Páncreas ectópico, diagnóstico diferencial de lesión gástrica subepitelial: reporte de caso y enfrentamiento inicial / Ectopic pancreas, differential diagnosis of subepithelial gastric lesion: case report and initial confrontation

Subepithelial lesions are generally an incidental diagnosis with an prevalence of 0.4%. These tumors represent a great diagnostic challenge, mainly when ruling out potentially malignant lesions, such as gastrointestinal stromal tumor (GIST), lymphomas and carcinomas. Among the many differential diagnosis, the ectopic pancreas arises with an prevalence of 1-2% in general population. The first diagnostic approach is performed using upper digestive endoscopy, computed tomography and endosonography. This last one has a diagnostic performance of less than 50%, which increases to 90% when it is associated with a histopathological examination. There is no current consensus regarding the management and monitoring of these lesions. Based on the imaging and histological characteristics, the possibilities range from observation to endoscopic or surgical resection. In this context, we will present a clinical case of ectopic pancreas as an incidental finding, and afterwards the diagnostic and therapeutic breakdown of subepithelial lesions.

Las lesiones subepiteliales son pesquisadas generalmente de manera incidental, con una prevalencia de 0,4%. Estos tumores suponen un gran desafío diagnóstico, principalmente al momento de descartar lesiones potencialmente malignas, como el tumor estromal gastrointestinal (GIST), linfomas y carcinomas. Dentro de los posibles diagnósticos, surge el páncreas ectópico, con una prevalencia de hasta 1-2% en la población general. La primera aproximación diagnóstica se realiza mediante endoscopia digestiva alta, tomografía computarizada y la endosonografía, ésta última con un rendimiento diagnóstico menor del 50%, que aumenta hasta el 90% al asociar el examen histopatológico. No existe consenso actual respecto al manejo y seguimiento de estas lesiones, que según sus características imagenológicas e histológicas, va desde la observación hasta la resección endoscópica o quirúrgica. En este contexto, se presenta un caso clínico de páncreas ectópico como hallazgo incidental y el desglose diagnóstico y terapéutico de las lesiones subepiteliales.

Insuficiencia suprarenal secundaria al uso de corticoides inhalados: reporte de caso / Adrenal insufficiency secondary to use of inhaled corticosteroids: case report

La insuficiencia suprarrenal es un síndrome que se produce por la disminución de niveles séricos de glucocorticoides, la cual se clasifica en primaria o secundaria, según la etiología. El uso prolongado de corticoides exógenos a altas dosis puede producir una inhibición en el eje hipotálamo-hipofisiario-adrenal, y la supresión aguda de éstos produce insuficiencia suprarrenal secundaria. Los glucocorticoides inhalados, usados ampliamente como tratamiento del asma bronquial, pudiesen tener un impacto a nivel del eje adrenal, principalmente en la población pediátrica. Por el momento, si bien hay reportes de casos que evidencian insuficiencia suprarrenal secundaria al uso de corticoides tanto tópicos como inhalatorios, aún es materia de discusión esta interacción a nivel sistémico, con artículos que se contraponen en sus resultados. Se presenta un caso clínico de una paciente usuaria de glucocorticoides inhalatorios por el antecedente de asma bronquial, que desarrolla una clínica de insuficiencia suprarrenal en el periodo de lactancia.

Adrenal insufficiency is a syndrome that is produced by the decrease in serum glucocorticoid levels, which is classified as primary or secondary, according to the etiology. Prolonged use of exogenous corticosteroids at high doses may cause inhibition in the hypothalamic-pituitary-adrenal axis, and acute suppression of these results in secondary adrenal insufficiency. Inhaled glucocorticoids, widely used as a treatment for bronchial asthma, could have an impact at the level of the adrenal axis, mainly in the pediatric population. At the moment, although there are reports of cases that show adrenal insufficiency secondary to the use of both topical and inhalation corticosteroids, this interaction at systemic level is still a matter of discussion, with articles that contrast in their results. We present a clinical case of a patient using inhaled glucocorticoids due to a history of bronchial asthma, which develops a clinical of adrenal insufficiency in the period of breastfeeding.

Anatomical Variants in Renal Transplantation, Surgical Management, and Impact on Graft Functionality.

INTRODUCTION: Chronic kidney disease (CKD) is a priority problem due to its high prevalence. According to the modalities of renal replacement therapy, kidney transplantation (TR) offers to be the best alternative. TR presents multiple factors of dependence of success; among them is the management of the anatomical variants of the graft and the surgical decision on the basis of these. Therefore, the objective of this study is to determine the frequency of variants in the graft, its surgical management, and the impact on the functionality of the transplanted kidney. MATERIAL AND METHODS: This was an observational, retrospective study of patients in the renal transplant unit of the Siglo XXI National Medical Center from 2002-2016. The analysis begins in the description of the population doing bivariate analysis to establish relative risks. For variables with a central tendency, the parametric tests analysis of variance, Student t paired, and unpaired will be used. In the case of nominal variables, the proportion's difference will be estimated using the chi-square test, establishing significance when P is ≤ .05. SPSS 21 software was used. RESULTS: There were a total of 773 patients, with 576 transplants from living donors and 197 from deceased donors. In the case of the artery, a greater number of variants is observed-27.8% being alive versus 17.3% of the variants found in deceased donors. For the renal vein, 12.7% of the kidneys were taken from living donor vs 6.1% from deceased donors. This required one more day of hospitalization (6 vs 7 days of single vs multiple vessels); likewise, increases in immediate post-transplant infections were 5% for single vessels vs 8% in the case of multiple variants. CONCLUSIONS: The importance of knowing the anatomical variants prior to the TR allows them to plan the potential surgical maneuvers, decreasing the times aimed at improving the immediate functionality of the renal graft, while also considering the increase in hospital expenses due to the greater number of days of hospitalization.

Reporte de caso fatal por perforación de divertículo de Meckel / Fatal case report due to perforation of Meckel’s diverticulum

El divertículo de Meckel es una anormalidad congénita del tracto grastrointestinal debida a la falta del cierre del conducto onfalomesentérico y sus complicaciones son raras en los adultos. Se presenta el caso de un hombre de 35 años, quien después de la ingesta de alcohol presentó dolor abdominal y fallece repentinamente. Se le realiza autopsia y estudios histopatológicos donde se evidenció hemoperitoneo masivo originado por la erosión de vasos sanguíneos secundarios a la ulceración de la pared del divertículo de Meckel localizado en el intestino delgado. Esta causa de muerte es infrecuente debido a que la complicación másusual del divertículo es la obstrucción.

Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy.

OBJECTIVE: To characterize the epidemiological, clinical, and histopathological features of patients with cancer who develop widespread polymorphic and pruritic skin lesions following radiotherapy. PATIENTS, DESIGN, AND INTERVENTIONS: During phase 1, epidemiological and clinical features of 103 patients with cancer, 83 treated with radiotherapy (71 women and 12 men) and 20 controls who did not undergo radiotherapy (16 women and 4 men), were explored during 3 months (October 1995 to January 1996). During phase 2, in 30 additional patients with cancer who were treated with telecobalt or linear accelerator, 18 with skin lesions (15 women and 3 men) and 12 without lesions (10 women and 2 men), the following were investigated: (1) hematoxylin-eosin-stained sections for routine histopathological examination and direct immunofluorescence, and lymphocytic markers; (2) blood, skin, and primary tumor eosinophilia; and (3) the presence of antiepidermal autoantibodies. Patients were examined during 5 months (February 1996 to June 1996). SETTING: A dermatology department at a university hospital. RESULTS: During phase 1, 14 (17%) of the 83 patients undergoing radiotherapy developed an eruption. Acral excoriations, erythematous papules, vesicles, and bullae were the most frequent lesions. During phase 2, in 18 patients, a superficial and deep lymphocytic perivascular infiltrate with numerous eosinophils, intraepidermal and interstitial eosinophilic infiltrates, eosinophilic panniculitis, IgM and C3 perivascular deposits, and slightly predominant CD4+ cells were observed. No antiepidermal autoantibodies were found. CONCLUSIONS: The clinical, histopathological, and immunopathologic features in patients with cancer undergoing radiotherapy are described. To our knowledge, this condition has not been well characterized. Because of its unique presentation, the denomination "eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy" is suggested.

Addition of gangliosides to an adapted milk formula modifies levels of fecal Escherichia coli in preterm newborn infants.

Because some gangliosides bind bacteria, we tested the influence of supplementating an adapted milk formula with gangliosides, at a total concentration of 1.43 mg/100 kcal, on the fecal microflora of preterm infants. At all sampling times, feces from infants fed with ganglioside-supplemented formula had significantly lower relative content of Escherichia coli than feces from infants fed with control milk formula: the difference was especially significant at age 7 days postnatal < .001). At age 30 days postnatal, fecal bifidobacterial counts were higher in infants fed with ganglioside-supplemented formula (P < .05). We conclude that gangliosides at concentrations present in human milk significantly modify the fecal flora.

Gestational age and origin of human milk influence total lipid and fatty acid contents.

The human milk composition may be influenced by several factors, such as gestational age or genetic characteristics and dietary habits of different populations. To analyze the total lipid and fatty acid contents of human milk, we have conducted two studies, one on mothers who had delivered preterm and term newborns and another on mothers from two different sociocultural backgrounds (Spain and Panama). The total lipid content (g/100 g wet weight) was significantly higher in term (2.76 +/- 0.66; mean +/- SD) than in preterm mature milk (1.06 +/- 0.4). The relative amount of 18:1n-9 was significantly higher in preterm than in term milk for transitional and mature milk, whereas that for the colostrum followed the opposite trend. Concerning the comparison between milk from mothers born in different countries, the relative contents of each of the fatty acids 16:0, 16:1n-7, 18:2n-6, 18:3n-3, and 22:5n-3 were higher in Panamanian than in Spanish milk, whereas the mean percentages of saturated fatty acids < 14:0, of 16:1n-9, and of 18:1n-9 were higher in Spanish than in Panamanian milk. Statistically significant differences were found during the three periods of lactation considered for almost all the fatty acids mentioned above, especially for 18:1n-9 and 18:3n-3. Although the potential biological significance of the changes in oleic acid content between preterm and term milk remains unclear, differences in fatty acid content between Spanish and Panamanian milk reflect the different composition of the diet among women from these countries.

Comparison of content and distribution of human milk gangliosides from Spanish and Panamanian mothers.

The lactational changes in content and distribution of gangliosides in human milk from Spanish and Panamanian mothers delivering term newborns were studied. There were no statistically significant differences in the concentration of gangliosides between Spanish and Panamanian milk. The ganglioside content expressed as a function of total milk lipids tended to decrease as lactation progressed in both types of milk. There was a significant correlation (r = 0.5896; p = 0.0062) between ganglioside and total lipid contents in Panamanian milk. However, in Spanish milk, the correlation was not significant (r = 0.1516; p = 0.3439). We did not detect important differences in the relative concentrations of individual gangliosides during lactation among milk samples from Spanish and Panamanian mothers. For both of them, GD3 was the most abundant ganglioside in colostrum, whilst in mature milk it was GM3.

Sonohisterografia en la evaluacion endometrial en la postmenopausia / Sonohisterography in the evolution endometrial in the postmenopause

La evaluación ecográfica de la mujer en la postmenopausia ha evolucionado grandemente con el advenimiento de transductores de uso intracavitario, particularmente con el uso de la ecografía endovaginal. Actualmente se pueden hacer diagnósticos con altos grados de certeza utilizando esta técnica, y en muchos casos obviando procedimientos más invasivos como la biopsia endometrial, la D&C y la histeroscopia. Con el advenimiento de la sonohisterografia, se pueden evaluar con mucho más detalle lesiones endometriales focales, pacientes en tratamiento antiestrogénico con tamoxifén, así como en estadificación de cáncer del endometrio. Por medio de la utilización de algunos medios de contraste para ecografía, se puede inclusive evaluar permeabilidad tubárica tempranamente en el estudio de fertilidad por medio de la Histerosalpingosonografía de contraste (HyCoSy). La utilización de la tecnología Doppler color para el diagnóstico de la patología endometrial, aunque prometedora, no ha sido aún estandarizada

Hormonoterapia de suplencia en mujeres copn antecedente de carcinoma de endometrio / Hormonotherapy of suplence in women with antecedents of carcinoma endometry

La terapia hormonal de suplencia (ETS/THS) en la mujer previamente tratada de un carcinoma de endometrio es un tema aún ampliamente debatido. En las recomendaciones a la paciente el clínico debe basarse en una cuidadosa evaluación de los factores de riesgo asociados a cada paciente en particular, versus los potenciales beneficios a obtener con la ETS/ THS. Los factores principales a tener en cuenta son: un adecuado entendimiento de la paciente sobre su enfermedad y su pronóstico, y el deseo de ella de correr los riesgos de la THS de acuerdo con la información dada por el clínico, además se deben tener en cuenta el tipo histológico del tumor, su grado de diferenciación, su estadio incluyendo la invasión miometrial, metástasis ganglionares, citologías peritoneales y también el estado de los receptores esteroideos. A su vez se debe tener en cuenta el intervalo de tiempo transcurrido entre el tratamiento de la neoplasia y el inicio de la ETS/THS

Polipos de la uretra prostatica en adultos / Polypos of prostatic urethra in adults

Los pólipos de la uretra prostática pueden presentarse clínicamente como hematuria, hemospermia, obstrucción o disuria; ellos ocurren más frecuentemente de lo sospechado. La presentación clínica, los hallazgos uretrocistoscópicos, patológicos y el tratamiento son revisados. Nosotros informamos 3 casos de pólipos de la uretra prostática, creemos que son benignos y deberán ser resecados como una medida diagnóstica y algunas veces terapéutica

Pielonefritis enfisematosa / Emphysematous Pyelonephritis

La Pielonefritis enfisematosa es infrecuente y todavía en algunos casos mortal. Se describe un caso en una mujer diabética de 48 años de edad en el Hospital Universitario del Valle. Aproximadamente 80 casos de pielonefritis enfisematosa han sido reportados desde el primer caso descrito por Kelly and Mac Callum en 1898. La patología, radiología, clínica y algunos conceptos de patogénesis, diagnóstico y manejo son discutidos