Leiomiosarcoma intratesticular primario diagnosticado por biopsia hepática percutánea ecodirigida / Intratesticular Leiomyosarcoma Diagnosed by Percutaneous Liver Biopsy

Se presenta el caso clínico de un varón de 80 años diagnosticado de leiomiosarcoma testicular primario, a raíz de alteraciones del perfil hepático en analítica sanguínea y lesiones ocupantes de espacio (LOE) hepatoesplénicas en ecografía abdominal. En primer lugar, se realizó punción de lesión hepática y posteriormente orquiectomía radical, revelando concordancia histológica, compatible con leiomiosarcoma intratesticular. Presentamos el caso clínico debido a la rareza de ese tipo de tumores, sobre todo en estadio III, y su peculiar diagnóstico, tras la detección de alteración hepática tanto analítica como ecográfica

We present a case of an 80-year-old male diagnosed with primary testicular leiomyosarcoma due to the detection of hepatic profile analytical alterations and hepatosplenic space-occupying lesions in abdominal ultrasound. Puncture of hepatic lesion was performed first and radical orchiectomy later, revealing histological concordance, compatible with intratesticular leiomyosarcoma. We present the case due to the uncommon of this type of tumors, especially in stage III and its peculiar diagnosis, secondary of hepatic alteration, both analytic and ultrasound.

[Ultrasound-guided biopsy of the pancreas: a multicenter study]. / Punción pancreática ecodirigida: estudio multicéntrico.

OBJECTIVE: Members of "Asociación de Ecografía Digestiva" decided to carry out a multicenter retrospective study on fine-needle aspiration biopsy for pancreatic space-occupying lesions under ultrasonographic guidance and via the percutaneous route in order to assess this technique s performance versus endoscopic ultrasound-guided biopsy. SUBJECTS: 10 hospitals for a total of 222 patients with suspiciously malignant, 8-120-mm pancreatic lesions were included in the study. RESULTS: The analysis of results shows a sensitivity of 89%, a specificity of 98%, a positive predictive value of 99%, and a negative predictive value of 74%, for an overall diagnostic accuracy of 91%. No major complications occurred. CONCLUSION: Percutaneous fine-needle aspiration for pancreatic lesions is highly cost-effective and has few and mild complications.

Punción pancreática ecodirigida: estudio multicéntrico / Ultrasound-guided biopsy of the páncreas: a multicenter study

Objetivo: en el seno de la Asociación de Ecografía Digestivase decidió realizar un estudio retrospectivo multicéntrico sobre lapunción-aspiración con aguja fina (PAAF) de lesiones ocupantesde espacio pancreáticas, mediante control ecográfico y por víapercutánea, con el objetivo de valorar el rendimiento de dicha técnicay poder compararla con la punción mediante ultrasonografíaendoscópica.Participantes: en el estudio han participado 10 hospitalescon 222 pacientes con lesiones pancreáticas entre 8 y 120 mm,sospechosas de malignidad.Resultados: el análisis de los resultados muestra una sensibilidaddel 89%, especificidad 98%, valor predictivo positivo 99% ynegativo 74%, con precisión diagnóstica global 91%. No encontramosninguna complicación significativa.Conclusión: la PAAF de lesiones pancreáticas por vía percutáneaes de alta rentabilidad diagnóstica y con pocas y leves complicaciones

Objective: members of “Asociación de Ecografía Digestiva”decided to carry out a multicenter retrospective study on fine-needleaspiration biopsy for pancreatic space-occupying lesions underultrasonographic guidance and via the percutaneous route in orderto assess this technique’s performance versus endoscopic ultrasound-guided biopsy.Subjects: 10 hospitals for a total of 222 patients with suspiciouslymalignant, 8-120-mm pancreatic lesions were included inthe study.Results: the analysis of results shows a sensitivity of 89%, aspecificity of 98%, a positive predictive value of 99%, and a negativepredictive value of 74%, for an overall diagnostic accuracy of91%. No major complications occurred.Conclusion: percutaneous fine-needle aspiration for pancreaticlesions is highly cost-effective and has few and mild complications

Marcadores tumorales en la cirrosis hepática y el carcinoma hepatocelular / Tumoral markers in liver cirrhosis and hepatocellular carcinoma

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Idiopathic adulthood ductopenia: a diagnosis: two clinicopathologic courses.

Idiopathic adulthood ductopenia is a chronic cholestatic entity of unknown origin that was discovered in the past decade. Although it is classically a progressive and severe disease, a benign and responsive-to-therapy form has been reported recently. We present two middle-aged females that represent the extremes of the clinicopathologic spectrum: One with a severe form of the disease for whom liver transplantation was considered and the other with a benign form.

Pseudoobstrucción intestinal crónica y desnutrición por endometriosis intestinal / Chronic intestinal pseudo-obstruction and malnutrition due to intestinal endometriosis

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[Acute pancreatitis and malabsorption with tetany secondary to Crohn's disease with duodenal involvement]. / Pancreatitis aguda y malabsorción con tetania secundarias a enfermedad de Crohn con afectación duodenal.

Involvement of the duodenum in Crohn's disease is uncommon, and the pathomechanism of the associated acute pancreatitis remains controversial. We describe a case of Crohn's disease with duodenal involvement associated with hyperamylasemia and malabsorption showing a favorable response to steroid treatment.

Spontaneous bacterial peritonitis due to Plesiomonas shigelloides.

Spontaneous bacterial peritonitis is a well known complication in cirrhotic patients with ascites. The etiological spectrum is broad. We report a case of spontaneous bacterial peritonitis due to Plesiomonas shigelloides.

[Immunological and biochemical factors associated with spontaneous bacterial peritonitis]. / Factores inmunológicos y bioquímicos relacionados con la peritonitis bacteriana espontánea.

A prospective study (June 1988-December 1989) of all patients admitted with ascites due to cirrhosis was undertaken: Biochemical and immunological factors which may have significance in the development of spontaneous bacterial peritonitis were determined. Among 56 patients (44 males and 12 females) SBP developed in 16% of the group. No age differences were found and the etiology of the cirrhosis was mainly alcoholic. Patients with SBP had lower alpha-2 globulin concentrations: 0.43 +/- 0.12 vs. 0.60 +/- 0.18 g/dl (p less than 0.05) and a lower prothrombin time: 41 +/- 13% vs. 69.5 +/- 13 vs. 69.5 +/- 21% (p less than 0.001). Patients with SBP had also lower ascitic fluid total protein 0.99 +/- 0.4 vs. 1.64 +/- 1.1 g/dl (p less than 0.01) as well as lower alfa-2 globulin: 0.065 +/- 0.012 vs. 0.096 +/- 0.067 g/dl (p less than 0.05); beta globulin, 0.11 +/- 0.047 vs. 0.2 +/- 0.17 g/dl (p less than 0.05); gamma globulin, 0.32 +/- 0.1 vs. 0.52 +/- 0.4 g/dl (p less than 0.05); IgG, 275 +/- 157 vs. 477 +/- 335 g/dl (p less than 0.05); C3, 9.2 +/- 3.2 vs. 17 +/- 13 mg/dl (p less than 0.01) and C4, 2.83 +/- 1.5 vs. 4.66 +/- 3.9 mg/dl (p less than 0.05) than patients without this complication.

[A microbiological and clinical study of 57 cases of spontaneous bacterial peritonitis in liver cirrhosis patients]. / Estudio microbiológico y clínico de 57 episodios de peritonitis bacteriana espontánea en pacientes con cirrosis hepática.

We studied fifty seven episodes of cirrhotic spontaneous bacterial peritonitis in order to know its microbiological, clinical and evolutive characteristics. One third of the patients had presented some previous peritonitis episodes. Ninety three percent of the patients referred some symptoms at time of diagnosis. Ascitic fluid Gram stain showed the presence of bacteria in 72% of the samples. Culture of ascitic fluid was positive for a single microorganism in 50 cases (88%). Seventy seven percent of microorganisms were Gram negative being Escherichia Coli in 63% of cases. Hemoculture was positive in 68% of cases with an almost complete correspondence with germs found in ascites. Seventy four percent of patients presented some complication throughout their hospital stay being the most frequent renal failure (49%) and encephalopathy (46%). Sixty three percent of patients died being the mortality rate higher amongst the older patients and amongst those who did not present neither high temperature or peritonism, or those who developed some complication.

[Fournier's disease: a report of 9 cases]. / Enfermedad de Fournier: aportación de nueve casos.

Nine cases of Fournier's gangrene diagnosed between 1982 and 1989 are reported. All were males with a mean age of 76 (47-82 years). Seven had a history of alcoholism and one had non insulin-dependent diabetes. Six patients also had an anal fistula which may have been the starting point of the infection. The causal agents were two anaerobes (Clostridium perfringens and Bacteroides fragilis) two gram-negatives (Morganella morgagni and Pseudomonas aeruginosa) and one, an unidentified gram-positive. In three patients a mixed intestinal flora was isolated and in another no germs were found. All were treated with broad-spectrum antibiotics and surgery. Seven patients survived and two died.

Cognitive effects of long-term treatment with phenobarbital and valproic acid in school children.

The Wechsler Intelligence Scales for Children was applied to 64 epileptic children and 60 healthy subjects; patients followed chronic treatment with valproic acid (n = 32) or phenobarbital (n = 32). None of the children suffered mental retardation or neurological abnormalities. The test was repeated after a 9-12 month interval: 26 of the valproate treated children and 23 of the phenobarbital-treated children performed the second evaluation. At baseline, total, verbal and performance IQ scores of children receiving phenobarbital were lower than those of controls. When the results of the first and the second tests were compared, a significant increase in IQ scores was detected among controls and patients treated with valproic acid, but not among phenobarbital-treated patients. It is concluded that long-term phenobarbital therapy induces a significant impairment in learning ability whereas long-term valproate therapy does not exert a noticeable noxious effect at this respect.