Bowel ischaemia and cocaine consumption; case study and review of the literature.

BACKGROUND: Amongst others, cocaine consumption has a detrimental effect in the vascular supply to the mesenteric area causing abdominal ischemic changes. Early recognition of these changes and adequate treatment are essential to avoid serious complications and possible death of the patient from sepsis. CASE REPORT: In this case study, the subject is a 40-years-old gentleman presenting with acute abdominal pain due to multiple ischemic changes in both small bowel and sigmoid loops. The patient required emergency surgical intervention consisting of bowel resection and anastomosis. The pathologic analysis of the segment showed transmural necrosis and necrotizing phlebitis caused by the ingestion of drugs or toxic agents. The patient later confirmed the habitual consumption of cocaine. DISCUSSION: The increase in cocaine consumption and other recreational toxins substructed from erythroyilon coca alkaloids amongst young people have generated a large number of admissions to Hospital Accident and Emergency Departments with patients complaining of acute abdominal pain. In many of these cases, surgical intervention is required and in some cases patients will sadly die without a proper diagnosis. Some of the most common effects of cocaine and its compounds includes; hollow viscus perforation, gastro-intestinal bleed, and other vascular problems such as enteritis and ischemic colitis. It appears clear that there is a great need for an advance history taking of these patients and their habit to cocaine and other drugs together with a urine test for drug screening. These together with a suspicion of a non- occlusive ischemic bowel caused by the effects of cocaine in young adults with no cardiac risk factors will guide clinicians and establish, and plan the correct treatment for these categories of patients.

Isquemia intestinal y consumo de cocaína; presentación de un caso y revisión de la literatura / Bowel ischaemia and cocaine consumption; case study and review of the literature

Introducción: entre los efectos nocivos del consumo de cocaína se incluyen los producidos a nivel de la vascularización mesentérica, instaurándose en forma de cuadros abdominales isquémicos de potencial gravedad que, si no son diagnosticados y tratados adecuada y precozmente, conllevan complicaciones serias e incluso a la muerte por sepsis. Caso clínico: presentamos el caso de un hombre de 40 años que fue intervenido de urgencias por abdomen agudo secundario a isquemia segmentaria múltiple de asas de delgado y sigmoides. Se realizó resección intestinal y anastomosis. La anatomía patológica del segmento describió hallazgos compatibles con necrosis transmural y flebitis necrotizante producida por el efecto de drogas o tóxicos; el paciente confirmó el consumo previo y habitual de cocaína. Discusión: la difusión entre la población generalmente joven, del consumo de este y de otros tóxicos derivados de los alcaloides de la Erythroyilon coca, ha condicionado un incremento de las consultas en urgencias por dolor abdominal agudo; generalmente, en muchos de estos casos, los pacientes se intervienen quirúrgicamente sin diagnóstico o lo que es más grave, fallecen sin el mismo. Entre los efectos adversos a nivel gastrointestinal de la cocaína y sus derivados, se encuentran la perforación de víscera hueca, la hemorragia digestiva, y los problemas vasculares en forma de enteritis y colitis isquémica. Sería aconsejable un interrogatorio minucioso sobre el consumo de cocaína y otras drogas o la solicitud de su presencia en orina, y la sospecha clínica de una isquemia intestinal no oclusiva originada por cocaína en aquellos adultos jóvenes sin factores de riesgo cardiovascular, sobre todo con vistas a planificar el correcto tratamiento (AU)

Background: Amongst others, cocaine consumption has a detrimental effect in the vascular supply to the mesenteric area causing abdominal ischemic changes. Early recognition of these changes and adequate treatment are essential to avoid serious complications and possible death of the patient from sepsis. Case report: In this case study, the subject is a 40-years-old gentleman presenting with acute abdominal pain due to multiple ischemic changes in both small bowel and sigmoid loops. The patient required emergency surgical intervention consisting of bowel resection and anastomosis. The pathologic analysis of the segment showed transmural necrosis and necrotizing phlebitis caused by the ingestion of drugs or toxic agents. The patient later confirmed the habitual consumption of cocaine. Discussion: The increase in cocaine consumption and other recreational toxins substructed from erythroyilon coca alcaloids amongst young people have generated a large number of admissions to Hospital Accident and Emergency Departments with patients complaining of acute abdominal pain. In many of these cases, surgical intervention is required and in some cases patients will sadly die without a proper diagnosis. Some of the most common effects of cocaine and its compounds includes; hollow viscus perforation, gastro-intestinal bleed, and other vascular problems such as enteritis and ischemic colitis. It appears clear that there is a great need for an advance history taking of these patients and their habit to cocaine and other drugs together with a urine test for drug screening. These together with a suspicion of a non- occlusive ischemic bowel caused by the effects of cocaine in young adults with no cardiac risk factors will guide clinicians and establish, and plan the correct treatment for these categories of patients (AU)

[Retroperitoneal sarcomas. Report of five new cases and review of the current situation]. / Sarcomas retroperitoneales. Aportación de cinco nuevos casos y revisión de la situación actual.

INTRODUCTION: Soft-tissue sarcomas represent a heterogeneous group of rare tumors arising from the mesenchymal cells of the connective tissue. Approximately 15% of these tumors arise in the retroperitoneum. These neoplasms are locally aggressive and the only curative treatment is surgical resection "en-bloc". The main cause of mortality is locoregional recurrence. Five-year survival is 3-58%, depending on the histologic subtype and grade. PATIENTS AND METHOD: Over a 5-year period (2001 to 2006), we performed surgery in five patients with retroperitoneal sarcomas. The mean age was 59 years (range, 46-76) with a male-to-female ratio of 3:2. The most frequent signs were abdominal pain and the appearance of a mass. In 2 patients, an incidental diagnosis was made during the surgical intervention. RESULTS: Surgical resection was performed in 5 patients but was incomplete in two patients. We removed 2 liposarcomas, 1 leiomyosarcoma, 1 chondrosarcoma and 1 fusocellular sarcoma arising in the kidney. Locoregional recurrence occurred in four patients, requiring between 1 and 2 new relaparotomies (using the retroperitoneal approach in 2 patients). There was one death. CONCLUSIONS: Retroperitoneal sarcomas are a heterogeneous group of tumors, in which the only common factor is the anatomical location. New randomized, prospective, multicenter trials are required to apply different therapeutic options according to the subtype of retroperitoneal sarcoma.

Sepsis, absceso del psoas y artritis séptica de cadera por Yersinia enterocolitica / Sepsis, psoas abscess and septic arthritis of the hip caused by Yersinia enterocolitica

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Sarcomas retroperitoneales. Aportación de cinco nuevos casos y revisión de la situación actual / Retroperitoneal sarcomas. Report of five new cases and review of the current situation

Introducción. Los sarcomas constituyen un grupo muy heterogéneo de tumores infrecuentes que se originan a partir de las células mesenquimales localizadas en el tejido conectivo. De éstos, el 15% es de localización retroperitoneal. Son tumores localmente agresivos cuyo único tratamiento curativo es la resección quirúrgica en bloque con márgenes libres. La principal causa de muerte es la recidiva locorregional. La supervivencia a los 5 años es de un 3-58%, y la evolución varía según el subtipo histológico y el grado de diferenciación del sarcoma. Pacientes y método. Desde 2001 hasta 2006, hemos operado 5 sarcomas retroperitoneales. La media de edad fue de 59 (46-76) años, con una proporción varones:mujeres de 3:2. El dolor y la masa abdominal fueron los signos iniciales más frecuentes. En 2 casos el diagnóstico se realizó incidentalmente en el acto quirúrgico. Resultados. Los 5 casos fueron resecados, si bien fue incompleta en 2. Resecamos 2 liposarcomas, 1 leiomiosarcoma, 1 condrosarcoma y 1 sarcoma fusocelular de origen renal; 4 pacientes refirieron recidiva local y precisaron entre 1 y 2 nuevas resecciones con intención curativa (en esa ocasión realizamos un abordaje retroperitoneal en 2 casos). Registramos una muerte. Conclusiones. Los sarcomas retroperitoneales constituyen un grupo muy heterogéneo de tumores que tienen como único dato común la localización. Creemos que deberían llevarse a cabo estudios prospectivos aleatorizados y multicéntricos para aplicar criterios terapéuticos distintos según el subtipo de sarcoma retroperitoneal (AU)

Introduction: Soft-tissue sarcomas represent a heterogeneous group of rare tumors arising from the mesenchymal cells of the connective tissue. Approximately 15% of these tumors arise in the retroperitoneum. These neoplasms are locally aggressive and the only curative treatment is surgical resection "en-bloc". The main cause of mortality is locoregional recurrence. Five-year survival is 3-58%, depending on the histologic subtype and grade. Patients and method. Over a 5-year period (2001 to 2006), we performed surgery in five patients with retroperitoneal sarcomas. The mean age was 59 years (range, 46-76) with a male-to-female ratio of 3:2. The most frequent signs were abdominal pain and the appearance of a mass. In 2 patients, an incidental diagnosis was made during the surgical intervention. Results. Surgical resection was performed in 5 patients but was incomplete in two patients. We removed 2 liposarcomas, 1 leiomyosarcoma, 1 chondrosarcoma and 1 fusocellular sarcoma arising in the kidney. Locoregional recurrence occurred in four patients, requiring between 1 and 2 new relaparotomies (using the retroperitoneal approach in 2 patients). There was one death. Conclusions. Retroperitoneal sarcomas are a heterogeneous group of tumors, in which the only common factor is the anatomical location. New randomized, prospective, multicenter trials are required to apply different therapeutic options according to the subtype of retroperitoneal sarcoma (AU)