Infantile convulsions with mild gastroenteritis: a retrospective study of 25 patients.

BACKGROUND: The aim of this study was to analyze the epidemiologic, clinical, and evolutional characteristics in patients who presented convulsions with mild gastroenteritis (CwG) to facilitate the diagnosis in daily clinical practice. METHODS: Twenty-five medical records of patients diagnosed with CwG were reviewed, and the epidemiological and clinical features, results of complementary studies, and evolutional data were collected. RESULTS: Age of onset ranged between 12 and 24 months in 76% of patients. Female/male ratio was 2.6 (18 women and seven men). Seizures were mostly brief (<5 min) and apparently generalized, and often repetitive occurring in cluster (2.2 seizures per episode). One patient with status epilepticus was recorded. The average interval between the onset of gastroenteritis and seizures was 3.8 days, even though seizure preceded diarrhea in three cases. Mean rectal temperature at the moment of seizure was 37.1°C. Rotavirus antigen was positive in stool in 17 episodes (55.8%). There were no abnormalities in serum biochemistry tests and cerebrospinal fluid studies. Four patients showed anomalies in the interictal electroencephalogram. The period of follow-up was 4.2 years. Five patients (20%) experienced recurrences when suffering a new gastroenteritis episode. One patient developed epilepsy during the follow-up period. CONCLUSIONS: CwG would constitute a well-differentiated convulsive syndrome. Prognosis is excellent, but a relatively important percentage of patients relapse when suffering a new diarrhea episode.

[Paediatric myofibroblastic tumours. A presentation of three cases]. / Tumor miofibroblástico en la edad pediátrica. A propósito de 3 casos.

There cases of paediatric inflammatory myofibroblastic tumours in different locations are presented. This a rare benign disease, that can develop into malignant forms. Clinical features are associated with the location. Fever was the main symptom in all our cases. The symptoms that indicated the location of the tumour were, haematemesis in the first case, and respiratory disease in the third. In the third case our patient was diagnosed with tuberculosis due to mycobacterium avium. All cases had increased CRP, ESR, thrombocytosis and high levels of gamma globulins Surgery is curative if total resection is possible, and the diagnosis is made by histopathology. We would like to emphasise the early development in the second case as this was a 3 months-old infant.

Histopathological and Ultrastructural Changes after Electroporation in Pig Liver Using Parallel-Plate Electrodes and High-Performance Generator.

Irreversible electroporation (IRE) has gained attention as a new non-thermal therapy for ablation with important benefits in terms of homogeneous treatment and fast recovery. In this study, a new concept of high voltage generator is used, enabling irreversible electroporation treatment in large tissue volume using parallel plates. Unlike currently available generators, the proposed versatile structure enables delivering high-voltage high-current pulses. To obtain homogeneous results, 3-cm parallel-plates electrodes have also been designed and implemented. IRE ablation was performed on six female pigs at 2000 V/cm electric field, and the results were analysed after sacrifice three hours, three days and seven days after ablation. Histopathological and ultrastructural studies, including transmission and scanning electron microscopy, were carried out. The developed high-voltage generator has proved to be effective for homogeneous IRE treatment using parallel plates. The destruction of the membrane of the hepatocytes and the alterations of the membranes of the cellular organelles seem incompatible with cell death by apoptosis. Although endothelial cells also die with electroporation, the maintenance of vascular scaffold allows repairing processes to begin from the third day after IRE as long as the blood flow has not been interrupted. This study has opened new direction for IRE using high performance generators and highlighted the importance of taking into account ultrastructural changes after IRE by using electron microscopy analysis.

[Reversible posterior leukoencephalopathy: report of two cases after vincristine treatment]. / Leucoencefalopatía posterior reversible: descripción de dos casos asociados a vincristina.

Reversible posterior leukoencephalopathy syndrome is a clinical-radiological phenomenon associated with headache, vomiting, lethargy, visual disturbances and seizures, concomitant with radiological abnormalities predominantly within posterior cerebral white matter due to cerebral edema. There are multiple triggers as acute hypertension, cancer, hematological disease, renal pathology, red cells transfusions and different drugs. We present two patients with reversible posterior leukoencephalopathy under treatment for acute lymphoblastic leukemia because of the probable association with vinca alkaloids.

The autonomic innervation of the liver and gallbladder of Rana ridibunda.

1--The innervation of the liver and gallbladder of Rana ridibunda has been studied by the following methods: (a) demonstration of cholinesterase activity; (b) FIF method for catecholamines; (c) immunohistochemistry for VIP and (d) electron microscopy. 2--The hepatocytes are arranged in regular rows of hepatic cords, very little connective tissue is distributed in the parenchyma, the innervation being restricted to the big branches of blood vessels. 3--Well defined cholinergic and adrenergic plexuses surround the hepatic arteries, portal veins and biliary ducts. The VIPergic innervation is scarce in the liver but a richly branched plexus spreads in the wall of the gallbladder. 4--Cholinesterase-positive cells are widely distributed accompanying the nerve trunks of the gallbladder. The innervation distribution is prominent in the portion of the gallbladder next to the hepatic hilus. 5--A population of melanin-storing cells besides free melanin granules are present in the liver parenchyma and are prominent in the gallbladder where the melanocytes are disposed in close contact with blood vessels and nerve structures. We have observed that the number of these visceral melanocytes considerably increases in winter, particularly in the liver.

Intrinsic innervation in the intestine of the lizard Podarcis hispanica.

The aim of this study was the description of the morphology and distribution of nerve structure elements in the intestine of the lizard Podarcis hispanica using different histochemical methods; namely acetylcholinesterase (AChE), formol-induced fluorescence for catecholamines (FIF), nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d), and immunohistochemistry for vasoactive intestinal peptide (VIP), as well as substance P (SP) and electron microscopy. The AChE method showed fibres in the myenteric and submucosal plexus, with a higher fibre density in the large intestine. The highest number of related neurons was located in the myenteric plexus ganglia. Noradrenergic innervation was distributed through the myenteric and submucosal plexus, and also around blood vessels, with the highest fibre density in the large intestine. VIP immunohistochemistry showed a wide distribution of positive fibres throughout the intestine, although the highest density was again detected in the large intestine. Small positive cells for VIP were located at internodal segments in the plexus. SP labeling, although subtle, was present all along the intestine. It showed delicate varicose nets and few fibres innervating blood vessels. Small positive cells for SP were located in the large intestine. The indirect method to detect nitric oxide (NO)-producing system showed neural cells in the myenteric plexus ganglia of the large intestine. Electron microscopy showed ganglion neurons with scattered chromatin condensations, glial cells with higher electron density, and axons with varicosities occupied by different vesicles. We also identified certain cells as interstitial cells of Cajal due to their ultrastructural features. They were mostly located in the region of the myenteric plexus.

Enteric plexus and interstitial cells of Cajal: interrelationship in the stomach of Podarcis hispanica (Reptilia). An ultrastructural study.

The ultrastructure organization of the stomach enteric plexus was examined in the lizard Podarcis hispanica. The ganglions of the myenteric plexus present a low number of nerve cell bodies with a peculiar nucleus, which occasionally establish direct contacts with cells of the circular muscle layer. Glial cells are smaller than the neurones, and their nucleus is very electron-dense. They surround the axons that constitute the fibres of the myenteric plexus. Four main types of axon profile are described in a morphological consideration of the vesicle population. In the interstice of the circular muscle layer we describe two types of interstitial cells that, due to their ultrastructural characteristics, may be equivalent to the interstitial cells of Cajal which have been described in mammalians. These cells shows parallel distribution to the stomach nerve plexuses, establishing close contacts with them through their long cytoplasmic prolongations. By means of small gap-like unions, they contact both each other and the smooth muscle cells near them. We describe a submucous plexus, where neuronal bodies are scattered among bundles of nervous fibres, some of which are myelinated. A mucous plexus with isolated neurones is located in the lamina propria. Axonal varicosities containing vesicles contact with the cells of the mucous. Interconnected interstitial cells may also be found in this plexus.

Hepatic lesion ablation with bipolar saline-enhanced radiofrequency in the audible spectrum.

RATIONALE AND OBJECTIVES: The authors' purpose was to create larger and more regular liver lesions in vitro by testing a new hyperthermia approach that uses a bipolar saline-enhanced electrode for radiofrequency (RF) in the audible spectrum and a greater power supply. MATERIALS AND METHODS: The authors' hyperthermia approach (group A, n = 23) was used in excised porcine livers, and the results were compared with those of a previously described monopolar saline-enhanced electrode procedure (group B, n = 23). In each set of experiments, RF in the audible spectrum current (50 Hz) was provided for 15 minutes with a similar ablation protocol. Electrical variables (impedance, current, voltage, power, and energy), temperatures in the lesions, volume size, regularity ratio of the lesion, and microscopic findings were measured. RESULTS: In group A, the mean volume size and the mean regularity ratio values were 144.8 cm3 +/- 59.8 and 0.78 +/- 0.1, respectively. In group B, the mean volume size and regularity ratio values were 62.1 cm3 +/- 36.4 and 0.62 +/- 0.1, respectively. The values in group B were thus significantly lower than those in group A (P < .01). The lesions in group A were also more homogeneous. No significant differences were found in electrical variables. CONCLUSION: The new bipolar saline-enhanced electrode produced larger, more regular, and more homogeneous lesions ex vivo than the previously used monopolar saline-enhanced electrode method. Using a greater power supply increased the amount of coagulative necrosis.

Ganglion cysts associated with cruciate ligaments of the knee: a possible cause of recurrent knee pain.

Intraarticular ganglia of the knee are uncommon; however, these ganglion cysts may produce knee discomfort without a clear etiology. We present the cases of 10 patients with ganglion cysts arising from cruciate ligaments of the knee joint who underwent arthroscopic excision after MR examination. The MR findings, clinical features and arthroscopic findings were evaluated comparatively. Diagnoses were confirmed by means of a histological study after arthroscopic excision. The cysts were fluid-filled, with low T1-weighted signal intensity and high T2-weighted signal intensity. Except for two patients with recent accidents, the remaining eight presented chronic pain without any history of trauma. Pain was the most frequent clinical sign. It was associated with knee extension in 3 cases and with flexion in 3 cases. In 7 cases, cysts were exclusively associated with the anterior cruciate ligament (ACL). Only in one case was a cyst associated with an ACL rupture. Four patients presented meniscal lesions. All ganglia appeared solitary in each knee. Postarthroscopy evolution was painless in 8 patients. Histologic diagnoses corresponded to ganglion cysts. The tissues from the patient with the ACL rupture presented a fibrous reaction with myxoid degeneration forming intraligamentary ganglion cysts.

Late recurrence and endocranial metastasis caused by giant cell tumor.

A case of giant cell tumor localized in the proximal end of the right tibia, initially treated by simple curettage is described. After 11 years there was local recurrence, confirmed anatomopathologically, observed during wide resection and reconstruction by arthroplasty plus homoplastic grafting. After a few months there were metastatic lesions in the left parietooccipital and right retroorbitary area. Biopsy of the parietooccipital lesion showed giant cells in a sarcomatous stroma. The patient died after several attempts at chemotherapy. Even if only sporadic cases have been described of late recurrences and of extrapulmonary metastases for giant cell tumors, the case presented here is exceptionally rare. The factors that influence recurrence of these tumors and their ability to metastasize is discussed.

Baker's pseudocyst in the prosthetic knee affected with aggressive granulomatosis caused by polyethylene wear.

It is our belief that this is the first histologically documented case of popliteal cyst secondary to early failure of a cementless knee prosthesis, that occurred after 4 years. The walls of the cyst presented with granulomatous reaction to polyethylene particles. In prosthetic reimplantation successive to excision of the cyst we observed a recurrence of cysts and osteointegration of the prosthetic components, that made reimplantation difficult. Histological assessment of the synovial tissue, periprosthetic tissue and underlying bone showed granulomatous reaction to polyethylene debris. A "tumor" in a patient that has a knee prosthesis can be caused by implant failure. In cases of early failure wear forms large particles and their migration at the bone-prosthesis interface may be obstructed and thus cause a different biological response. If reimplantation is necessary osteointegration of the implants may make surgery difficult.

Bizarre parosteal osteochondromatous proliferation. Difficulty in diagnosis.

Nora's tumor, also known as bizarre paraosteal osteochondromatous proliferation, is an exophytic outgrowth from the cortical surface that consists of a mixture of bone, cartilage, and fibrous tissue. It is a benign lesion with atypical microscopic features and a tendency to recur. Nora reported 35 cases emerging from the bones of the hands and feet. The largest published series is of 65 cases, with 17 lesions involving the long bones. With this exception, most authors report isolated cases. Age range from 8 to 74 years but most patients are between 20 and 35 years of age, and with the lesion affecting males and females in equal proportions. Usually the presenting symptoMs are due to bony mass, with a variable growth rate (months-years), and infrequent pain. In 15-20% of the cases there was trauma in the patient history: nevertheless, Fechner and Mills report no association with trauma. Radiography shows a calcified, rounded mass emerging directly from the surface of the bone. Isotope bone scans show intense tracer uptake in the lesion. With time, the appearance progresses to the more characteristic mature bone architecture.

[Forearm malignant epithelioid schwannoma associated with melanoma]. / Schwannoma maligno epitelioide en antebrazo asociado a melanoma.

Tumours originating in peripheric nerves usually appear in patients with neurofibromatosis (NF) signs, presenting frequent combinations of tumours in nerves and cutaneous lesions. Nevertheless, this association is very rare in cases without NF. Therefore, the aim of the present article is to present a case of malignant melanoma and malignant schwannoma, without any described NF. A 69-year-old woman with antecedents of malignant melanoma diagnosed two years previously in the dorsum of the fifth finger of the left hand, treated by means of amputation of the finger. The patient presented a malignant epithelioid schwannoma adhered to the median nerve that required elbow amputation. One month later lung metastases appeared and the patient died. This case presented no known NF sign. However, a relationship must be searched for in the common origin of melanoma and schwannoma from the embryonic neural crest.

[Pigmented mucosal lesion associated with oropharyngeal squamous carcinoma]. / Asociación entre lesión mucosa pigmentada y carcinoma escamoso orofaríngeo.

The presence, in a same anatomical location, of an aquired melanopathy and a carcinoma squamous, obliges us to stablish a communal etiopathogenic hypothesis that we interpret through a bibliographic review carried out on the theme.

Analysis of tissue bioimpedance as a measurement of liver steatosis: experimental model in large animals.

BACKGROUND: Electrical bioimpedance (BI) has been used to indirectly measure steatosis. This method has not yet been established in the clinics thus experimental studies are needed in big animals. We assessed BI to measure liver steatosis in porcine animals. METHODS: Twelve large-white × Landrace pigs weighing 35 kg were allocated to a study (n = 9) and a control group (n = 3). A special diet was used to promote steatosis among the study group: methionine deficient and choline-restricted diet that contains supplements of cholesterol, collate and excess of saturated fat. Control group animals were fed a normal diet. A new tetrapolar electrode model was used for BI measurement, which were performed during open laparotomy by inserting a probe into one of the lobes. Measurements were done in the third and fourth segments of the pig liver, placing the probe either on the surface or inserted into the parenchyma of the liver. Open biopsies were obtained at the end of the measurements. Histological samples were processed and stained with hematoxylin-eosin to estimate macrosteatosis. Pearson correlation coefficient between BI and percentage steatosis were calculated at different frequencies. RESULTS: After 4 months of the special diet all the animals in the study group developed steatosis (90% to 20%), whereas none of the control group was affected. Pearson correlation coefficients between BI and percentage of steatosis were significant (0.877-0.878) with the best correlations obtained with a probe placed on the fourth segment of the liver surface and the best frequency to perform the measurements being 50 and 75 kHz. CONCLUSIONS: BI is an accurate, fast method for steatosis measurements, that is easier and cheaper than either open or needle biopsy.

[Partial jejunal volvulus due to a mesenteric cystic lymphangioma]. / Vólvulo yeyunal incompleto por linfangioma quístico mesentérico.

Mesenteric cysts are unusual benign tumours that include lymphangioma. Their clinical presentation is variable and acute symptoms can be produced due to complications. This tumour appears especially in childhood, and its prognosis after surgical removal is excellent. We present the case of a 15 year old female patient with symptoms of postprandial abdominal pain and palpation of smooth mass in hypogastrium. Radiological studies showed a big polilobular mass of cystic substance that included a portion of jejune with incomplete volvulus. The treatment was the removal of the cyst and a jejunal portion and the pathological diagnosis was mesenteric cyst lymphangioma. The patient is asymptomatic more than three years after the intervention.

A radiofrequency-assisted device for bloodless rapid transection of the liver: a comparative study in a pig liver model.

BACKGROUND: Efficient and safe liver parenchymal transection is dependent on the ability to address both parenchymal division and hemostasis simultaneously. In this article we describe and compare with a saline-linked instrument a new radiofrequency (RF)-assisted device specifically designed for tissue thermocoagulation and division of the liver used on an in vivo pig liver model. METHODS: In total, 20 partial hepatectomies were performed on pigs through laparotomy. Two groups were studied: group A (n=8) with hepatectomy performed using only the proposed RF-assisted device and group B (n=8) with hepatectomy performed using only a saline-linked device. Main outcome measures were: transection time, blood loss during transection, transection area, transection speed and blood loss per transection area. Secondary measures were: risk of biliary leakage, tissue coagulation depth and the need for hemostatic stitches. Tissue viability was evaluated in selected samples by staining of tissue NADH. RESULTS: In group A both blood loss and blood loss per transection area were lower (p=0.001) than in group B (70+/-74 ml and 2+/-2 ml/cm(2) vs. 527+/-273 ml and 13+/-6 ml/cm(2), for groups A and B, respectively). An increase in mean transection speed when using the proposed device over the saline-linked device group was also demonstrated (3+/-0 and 2+/-1cm(2)/min for group A and B, respectively) (p=0.002). Tissue coagulation depth was greater (p=0.005) in group A than in group B (6+/-2 mm and 3+/-1 mm, for groups A and B, respectively). Neither macroscopic nor microscopic differences were encountered in transection surfaces between both groups. CONCLUSIONS: The proposed RF-assisted device was shown to address parenchymal division and hemostasis simultaneously, with less blood loss and faster transection time than saline-linked technology in this experimental model.