[Knowledge, attitudes, and practices about COVID-19 in Argentina. A cross-sectional study]. / Conocimientos, actitudes y prácticas sobre COVID-19 en Argentina. Estudio tranversal.

Our objective was to assess levels of knowledge, attitudes, and practices against COVID-19. A total of 3774 persons were surveyed between September 18 and October 16, 2020. Eighty% resided in Buenos Aires City or Buenos Aires Province: 58% had completed tertiary education; 72% worked either independently or as employees in the public or the private sector; 51% used a prepaid health care plan, 34% were covered by a trade union-based health system, and near 10% used the public health services. According to the socio-demographic variables analyzed, the population studied was representative of the middle class. A total of 7% had been diagnosed with COVID-19. There was a high level of knowledge about the disease, judging by the high proportion of correct answers (80-90%). Regarding the measures taken by the government, the answers varied widely ("correct", "inadequate", "harmful", "unnecessary", etc.). The medical staff was the preferred source of information; 44% of respondents felt protected by their health system; 28% would only seek healthcare when feeling very sick. There was a high degree of compliance with most protection measures, except for attendance to social events in poorly ventilated spaces (50%). The results of these studies contribute to establishing communication strategies for the prevention and control of COVID-19 and thus deal more efficiently with eventual outbreaks of the disease.

Nuestro objetivo fue evidenciar el nivel de conocimientos, actitudes y prácticas frente al COVID-19. Fueron encuestados 3774 individuos mayores de 16 años entre el 18/09/20 y el 16/10/20. El 80% residía en la ciudad de Buenos Aires o la Provincia de Buenos Aires. El 58% había completado estudio terciario. El 72% tenía actividad laboral independiente o en relación de dependencia pública o privada. Utilizaban el sistema de salud prepago el 51%, obra social laboral el 34%, y sistema público de salud cerca del 10%. De acuerdo a las variables socio-demográficas analizadas, la mayoría de la población fue representativa de la clase media. Del total de encuestados, el 7% tuvo diagnóstico de COVID-19. Observamos un alto nivel de conocimiento de la enfermedad, con 80 a 90% de respuestas correctas. En relación a las medidas adoptadas por las autoridades, los juicios emitidos variaron entre "correctas", "insuficientes", "perjudiciales", "innecesarias", etc. El 44% se sentía protegido por el sistema de salud. En cuanto a los referentes válidos para transmitir información, la respuesta preponderante fue el personal médico. En cuanto al momento deconsultar por síntomas, un porcentaje importante (28%) lo haría en forma tardía. Observamos un alto grado de cumplimiento de las medidas de protección, a excepción del ítem "Asistencia a reuniones" (50%). Los resultados de estos estudios contribuyen a establecer estrategias comunicacionales para la prevención y el control de la enfermedad y de ese modo enfrentar de forma más eficiente eventuales rebrotes de la enfermedad.

Conocimientos, actitudes y prácticas sobre covid-19 en argentina. estudio tranversal / Knowledge, attitudes, and practices about COVID-19 in Argentina. A cross-sectional study

Resumen Nuestro objetivo fue evidenciar el nivel de conocimientos, actitudes y prácticas frente al COVID-19. Fueron encuestados 3774 individuos mayores de 16 años entre el 18/09/20 y el 16/10/20. El 80% residía en la ciudad de Buenos Aires o la Provincia de Buenos Aires. El 58% había completado estudio terciario. El 72% tenía actividad laboral independiente o en relación de dependencia pública o privada. Utilizaban el sistema de salud prepago el 51%, obra social laboral el 34%, y sistema público de salud cerca del 10%. De acuerdo a las variables socio-demográficas analizadas, la mayoría de la población fue representativa de la clase media. Del total de encuestados, el 7% tuvo diagnóstico de COVID-19. Observamos un alto nivel de conocimiento de la enfermedad, con 80 a 90% de respuestas correctas. En relación a las medidas adoptadas por las autoridades, los juicios emitidos variaron entre "correctas", "insuficientes", "perjudiciales", "innecesarias", etc. El 44% se sentía protegido por el sistema de salud. En cuanto a los referentes válidos para transmitir información, la respuesta preponderante fue el personal médico. En cuanto al momento deconsultar por síntomas, un porcentaje impor tante (28%) lo haría en forma tardía. Observamos un alto grado de cumplimiento de las medidas de protección, a excepción del ítem "Asistencia a reuniones" (50%). Los resultados de estos estudios contribuyen a establecer estrategias comunicacionales para la prevención y el control de la enfermedad y de ese modo enfrentar de forma más eficiente eventuales rebrotes de la enfermedad.

Abstract Our objective was to assess levels of knowledge, attitudes, and practices against COVID-19. A total of 3774 persons were surveyed between September 18 and October 16, 2020. Eighty% resided in Buenos Aires City or Buenos Aires Province: 58% had completed tertiary education; 72% worked either independently or as employees in the public or the private sector; 51% used a prepaid health care plan, 34% were covered by a trade union-based health system, and near 10% used the public health services. According to the socio-demographic variables analyzed, the population studied was representative of the middle class. A total of 7% had been diag nosed with COVID-19. There was a high level of knowledge about the disease, judging by the high proportion of correct answers (80-90%). Regarding the measures taken by the government, the answers varied widely ("correct", "inadequate", "harmful", "unnecessary", etc.). The medical staff was the preferred source of information; 44% of respondents felt protected by their health system; 28% would only seek healthcare when feeling very sick. There was a high degree of compliance with most protection measures, except for attendance to social events in poorly ventilated spaces (50%). The results of these studies contribute to establishing communication strategies for the prevention and control of COVID-19 and thus deal more efficiently with eventual outbreaks of the disease.

Common bile duct pressure in patients with and without cholelithiasis: A case-control study.

BACKGROUND: The reflux of pancreatic enzymes into the bile duct and the gallbladder is an abnormal phenomenon that plays a role in lithogenesis and carcinogenesis. Because the pressure of the common bile duct depends on the pressures of the sphincter of Oddi, its dysfunction would be reflected in an increase in the pressure of the common bile duct in patients with cholelithiasis. The objective of this study was to measure the pressures of the common bile duct in patients with and without cholelithiasis and to relate them to the presence of pancreatobiliary reflux. METHODS: A prospective case-control study was designed. The study universe was constituted by all patients undergoing total gastrectomy for gastric cancer stages I and II over 30 months. The primary outcome measure was to establish differences between common bile duct pressures in patients with and without cholelithiasis. RESULTS: Common bile duct pressures in patients with gallstones showed a significant elevation (16.9 mmHg) compared to patients without gallstones (3.3 mm Hg) (p < 0.0001). These pressures correlated with the levels of amylase and lipase in gallbladder bile; higher levels were found in patients with gallstones compared to patients without gallstones (P < 0.0001). CONCLUSIONS: Common bile duct pressure in patients with cholelithiasis was significantly higher compared to patients without cholelithiasis leading to pancreatobiliary reflux.

[Relationship between crowding and community acquired skin and soft tissues infections]. / Relación entre hacinamiento e infecciones comunitarias de piel y partes blandas.

The association of the spread of community infections with poverty and overcrowding is well known. In our hospital, located in José C. Paz, we assist sporadic cases of post-cesarean infections caused by community acquired methicillin-resistant Staphylococcus aureus (CaMRSA). In a prospective study of families treated at our hospital, we investigated the relationship between a history of skin and soft tissue infections (SSTI) and extreme overcrowding defined as households with unsatisfied basic needs type 3 (NBI 3). A total of 264 households were included in the study; 109 (41.3%) had a history of SSTI and 59 (22.3%) were NBI 3. A total of 61.0% of the NBI 3 households and 35.6% of the non-NBI 3 households reported SSTI (p = 0.00047). Using Google Maps, we georeferenced households and identified them on a NBI map adapted from the 2010 demographic census. In neighborhoods with NBI > 9.7%, 51.2% of the households had a history of SSTI. When NBI was < 9.7%, the percentage fell to 31.1% (p = 0.0019). These results are suggestive of an association of SSTI acquired in the community with overcrowding and poverty. The presence of CaMRSA in community SSTIs should be suspected. Vancomycin or clindamycin prophylaxis could be considered when cesarean deliveries are performed in women from areas with high NBI or with a history of SSTI.

Relación entre hacinamiento e infecciones comunitarias de piel y partes blandas / Relationship between crowding and community acquired skin and soft tissues infections

La asociación entre diseminación de infecciones comunitarias, pobreza y hacinamiento es bien conocida. En nuestro hospital observamos casos esporádicos de infecciones post-cesárea por cepas de Staphylococcus aureus meticilino resistente de origen comunitario (SAMRCo). En un estudio prospectivo de familias de José C. Paz atendidas en nuestro hospital, investigamos la relación entre antecedentes de infecciones de piel y partes blandas (IPPB) y hacinamiento extremo (hogares con necesidades básicas insatisfechas tipo 3, (NBI 3). Fueron incluidos 264 hogares; 109 (41.3%) tenían historia de IPPB y 59 (22.3%) eran NBI 3. El 61.0% de los hogares NBI 3 y el 35.6% de los hogares no NBI 3 refirieron IPPB (p = 0.00047). Georreferenciamos los domicilios con Google Maps y los ubicamos en un plano de José C. Paz NBI del censo nacional 2010. En barrios con un porcentaje de NBI > 9.7%, el 51.2% de los hogares tuvo antecedentes de IPPB. Cuando este porcentaje era ≤ 9.7% el porcentaje bajó al 31.1% (p = 0.0019). Estos resultados son sugestivos de diseminación comunitaria de estas infecciones asociada a hacinamiento y barrios pobres. Se debe considerar la presencia de SAMRCo en IPPB comunitarias. Por ello, en mujeres procedentes de zonas con alto porcentaje NBI o con antecedentes de IPPB se podría considerar la inclusión de la vancomicina o la clindamicina en la profilaxis de los partos por cesárea.

The association of the spread of community infections with poverty and overcrowding is well known. In our hospital, located in José C. Paz, we assist sporadic cases of post-cesarean infections caused by community acquired methicillin-resistant Staphylococcus aureus (CaMRSA). In a prospective study of families treated at our hospital, we investigated the relationship between a history of skin and soft tissue infections (SSTI) and extreme overcrowding defined as households with unsatisfied basic needs type 3 (NBI 3). A total of 264 households were included in the study; 109 (41.3%) had a history of SSTI and 59 (22.3%) were NBI 3. A total of 61.0% of the NBI 3 households and 35.6% of the non-NBI 3 households reported SSTI (p = 0.00047). Using Google Maps, we georeferenced households and identified them on a NBI map adapted from the 2010 demographic census. In neighborhoods with NBI > 9.7%, 51.2% of the households had a history of SSTI. When NBI was < 9.7%, the percentage fell to 31.1% (p = 0.0019). These results are suggestive of an association of SSTI acquired in the community with overcrowding and poverty. The presence of CaMRSA in community SSTIs should be suspected. Vancomycin or clindamycin prophylaxis could be considered when cesarean deliveries are performed in women from areas with high NBI or with a history of SSTI.

Tumor fibroso solitario del hígado: revisión del conocimiento actual Solitary fibrous tumor of the liver: updating knowledge / Solitary fibrous tumor of the liver: updating knowledge

El tumor fibroso solitario del hígado es infrecuente. Hasta la fecha, se han reportado menos de 50 casos en la literatura científica inglesa, la mayoría de los cuales se comportaron como tumores benignos. El objetivo del presente artículo es actualizar el conocimiento sobre este tumor porque, debido a su rareza, la presentación clínica, el estudio, el tratamiento y el pronóstico no son bien conocidos. Habitualmente, no produce sintomatología o es inespecífica y su comportamiento a largo plazo es incierto; no obstante, en algunos casos, se comporta agresivamente como un sarcoma de mal pronóstico. Actualmente, solo el tratamiento quirúrgico puede ofrecer una oportunidad terapéutica para estos pacientes. Debido a la falta de conocimiento sobre el comportamiento a largo plazo de estos tumores supuestamente benignos y a la falta de tratamiento médico específico, se sugiere el seguimiento metódico a largo plazo para garantizar la supervivencia de los pacientes operados por un tumor fibroso solitario del hígado.

Solitary fibrous tumors of the liver (SFTL) are uncommon tumors. To the present day less than 50 cases has been reported in the scientific English literature, most of which behaved as benign tumors. The present article has the main purpose of updating knowledge on SFTL because, due to its rarity, its clinical presentation, study, treatment and prognosis, are not well known. The clinical presentation, radiologic study, surgical treatment, immunohistochemical study and prognosis are updated and comprehensively discussed. The SFTL is an uncommon neoplasm. The clinical presentation is habitually indolent and its behavior is uncertain. In some cases, the SFTL acts as an aggressive sarcoma with poor prognosis. Currently, only surgery offers a therapeutic opportunity for these patients. Due to the lack of current knowledge on the long-term behavior of supposedly benign SFTLs and to the lack of specific therapies, methodical long-term follow-up is essential to ensure the survival of patients treated for SFTL.

The Systemic Inflammatory Response in Patients with Appendicitis: a Progressive Phenomenon.

The systemic inflammatory response has been described in patients with appendicitis. However, its progression from onset of symptoms to diagnosis has not been characterized. The specific purpose of this study was to describe and characterize the systemic inflammatory response to appendicitis. A descriptive cross-sectional study was conducted. One hundred eighty-three patients were studied, divided into four groups from onset of symptoms to diagnosis. The primary outcome measure was to determine the systemic inflammatory response to appendicitis according to the established groups of time intervals. The secondary outcome measure was the analysis of C-reactive protein for the same purpose. The variables of the systemic inflammatory response, according to diagnostic intervals, showed non-significant differences in white blood cell count. The temperature rose constantly after 48 h, reaching its peak after 72 h (p = 0.001), and the respiratory rate rose after 73 h (p < 0.0001). After 73 h, most patients had three or four systemic inflammatory response criteria (p < 0.0001). C-reactive protein levels rose progressively, showing higher levels after 48 h (p = 0.005). The inflammatory response to appendicitis is progressive, being more marked along the timeline from onset of symptoms to diagnosis.

Presentación tardía de hernia diafragmática traumática con necrosis gástrica: revisión de la literatura científica / Delayed presentation of diaphragmatic hernia with gastric necrosis: literature review

La hernia diafragmática complicada de presentación tardía constituye una urgencia quirúrgica debido a la isquemia y eventual necrosis y gangrena de los órganos herniados. Los órganos o estructuras que se encuentran con mayor riesgo de sufrir complicaciones por la hernia son el colon, el estómago, el bazo, el epiplón mayor y los intestinos. La necrosis y gangrena del estómago se deben a su estrangulamiento dentro de la hernia, lo que constituye una complicación grave y potencialmente mortal. El presente artículo resume brevemente la literatura científica relevante sobre el diagnóstico clínico y radiológico, y el tratamiento de la necrosis gástrica como complicación de la hernia diafragmática de presentación tardía.

Complicated diaphragmatic hernia with delayed presentation constitutes a surgical emergency due to ischemia and eventual necrosis and gangrene of the herniated organs. The organs or structures at greater risk of complications are colon, stomach, spleen, greater omentum, and small bowel. Gastric necrosis and gangrene are secondary to the twisting and strangulation of the stomach inside the hernia sac, constituting a severe and potentially lethal complication. This article reviews and briefly resumes the current relevant literature on the clinical and radiological diagnosis and the treatment of gastric necrosis as complication of diaphragmatic hernia with delayed presentation.

Mirizzi syndrome: history, current knowledge and proposal of a simplified classification.

Chronic complications of symptomatic gallstone disease, such as Mirizzi syndrome, are rare in Western developed countries with an incidence of less than 1% a year. The importance and implications of this condition are related to their associated and potentially serious surgical complications such as bile duct injury, and to its modern management when encountered during laparoscopic cholecystectomy. The pathophysiological process leading to the subtypes of Mirizzi syndrome has been explained by means of a pressure ulcer caused by an impacted gallstone at the gallbladder infundibulum, leading to an inflammatory response causing first external obstruction of the bile duct, and eventually eroding into the bile duct and evolving to a cholecystocholedochal or cholecystohepatic fistula. This article reviews the life of Pablo Luis Mirizzi, describes the earlier and later descriptions of Mirizzi syndrome, discusses the pathophysiological process leading to the development of these uncommon fistulas, reviews the current diagnostic modalities and surgical approaches and finally proposes a simplified classification for Mirizzi syndrome intended to standardize the reports on this condition and to eventually develop a consensual surgical approach to this unexpected and seriously dangerous condition.

Hemicolectomía derecha en pacientes operados por apendicitis: de la incisión de McBurney y apendicectomía, a la laparotomía media y hemicolectomía / Right hemicolectomy in patients operated on for acute apendicitis: from the McBurney incision and appendectomy to the midline laparotomy and hemicolectomy

Introducción. La infrecuente situación clínica que constituye la gran masa inflamatoria encontrada durante una apendicectomía que llevó a una hemicolectomía y los hallazgos patológicos que causaron el proceso inflamatorio, son las razones que motivaron la revisión de los casos presentados durante los últimos 10 años en nuestra institución, con el objetivo de establecer sus características y la conducta apropiada. Pacientes y método. Se llevó a cabo un estudio retrospectivo y descriptivo de casos consecutivos. Se revisaron las historias clínicas de los pacientes adultos operados con diagnóstico de apendicitis entre 1999 y 2008. Durante este periodo, 2.175 pacientes fueron operados a través de una incisión de McBurney. En 39 casos (1,7 %) fue necesaria la hemicolectomía derecha. Resultados. En todos los casos se practicó anastomosis primaria íleo-colon. Se presentaron complicaciones en 69 % de los casos, con una mortalidad de 5 %. Según el estudio histopatológico, la condición más frecuente que causó la masa inflamatoria fue la apendicitis asociada a hiperplasia linfática focal (25 pacientes, 54 %, p<0,0001). Otras condiciones patológicas fueron: diverticulitis del colon derecho, diverticulitis cecal, necrosis de pared del colon y otros tumores del colon y del apéndice. Conclusiones. Los resultados de esta serie confirman que la hemicolectomía derecha en pacientes inicialmente programados para apendicectomía, es una situación inusual. Cuando ocurre, se debe a la presencia de una condición patológica compleja e inesperada. La hemicolectomía derecha con anastomosis primaria tiene una elevada morbilidad y mortalidad; sin embargo, ante los hallazgos y la duda diagnóstica, constituye una opción apropiada.

Introduction: The uncommon clinical condition resulting from a large inflammatory mass encountered at appendectomy that lead to a major colonic resection and the pathology findings motivated this review covering all cases operated on over the past 10 years at our institution, aiming to define the characteristics and adequate approach. Patients and methods: The present study is a retrospective descriptive review of consecutive cases. All clinical records of adult patients operated on for suspected acute appendicitis between 1999 and 2008 were reviewed. During this period 2,175 patients were approached through a McBurney incision. Of them, 39 patients (1.7%) required a right hemicolectomy and were the subject of this analysis. Results: A right hemicolectomy with primary anastomosis was performed in all cases. Complications developed in 69% cases, with 5% mortality. According to the histologic report, the most frequent condition causing the inflammatory mass was acute appendicitis with focal lymphatic hyperplasia (25 patients, 54%, p<0.0001). Other pathological conditions were: right colonic diverticulitis, cecal diverticulitis, colonic wall necrosis, and appendicular or colonic tumors. Conclusions: The results of this series confirm that a right colectomy in patients initially submitted to appendectomy is an unusual clinical scenario. When this occurs, it is due to serious and unexpected pathological conditions. Right colectomy with primary anastomosis has a high morbidity and mortality rates; however, when facing the findings and diagnostic concerns constitutes the appropriate choice.

Current knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction.

Knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction and their pathologic implications has experienced tremendous progress during the last few years. This article reviews the current knowledge on this condition and its pathological implications on gallbladder diseases. Many publications with different levels of evidence were found supporting biliary carcinogenesis associated with pancreaticobiliary reflux in normal and abnormal pancreaticobiliary junction. Also, there are many publications supporting the common occurrence of pancreaticobiliary reflux in normal pancreaticobiliary junction, and sphincter of Oddi dysfunction as the most plausible cause of this condition. Although an important body of research has been published regarding pancreaticobiliary reflux in normal pancreaticobiliary junction and their clinical significance, the current evidence does not fully support what has been suggested. The reflux of pancreatic enzymes into the bile tract and gallbladder is a fascinating subject of study which is open to active research. The final demonstration of the pathophysiology and consequences of PBR in NPBL and support by evidence level type I would constitute a major breakthrough in the understanding and eventually in the treatment of gallbladder diseases.

Pancreaticobiliary reflux in patients with and without cholelithiasis: is it a normal phenomenon?

BACKGROUND: Pancreaticobiliary reflux is a pathologic phenomenon occurring in patients with gallstones. However, the occurrence of pancreaticobiliary reflux has not been studied in patients without gallstones. The objective of the present study was to measure the bile levels of amylase and lipase in patients without gallstones submitted to cholecystectomy as part of another surgical procedure, and to compare these values with the bile levels of amylase and lipase of patients submitted to cholecystectomy for gallstone disease. PATIENTS AND METHODS: A prospective observational and comparative study was designed. A sample of 136 consecutive patients was included. Amylase and lipase levels were measured in bile. At our institution, normal plasma concentrations of amylase are 28-100 IU/l and lipase 13-60 IU/l. Normal values for pancreatic enzyme concentrations in bile have not been established. Therefore, bile amylase and lipase concentrations exceeding normal plasma concentrations were deemed to be elevated. RESULTS: Of the patients in the present study, 103 (76%) had gallstones and 33 (24%) had healthy gallbladders without gallstones. According to normal plasma levels for amylase and lipase, these enzymes in bile were elevated in 83.5% patients with gallstones, compared to elevated levels of amylase in 6% patients and lipase in 3% patients without gallstones (P < 0.0001). CONCLUSIONS: Pancreaticobiliary reflux is a common phenomenon in patients with gallstones and an uncommon phenomenon in patients with healthy gallbladders without gallstone disease.

Gastric gastrointestinal stromal tumor (GIST) incidentally found and resected during laparoscopic sleeve gastrectomy.

The incidence of incidental pathology found during laparoscopic bariatric surgery has been estimated to be around 2%, and gastric gastrointestinal stromal tumors (GISTs) have been found in 0.8% of patients, constituting a rather uncommon finding. Safe laparoscopic resection of gastric GISTs is an established procedure and has been described associated to gastric Roux-en-Y bypass for morbid obesity. We discuss one case of a gastric GIST incidentally discovered during laparoscopic sleeve gastrectomy for morbid obesity. The procedure was performed via laparoscopy, and the patient recovered without any complication. Currently, the patient has lost weight according to what was expected, is asymptomatic, and free of disease.

[Adenocarcinoma and intestinal duplication of the ileum. Report of one case]. / Adenocarcinoma en duplicación intestinal del íleon: Caso clínico.

Gastrointestinal duplications are uncommon developmental abnormalities that occur anywhere along the gastrointestinal tract. We report a 36 year-old female admitted to the emergency room due to abdominal pain. Computed abdominal tomography demonstrated small bowel loops surrounding a tubular cystic structure and peritoneal free fluid. The surgical exploration revealed multiple malignant implants covering the visceral and parietal peritoneum and infiltrating completely the omentum. At the ileal mesentery we found a tubular cystic whitish tumor measuring 12 cm of diameter and 15 cm on length. A complete resection of the tumor was not considered an option due to the extensive peritoneal dissemination. Thirty-four days after the operation the patient died. The histopathology of the cystic wall was compatible with the architecture of intestinal wall extensively infiltrated by a moderately differentiated mucinous adenocarcinoma; a mucosal lining in parts atrophic and in parts infiltrated or replaced by adenocarcinoma was observed. A well structured muscular layer was recognized, and the myenteric plexus was identified.

[Gastrointestinal stromal tumor (GIST) in a patient with neurofibromatosis type 1. Report of one case]. / Tumor del estroma gastrointestinal (GIST) en una paciente con neurofibromatosis tipo 1.

Neurofibromatosis Type 1 (NF1) is an autosomic dominant condition affecting the central nervous system and presenting a disposition towards development of gastrointestinal stromal tumors (GIST). We report a 38 year-old female patient with neurofibromatosis type 1 that required emergency surgery due to a perforated GIST originating in the fourth duodenal portion. The GIST, and the fourth duodenal portion, were excised and a primary duodenum-jejunal anastomosis was performed. The pathological study showed a partially necrotic solid-cystic tumor with 1 to 2 mitoses per 50-high-power fields. The cells stained positively to CD 117, CD34 and Desmin, and were negative to S-100, Vimentin, and Smooth Muscle a-Actin. The patient is currently asymptomatic and under follow-up during the last 11 months after surgery.

Linfangioma esplénico gigante: Caso clínico / Gigantic cystic splenic lymphangioma: Report of one case

Splenic lymphangiomas are benign primary simple or multiple tumors. They are incidentally diagnosed in children and people younger than 20 year-old. We report a 26-year-old female presenting with a history of five months of abdominal pain localized over the left upper hemi abdomen. A computed tomographic abdominal scan demonstrated a cystic tumor of 16 cm diameter originating from the spleen. Hydatic serology was negative and all blood tests were normal. At surgery, a spienic cyst was found and almost all the cystic wall was excised, leaving only a small portion attached to the spleen. The pathological report described spienic parenchyma with endothelial lining over the internal side of the cyst. Immunohystochemical stains of the endothelial cells were positive for VIII Factor and D2-40 that are specific for lymphatic endothelium, yielding the final diagnosis of a cystic spienic lymphangioma.

Adenocarcinoma en duplicación intestinal del íleon: Caso clínico / Adenocarcinoma and intestinal duplication of the ileum: Report of one case

Gastrointestinal duplications are uncommon developmental abnormalities that occur anywhere along the gastrointestinal tract. We report a 36 year-old female admitted to the emergency room due to abdominal pain. Computed abdominal tomography demonstrated small bowel ¡oops surrounding a tubular cystic structure and peritoneal free fluid. The surgical exploration revealed multiple malignant implants covering the visceral and parietal peritoneum and infiltrating completely the omentum. At the Heal mesentery we found a tubular cystic whitish tumor measuring 12 cm of diameter and 15 cm on length. A complete resection of the tumor was not considered an option due to the extensive peritoneal dissemination. Thirty-four days after the operation the patient died. The histopathology of the cystic wall was compatible with the architecture of intestinal wall extensively infiltrated by a moderately differentiated mucinous adenocarcinoma; a mucosal lining in parts atrophic and in parts infiltrated or replaced by adenocarcinoma was observed. A well structured muscular layer was recognized, and the myenteric plexus was identified.

Tumor del estroma gastrointestinal (GIST) en una paciente con neurofibromatosis tipo 1 / Gastrointestinal stromal tumor (GIST) in a patient with neurofibromatosis type 1. Report of one case

Neurofibromatosis Type 1 (NF1) is an autosomic dominant condition affecting the central nervous systema and presenting a disposition towards development of gastrointestinal stromal tumors (GIST). We report a 38year-old female patient with neurofibromatosis type 1 that required emergency surgery due to a perforated GIST originating in the fourth duodenal portion. The GIST, and the fourth duodenal portion, were excised and a primary duodenum-jejunal anastomosis was performed. The pathological study showed a partially necrotic solid-cystic tumor with 1 to 2 mitoses per 50-high-power fields. The cells stained positively to CD 117, CD34 and Desmin, and were negative to S-100, Vimentin, and Smooth Muscle a-Actin. The patient is currently asymptomatic and under follow-up during the last 11 months after surgery (Rev Méd Chile 2009; 137:1197-200).