Tratamiento coadyuvante con corticoides de la tuberculosis peritoneal / Coadjuvant corticoid treatment of peritoneal tuberculosis

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[Mucinous adenocarcinoma of the appendix associated with ovarian tumors and pseudomyxoma peritonei. The difficulty in differential diagnosis]. / Adenocarcinoma mucinoso de apéndice asociado con tumores ováricos y pseudomixoma peritonei. Dificultad en el diagnóstico diferencial.

Mucinous adenocarcinoma of the appendix is rare. If there is a concomitant ovarian tumor to determine the primary might be difficult. Histological features are not always determinant, but there are some macroscopic findings that may suggest an origin in the appendix. We report a case of synchronous tumors in appendix and ovaries with pseudomyxoma peritonei. The patient presented with mass sensation in the right lower quadrant, asthenia, anorexia and weight loss. Abdominal ultrasound and CT scan showed a tumor involving cecum, appendix, terminal ileum and pelvis. Findings on colonoscopy and biopsies were inconclusive. At laparotomy, the tumor compressed appendix, cecum and ascendant colon, terminal ileum, ovaries and peritoneum. Histopathological analysis demonstrated a well-differentiated mucinous adenocarcinoma of appendiceal origin with metastasis in ovaries and peritoneum (pseudomyxoma peritonei).

Adenocarcinoma mucinoso de apéndice asociado con tumores ováricos y pseudomixoma peritonei. Dificultad en el diagnóstico diferencial / Mucinous adenocarcinoma of the appendix associated with ovarian tumor and pseudomyxoma peritonei: a difficult differential diagnosis

El adenocarcinoma mucinoso de apéndice es raro. Si existe un tumor ovárico concomitante, determinar cual es el origen del tumor primario puede ser difícil. Las características histopatológicas no son siempre concluyentes pero hay algunos hallazgos macroscópicos que pueden sugerir que el origen es en el apéndice. Presentamos el caso de tumores sincrónicos en apéndice y ovarios con pseudomixoma peritonei. La paciente presentaba sensación de masa en cuadrante inferior izquierdo con astenia, anorexia y pérdida de peso. En la ecografía abdominal y la TAC se evidenció un tumor que se extendía a ciego, apéndice, ileon terminal y pelvis. Los hallazgos de la colonoscopia y las biopsias no fueron concluyentes. En la laparotomía, el tumor abarcaba apéndice, ciego y cólon ascendente, íleon terminal, ovarios y peritoneo. El examen histológico demostró un adenocarcinoma mucinoso bien diferenciado con metástasis en ovario y peritoneo (pseudomixoma peritonei) (AU)

Five-year analysis of endoscopic retrograde cholangiopancreatography in the Hospital del Bierzo.

OBJECTIVES: endoscopic retrograde cholangiopancreatography (ERCP) is a widely available endoscopic modality, that is not without risks, but is no longer limited to tertiary referral centers. We evaluated the procedure in terms of imaging success, overall therapeutic failure, complications and mortality. METHODS: this retrospective study ran from January 1992 to December 1997. The following data were collected: 1) cannulation rate, 2) failure to obtain images of the duct, 3) type of ERCP, 4) overall therapeutic failure rate and stone extraction, 5) overall complication rate, 6) immediate complications, 7) late complications (within the first 30 days), and 8) mortality. RESULTS: of 425 ERCP procedures performed, all data for 393 were obtained and included in the analysis. The cannulation success was 94%. Failure to obtain a suitable image occurred in 10%. ERCP was diagnostic in 60% and therapeutic in 40%. Sphincterotomy was performed in 83% of the patients. The therapeutic failure rate was 15%. Stone extraction was successful in 69%. The overall complication rate was 8.6%; 2.2% of these complications were severe or fatal. Immediate complications occurred in 4% and late complications in 5.9%. Immediate complications were less frequent in diagnostic ERCP (p < 0.01). Late complications were: pancreatitis (3. 5%), bleeding (1.4%), perforation (0.3%) and cholangitis (0.8%). There was no difference in the frequency of severe pancreatitis between the types of ERCP procedure. Bleeding occurred more frequently in sphincterotomy (p < 0.05). The overall mortality rate was 1.6%. CONCLUSIONS: a continuous audit in each endoscopy unit should be performed to improve ERCP procedures. Diagnostic and therapeutic ERCP carry a similar risk of severe pancreatitis. The bleeding rate was higher in therapeutic ERCP and sphincterotomy.

[Amebic liver abscesses with bacterial superinfection in a nonendemic area]. / Abscesos hepáticos amebianos sobreinfectados por bacterias en un área no endémica.

A 26-year-old man was admitted to hospital with asthenia, weight loss, right upper quadrant abdominal pain, diarrhea without blood, and fever. Abdominal ultrasonography showed multiple hypoechoic areas in the left hepatic lobe. On abdominal CT, multiple hypodense areas without contrast capture were consistent with hepatic abscesses. Cultures were obtained and the patient was placed empirically on metronidazole, gentamicin and ampicillin, without improvement in the first 72 hours, and a drain was placed in the largest lesion collecting a purulent material. The abscess culture was positive for group C beta-hemolytic Streptococcus. Entamoeba histolytica serology was positive and colon biopsies revealed trophozoites. Multiple left hepatic lobe abscesses secondary to E. histolytica, with bacterial superinfection, is an unusual presentation of amoebic infection, considering that Spain is not an endemic area.