Hematoma mesentérico espontáneo de causa incierta / Spontaneous mesenteric hematoma on unknown origin

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[Utility of Tc-99m labeled heat-denatured red blood cell scintigraphy in a case of hepatic splenosis]. / Utilidad de la gammagrafía selectiva con hematíes desnaturalizados Tc-99m en un caso de esplenosis hepática.

The term splenosis, first used in the medical literature in 1939, refers to the autotransplantation of splenic tissue in a heterotopic location. We report the case of a known hepatitis C carrier in whom computed tomography scanning revealed a hepatic lesion suggestive of hepatocarcinoma. Magnetic Resonance imaging was performed for suspected hepatic splenosis, which was confirmed by Tc-99m labeled heat-denatured red blood cell scintigraphy. In addition to confirming the suspected diagnosis, this technique showed several pathological foci in distinct abdominal locations compatible with splenosis that had not previously been identified.

[Localized Castleman's disease: description of a case and review of the literature]. / Enfermedad de Castleman localizada: descripción de un caso y revisión de la literatura.

Castleman's disease is a rare entity which is caracterized by its histological features: hyperplasia of lymph nodes and capillary proliferation. Two histological patterns has been described: hyaline vascular type and plasma cell type. From a clinical viewpoint has been identified two different clinical course: a localized type (ECL) usually of benign clinical course and a multicentric type (ECM) of worst prognosis. We present a case of Castleman"s disease localized in the neck region in which the excision was both diagnostic and therapeutic. The variety histological was hyaline-vascular type.

[Incidence and natural history of hepatocellular carcinoma in patients with chronic hepatitis C virus infection]. / Incidencia e historia natural del carcinoma hepatocelular en los pacientes con infección crónica por el virus de la hepatitis C.

OBJECTIVE: To report the natural history of patients with hepatitis C virus (HCV) infection and hepatocarcinoma (HCC) and to define clinico-biological variables with prognostic and predictive value of this complication. MATERIALS AND METHODS: A total of 543 patients consecutively diagnosed of chronic infection with HCV were included and followed prospectively and observationally regarding the development of HCC by means of semestral abdominal ultrasonography and measurement of serum alpha-fetoprotein (AFP). To determine variables with predictive value of HCC, the parameters determined at the start were compared, and all subjects diagnosed of hepatoma during the first twelve months after admission were excluded from the analysis. The Kaplan-Meier method was used to evaluate both survival and accumulated probability of HCC. RESULTS: During a mean follow-up period of 28.9 months, an incidence density of HCC of 2.6 per 100 inhabitants-year was obtained (n = 35). 52.6% of those with HCC in the first year were asymptomatic. The only initial variables associated with further development of HCC were age (64.6 vs 58.4 years; p = 0.0039) and alkaline phosphatase (373.5 vs 259 U/l; p = 0.001). Patients with cirrhosis at the start of the study had a higher risk of developing hepatoma than non-cirrhotic patients (RR: 11.5; 95% CI: 4.25-29.9; p < 0.0001). The presence of HCC decreased the survival of patients with cirrhosis (median 20 vs 75 months; log rank < 0.0001), with the exception of patients in stage C of the Child-Pugh classification. CONCLUSIONS: a) In the chronic infection with HCV, HCC showed to be an oligosymptomatic complication affecting almost exclusively patients with long-lasting cirrhosis. b) Survival in patients in the stage C of the Child-Pugh classification is independently associated with the coexistence of hepatoma; therefore, the early diagnosis of this complication should be restricted to those with a better liver functional reserve.

Incidencia e historia natural del carcinoma hepatocelular en los pacientes con infección crónica por el virus de la hepatitis C / Incidence and natural history of hepatocellular carcinoma among patients with chronic infection with hepatitis C virus

Objetivo. Describir la historia natural de los pacientes infectados por el virus de la hepatitis C (VHC) que presentan hepatocarcinoma (HCC) y definir variables clínico-biológicas con valor pronóstico de esta complicación. Material y método. Se incluyeron 543 pacientes diagnosticados de forma consecutiva de infección crónica por VHC y se siguieron de forma prospectiva y observacional respecto al desarrollo de HCC mediante la realización semestral de ecografía abdominal y alfafetoproteína sérica (AFP). Para determinar variables con valor predictivo de HCC se compararon los parámetros determinados al inicio, eliminándose del análisis todos aquellos sujetos que fueron diagnosticados de hepatoma dentro de los doce meses posteriores al ingreso. Se utilizó el método de KaplanMeier tanto para evaluar la supervivencia como la probabilidad acumulada de HCC. Resultados. Durante un período medio de seguimiento de 28,9 meses obtuvimos una densidad de incidencia de HCC de 2,6 por 100 habitantes-año (n = 35). El 52,6 por ciento de los que presentaron HCC durante el primer año estaban asintomáticos. Las únicas variables iniciales que se asociaron al ulterior desarrollo de HCC fueron la edad (64,6 frente a 58,4 años; p = 0,0039) y la fosfatasa alcalina (373,5 frente a 259 U/l; p = 0,001).Los pacientes con cirrosis al inicio del estudio tenían mayor riesgo de desarrollar hepatoma que los no cirróticos (RR: 11,5; IC 95 por ciento: 4,5-29,9; p < 0,0001). La presencia de HCC disminuyó la supervivencia de los enfermos con cirrosis (mediana de 20 frente a 75 meses; log rank < 0,0001), salvo que se encontraran en el estadio C de Child-Pugh. Conclusiones. a) En la infección crónica por VHC el HCC se muestra como una complicación oligosintomática que afecta de forma casi exclusiva a los enfermos con cirrosis de larga duración. b) La supervivencia mostrada por los pacientes con cirrosis en estadio C de Child-Pugh es independiente de la coexistencia de hepatoma, por lo que el diagnóstico precoz de esta complicación debería restringirse a los que presenten mejor reserva funcional hepática (AU)

Absence of the inferior vena cava causing repeated deep venous thrombosis in an adult--a case report.

Agenesis of the inferior vena cava is an uncommon congenital vascular malformation. Although theoretically it may favor venous stasis, it is not normally associated with venous thrombosis. The authors found only three reports of the coexistence of both entities, and only one of these rules out the existence of associated hypercoagulability. They report the case of a patient with a history of repeated venous thrombosis. Magnetic resonance angiography and venography demonstrated complete agenesis of the inferior vena cava and persistence of a cardinal venous system with azygos and hemiazygos continuation, associated with right renal hypoplasia. Studies ruled out hypercoagulability syndrome, either primary or secondary to an occult neoplasm. The authors conclude that venous malformations, although rare, may cause thromboembolic disease, especially in young patients, and that magnetic resonance angiography is a useful diagnostic alternative to conventional phlebography.

[A 73 year-old patient with thrombocytopenia and a giant cerebral vascular malformation]. / Paciente de 73 años con trombopenia y malformación vascular cerebral gigante.

We report the case of a patient who was seen by purpura and thrombocytopenia. The differential diagnosis in this patient included the presence of cerebral giant vascular malformation, the intake antiepileptic drugs and the presence of a chronic liver disease caused by viral hepatitis C infection. However the final diagnoses of Idiopathic Thrombocytopenia Purpura was made because of the presence of antiplatelets antibodies, the fluctuate evolution, and the increase of platelet count after costicosteroid therapy.

[The prevalence of hepatitis C antibodies among volunteer blood donors with elevated blood transaminase and antibodies to the B virus core antigen]. / Prevalencia de anticuerpos frente al virus de la hepatitis C entre donantes voluntarios de sangre con hipertransaminasemia y anticuerpos frente al core del virus B.

The use of non-specific markers before 1989 (increased serum transaminase values and antibodies to hepatitis B core antigen) as a screening method for blood donors in an attempt to decrease the incidence of post-transfusional non-A non-B hepatitis (currently hepatitis C virus) was a matter of controversy. To determine the impact of the use of these markers on the detection of blood donors infected with hepatitis C virus, a prospective study was undertaken in Málaga (1988-1989) with 5,003 volunteer donors with two objectives: a) to know the prevalence of these non-specific markers (anti-HBc and increased serum transaminase) and antibodies to HCV (anti-C100) in our blood donor population; b) to determine whether the presence of some of these non specific markers in blood donors was associated with a higher rate of virus C infection. The prevalence of antibodies to HCV in blood donors with increased serum transaminase and/or anti-HBc was significantly higher than the prevalence found among the general blood donor population.