive patients. Neither did the degree of hypertension induce differences. However, upon classifying the patients according to PRA, it was found that those with PRA higher than 0.5 ng/ml-1/h-1 had less secondary natriuresis to a greater fractional distal reabsorption of sodium (p < 0.05). CONCLUSIONS: The findings of the this study do not support the possible existence of a primary defect of the transport of sodium in the proximal tubule in the origin and/or maintenance of essential arterial hypertension.

[Lymphomatoid granulomatosis: clinicopathologic analysis of 7 cases]. / Granulomatosis linfomatoidea: análisis clinicopatológico de 7 casos.

The aim of the present was to study the possible clinical histological correlations in the cases of lymphomatoid granulomatosis (LG) diagnosed in the last 10 years. Clinic evolutive data were collected in 7 patients diagnosed LG. The histological samples related to the same were revised and an immunohistochemical study was carried out with the oxidase/antiperoxidase technique. Seven patients (5 females and 2 men) with a mean age of 47 years (limit 23-47) were studied. The form of presentation was alteration of the general state in 5 cases accompanied by respiratory symptoms in 4. In 2 cases lung involvement was not found. In 7 biopsies performed at the initiation of the disease, 3 presented characteristics of lymphoma. Three patients are presently alive with a mean follow up time of 31 months and 4 have died (mean survival 17 months). Immunohistochemistry demonstrated T lymphocyte predominance in most of the cases (5 out of 6). The first case of LG in a patient simultaneously infected with the HIV and HTLV-1 is presented. Lymphomatoid granulomatosis possesses a symptomatology which is very inspecific and has histological features which may be superposed to other lymphoproliferative disorders, specially those of the T strain. Given the known relation between HTLV-1 and T lymphomas the role of HTLV-1 in the genesis of LG should be studied in these patients specially in those with the HIV.

[Cytomegalic inclusion disease in a patient with systemic lupus]. / Enfermedad por inclusión citomegálica en paciente con lupus sistémico.

Cytomegalovirus (CMV) infections acquire characteristics of special severity when they occur in patients suffering primary or secondary cellular immune depression. We present a case of pneumonia with fatal evolution caused by CMV, in a female patient suffering systemic lupus erythematosus. The underlying disease, of recent onset, presented multiorgan involvement (skin, joints, kidney, blood) which could be controlled with steroids and azathioprine. The patient presented a few days after she had overcome an acute outbreak of the disease, a febrile status with rapid evolution with a diffuse pulmonary interstitial infiltrate. Circulating anti CMV antibodies were detected, of IgM class, by a enzyme-immunoassay. The necropsy showed a multiorgan infiltrate (liver, lung, skin, kidney) with cells containing cytomegalic inclusion.

[Abscessing rhombencephalitis caused by Listeria in an iummunodepressed patient]. / Rombencefalitis abscesificante por Listeria en paciente inmunodeprimido.

The cerebral trunk infection by Listeria monocytogenes is a very rare process, with only 24 described cases and only 2 in immunodepressed patients. We present a new case of cerebral trunk encephalitis caused by Listeria in a patient diagnosed of Polyarteritis nodosa on steroids and cyclophosamide treatment and fatal evolution, and whose hemoculture, spinal fluid culture and cranial CT scan did not contribute to the diagnosis. A necrotizing lesion in the protuberance with mesencephalic extension was observed in the necropsy study in which intra- and extracellular Gram + and silver positive bacilli were detected. Since L. monocytogenes was suspected as the causative agent, indirect immunofluorescence was performed on histological preparations with hyperimmune anti-L. monocytogenes serum giving a clearly positive result. In our case, this technique permitted the etiological diagnosis in the absence of positive cultures.