[Mesenteric panniculitis as the initial manifestation of a B cell lymphoma]. / Paniculitis mesentérica como manifestación inicial de un linfoma de células B.

Mesenteric panniculitis is an uncommon clinical entity which sometimes may be associated with hematologic, gastrointestinal and urological neoplasms. The diagnostic procedure ofchoice is based on obtaining a tissue sample for histopathological study usually through apercutaneous procedure. Treatment is indicated in symptomatic cases.

[Pylephlebitis: a rare but possible complication of intra-abdominal infections]. / Pileflebitis: una extraña pero posible complicación de las infecciones intraabdominales.

BACKGROUND: Pylephlebitis or septic thrombophlebitis of the portal venous system is a rare but serious complication of intra-abdominal infections which drain into the portal venous system. Its diagnosis is based on clinical suspicion and imaging tests, mainly a computed tomography scan, given the lack of specificity of the signs and symptoms. Spread of septic emboli is the major cause of morbidity and mortality. The aim of the study was to analyse patients diagnosed in our hospital. MATERIAL AND METHODS: Retrospective descriptive study of patients diagnosed with pylephlebitis in our hospital. CLINICAL CASES: Four patients were included, 3 men and one woman. In 3 cases it was acute cholecystitis that led to the diagnosis of pylephlebitis at the same time as the intra-abdominal infection. Emergency surgery was performed in one case, whilst the other 2 were treated conservatively. Blood cultures were performed in all cases, and empirical antibiotic treatment was used. In the only case of acute appendicitis, diagnosis of pylephlebitis was achieved during the study of postoperative fever, with empirical antibiotic treatment also being started. The haematologist was requested to start the required anticoagulation therapy in all cases. CONCLUSIONS: Pylephlebitis is a rare complication of intra-abdominal infections that may make lead to a worse outcome. A high level of suspicion is required as well as imaging tests to make an early diagnosis and appropriate treatment.

[Appendiceal diverticulitis: comparative study of 7 cases versus 442 acute appendicitis]. / Diverticulitis apendicular: Estudio comparativo de 7 casos versus 442 apendicitis agudas.

BACKGROUND: Appendiceal diverticulitis (AD) is a rare cause of acute appendicitis (AA) which is most frequently diagnosed after appendectomy in pathological study. OBJECTIVE: To compare AA versus AD. METHODS: Retrospective analytic study in avperiod of 51 months fom January 2009 to March 2013 in the Hospital Universitario San Juan de Alicante (Spain), including patients with clinical or radiological suspicious of acute appendicitis which was confirmed intraoperatively and with the pathological study. RESULTS: We included 449 patients, 442 typical AA (98.5%) and 7AD (1.5%). DA was more frequent in women (57%) with a median age of 44 years old (range 37 to 57 years old), whereas AA was more frequent in men (61%) with a median age of 28 years old (range 15 to 46 years old). Leukocyte count, neutrophils and C-reactive protein were respectively 13,300 per mm3 (range 10,700 to 15,700 per mm3), 87.1% (range 84.6 to 89.6%) and 1.82 mg/dL (range 0.59 to 5.31 mg/dL) in AD versus 14,700 per mm3 (range 12,300 to 17,600 per mm), 81.6% (range 75.1 to 86.4%) and 2.71 mg/dL (range 0.67 to 75 mg/dL) in AA. Alvarado score and appendicitis diagnostic score were respectively 7 (range 6 to 8) and 6 (range 5 to 7) in AD and 7 (range 5 to 7) and 6 (range 5 to 6) in AA. An appendiceal perforation was seen in 3 AD (43%) and 80 AA (18%). CONCLUSION: AD appeared in older patients with a clinical and blood test profile similar to AA but with a higher perforation rate.

Sentinel node biopsy for melanoma. Analysis of our experience (125 patients).

INTRODUCTION: The objective of this study is to analyze our experience in the use of sentinel node biopsy (SNB) in melanoma and identify the predictive factors of positive SNB and multiple drainage. MATERIAL AND METHODS: Retrospective study of patients who underwent SNB for melanoma between August of 2000 and February of 2013. RESULTS: SNB was performed in 125 patients with a median of age of 55,6 (±15) years. The anatomic distribution was: 44 (35,2%) in legs, 24 (19,2%) in arms, 53 (42,4%) trunk and 3 (2,4%) in head and neck. The median Breslow index was 1,81 (0,45-5). Between 1 and 6 nodes were isolated. The drainage was unique in 98 (78,4%) and multiple in 27 (21,6%). The trunk was the localization of 25 (92,6%) nodes with multiple drainage. The definitive result of sentinel node (SN) was positive in 18 cases (7,1%). Breslow thickness (p=0,01) was statistically significant predictor of a positive SNB. CONCLUSIONS: The SNB allows patients to be selected for lymphadenectomy. Melanoma of the trunk was the principle location of multiple drainage. The only predictive factor of positive SNB was Breslow thickness.

Diverticulitis apendicular: Estudio comparativo de 7 casos versus 442 apendicitis agudas / [Appendiceal diverticulitis: comparative study of 7 cases versus 442 acute appendicitis].

BACKGROUND: Appendiceal diverticulitis (AD) is a rare cause of acute appendicitis (AA) which is most frequently diagnosed after appendectomy in pathological study. OBJECTIVE: To compare AA versus AD. METHODS: Retrospective analytic study in avperiod of 51 months fom January 2009 to March 2013 in the Hospital Universitario San Juan de Alicante (Spain), including patients with clinical or radiological suspicious of acute appendicitis which was confirmed intraoperatively and with the pathological study. RESULTS: We included 449 patients, 442 typical AA (98.5

) and 7AD (1.5

). DA was more frequent in women (57

) with a median age of 44 years old (range 37 to 57 years old), whereas AA was more frequent in men (61

) with a median age of 28 years old (range 15 to 46 years old). Leukocyte count, neutrophils and C-reactive protein were respectively 13,300 per mm3 (range 10,700 to 15,700 per mm3), 87.1

(range 84.6 to 89.6

) and 1.82 mg/dL (range 0.59 to 5.31 mg/dL) in AD versus 14,700 per mm3 (range 12,300 to 17,600 per mm), 81.6

(range 75.1 to 86.4

) and 2.71 mg/dL (range 0.67 to 75 mg/dL) in AA. Alvarado score and appendicitis diagnostic score were respectively 7 (range 6 to 8) and 6 (range 5 to 7) in AD and 7 (range 5 to 7) and 6 (range 5 to 6) in AA. An appendiceal perforation was seen in 3 AD (43

) and 80 AA (18

). CONCLUSION: AD appeared in older patients with a clinical and blood test profile similar to AA but with a higher perforation rate.

[Acute abdomen due to perforated appendicular mucocele]. / Abdomen agudo por mucocele apendicular perforado.

Primary neoplasms of the appendix are present in approximately 0.2% to 0.3% of appendectomy specimens. Generally affect middle-age adults and elderly people. Approximately 30% to 50% of appendiceal neoplasms manifest with acute appendicitis by luminal obstruction. The definitive diagnosis is histological. We must avoid simple laparoscopic appendectomy and adopt an open procedure with a laparotomy appendectomy for a bening process. Right hemicolectomy is indicated when a malignant condition is suspected Follow-up is recommended in this pathology due to the risk of associated malignant neoplasms. We report a case of perforated appendiceal mucocele in a 84-year-old man presented as an acute abdomen.

[Leiomyomatosis peritonealis disseminata]. / Leiomiomatosis peritoneal difusa.

Leiomyomatosis peritonealis disseminata (LPD) is a rare, benign proliferative process characterized by multiple smooth muscle nodules throughout the peritoneum. Predominantly affects women in their reproductive years. The cause of LPD is unknown although it may be associated with high estrogen state. The clinical appearance mimics a peritoneal carcinomatosis and the radiologic findings are unspecific. So, the definitive diagnosis is histological. Treatment must be individualized depending on age, hormonal status and symptomatology. To date, less than 140 cases have been reported. We report a case of LPD in a 50-year-old woman presented as an intestinal obstruction.