[Hemoperitoenum as presentation of hepatocellular carcinoma: experience in three cases with spontaneous tumoral rupture and review of the literature]. / Hemoperitoneo como forma de presentación del carcinoma hepatocelular: experiencia de tres casos con rotura tumoral espontánea y revisión de la literatura.

Hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma (HCC) constitutes a life-threatening situation if no appropriate therapy is provided. This complication is a well-known form of HCC presentation in countries with high incidence of liver tumours, but is an unusual event in Western countries, where it has been described in 5% or less of cases with HCC. We report three patients admitted to our centre with acute hemoperitoneum secondary to non-traumatic rupture as a first manifestation of not previously diagnosed HCC. A review of the related literature is also performed.

[Clinical manifestations associated with antiphospholipid antibodies]. / Manifestaciones clínicas asociadas a anticuerpos antifosfolípido.

The antiphospholipid antibodies are immunoglobulins able to join negative charge phospholipids. The have been related to a great variety of conditions, specially among connective tissue illness although the idiopathic form seems to be the most frequent. Their presence must be ruled out in cases of young patients with stroke, deep veins thrombosis, acute heart attack and woman suffer multiple abortions and foetal death. These antibodies appear to be related to different clinical entities like Sneddon syndrome. Evans syndrome, "chorea gestationis", migraine. The laboratory determinations are based in direct methods (ELISA, RIA, ...) as well as in indirect ones (activated partial thromboplastin time, reptilase time, ...). The appropriate management and treatment may be based upon clinical expression, in case of arterial thrombosis (type II APS), or deep vein thrombosis (Type II) long term anticoagulation is indicated; Association with pentoxifylline in the case of retinal thrombosis (type IIIa), Stroke (type IIIb) cases may require long term anticoagulation as well as aspirin. Type IV cases are better managed with an individualised treatment.

Conventional viral cultures and shell vial assay for diagnosis of apparently culture-negative Coxiella burnetii endocarditis.

A patient with culture-negative endocarditis was diagnosed with Q fever endocarditis based on the results of serological tests and positive leukocyte cultures obtained using conventional viral cultures and the shell vial technique. This case report suggests that isolation of Coxiella burnetii from blood may allow better diagnostic and therapeutical evaluation of patients with Q fever endocarditis. The use of both conventional and shell vial viral cultures is recommended for the isolation of Coxiella burnetii from the blood of patients with apparently culture-negative endocarditis.

[Hereditary hemorrhagic telangiectasia as a cause of iron-deficiency anemia]. / Telangiectasia hemorrágica hereditaria como causa de anemia ferropénica.

We reviewed cases with Rendu-Osler disease or hereditary hemorrhagic telangiectasia (HHT) between 1976 and 1989 in our area of internal medicine. Of the ten reported cases, six presented severe iron deficiency anemia-three as a result of repeated and intense epistaxis and the rest as a result of digestive losses. The most frequent clinical manifestations were: epistaxis (80%) and the presence of characteristic mucocutaneous lesions easily explored by sight (80%). We emphasize the role of this disease as a cause of iron deficiency anemia and the importance of clinical exploration.