Mujer de 71 años con edema cervical doloroso y derrame pleural bilateral / No disponible

El derrame pleural de tipo exudado tiene múltiples etiologías, siendo las más frecuentes los derrames paraneumónicos (50-70%), las neoplasias (15-35%) y la tuberculosis. Presentamos el caso de una mujer de 71 años con edema doloroso en la región laterocervical izquierda y radiografía de tórax con aumento de partes blandas en dicha región y pinzamiento de senos costofrénicos, que tras los estudios complementarios fue diagnosticada de quilotórax espontáneo con extravasación de quilo a regiones cervical y mediastínica, en probable relación con sobreesfuerzo o traumatismo mínimo. Presentó una mejoría clínica y radiológica tras dieta exenta de grasas y administración de suplementos de triglicéridos de cadena media. Las causas más frecuentes de quilotórax son las intervenciones quirúrgicas, los traumatismos y las neoplasias. Además, se describen también casos de quilotórax espontáneo sin causa objetivable. Por último, en pacientes con derrame pleural y edema cervical hemos de tener en cuenta la posibilidad de una patología aguda del conducto torácico

Exudative pleural effusion has several etiologies, being the most frequent parapneumonic effusion, neoplasias and tuberculosis. We report a case of a 71-year-old woman with painful edema on the left side of the lateral cervical region, accompanied by increased soft tissues in that region in chest radiography and bilateral pleural effusion. After additional studies were conducted, she was diagnosed with spontaneous chylothorax with extravasation of chyleinto the cervical and mediastinal regions, possibly due to overexertion or minimal trauma. She underwent clinical and radiological improvement after a fat-free diet and the administration of medium chain triglycerides supplements. The most common causes of chylothorax are surgical procedures, trauma and cancer. In addition, cases of spontaneous chylothorax are also described without apparent cause. Finally, in patients with pleural effusion and cervical edema we must consider the possibility of an acute disorder of the thoracic duct

[Macroscopic liver pathology in patients with dissociated cholestasis]. / Lesiones hepáticas macroscópicas en pacientes con colestasis disociada.

OBJECTIVE: To establish the prevalence of liver focal pathology in patients with increase of alkaline phosphatase and gamma-glutamil transpeptidase and normal bilirubin (dissociated cholestasis), and to analyze the related risk factors for such pathology. METHODS: All laboratory studies of patients admitted to an Internal Medicine Department were reviewed prospectively throughout a period of 9 months. For the purpose of detecting focal liver pathology imaging liver studies (echography and/or CT) were carried out in those in which biochemical analyses showed dissociated cholestasis. RESULTS: A dissociated cholestasis pattern was found in 81 patients. In 13 of them (16%) focal liver pathology was demonstrated. The majority of the lesions (10 of 13) were local or metastatic malignant neoplasms. Sex, alcohol consumption, presence of diabetes mellitus, tumor or hepatobiliar disease previously known, or abnormalities in liver physical examination were not risk factors. No liver pathology was found in patients with an alkaline phosphatase level higher than double of gamma-glutamil transpeptidase level (sensitivity: 100%; negative predictive value: 100%). Diagnosis of a non-hepatic malignant neoplasm at discharge was associated to a risk 12 times bigger for the presence of liver lesions (p < 0.01). CONCLUSIONS: It is uncommon to find focal liver pathology in patients with dissociated cholestasis. It is more common to discover focal liver pathology in patients with non-hepatic tumors and less probable when phosphatase alcaline: gamma-glutamil transpeptidase ratio is higher than two.

Taponamiento cardiaco como manifestación inicial de un lupus eritematoso sistémico de comienzo tardío / Cardiac tamponade as initial manifestation of late onset systemic lupus erythematosus

No disponible

[Splenectomy indications at a general hospital]. / Indicaciones de esplenectomía en un hospital general.

BACKGROUND: To analyse the evolution of indications for splenectomy for a 11-year period. METHODS: A review was made of cases of splenectomy from clinical records and the records of the Pathology Service at Hospital General Universitario Gregorio Marañón from 1986 to 1996. Both adult and pediatric cases were included. RESULTS: From 1986 to 1996 there was a total of 354 patients (273 males and 162 females) who underwent splenectomy. Mean age of patients was 44.6 years (SD +/- 20.5 years) and there was an average of 39.5 cases per year. The most common causes were trauma (32%), "incidental" splenectomy (14%), thrombopenia (12%) and non Hodgkin lymphoma (11%). Compared with the other causes, the mean age of patients with trauma was lower than that of the other groups (p < 0.0001), in contrast with patients with non Hodgkin lymphoma or extra-splenic tumors, where it was higher (p < 0.0001 for both groups). A decline was observed of cases due to trauma from the first to the last year of the study (p = 0.0009), as well as an increase in the group of splenectomy related to extrasplenic tumors (p = 0.01). In the group of the HIV infected patients (n = 30), thrombopenia was the most common indication for splenectomy (11 cases). CONCLUSIONS: Although the average of splenectomy cases remains relatively constant, a decrease in cases due to trauma was observed and an increase of splenectomies on account of abdominal oncologic resections.