Hallazgo incidental de arteria subclavia derecha aberrante / Incidental finding of aberrant right subclavian artery

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[Intestinal tuberculosis. A diagnostic challenge]. / Tuberculosis intestinal. Un reto diagnóstico.

Tuberculosis (TB) is a common disease in Spain, whose incidence has increased due to AIDS, immunotherapy and immigration. Intestinal disease is rare and can be difficult to diagnose because its symptoms and laboratory results are nonspecific. In addition, endoscopic lesions resemble those of other diseases such as Crohns disease (CD). Differentiating between intestinal TB and CD is very important since steroid treatment con be life saving in CD and lethal in intestinal TB. Colonoscopy plays an important role in establishing a suspected diagnosis. The endoscopic findings most characteristic of intestinal TB are circular ulcers, small diverticula (3-5 mm), and sessile firm polyps. The suspected diagnosis must be confirmed by the presence of caseating granulomas and/or acid fast bacilli. Polymerase chain reaction is currently recommended for assessing the presence of tubercle bacilli in tissue specimens obtained by endoscopic biopsy. We report a case of intestinal TB in a female renal transplant recipient that demonstrates the difficulty of making this diagnosis.

Un paciente con ascitis en atención primaria

El médico de familia debe ser capaz no sólo de identificar una ascitis, sino también de hacer una aproximación diagnóstica, un correcto tratamiento médico de la misma y conocer las posibles complicaciones que pueden aparecer en un paciente afectado de esta enfermedad, para prevenir su aparición y, en el caso de que aparezca, poder decidir su traslado a un centro hospitalario. Para ello es fundamental que el médico de familia tenga claro cuáles son los criterios de derivación hospitalaria de un enfermo con ascitis y cómo ha de realizarse dicho traslado. En el presente artículo se analizará brevemente la fisiopatología de la ascitis, haciendo más hincapié sobre clínica y diagnóstico; se tratará con detenimiento el tratamiento médico de ésta en el ámbito de atención primaria, se definirán cuáles son los criterios de derivación hospitalaria, haciendo una pequeña mención a la técnica de la paracentesis evacuadora, técnica hasta ahora reservada al medio hospitalario, cuya realización se empieza a plantear en atención primaria (AU)

[Gastroenteritis eosinophilic presenting as colitis with acute abdomen]. / Presentación de gastroenteritis eosinofílica como brote de colitis con abdomen agudo.

Eosinophilic gastroenteritis is rare. Fewer than 30 cases have been published in the Spanish literature, although Kaijser first described this entity in 1937. Its etiology is still unknown and it has frequently been reported to involve the stomach and small bowel, with characteristic eosinophilic infiltration of the bowel wall. The colon has rarely been reported as a site of this condition, which manifests as acute abdominal pain due to intestinal obstruction. We report the case of a 38-year-old woman who presented eosinophilic gastroenteritis. Onset was acute colitis causing acute abdomen. The patient received conservative treatment and responded well to steroids. To our knowledge, such a case has not previously been reported.