[Effectiveness of weight loss in the treatment of non-alcoholic steatohepatitis in an obese adolescent]. / Eficacia de la reducción de peso en la curación de la esteatohepatitis no alcohólica en un adolescente obeso.

Childhood obesity is the most frequent nutritional disorder in developed countries and has been described as a global epidemic by the World Health Organization. In children, as in adults, obesity is the most significant risk factor for the development of non-alcoholic fatty liver disease. Therefore, it may become the most frequent chronic liver disease in children. However, pediatric publications on this disorder, which can progress to severe liver disease with risk of mortality, are scarce, with small series and few histological studies. The present article describes an obese adolescent who presented severe steatosis and steatohepatitis, which responded to weight loss with clinical and histological normalization. The risk of obesity comorbidity is increasing significantly in the pediatric population.

Eficacia de la reducción de peso en la curación de la esteatohepatitis no alcohólica en un adolescente obeso / Effectiveness of weight loss in the treatment of non-alcoholic steatohepatitis in an obese adolescent

La obesidad infantil es el trastorno nutricional más frecuente en los países desarrollados, habiendo sido declarada por la Organización Mundial de la Salud como una epidemia global. En los niños, al igual que ocurre en los adultos, la obesidad es el factor de riesgo más importante para el desarrollo de la enfermedad hepática grasa no alcohólica, por lo que es probable que se convierta en la enfermedad hepática crónica infantil más frecuente. Sin embargo las publicaciones pediátricas sobre este trastorno, que puede llegar a ocasionar una grave enfermedad hepática con riesgo para la vida, son relativamente poco numerosas, con series pequeñas y con escasos estudios histológicos. El artículo describe a un adolescente obeso en el que se demostró esteatosis grave y esteatohepatitis que respondieron con normalización analítica e histológica a la reducción de peso. Se alerta sobre el incremento de esta comorbilidad de la obesidad en la población pediátrica

Childhood obesity is the most frequent nutritional disorder in developed countries and has been described as a global epidemic by the World Health Organization. In children, as in adults, obesity is the most significant risk factor for the development of non-alcoholic fatty liver disease. Therefore, it may become the most frequent chronic liver disease in children. However, pediatric publications on this disorder, which can progress to severe liver disease with risk of mortality, are scarce, with small series and few histological studies. The present article describes an obese adolescent who presented severe steatosis and steatohepatitis, which responded to weight loss with clinical and histological normalization. The risk of obesity comorbidity is increasing significantly in the pediatric population

[Effect of complete androgen block before radical prostatectomy for cancer of the prostate]. / Efecto del bloqueo androgénico completo previo a la prostatectomía radical por cáncer de próstata.

OBJECTIVE: To evaluate the efficacy of complete androgen deprivation in downstaging advanced localized prostate cancer prior to radical prostatectomy. The study evaluated positive margins, prostate volume, PSA and histological changes. METHODS: We evaluated 22 patients with stage T2 (13 pts, 59%) and T3 (13 pts, 59%) prostate cancer treated with complete androgen deprivation for at least 3 months prior to radical prostatectomy. RESULTS: PSA levels dropped in 97% (51.1-1.4 ng/dl) after treatment (p < 0.001); 20 (90%) had PSA < 3 ng/dl, including 3 cases (14%) with positive nodes; 2 cases (9%) with pT2 tumor had PSA > 3 ng/ml. The mean prostate volume dropped 33% from 52.6 to 35.2 cc (p < 0.001). Of the 22 cases, only one T2 (4%) was staged down; 10 (45.5%) had positive margins versus 17 (53%) of the control group (p > 0.05). The Gleason score increased in 19 (86%) and 90% had cytoplasmic vacuolization and pyknosis with moderate nuclear lysis in 50%. CONCLUSION: Neoadjuvant treatment significantly reduces PSA levels and prostate volume. The decrease in PSA levels, however, does not appear to have a direct correlation with the final pathologic stage. Tumor stage changed slightly in patients with T2 tumors and no response was observed in those with T3. Patients receiving neoadjuvant therapy had a slight advantage with respect to positive margins. The histological findings were suggestive of cellular lysis.

[Value of PSA and (pre- postoperative) Gleason in predicting the potential lymphatic involvement in patients with prostatic cancer]. / Valor del PSA y del Gleason (pre-postoperatorio) en la predicción de la posible afectación ganglionar en pacientes con cáncer de próstata.

OBJECTIVE: To determine the possibility of selecting patients at risk for lymph node involvement prior to radical prostatectomy utilizing PSA concentration and/or the Gleason score. METHODS: We reviewed the records of 52 patients with tumor stage T1 to T3, who had undergone lymphadenectomy; of these, 50 patients underwent radical prostatectomy. The predictive values for PSA and the Gleason score and their utility in predicting risk of lymph node involvement were analyzed. RESULTS: Of the 52 patients, 10 (19%) had lymph node involvement. Nine of 26 patients (35%) with PSA > 20 and 9 of 21 patients (42%) with a Gleason score > 7 had lymph node involvement. No patient with PSA < 15 or Gleason score < 5 and none of the 24 patients (57%) with PSA < 20 and Gleason score < 7 had lymph node involvement. The preoperative biopsy was understaged in 21 patients (41%); of these, 16% had a Gleason score of 5-6. Two of these patients with PSA > 20 micrograms/ml had lymph node involvement. CONCLUSION: PSA concentration and the Gleason score are useful in predicting the risk of lymph node involvement. Patients with PSA < 20 and a Gleason score of < 7 can be considered to be at no risk and staging lymphadenectomy could be unnecessary. Although the preoperative Gleason score appears to have a predictive value, the possibility of understaging should be taken into account. In this regard PSA can be useful in identifying those patients at risk.

Giant primary amyloidoma of the tonsil.

A case of giant amyloidoma in the left tonsil with extensive osseous metaplasia and a scanty and patchy monoclonal population of IgG Kappa plasma cells, is presented. Localized tumoral amyloidosis is a rare, benign tumour of the upper aerodigestive tract. Organ-limited amyloidosis has been shown to be confined to various systems but, since the lesion was first described, only four cases situated in the tonsils have been reported in the English literature, and none of these had either osseous metaplasia or a monoclonal population of IgG Kappa plasma cells.

[Signet ring cell carcinoma of the Vater's ampulla]. / Carcinoma de células en anillo de sello de ampolla de Vater.

We report an unusual type of carcinoma of the ampulla of Vater composed of signet-ring cells with few neuroendocrine cells and without other variants of carcinoma. The tumor presented with obstructive jaundice and invaded diffusely the ampulla and adjacent duodenal wall. The patient is alive and disease free 24 months after Whipple's resection.

[Malignant pancreatic oncocytoma]. / Oncocitoma pancreático maligno.

A pancreatic oncocytoma in a 77 year old man is described. A CT scan showed liver metastases three years earlier. The patient died from complications after surgery for a perforated duodenal ulcer, and at autopsy a primary tumor in the tail of the pancreas and several liver metastases were found. The morphologic and biologic features of this unusual tumor are discussed.

[Gastroesophageal infection caused by cytomegalovirus in immunodepressed patients. Presentation of 3 cases]. / Infección gastroesofágica por citomegalovirus en pacientes inmunodeprimidos. Presentación de tres casos.

We report three cases of upper gastrointestinal infection by Cytomegalovirus in immunocompromised patients. Two patients suffered from AIDS and the other one had a recent heart transplantation and was on immunodepressant drugs for an episode of rejection. The stomach in two cases and the esophagus in the other were the affected organs. In all cases there were upper gastrointestinal symptoms and the diagnosis was established by biopsy of endoscopically suspicious lesions. Antiviral therapy was effective in all three cases. This diagnosis has to be considered whenever immunocompromised patients present with unusual clinical and endoscopic findings.

[Bone metaplasia in colorectal carcinoma]. / Metaplasia ósea en carcinoma colorectal.

We report two cases of osseous metaplasia in the polypoid areas of colorectal carcinomas. This is an extremely rare condition with no more than 30 cases published, that has to be recognized to avoid misinterpretations on biopsies or surgical specimens. The pathogenesis is unknown and it does not change the biological behaviour of these tumors.