Hepatic Epithelioid Hemangioendothelioma as a Rare Indication for Liver Transplantation.

BACKGROUND: Hepatic epithelioid hemangioendothelioma (HEHE) is a rare neoplasm of vascular origin, with nonspecific presentation and unpredictable clinical course. Several therapeutic options are available according to the literature, including chemotherapy and radiotherapy, liver resection (LR), and liver transplantation (LT). METHODS: We present 2 cases of patients with HEHE treated with liver transplantation in our center, a 30-year-old man and a 42-year-old woman, diagnosed with several lesions involving both liver lobes. RESULTS: Levels of tumor markers (carcinoembryonic antigen [CEA], cancer antigen 19.9 [Ca19.9], and alpha-fetoprotein [AFP]) were negative. Percutaneous biopsy revealed HEHE in both cases. Due to the bilobar location, liver transplantation was performed. Postoperative course was unremarkable, and no significant complications developed. At this time, 10 and 5 years' follow-up has concluded, respectively. Both patients remain alive, asymptomatic, with normal liver function and no sign of recurrence. CONCLUSIONS: HEHE is an uncommon malignant hepatic disease. Most cases present with bilobar involvement, and LT is probably the most useful treatment with favorable outcomes according to the literature and our experience. Further studies are needed to establish the optimal management of this rare entity.

Hernia de Garengeot: hernia crural incarcerada conteniendo el apendice. Revisión de la literatura a proposito de 2 casos / De Garengeot's hernia: Incarcerated femoral hernia containing the vermiform appendix. Report of two cases and literature review

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Effect of bombesin receptor subtype-3 and its synthetic agonist on signaling, glucose transport and metabolism in myocytes from patients with obesity and type 2 diabetes.

Bombesin receptor subtype-3 (BRS-3) is an orphan G-protein-coupled receptor (GPCR) member of the bombesin receptor family. Several studies have suggested an association between obesity, alterations in glucose metabolism, diabetes and the BRS-3 receptor. In this study, we focused on patients simultaneously diagnosed with obesity and type 2 diabetes (OB/T2D). The analysis of BRS-3 expression in the skeletal muscle of these patients revealed a marked decrease in the expression of BRS-3 at the mRNA (23.6 ± 1.3-fold downregulation, p<0.0001) and protein level (49 ± 7% decrease, p<0.05) compared to the normal patients (no obesity and diabetes). Moreover, in cultured primary myocytes from patients with OB/T2D, the synthetic BRS-3 agonist, [D-Try6,ß-Ala11,Phe13,Nle14]bombesin6-14, significantly increased the phosphorylation levels of mitogen-activated protein kinase (MAPK), p90RSK1, protein kinase B (PKB) and p70s6K. Specifically, the ligand at 10-11 M induced the maximal phosphorylation of MAPKs (p42, 159 ± 15% of the control; p44, 166 ± 11% of the control; p<0.0001) and p90RSK1 (148 ± 2% of the control, p<0.0001). The basal phosphorylation levels of all kinases were reduced (p<0.05) in the patients with OB/T2D compared to the normal patients. Furthermore, the BRS-3 agonist stimulated glucose transport, which was already detected at 10-12 M (133 ± 9% of the control), reached maximal levels at 10-11 M (160 ± 9%, p<0.0001) and was maintained at up to 10-8 M (overall mean, 153 ± 7%; p < 0.007). This effect was less promiment than that attained with 10-8 M insulin (202 ± 9%, p = 0.009). The effect of the agonist on glycogen synthase a activity achieved the maximum effect at 10-11 M (165 ± 16% of the control; p<0.0001), which did not differ from that observed with higher concentrations of the agonist. These results suggest that muscle cells isolated from patients with OB/T2D have extremely high sensitivity to the synthetic ligand, and the effects are particularly observed on MAPK and p90RSK1 phosphorylation, as well as glucose uptake. Moreover, our data indicate that BRS-3 may prove to be useful as a potential therapeutic target for the treatment of patients with OB/T2D.

Enteritis por Clostridium difficile / Clostridium difficile enteritis

La afectación del intestino delgado por Clostridium difficile constituye una entidad clínica infrecuente.MétodoSe presenta el primer caso de enteritis por C. difficile diagnosticado en España y se realiza una revisión de la literatura médica.ResultadosVarón de 30 años de edad intervenido por recidiva de un tumor germinal retroperitoneal. Siete días después presentó vómitos, diarrea y, finalmente, obstrucción intestinal por seudomembranas originadas por enteritis por C. difficile. En la literatura médica han sido descritos otros 57 casos de enteritis por C. difficile. La edad media era de 52±17 años con un rango desde 18 a 86 años. Veintinueve pacientes (50%) presentaban enfermedad inflamatoria intestinal. Cuarenta y siete (81%) tenían antecedentes de cirugía de colon o intestino delgado. La mortalidad fue más acusada en pacientes de mayor edad y en los que no presentaban enfermedad inflamatoria intestinal.ConclusiónLa enteritis por C. difficile se caracteriza por su elevada gravedad y morta(AU)

A 30-year-old man underwent surgery for recurrence of a retroperitoneal germ cell tumor. Seven days later the patient developed vomiting, diarrhea and, finally, intestinal obstruction due to pseudomembranes caused by CDE. Only 57 cases of CDE have been reported in the literature. The mean age was 52±17 years with a range of 18 to 86 years. Twenty-nine patients (50%) had inflammatory bowel disease. Forty-seven (81%) had a history of colon or small intestine surgery. Mortality was higher in older patients and in those without inflammatory bowel disease (AU)

[Clostridium difficile enteritis]. / Enteritis por Clostridium difficile.

INTRODUCTION: Clostridium difficile infection of the small intestine is infrequent. METHOD: We present the first case of C. difficile enteritis (CDE) diagnosed in Spain and provide a review of the literature. RESULTS: A 30-year-old man underwent surgery for recurrence of a retroperitoneal germ cell tumor. Seven days later the patient developed vomiting, diarrhea and, finally, intestinal obstruction due to pseudomembranes caused by CDE. Only 57 cases of CDE have been reported in the literature. The mean age was 52±17 years with a range of 18 to 86 years. Twenty-nine patients (50%) had inflammatory bowel disease. Forty-seven (81%) had a history of colon or small intestine surgery. Mortality was higher in older patients and in those without inflammatory bowel disease. CONCLUSION: CDE is characterized by high severity and mortality.

Non-alcoholic fatty liver disease proteomics.

PURPOSE: Non-alcoholic fatty liver disease (NAFLD) is an important cause of chronic liver injury that has gained concern in clinical hepatology. The principal aim of this study was to find differences in protein expression between patients with NAFLD and healthy controls. EXPERIMENTAL DESIGN: Changes in protein expression of liver samples from each of the three groups of subjects, controls, non-alcoholic steatosis, and non-alcoholic steatohepatitis (NASH), were analyzed by DIGE combined with MALDI TOF/TOF analysis, a proteomic approach that allows to compare hundreds of proteins simultaneously. RESULTS: Forty-three proteins exhibiting significant changes (ratio ≥1.5, p<0.05) were characterized, 22 comparing steatosis samples versus control samples and 21 comparing NASH versus control samples. Ten of these proteins were further analyzed by Western blot in tissue samples to confirm the observed changes of protein expression using DIGE. The proteins validated were further tested in serum samples of different cohorts of patients. CONCLUSIONS AND CLINICAL RELEVANCE: Following this approach we identified two candidate markers, carbamoyl phosphate synthase 1 and 78 kDa glucose-regulated protein, differentially expressed between control and NASH. This proteomics approach demonstrates that DIGE combined with MALDI TOF/TOF and Western blot analysis of tissue and serum samples is a useful approach to identify candidate markers associated with NAFLD, resulting in proteins whose level of expression can be correlated to a disease state.

Contraindicaciones absolutas del retrasplante hepático / No disponible

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Mujer de 56 años con dolor y crepitación en miembro inferior izquierdo / A 56-year-old woman with pain and crepitations in the leftlower limb

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