[Gastric adenocarcinoma in young adults; comparative study with older patients]. / Adenocarcinoma gástrico en adultos jóvenes; estudio comparativo con pacientes mayores.

BACKGROUND: Gastric adenocarcinoma (GA) has been considered a disease of elderly age and has been rarely reported in patients younger than 35 years of age. The aim of thisΩ demographic, clinicopathological and prognosis of gastric cancer in young patients and to compare their features with the behavior in elder adults. METHODS: Between 1993 and 2008, 1536 patients with GA were enrolled in a retrospective database. Clinical and pathologic features of thirty patients aged 35 years or less (young group) were compared with those of 458 aged 75 years or more (elder group). RESULTS: Mean patient age was 31 and 80-years old in the young and elder groups, respectively, with a predominance of females in the last group (61%). Lauren diffuse type carcinoma was more frequent in people younger than 35 years (70%) than in older patients (17.4%). Main symptoms were dyspepsia (40%) and hemorrhage (20%). The most common T stage in young and elder patients was T3 (52.9% and 56.7% respectively). Surgical resection was performed in 68% of cases and the rest received only systemic chemotherapy. CONCLUSION: Gastric adenocarcinoma is rare in young patients and most cases presented at advanced clinical stage similar to elderly patients, so the prognosis in both age groups is poor. For this reason is important to be aware of alarm symptoms and risk factors in order to perform an early endoscopic diagnosis and a treatment with curative intent.

Acute spontaneous tumor lysis syndrome in a patient with Crohn's disease taking immunosuppressants.

Acute tumour lysis syndrome (TLS) is a catastrophic complication of the treatment of certain neoplastic disorders. It most commonly occurs in association with hematologic malignancies and appears a few hours to a few days after initiation of specific chemotherapy, as the result from the release of intracellular components into the bloodstream due to abrupt malignant cell death. Acute spontaneous TLS is rare, and it has been described in leukemia and lymphoma and in some patients with solid tumors prior to institution of therapy. The syndrome is characterized by hyperuricemia, hyperphosphatemia, hypocalcemia, hyperkalemia, and acute oliguric or anuric renal failure due to uric acid precipitation within the tubules (acute uric acid nephropathy) and to calcium phosphate deposition in the renal parenchyma and vessels.We report a case of acute spontaneous TLS in a patient with Crohn s disease treated with immunosuppressive drugs, who developed a plasmocytoma, in which serum uric acid concentration attained exceptionally high levels (44 mg/dL). The patient underwent acute oliguric renal failure, which required treatment with hyperhydration, urine alkalinization, urate oxidase and hemodialysis, with a fatal evolution.In conclusion, the present case report has several peculiarities: that of being one of the rare examples of spontaneous TLS, that of showing an exceptionally severe hyperuricemia, probably the highest ever reported in the literature, and that of the possible increased risk of tumours in patients with Crohn s disease taking inmunosuppressives and/or TNF antagonists.

Síndrome de lisis tumoral “espontáneo” en paciente con enfermedad de Crohn tratado con inmunosupresores / Acute spontaneous tumor lysis syndrome in a patient with Crohn's disease taking immunosuppressants

El síndrome de lisis tumoral (SLT) es una complicación catastrófica del tratamiento de ciertas enfermedades neoplásicas. Si bien es más frecuente en pacientes con neoplasias hematológicas malignas tras el inicio de la quimioterapia, puede presentarse excepcionalmente, tras la necrosis espontánea de algunos tumores, en ausencia de tratamiento citostático. Clínicamente cursa con hiperuricemia, hiperfosfatemia, hipocalcemia, hiperpotasemia y fallo renal agudo. Presentamos el caso de un paciente con enfermedad de Crohn en tratamiento inmunospresor, que desarrolló un síndrome de lisis tumoral espontáneo como debut de un plasmocitoma. Al ingreso, se objetivó un fracaso renal oligoanúrico que, a pesar de tratamiento precoz con hiperhidratación, alcalinización de la orina, urato-oxidasa y hemodiálisis, tuvo un desenlace fatal en 72 horas. Este caso reviste un interés particular por lo excepcional de la naturaleza "espontánea" del síndrome de lisis tumoral en ausencia de quimioterapia, por presentarse con una hiperuricemia extrema, probablemente la más alta de las recogidas en la literatura, y por la controversia actual de la terapia con inmunosupresores y/o biológicos en la enfermedad inflamatoria intestinal y su relación con el desarrollo de determinados tumores(AU)

Acute tumour lysis syndrome (TLS) is a catastrophic complication of the treatment of certain neoplastic disorders. It most commonly occurs in association with hematologic malignancies and appears a few hours to a few days after initiation of specific chemotherapy, as the result from the release of intracellular components into the bloodstream due to abrupt malignant cell death. Acute spontaneous TLS is rare, and it has been described in leukemia and lymphoma and in some patients with solid tumors prior to institution of therapy. The syndrome is characterized by hyperuricemia, hyperphosphatemia, hypocalcemia, hyperkalemia, and acute oliguric or anuric renal failure due to uric acid precipitation within the tubules (acute uric acid nephropathy) and to calcium phosphate deposition in the renal parenchyma and vessels. We report a case of acute spontaneous TLS in a patient with Crohn's disease treated with immunosuppressive drugs, who developed a plasmocytoma, in which serum uric acid concentration attained exceptionally high levels (44 mg/dL). The patient underwent acute oliguric renal failure, which required treatment with hyperhydration, urine alkalinization, urate oxidase and hemodialysis, with a fatal evolution. In conclusion, the present case report has several peculiarities: that of being one of the rare examples of spontaneous TLS, that of showing an exceptionally severe hyperuricemia, probably the highest ever reported in the literature, and that of the possible increased risk of tumours in patients with Crohn's disease taking inmunosuppressives and/or TNF antagonists(AU)

Hidatidosis hepática: manejo actual de una entidad aún presente / No disponible

No disponible

[Idiopathic thrombocytopenic purpura as an extraintestinal manifestation of Crohn's disease]. / Púrpura trombocitopénica idiopática como manifestación extraintestinal de la enfermedad de Crohn.

Idiopathic thrombocytopenic purpura is an infrequent extraintestinal manifestation of inflammatory bowel disease. It is particularly rare in association with Crohn's disease. In these cases it presents certain peculiarities with respect to its normal clinical features, occurring more frequently when Crohn's disease is mainly colonic and usually appearing after the diagnosis of Crohn's disease has been made. Moreover, it usually complicates the clinical course of both diseases. We present a case of idiopathic thrombocytopenic purpura in a 14-year-old girl in whom the two diseases first presented simultaneously. The clinical course was poor and both diseases were refractory to habitual treatment.