Dolor abdominal en paciente tratado con acenocumarol. Un caso de hematoma intramural espontáneo de intestino delgado / Abdominal ain in a patient using acenocoumarol. A case of spontaneous intramural samll-bowel hematoma

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Value of helical computed tomography in the management of upper esophageal foreign bodies.

PURPOSE: To analyze the utility of helical computed tomography (CT) in the diagnosis of suspected upper esophageal foreign bodies. MATERIAL AND METHODS: A prospective study was performed on 36 patients (26 F, 10 M, mean age 70 years) with a history of foreign body impaction. All had negative findings at indirect laryngoscopy. Radiologic assessment included unenhanced helical CT and a barium contrast study. Patients with positive findings were taken to esophagoscopy. All patients had a posterior clinical surveillance. RESULTS: Twenty patients had both normal CT and barium study and satisfactory clinical outcome. In 12 patients a foreign body was noted in the cervical esophagus by CT, barium study, and endoscopy. In one patient a fish bone was detected by CT (and not by barium) confirmed with esophagoscopy. Another patient had a fish bone esophageal perforation which was observed only by CT and confirmed at surgery. Two patients with normal barium and endoscopy presented a false-positive CT result. CONCLUSION: Barium swallow is currently the first radiologic study, but may involve a risk of aspiration and can impede a subsequent esophagoscopy. Esophagoscopy is an invasive technique with a certain risk of serious complications that can be avoided with a satisfactory radiologic assessment. CT is easy, fast, has 100% sensitivity and is therefore the first choice technique for diagnosing suspected upper esophageal foreign bodies not expected to be visible on plain radiographs.

Enfisema subcutáneo de miembro inferior como primera manifestación de una dehiscencia colónica / Subcutaneous emphysema of the lower limb as presenting manifestation of colon dehiscence

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[Castleman's disease: isolated retroperitoneal mass. Report of a case]. / Enfermedad de Castleman: masa única retroperitoneal. A propósito de un caso.

OBJECTIVE: To describe a rare case of vascular hyaline variant of Castleman's disease presenting as a solitary mass, with special reference to the radiological findings and differential diagnosis. The literature is briefly reviewed. METHODS/RESULTS: A 48-year-old male presented with nonspecific pain in the left flank. Routine analyses were unremarkable. Sonographic and CT studies showed a well-defined, highly vascularized, 3.3 x 3.6 x 4 cm retroperitoneal mass. The risk of hemorrhage made a preoperative biopsy impracticable and the mass was removed surgically. The pathological analysis of the surgical specimen showed a localized retroperitoneal angiofollicular lymphoid hyperplasia (vascular hyaline variant). CONCLUSIONS: Castleman's disease can rarely present as a solitary retroperitoneal mass, which must be distinguished from primary retroperitoneal masses that are usually malignant. Imaging techniques are not conclusive. Definitive diagnosis is based on the postoperative pathological findings.

[Urologic iatrogenic disease]. / Yatrogenia urológica.

OBJECTIVE: The purpose of this paper is to emphasize that despite the undeniable advantages of urological instrumentation (insertion of a ureteral catheter, double-J catheter; percutaneous nephrostomy, etc.), it also carries some risks and complications. METHODS: We report three cases of iatrogenic urological complications due to use of endoscopic and percutaneous material. RESULTS/CONCLUSION: Urologists, and particularly the residents, are reminded that iatrogenic complications may occur even in the easiest and routine procedures of the medical activity.

[Prostatic malacoplakia: report of a case and review of the literature]. / Malacoplaquia de próstata: aparición de un caso y revisión de la literatura.

OBJECTIVE: To describe an additional case of malakoplakia of the prostate. The etiopathogenesis, the histological and clinical features of this disease are analyzed and the literature briefly reviewed. METHODS/RESULTS: The pathological features of malakoplakia of the prostate in an elderly man with severe prostatic syndrome and recurrent urinary infections from E. Coli are described. The clinical manifestations disappeared following adenomectomy according to the Millin technique. CONCLUSION: Diagnosis of malakoplakia of the prostate is based on the pathological findings. The importance of the pathologist's role in the diagnosis of this condition, which will determine the treatment to follow, is therefore underscored.

[Erectile dysfunction caused by neurapraxia of the pudendal nerve after the use of a traction table for the treatment of traumatic fractures. Report of a case and review of the literature]. / Disfunción eréctil por neuroapraxia del nervio pudendo tras el uso de la mesa de tracción para la solución de fracturas traumatológicas. A propósito de un caso y revisión de la literatura.

OBJECTIVE: To describe a case of erectile dysfunction as a result of traction on the fracture table. METHODS: We report on a 39-year-old man who developed erctile dysfunction postoperatively and for several months thereafter, following intramedullary nailing with the Grosse-Kept bolt type fixation system. RESULTS: The patient spontaneously recovered erectile function six months after orthopaedic treatment. CONCLUSION: Erectile dysfunction induced by orthopaedic fracture table is a complication that should be taken into account. There are many procedures available to reduce the risk of this complication.

[[Brucellar orchiepididymitis with abscess]. / Orquiepididimitis brucelósica abscesificante.

OBJECTIVE: To emphasize the need to consider Brucella infection in patients presenting with acute scrotum of a possible inflammatory etiology, in endemic areas, as in some Spanish regions. The abscess forming type, although rare, should be considered. One such case is described herein and the literature briefly reviewed. METHODS: A male patient consulted for subacute inflammation and left testicular pain. He had systemic brucellosis four months earlier that had completely remitted following specific therapy. The patient had a physical examination, analytical, blood and urine analyses, specific serological tests and testicular ultrasound evaluation. RESULTS: Physical examination disclosed left testicular pain and inflammation suggesting epididimo-orchitis. The laboratory findings were normal except for high titles against Brucella. Ultrasound disclosed diffuse enlargement of the left testis with several well-defined hypoechoic areas. The foregoing data suggested abscess forming orchitis, although a neoplasm could not be discarded. Empirical antibiotic therapy was instituted initially and specific therapy for Brucella was administered subsequently, but unilateral orchidectomy was decided because of the poor response to therapy. Histopathological analysis of the surgical specimen disclosed acute abscess forming epididimo-orchitis with multifocal chronic granulomatous involvement. CONCLUSION: Brucella epididimo-orchitis must be considered when making the differential diagnosis in acute inflammatory scrotum, particularly in endemic areas, even in the absence of suggestive clinical and/or US findings. Necrotizing orchitis is a rare form of Brucella infection which must be distinguished from necrotizing involvement arising from other pathogens (TB or Salmonella). Above all, this condition must be distinguished from a tumor.

[Testicular microlithiasis associated with infertility]. / Microlitiasis testicular asociada a infertilidad.

OBJECTIVE: A case of testicular microlithiasis that had been incidentally diagnosed by ultrasound in a patient undergoing evaluation for infertility is described and the literature briefly reviewed. METHODS: The clinical, laboratory (routine blood and urine tests, hormone studies, spermiogram) and testicular ultrasound findings in a 28-year-old male who consulted for infertility are presented. RESULTS: Serum FSH and LH were raised and testosterone fell within the lower ranges. The spermiogram revealed azoospermia. US evaluation showed bilateral small hyperechoic foci without posterior acoustic shadowing, dispersed within a normal testicular parenchyma. CONCLUSIONS: Testicular microlithiasis is a rare entity which is usually discovered incidentally during testicular ultrasound evaluation for other conditions such as infertility. The underlying condition (calcium in the seminiferous duct lumen) has a specific ultrasonographic appearance and further studies are not required to make the diagnosis. The patho-genesis and the clinical implications of microlithiasis remain unclear, therefore any associated pathology, such as tumor, infertility, systemic diseases, or chromosomal disorders, must be ruled out. Regular US follow-up is advocated.

[Acute orchiepididymitis: assessment with high-resolution ultrasonography in 52 cases]. / Orquiepididimitis aguda: valoración mediante ecografía de alta resolución en 52 casos.

OBJECTIVES: The present study describes our experience in ultrasound diagnosis of acute orchiepididymitis, with special reference to the most common US patterns and complications of this disease entity. METHODS: In acute scrotum suspected as having an inflammatory origin, high resolution ultrasonography is performed in the acute phase in addition to routine blood and urine analyses. Treatment and subsequent US control evaluation vary according to each case. RESULTS: The sonographic findings in 52 cases with a clinical suspicion of acute orchiepididymitis are presented. All examinations were performed in the acute phase. Subsequent sonographic control evaluation was performed 2-4 months after treatment. Seven cases had a negative ultrasound; in 4 cases ultrasound disclosed a different pathology (2 tumors, 1 testicular torsion and 1 hydatid torsion); 12 had both testicular and epididymal involvement; one had testicular and 28 had epididymal involvement alone. Complications were observed in 21 cases (hydrocele, abscess, pyocele, infarct...). Sonographic evaluation after treatment showed complete resolution in 26 cases whereas 15 cases showed postinflammatory sequelae (atrophy, changes in testicular ultrasound pattern, calcifications, chronic hydrocele...). The ultrasound findings indicated surgery in 2 cases. CONCLUSIONS: High resolution ultrasonography is currently the diagnostic method of choice in scrotal inflammation. It permits determining the extent of the lesion (orchitis, epididymitis, orchiepididymitis), complications (hydrocele, hematocele, pyocele, abscess, infarct...) and the result of therapy.