[Association of adenocarcinoma of esophagus and breast cancer in a male with Madelung' disease]. / Asociación de adenocarcinoma de esófago y cáncer de mama en un varón con enfermedad de Madelung.

The development of a cancer of the esophagus in women who previously had received radiotherapy for breast cancer is a known although infrequent event. The risk of apparition of the second neoplasia is greater in women who survive at least ten years after the exposition to the radiation. Squamous cell carcinoma is the histological subtype more frequent. We report a case of adenocarcinoma of the esophagus in a man diagnosed of benign symmetrical lipomatosis (Madelung' disease), who had received adjuvant radiotherapy three years before for breast cancer.

Asociación de adenocarcinoma de esófago y cáncer de mama en un varón con enfermedad de Madelung / Association of adenocarcinoma of esophagus and breast cancer in a male with Madelung´ disease

La aparición de un cáncer de esófago en mujeres que previamente han recibido radioterapia como tratamiento de un cáncer de mama es un hecho conocido aunque poco frecuente. El riesgo de aparición de la segunda neoplasia es mayor cuando han transcurrido diez o más años desde la exposición a la radiación. La estirpe histológica de la neoplasia de esófago más frecuente es la de carcinoma de células escamosas. Se presenta un caso de adenocarcinoma de esófago en un varón, diagnosticado de lipomatosis bilateral simétrica o enfermedad de Madelung, que recibió radioterapia tres años antes por presentar un cáncer de mama

The development of a cancer of the esophagus in women who previously had received radiotherapy for breast cancer is a known although infrequent event. The risk of apparition of the second neoplasia is greater in women who survive at least ten years after the exposition to the radiation. Squamous cell carcinoma is the histological subtype more frequent. We report a case of adenocarcinoma of the esophagus in a man diagnosed of benign symmetrical lipomatosis (Madelung’ disease), who had received adjuvant radiotherapy three years before for breast cancer

Utilidad de la ecoendoscopia para la resección endoscópica de los tumores carcinoides duodenales / Utility of echoendoscopy for endoscopic resection of duodenal carcinoid tumors

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Hepatitis colestásica inducida por enalapril / Enalapryl-induced cholestatic hepatitis

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[Primary hepatic leiomyosarcoma in a patient with gastric non-Hodgkin lymphoma]. / Leiomiosarcoma hepático primario en un paciente con linfoma no hodgkiniano gástrico.

Primary leiomyosarcoma of the liver is a rare entity and fewer than 100 cases have been reported in the medical literature. Even more unusual is the association with another previous tumour. We report the case of a 84-year-old man who had been treated for a gastric non-Hodgkin lymphoma two years previously. He presented with a painful mass in the right upper abdomen. An ultrasound scan showed a large mass in the right lobe of the liver and chest radiography showed pulmonary metastases. Liver biopsy was performed and immunohistochemical analysis revealed a malignant leiomyosarcoma. We discuss this case and review the available literature.

Lipoma gigante de colon como causa de dolor y masa abdominal / Giant lipoma in colon causing abdominal pain and mass

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Presentación clínica atípica de un tumor testicular fundido. Revisión de la literatura / Atypical clinical presentation of a burned out testicular tumor. Review of the literature

Propósito: Se presenta un caso de tumor testicular fundido que se manifiesta de forma atípica con múltiples metástasis hepáticas y pulmonares. Se analiza el diagnóstico diferencial con el tumor germinal extragonadal y su importancia clínica. Observación clínica: Varón de 42 años que debuta con lesiones pulmonares y hepáticas de origen desconocido. La necropsia demostró metástasis de tumor germinal mixto (coriocarcinoma y carcinoma embrionario) y una fibrosis tubulo-intersticial en el testículo derecho. Conclusiones: En todo varón joven con sospecha de enfermedad tumoral, especialmente si la evolución clínica es rápida, hay que plantearse la posibilidad de un tumor germinal y descartar, mediante ecografía y eventual estudio histológico, la presencia de una neoplasia testicular (AU)

[Degree of association between serum levels and genotype in alpha-1-antitrypsin deficiency. Clinical usefulness]. / Grado de asociación entre valores séricos y genotipo en el déficit de alfa-1-antitripsina. Utilidad clínica.

AIM: To determine the degree of association between serum alpha-1-antitrypsin levels and its phenotypes as well as its clinical expression. PATIENTS AND METHODS: The alpha-1-antitrypsin genotype was identified using polymerase chain reaction followed by restriction enzyme digest in 212 patients in whom serum alpha-1-antitrypsin determination had been requested. The reasons for the request, the existence of pulmonary or liver disease, clinical diagnoses and functional repercussions were analyzed. RESULTS: Two hundred and twelve patients were evaluated (68% males; mean age: 34 20 years). In 23 patients (10.8%) a deficiency variant was found (one or two M alleles were lacking) and in 8 patients (3.8%) the genotype was ZZ. All patients with MM genotype had alpha-1-antitrypsin levels of 75 mg/dl or higher while none of the patients with ZZ genotype had levels higher than 40 ml/dl. All the patients with ZZ genotype showed alterations: 3 had pulmonary emphysema, 1 had chronic obstructive pulmonary disease and 4 had hypertransaminasemia. One patient with pulmonary emphysema had severe respiratory insufficiency while in the remaining patients with respiratory problems, respiratory insufficiency was slight or moderate. None of the patients with hypertransaminasemia showed echographic signs of portal hypertension or clinical or laboratory signs of reduced liver function. CONCLUSIONS: There is a close association between alpha-1-antitrypsin levels and the different genotypes. Consequently, in basal conditions with serum alpha-1-antitrypsin levels higher than 75 mg/dl genotyping is not required. The functional repercussions of deficiency variants in young adults is slight.

[Current status of endoscopic retrograde cholangiopancreatography. What is the effect of the introduction of magnetic resonance cholangiography?]. / Estado actual de la CPRE. Cómo se refleja la introducción de la colangiorresonancia magnética?

AIM: To determine the current status of endoscopic retrograde cholangiopancreatography (ERCP) and the effects of the introduction of magnetic resonance cholangiography (MRC) on ERCP and to evaluate the diagnostic yield of MRC since its introduction in obstructive biliary disease. MATERIAL AND METHODS: We performed a retrospective analysis of the ERCP carried out between January 1998 and December 2000 and of the MRC performed for suspected obstructive biliary disease from May 1999 to December 2000. When both techniques were performed, the diagnostic yield of MRC was evaluated. RESULTS: We performed 927 ERCP. A total of 45.3% of the patients were men. Mean age was 69.2 14.6 years. Treatment was performed on 688 occasions (77%), mainly sphincterotomy (69.9%) and placement of polyethylene (21.8%) or self-expanding (9.9%) prostheses. The number of ERCP performed each year was 261, 330 and 336 in 1998, 1999 and 2000, respectively; of these 76.6%, 80% and 76.9% were therapeutic. MRC was performed in 63 patients with suspected biliary disease. In 27 of 59 patients (45.8%) MRC was sufficient for diagnosis, avoiding the need for ERCP. In the 35 patients in whom both techniques (MRC and ERCP) were performed, the diagnostic yield of MRC compared with that of ERCP was: sensitivity 100%, specificity 50%, positive predictive value 87.1%, negative predictive value 100% and overall value 89%. The cases responsible for the low specificity (all due to choledocholithiases) were analyzed and a significant time lapse was found between the performance of MRC and ERCP (range: 7-35 days) during which choledocholithiasis probably resolved spontaneously. CONCLUSIONS: a) Contrary to what could be expected, the number of ERCP seems to be increasing with a high percentage of endoscopic treatment; b) Because of its diagnostic sensitivity, MRC is the ideal technique for eliminating the need for diagnostic ERCP, thus allowing greater development of the therapeutic aspect of ERCP.

Fascitis-paniculitis como manifestación paraneoplásica de un linfoma no Hodgkin paracortical nodular T / Fascitis-panniculitis as a paraneoplastic manifestation of a paracortical nodular T cell no-Hodgkin's lymphoma

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Tromboflebitis migratoria asociada a alteración del factor V de Leyden y neoplasia pulmonar / Migratory thrombophlebitis associated with an alteration of the Leyden factor V and lung neoplasm

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