Clinical characteristics of nonneoplastic cavernomatous transformation of the portal vein at a Gastroenterology Service in Spain.

OBJECTIVE: To identify predisposing factors, clinical characteristics and effective treatment in patients with nonneoplastic cavernomatous transformation of the portal vein in our gastroenterology service. METHODS: We retrospectively reviewed the clinical records of 2,201 patients diagnosed as having portal hypertension (2,165 with cirrhosis and 36 with noncirrhotic portal vein hypertension) during the period from 1977 to 1998. The diagnosis of cavernomatous transformation was confirmed with angiographic or Doppler echographic studies, or both. RESULTS: Thirteen patients (6 males, 7 females, age range 8 to 69 years) with cavernomatous transformation were found. Predisposing factors were omphalitis (1), echinococcal cyst (1), major abdominal surgery (3), liver cirrhosis (3), Sjögren syndrome (1), and no apparent cause (4). Eleven of the 13 patients had upper digestive tract bleeding from varices, 9 had splenomegaly, and 2 had cirrhotic decompensation. Splenectomy was done in 3 patients on admission, and in 5 patient shunts were used (splenorenal in 4, mesenteroatrial in 1) because of repeated bleeding. CONCLUSIONS: Of the patients with noncirrhotic portal hypertension, 27.7% had nontumoral cavernomatous transformation of the portal vein. Previous abdominal surgery was the most frequent predisposing factor; the 2 cases of echinococcal liver disease and Sjögren disease were exceptional. Age younger than 30 years, bleeding esophageal varices and splenomegaly were the most frequent clinical features. Portosystemic shunt was the only effective treatment alternative in these patients.

Características clínicas de la cavernomatosis portal no neoplásica en un servicio de Digestivo / Clinical characteristics of nonneoplastic cavernomatous transformation of the portal vein at a Gastroenterology Service in Spain

FUNDAMENTO: conocer las enfermedades predisponentes, las características clínicas y el tratamiento de los pacientes con cavernomatosis portal no neoplásica en nuestro Servicio de Digestivo. PACIENTES Y MÉTODOS: se revisan retrospectivamente los informes clínicos de 2.201 pacientes con el diagnóstico de hipertensión portal (2.165 con cirrosis y 36 con hipertensión portal no cirrótica) durante el período 1977-1998. El diagnóstico de cavernomatosis se confirmó por estudio angiográfico y/o ecografía Doppler. RESULTADOS: el número de pacientes con esta patología fue de 13 (seis varones y siete mujeres). La edad osciló entre 8 y 69 años. Las enfermedades predisponentes fueron onfalitis (uno), cirugía mayor abdominal (cuatro), cirrosis hepática (tres), síndrome de Sjögren (uno) y sin causa aparente (cuatro). De los 13, 11 presentaron hemorragia digestiva alta por varices, nueve esplenomegalia y dos descompensación cirrótica. En tres se hizo esplenectomía a su ingreso y en cinco derivaciones (cuatro esplenorrenales y uno mesentérico-atrial) por recidiva hemorrágica. CONCLUSIONES: de los enfermos con hipertensión portal no cirrótica, el 27,7 por ciento tuvo una cavernomatosis portal no turnoral. La cirugía abdominal previa fue la situación predisponente más habitual y dos casos de hidatidosis hepática y enfermedad de Sjögren son excepcionales. La edad menor de 30 años, las varices sangrantes y la esplenomegalia fueron las características clínicas más frecuentes. Las derivaciones portosistémicas son la única alternativa terapeútica definitiva en este tipo de pacientes (AU)

[Gastric carcinoma associated with other primary malignant neoplasms. A retrospective study of 25 cases]. / Carcinoma gástrico asociado a otras neoplasias malignas primarias. Estudio retrospectivo de 25 casos.

BACKGROUND: The risk of developing a second neoplasm in a person with gastric carcinoma (GC) is higher than among general population. OBJECTIVE: To analyze the clinical findings in patients with GC associated with other primary malignant neoplasms. PATIENTS AND METHODS: A total of 25 patients with GC associated with extragastric tumours were retrospectively studied. The following characteristics were studied: age, sex, location and staging, free interval, therapy, and survival. Survival of 13 patients with GC diagnosed as primary tumour was compared with that observed in a control group of 62 patients with GC alone. RESULTS: Twenty-five out of 792 (3.1%) patients with GC had other primary malignant neoplasms (seven synchronous and 18 metachronous). GC was associated with respiratory tumours in 7 cases. Sixty percent of patients with GC who had a second neoplasm had it diagnosed within the first year after gastric tumour was diagnosed (8 out of 13). Survival at 18 months was similar, both in the GC group with a second tumour as in the control group. CONCLUSIONS: The development of a second neoplasm among patients with GC usually occurs within the first year after diagnosis. Most commonly, the second neoplasm seats in the respiratory tract.

Carcinoma gástrico asociado a otras neoplasias malignas primarias. Estudio retrospectivo de 25 casos / Gastric carcinoma associated with other primary malignant neoplasms. Retrospective study of 25 cases

Objetivo. El riesgo de padecer una segunda neoplasia en una persona con carcinoma gástrico (CG) es superior al de la población general. El objetivo del estudio ha sido valorar los datos clínicos de los pacientes con CG asociado a otras neoplasias malignas primarias. Pacientes y método. Se estudian retrospectivamente 25 enfermos con CG asociado a tumores extragástricos. Se evaluaron edad, sexo, tipo, localización y estadio de las neoplasias, intervalo libre, tratamiento y supervivencia. Se compara la supervivencia de 13 pacientes con un CG diagnosticado como primera neoplasia con la de un grupo control de 62 pacientes con sólo un CG. Resultados. De 792 pacientes con CG, 25 (3,1 por ciento) tuvieron otras neoplasias malignas primarias (siete eran sincrónicas y 18 metacrónicas). El CG se asoció a tumores respiratorios en siete casos. De los pacientes con CG que tuvieron una segunda neoplasia, en el 60 por ciento ésta apareció en el primer año después del diagnóstico del tumor gástrico (ocho de trece). La supervivencia fue la misma a los 18 meses, tanto en el grupo de CG con una segunda neoplasia como en el grupo control. Conclusiones. Los pacientes con un CG que desarrollan una segunda neoplasia lo hacen en un 60 por ciento en el primer año. Esta segunda neoplasia es, más frecuentemente, del tracto respiratorio. (AU)

[Congenital intrahepatic venous shunt as a cause of hepatic encephalopathy]. / Derivación venosa intrahepática congénita como causa de encefalopatía hepática.

Macroscopic intrahepatic portosystemic shunts are extremely rare and may be due to liver injury, congenital vascular malformations or pathologic collaterals secondary to portal hypertension. Forty-eight cases have been reported in the literature up to 1994 with 50-60% presenting cerebral manifestations and 40% being associated with cirrhosis. The case of a patient without cirrhosis who was admitted for upper digestive hemorrhage secondary to gastroduodenal ulcer is described. At 48 hours the patient had an episode of hepatic encephalopathy coinciding with bleeding reactivation. Abdominal echography suggested communication between the right portal and suprahepatic veins and posterior angiography confirmed the diagnosis. Color Doppler echography determined shunt and portal vein blood flow. No case of intrahepatic portosystemic venous shunt as a cause of encephalopathy was found to have been reported in the Spanish literature.

[Hypothyroidism state with psychomotor agitation and fast atrial fibrillation: a rare form of presentation]. / Estado de hipotiroidismo con agitación psicomotriz y fibrilación auricular rápida: una rara forma de presentación.

Schizoid psychosis and atrial fibrillation are two rare signs of hypothyroidism which may suggest the opposite condition, hyperthyroidism, with the associated risk of adopting a wrong therapeutical approach. Recently, we have treated a patient in which those two mentioned circumstances were present. In this paper, we review psychiatric signs and electrocardiographic disorders associated to hypothyroidism.