Inflammatory pseudotumor of spleen: a case report.

INTRODUCTION: Inflammatory pseudotumor of spleen is an extremely rare benign condition of uncertain etiology that presents with nonspecific symptoms or as an incidental finding in patients studied by other processes. Since the first description in 1984 by Cotelingam and Jaffe, only 114 cases have been reported. PRESENTATION OF CASE: We present a case of a fifty-six years old woman with a splenic injury in ultrasound and computed tomography. The patient undergoes laparoscopic splenectomy and the histologic study of the specimen revealed findings consistent with inflammatory pseudotumor of spleen. DISCUSSION: This rare entity whose pathogenesis is still unknown, can present with nonspecific symptoms. Radiologic studies may lead the diagnosis being useful CT and MRI. The definitive diagnosis is established with the histological findings, characterized by the presence of inflammatory cells with areas of necrosis and fibrosis. There are multiple differentials diagnoses: metastasis, lymphoma, splenic infarction, hemangiomas, vascular malformations, lymphangioma, plasmacytoma, reactive lymphoid hyperplasia, abscess and infectious granulomatous processes; therefore suspicion of malignant neoplasm must be considered, being indicated splenectomy to confirm the diagnosis. CONCLUSION: Inflammatory pseudotumor of spleen is a benign disease, in which diagnostic approach must bear in mind the possibility of a malignant lesion. For this reason, the surgical approach is appropriate to confirm the diagnosis and rule out malignancy with histology.

An unsuspected clinical condition: Appendicitis of appendicular residual, three cases report.

INTRODUCTION: Stump appendicitis is a rare complication of appendectomy unusually included in the differential diagnosis. This is found in appendectomized patients with similar symptoms to those of a previous appendicitis. PRESENTATION OF CASE: We present three cases, two women and a man of 67, 30 and 24 years old, respectively. They underwent surgery at our centre and their appendectomies presented technical difficulties: problems when identifying the appendicular base or the complete appendicular structure. In the first case, diagnosis and therapy were performed with laparoscopy. The second case was diagnosed by an abdominal ultrasound (US) which revealed a tubular structure with thickened walls. An abscess was observed in the computed tomography (CT) scan for the third case and a laparotomy revealed the retained appendix. DISCUSSION: Although there are several factors that can contribute to this rare pathology, the main cause of stump appendicitis is the persistence of a large appendicular remnant. CT and US are very useful diagnosis tools. Treatment consists to a completion appendectomy of the stump which can be carried out by an open or a laparoscopic approach. CONCLUSION: In this rare pathology a prior history of appendicectomy can delay the diagnosis and increase its associated morbidity and even mortality. In patients with abdominal pain in the right lower quadrant and previous appendectomy, it is important to include this pathology in the differential diagnosis, in order to not delay the treatment and thus avoid complications.

Sarcoma hepático en paciente con cirrosis y antecedente de carcinoma hepatocelular / Liver sarcoma in a patient with cirrhosis and prior hepatocellular carcinoma

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Criterios mínimos de trasplante hepático: Child, MELD, excepciones / No disponible

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Mathematical model for optimal control in wastewater discharges: the global performance.

In this work we show how mathematical models and optimal control techniques can help us to solve some problems of environmental engineering, more precisely, water pollution problems arising from wastewater discharges into coastal areas or rivers. We deal with a complete two-dimensional mathematical model for the evolution of pollutant concentration in a shallow water domain. By integrating this model we obtain a zero-dimensional one and we use it to study the global performance of the system in a realistic situation. Finally, by using the two-dimensional model, we recall two optimal control problems related to the wastewater disposal problem.

Fibrosis retroperitoneal idiopática / Idiopathic retroperitoneal fribrosis

OBJETIVO: Presentamos el caso de una Fibrosis retroperitoneal idiopática en un varón de 34 años, con antecedentes de anemia y elevación de la velocidad de sedimentación eritrocitaria. MÉTODO: Se realizó estudio con técnicas de imagen (ecografía, TC y RM) y posterior estudio anatomopatológico. RESULTADOS: Se evidenció por métodos de imagen (ecografía, TC y RM) una masa de características infiltrantes circunscrita a la porción superior del abdomen, diagnosticada tras su exéresis y estudio histológico e inmunohistoquímico de retroperitonitis esclerosante. CONCLUSION: La fibrosis retroperitoneal idiopática o enfermedad de Ormond es una enfermedad rara, de etiología oscura, caracterizada por marcada fibrosis del retroperitoneo, con un infiltrado inflamatorio constituido por células plasmáticas, linfocitos y eosinófilos. El interés de este caso recae en la localización atípica de la FRI, así como su presentación en un hombre joven, sin antecedentes de interés, llamando únicamente la atención la anemia y el aumento de la velocidad de sedimentación eritrocitaria en la analítica (AU)