[Importance of microlithiasis in testicular germ cell tumor ultrasound]. / Importancia de microlitiasis en ultrasonido de neoplasias de células germinales de testículo.

INTRODUCTION: Testicular microlithiasis (TM) is an infrequent finding in testicular ultrasound and its clinical importance has not been completely defined. We analyzed the ultrasounds of patients with testicular germ cell tumors in order to analyze the correlation between TM, histological findings and clinical variables. METHODS AND MATERIALS: Fifty-seven patients with germ cell tumors and radical orchiectomy were included. Clinical, pathological, and echographic data were analyzed. RESULTS: TM was observed in 27 men (48.27%) and was absent in 30 (52.6%). Patients with TM had a greater likelihood of nonseminomatous germ cell tumors (NSGCT) vs seminomatous (55.6% vs 30%, p=0.05), stage II/III testicular cancer (51.8% vs 16.7%, p=0.005), positive surgical margins (18.5% vs 0%, p=0.021), and spermatic cord invasion (14.8% vs 0%, p=0.048). No significant difference was found in respect to other histopathological variables. CONCLUSION: This study showed that TM in testicular tumors is associated to NSGCT, advanced clinical stage, positive surgical margins, and spermatic cord invasion.

Importancia de microlitiasis en ultrasonido de neoplasias de células germinales de testículo / Importance of microlithiasis in testicular germ cell tumor ultrasound

Introducción: La microlitiasis testicular (MT) es un hallazgo poco frecuente en el ultrasonograma cuyo significado clínico no se ha definido. El presente estudio se realizó en pacientes con tumores de células germinales de testículo para analizar la relación entre MT, los hallazgos histológicos y las variables clínicas. Material y métodos: Se incluyeron 57 pacientes sometidos a orquiectomía radical por neoplasia testicular germinal y se revisaron las variables clínico patológicas y ultrasonográficas. Resultados: Hubo 30 hombres (52,6%) sin MT y 27 hombres con MT (48,27%). Los pacientes con MT tuvieron mayor proporción de tumor germinal no seminomatoso (TGNS, 55,6% vs 30%, p=0,05),de cáncer testicular estadio II/III (51,8% vs 16,7%, p=0,005), de borde quirúrgico positivo (18,5% vs0%, p=0,021) y de invasión al cordón espermático (14,8% vs 0%, p=0,048). No se encontró diferencia significativa en relación a otras variables histopatológicas. Conclusión: En este estudio se demostró una asociación entre MT en tumores testiculares con el hallazgo de TGNS, estadio clínico avanzado, borde quirúrgico positivo e invasión al cordón (AU)

Introduction: Testicular microlithiasis (TM) is an infrequent finding in testicular ultrasound and its clinical importance has not been completely defined. We analyzed the ultrasounds of patients with testicular germ cell tumors in order to analyze the correlation between TM, histological findings and clinical variables. Methods and materials: Fifty-seven patients with germ cell tumors and radical orchiectomy were included. Clinical, pathological, and echographic data were analyzed. Results: TM was observed in 27 men (48.27%) and was absent in 30 (52.6%). Patients with TM had a greater likelihood of non seminomatous germ cell tumors (NSGCT) vs seminomatous (55.6% vs 30%,p=0.05), stage II/III testicular cancer (51.8% vs 16.7%, p=0.005), positive surgical margins (18.5% vs0%, p=0.021), and spermatic cord invasion (14.8% vs 0%, p=0.048). No significant difference was found in respect to other histopathological variables. Conclusion: This study showed that TM in testicular tumors is associated to NSGCT, advanced clinical stage, positive surgical margins, and spermatic cord invasion (AU)

[Hemorrhagic stroke associated to neurocysticercosis]. / Accidente cerebrovascular hemorrágico asociado a neurocisticercosis.

A well-known complication of neurocysticercosis is cerebral arteritis, which is usually manifested by cerebral ischemia. Only anecdotal cases of hemorrhagic stroke associated to this parasitosis have been described. Previously there are only two reported cases of this association. One of these cases had an intracystic hemorrhage confirmed by autopsy without cerebrovascular risk factors. Autopsy revealed an inflammatory arteriopathy adjacent to the cyst intracystic hemorrhage. The second case had a subarachnoidal hemorrhage secondary to the rupture of an aneurysm in the right anteroinferior cerebellar artery. At surgery, the aneurysm was found to be surrounded by a thickened-leptomeninges, which histologically showed the presence of cysticercous with dense inflammation. Our first patient was a 32 year-old female developed a lenticulo-capsular hemorrhage around a cysticercotic lesion. The second patient was a 34 year-old male developed an intracystic hemorrhage. As cerebral angiography was normal in both patients, cerebral hemorrhages were considered to be related to cysticercotic arteritis of small penetrating vessels. We conclude that cysticercosis is associated with differenttypes of intracranial hemorrhage, as documented the present cases. In neurocysticercosis endemic areas, cysticercotic arteritis should be added to the list of causes of intracranial hemorrhage in young people.

[Peripheral neuropathy during a second cycle of treatment with high doses of interferon-alpha in a patient with hepatitis C, and a review of the literature]. / Neuropatía periférica durante un segundo ciclo de tratamiento con dosis altas de interferón alfa en un paciente con hepatitis C y revisión de la bibliografía.

INTRODUCTION: Alpha interferons (IFN a) have been shown to be effective in patients with chronic active hepatitis C. IFN a treatment may be associated with neurologic complications, including peripheral neuropathy. CASE REPORT: We describe a patient with active hepatitis C treated with IFN a, who developed peripheral neuropathy after a second cicle of treatment with interferon. He received a first cicle of treatment with IFN a during 22 weeks (6 MU/day 3 times a week). Afther that he did not received treatment during one year and then he received the second cycle (6 MU/day 3 times a week). After 3 months of therapy the patient complained about paresthesias of both legs. CONCLUSIONS: IFN a related neuropathy is probably rare; however, some cases may be misdiagnosed. Diagnosis of IFN a related neuropathy should be considered by physicians, particularly in patients given longterm treatment and high IFN a dosage. In this case we think that the patient had an acumulative efectt of interferon though he did not received treatment with interferon during one year.

Neuropatía periférica durante un segundo ciclo de tratamientocon dosis altas de interferón alfa en un paciente con hepatitis Cy revisión de la bibliografía / Peripheral neuropathy during a second cycle of treatment with high doses of interferon-alpha in a patient with hepatitis C, and a review of the literature

Introducción. La utilización de interferón alfa (IFN) ha mostrado su efectividad en el tratamiento de la infección por el virus de la hepatitis C. Se han descrito efectos secundarios del uso de interferón en el sistema nervioso, entre ellos la neuropatía. Caso clínico. En este artículo describimos un caso de neuropatía periférica asociada al uso de IFN-alfa en un paciente con hepatitis C, quien recibió un primer ciclo de tratamiento durante 22 semanas en dosis de 6 millones UI tres veces a la semana. Tras permanecer un año sin recibir ninguna terapia, recibió un segundo ciclo de IFN-alfa en dosis de 6 millones UI tres veces por semana. Después de tres meses de tratamiento el paciente desarrolló datos de neuropatía periférica. Los estudios de electrofisiología mostraron una polineuropatía axonal. Conclusiones. La neuropatía asociada al uso de IFN-alfa es una manifestación rara; sin embargo, hay que considerar que puede estar subdiagnosticada, ya que en la mayoría de los pacientes no se sospecha esta patología. El diagnóstico debe considerarse en pacientes que reciben tratamiento a largo plazo y en los que reciben dosis altas. Pensamos que en nuestro caso pudo haber un efecto acumulativo de la dosis de IFN-alfa , aunque el paciente había estado un año sin recibir IFN-alfa (AU)

[Guillain-Barre syndrome. Experience in a third level hospital]. / Síndrome de Guillain-Barré. Experiencia en un hospital de tercer nivel.

INTRODUCTION: Acute peripheral neuropathy represents a medical emergency. The causes of it are diverse and plentiful. The most common cause of acute paralytic peripheral neuropathy is the Guillain-Barré syndrome (GBS). As many as 85% of those affected can be expected to make an excellent recovery. OBJECTIVE: To describe the principal risk factors associated, clinical manifestations, treatment, evolution and complications of 28 cases of Guillain-Barré syndrome (GBS) in the "Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán". METHODS: We search in our computer records all files under diagnostic of GBS, during the last ten years. We found 28 cases that were available to study. RESULTS: Mean age was 37 years old (SD 17.2). Fifteen patients were female (54%) and 13 were male (46%). Nine patients (32%) were preceded by a superior via infection, 5 (18%) by a diarrhea illness and 14 patients had not a predisposing factor. The duration of symptoms before diagnostic has a median of 7 days (2-15). Twenty-six patients (93%) had an ascending paralysis and 18 had paresthesias (64%). The most frequent subtype was acute inflammatory-demyelinating polyneuropathy (AIDP) in 18 patients (64%), acute motor-sensory axonal neuropathy (AMSAN) in 5 (18%), acute motor axonal neuropathy (AMAN) in 3 (11%) and 2 patients (7%) had the Fisher-Miller syndrome. Fifteen patients (54%) developed respiratory involvement requiring mechanical ventilation. Twenty-four patients (86%) had cerebrospinal fluid proteins elevated. Twenty patients (72%) had a total recovery, 6 (21%) had a partial recovery and 2 had not any response (7%). DISCUSSION: GBS is a particularly highstakes illness in that its onset is sudden and paralysis is frequently extreme (requiring assisted respiration), however, as many as 85% of those affected can be expected to make an excellent recovery. In our study the majority of patients (54%) develop respiratory involvement requiring mechanical ventilation but in this group the majority had a favorable outcome (71%).