Comunicación masiva del ramo superficial del nervio radial con el nervio cutáneo antebraquial lateral, un análisis morfométrico: 1+1 < 2 / Massive communication between the superficial branch of radial nerve and the lateral cutaneous nerve of the forearm, a morphometric study: 1+1 < 2

La distribución de los ramos nerviosos sensitivos en el borde lateral y en el dorso de la mano han sido descritos con mayor exactitud en las últimas décadas, debido al avance de nuevas técnicas de diagnóstico, las cuales han permitido detectar que alrededor del 40 por ciento de la población examinada presenta algún grado de variación anatómica en el territorio de distribución de los nervios involucrados. Conocer el número de fibras que componen un ramo nervioso cutáneo de la región de la mano, ha adquirido mayor relevancia con el desarrollo de técnicas de microcirugía y de ultrasonografía, procedimientos que han demostrado la utilidad de este conocimiento en el diagnóstico y tratamiento de las lesiones nerviosas. Así, la arquitectura fascicular, el área adiposa y el área vascular de un ramo nervioso determinado constituyen datos que se ha demostrado se modifican con la edad y, en consecuencia, van condicionar la conducta terapéutica y el pronóstico de las lesiones nerviosas. En este caso presentamos una variación anatómica bilateral extremadamente rara, que involucra al ramo superficial del nervio radial y al nervio cutáneo lateral antebraquial; situación que aparece descrita en la literatura especializada sólo una vez y que modifica notablemente la inervación sensitiva del borde radial de la mano...

The distribution of sensory nerve branches in the lateral and the back of the hand have been described more accurately in recent decades due to advances in new diagnostic techniques, which have identified that about 40 percent of the population examined have some degree of anatomical variation in the distribution area of the sensitive nerves involved. The knowledge of the number of fibers forming a sensitive nerve of the hand has become more important with the development of microsurgical techniques and ultrasonography; procedures that have demonstrated the usefulness of this information in the diagnosis and treatment of nerve injuries. Thus, the fascicular architecture, adipose tissue area and the vascular area of a nerve branch, data that has been demonstrated that change with age, will determine the therapeutic and prognosis of nerve injuries. In this case we present an extremely rare and bilateral anatomical variation, involving the superficial branch of radial nerve and the lateral antebrachial cutaneous nerve, a situation that is described in the literature only once and which notably alter the sensory innervations of the radial edge of the hand...

Linfangioleiomiomatosis pulmonar: Caso clínico / Pulmonary lymphangioleiomyomatosis: Report of one case

Lymphangioleiomyomatosis (LAM) is a rare interstitial lung disease, of unknown etiology, affecting almost exclusively women. Microscopically LAM consists of a diffuse proliferation of smooth muscle cells. LAM can occur without evidence of other diseases (sporadic LAM) or in conjunction with tuberous sclerosis complex (TSC). It presents with progressive breathlessness or with recurrent pneumothorax or chylothorax. We report a 33 year-old woman with a history of recurrent pneumothorax. Computed tomography (CT) scans showed numerous thin-walled cysts throughout the lungs, a characteristic finding in LAM. A pulmonary biopsy was compatible with the diagnosis and HMB-45 monoclonal antibodies were positive. Treatment with Sirolimus was started.

Ectasia vascular gástrica antral: infrecuente causa de anemia ferropriva: comunicación de un caso / Antral vascular ectasia: unfrequent cause of ferroprive anemia: a case comunication

Se discute el caso de una paciente mujer de 70 años que cursa más de 3 años con anemia ferropriva intensa, progresiva y recidivante, cuyo estudio revela como único hallazgo, entre los múltiples exámenes realizados, la presencia en la endoscopía digestiva alta de un antro gástrico edematoso, con erosiones longitudinales, de aspecto hemorrágico. El tratamiento médico en base a bloqueadores de la secreción gástrica no es exitoso. La paciente es sometida a cirugía practicándose una hemigastrectomía distal. La evolución alejada de la paciente es muy satisfactoria. La reevaluación clínica y anátomo patológica posterior demuestra que se trata de una ectasia vascular gástrica antral. (Watermelon stomach). Se revisa los antecedentes de la literatura y la terapéutica utilizada

Hidatidosis cervical: compromiso de tiroides y glándula submaxilar en dos casos / Neck located hydatid cysts: report of 2 cases

Neck located hydatid cysts are of rare occurrence. We report two patients with such condition. A 66 years old male with a slowly progressive painless 4 cm nodule located in the right thyroid. It did not concentrate 131I and a fine needle aspiration cytology was informed as an acute thyroiditis. A 5 years old boy presented with a 5 cm painless right submaxillary cyst. Ultrasound examination showed that it was unilocular, and fine needle aspiration biopsy disclosed unspecific findings. In both cases surgical findings and the pathological study showed hydatid cysts. Both patients had normal chest x ray and abdominal ultrasound examinations. They had an uneventful postoperative evolution. Echinococcosis must be considered in the differential diagnosis of cervical cysts in endemic area

Feocromocitoma y neurofibromatosis de von Recklinghausen: crisis postparto y trombosis de arteria renal / Pheochromocytoma and von Recklinghausen neurofibromatosis presenting with a crisis during the puerperal period: report of 1 case

Pheochromocytoma is observed with higher frequency in patients with von Recklinghausen neurofibromatosis. We report a 36 years old female with von Recklinghausen neurofibromatosis who developed mild hypertension during the fourth month of pregnancy. A cesarean section was performed at 37 weeks of pregnancy. Thereafter, the patient presented severe hypertensive and hypotensive crises, sinus tachycardia and fever. No evidences of an infectious disease were found. Abdominal ultrasound examination showed a right adrenal mass of 7 x 5 cm. High levels of urinary cathecolamines confirmed the diagnosis of pheochromocytoma. After three weeks of prazosin therapy, the patient was operated. During the surgical procedure, an encapsulated pheochromocytoma was found and excised. A right renal atrophy and renal artery thrombosis were also found and a nephrectomy was done. Postoperative evolution was uneventful and the patient remains with normal blood pressure levels six months after the operation

Enfermedad ósea de Paget: diagnóstico diferencial de lesiones osteolíticas: caso clínico / Paget disease of the bone: differential diagnosis of osteolytic lesions: report of 1 case

We report a 48 years old female with Paget's disease of the bone who consulted for leg pain. After exhaustive examination a magnetic nuclear resonance revealed a 7 mm intradural schwannoma that was resected without improvement. Four years later, with generalized, progressive bone pains, several osteolytic rib lesions were detected. A bone scintigraphy showed extensive areas of hyperfixation of Tc99 DPM. Biochemical tests were normal with exception of very high serum alkaline phosphatases. Looking for some neoplastic disease, a breast nodule was detected by mammography. Biopsy demonstrated benign disease. Finally, a rib lesion biopsy disclosed diagnosis of Paget's disease of the bone. Treatment with calcitonin, etidronate and vitamin D resulted in partial clinical improvement, reduction of abnormal isotope hyperfixation in bone scintigraphy and of serum alkaline phosphatase levels