Torsión aislada de la trompa de Falopio en una adolescente premenárquica de 11 años de edad / Isolated torsion of the Fallopian tube in a 11 years premenarcheal adolescent girl

La torsión aislada de la trompa de Falopio es una causa muy rara de dolor abdominal agudo en adolescentes. Debemos tener en cuenta esta patología en el diagnóstico diferencial del dolor abdominal agudo, ya que el tratamiento quirúrgico precoz es fundamental para la conservación de la trompa. Presentamos un caso unilateral de esta patología en una adolescente de 11 años de edad, cuyo diagnóstico se realizó intraoperatoriamente(AU)

The isolated Fallopian tube torsion is an infrequent cause abdominal pain among premenarcheal adolescent girls. This entity produces symptoms of non-specific abdominal pain and consequently should be included in the differential diagnosis, because the early diagnosis and surgery mainstay for keeping the Fallopian tube. This case is about an 11 years adolescent girl with isolated torsion of left Fallopian tube, whose diagnosis was made during surgery(AU)

Minimally invasive endoscopic techniques for treating large, benign processes of the nose, paranasal sinus, and pterygomaxillary and infratemporal fossae: solitary fibrous tumour.

OBJECTIVES: We report an extremely rare case of a large solitary fibroma of the paranasal sinus, which we treated by sinonasal endoscopic surgery. We describe its clinical and histopathological features, and we report the endoscopic technique used to deal with such a large sinonasal mass (penetrating the pterygomaxillary and infratemporal fossae); we also offer a brief survey of the literature. CASE REPORT: A woman presented with an approximately one-year history of nasal obstruction. Nasal endoscopy revealed an irregularly shaped, friable, reddish mass that occupied the whole of the right nasal fossa. Magnetic resonance imaging of the paranasal sinuses revealed a large mass that occupied the anterior and posterior ethmoids and the maxillary and sphenoid sinuses, displacing the septum and penetrating the pterygomaxillary fossa, having destroyed the lateral wall of the right nasal fossa. The tumour was resected by means of sinonasal endoscopic surgery; an endoscopic medial maxillectomy with extension to the pterygomaxillary and infratemporal regions was performed. Histological analysis confirmed the diagnosis of solitary fibrous tumour. During follow up, we performed regular nasal endoscopies, as well as computed tomography scans one and six months post-operatively. CONCLUSIONS: Endoscopic techniques are currently the approach of choice for the treatment of such tumours of the sinonasal cavity and pterygomaxillary and infratemporal regions. The size of the lesion did not contraindicate endoscopic sinonasal surgery as a curative treatment.

[Indication of appendectomy in the recurrent abdominal pain]. / Indicación de la apendicectomía en el dolor abdominal recidivante.

INTRODUCTION: The frequency of the recurrent abdominal pain without demonstrable pathology is high and in occasions it takes to the surgeon to practice an appendectomy. In most of the cases the pain disappears. This performance although subjective, it doesn't base on objective data, what takes us to carry out this work. MATERIAL AND METHOD: The study is carried out in 47 patients with recurrent abdominal pain and subjected to appendectomy, 17 were excluded by diverse causes. The vermiform appendixes were studied by morphological and immunohistochemical methods, using the monoclonal antibodies, valuing morphologic sing of a chronic inflammation of the appendix. RESULTS: 100% of the samples studied presented microscopically chronic inflammatory changes microscopically. We observe fibrose in 100%, lympho-plasmocytic inflammatory infiltrate in 60% and a lymphocytes T prevalence has more than enough lymphocytes B. CONCLUSIONS: Our results support the existence of a clinical-pathological condition that can be defined as chronic appendicitis and therefore it justifies the appendectomy in recurrent abdominal pain when another disease has been excluded.

[Immunohistochemical study of hypertrophic pyloric stenosis]. / Estudio inmunohistoquímico en la estenosis hipertrófica del píloro.

INTRODUCTION: In spite of the clinical experience about infantil Hypertrophic Pyloric Stenosis (IHPS), its etiopathology remains unknown. Recent studies have been focussed in immunohistochemistry techniques for valuing the neuronal development in the pyloric muscle. MATERIAL AND METHODS: We took biopsy from 10 babies diagnosed of IHPS and 10 babies with similar age, died because of other causes. Immunohistochemical study was performed using monoclonal antibodies: S100 protein, GFAP, enolasa and neurofilaments NF. The results were showed semi-quantitativement as strong (++), moderate (+) and absent (-). Immunotinction of the myenteric plexus (ganglion cells and satellite) and nervous fibers of the muscle layer, were done. RESULTS: We observed a poor immunoreactivity in the muscle layer (longitudinal and circular) in the 60-70% of specimens of pyloric muscle in babies with IHPS. GFAP were absent in the 80% in the myenteric plexus. This poor innervation may be related to the etiopathogenesis of pyloric stenosis and hypertrophy.

Estudio inmunohistoquímico en la estenosis hipertrófica del píloro / Immunohistochemical study in hypertrophic pyloric stenosis

Introducción: A pesar de la experiencia clínica sobre la estenosis hipertrófica del píloro (EHP), los conocimientos sobre su etiopatogenia son muy limitados. Los trabajos actuales se han centrado en las técnicas de inmunohistoquímica para valorar el desarrollo neuronal en la capa muscular pilórica, objetivo de nuestro trabajo. Pacientes y métodos: Se tomaron biopsias de la capa muscular piló-rica de 10 pacientes con EHP y de 8 pacientes fallecidos por otras causas ajenas a dicha patología. Las biopsias se estudiaron mediante técnicas de inmunohistoquímica utilizando un panel de anticuerpos (Acs)monoclonales: proteína S100, GFAP (proteína glial fibrilar), enolasa y neurofilamento (NF). Los resultados fueron expresados semicuantitativamente como fuertemente positivos (++), moderadamente positivos (+) y negativos (-). Valoramos la inmunotinción del plexo mientérico (PM), (células ganglionares y satélites) y fibras nerviosas de la capa muscular longitudinal y circular (PML y PMC, respectivamente).Resultados: La inmunotinción en el PM fue negativa sólo para el AcGFAP en el 80%. En la capa muscular longitudinal y circular (PMLy PMC) la expresión para los anticuerpos estudiados fue negativa enel 60-70% de los casos. Estos resultados indican que existe un déficit neural en la inervación del músculo pilórico en la EHP. Dicho defecto puede estar implicado en la etiopatogenia de la enfermedad (AU)

[Fatal outcome after severe cerebellar infarction due to spontaneous dissection of the vertebral artery]. / Evolución fatal tras infarto cerebeloso masivo por disección espontánea de arteria vertebral.

Cerebellar infarction due to vertebrobasilar ischemia in spontaneous vertebrobasilar dissection is infrequent in children and adolescents. The commonest pathogenic mechanism of cerebellar infarction is arterial occlusion. Although usually favorable, outcome can be fatal, as in the present case. A previously healthy 4-year-old girl was admitted to the emergency room with sensory failure and trembling. The previous week she had suffered from a transitory ischemic attack that resolved spontaneously. On admission to the emergency department, the Glasgow Coma Scale score was 10/15 and she presented irregular polypneic breathing, anisocoric reactive pupils, enhanced reflexes, lower limb clonus and bilateral pyramidal signs. Cranial computed tomography revealed marked hypodensity in both cerebellar hemispheres and white supratentorial substance with obliteration of the quadrigeminus cisterns. Cerebral angiography showed left vertebral artery dissection with distal pseudoaneurysm and marked basilar occlusion. Despite aggressive antiedemic treatment and early instauration of intravenous continuous sodium heparin infusion, the patient developed a bilateral cerebellar infarction and supratentorial hydrocephalus. Brain death was diagnosed after 48 hours. Postmortem pathologic examination revealed previous thrombus the in superior left cerebellar artery and basilar artery occlusion. We discuss the absence of predisposing factors and the transitory ischemic attack in this patient 1 week before she developed massive cerebellar infarction.

Evolución fatal tras infarto cerebeloso masivo por disección espontánea de arteria vertebral / Fatal outcome after severe cerebellar infarction due to spontaneous dissection of the vertebral artery

El infarto cerebelar por isquemia vertebrobasilar originado por disección espontánea de la arteria vertebral es infrecuente en niños. El mecanismo más común del infarto cerebeloso es la oclusión arterial. Aunque el pronóstico suele ser favorable, en ocasiones la evolución puede ser fatal, como en la paciente que se presenta de 4 años de edad, previamente sana, que una semana antes de consultar en urgencias presentó un accidente cerebrovascular isquémico transitorio, que se resolvió espontáneamente. Al ingreso en urgencias destaca a la exploración física una puntuación en la escala de Glasgow 10/15, polipnea con respiración irregular, pupilas anisocóricas y reactivas, reflejos exaltados, clonus en miembros inferiores y piramidalismo bilateral. En la tomografía computarizada craneal se objetiva hipodensidad marcada en ambos hemisferios cerebelosos y sustancia blanca supratentorial con obliteración de las cisternas cuadrigéminas. En la angiografía cerebral se observa disección de la arteria vertebral izquierda con dilatación seudoaneurismática distal y estenosis marcada de la arteria basilar. En la evolución, a pesar del tratamiento agresivo del edema cerebral y de la anticoagulación precoz con heparina sódica intravenosa, desarrolló infarto cerebeloso masivo bilateral e hidrocefalia supratentorial, que requirió derivación ventricular externa. Evolucionó a muerte encefálica en 48 h. En el estudio anatomopatológico necrópsico se detectó trombo antiguo organizado en la arteria cerebelosa superior izquierda y obstrucción de la arteria basilar. Se discute la ausencia de factores predisponentes desencadenantes, a la vez que la presencia de isquemia cerebral transitoria una semana antes del infarto cerebelar masivo (AU)

[Lymphangioma of the spermatic cord]. / Linfangioma de cordón espermático.

We report a new case of spermatic cord lymphangioma in a infant 2 years old. The initial diagnosis was funicular hydrocele. The treatment was the local excision of tumor and the diagnostic was histological. Postoperative course was excellent. Must be explored the transillumination of the mass which would have led us to think other the diagnosis different from that of the cord hydrocele before the operation since it would have given negative. During the operation, must the assured that the cystic anomaly is limited to spermatic cord, to evite recurrences in the postoperative course.

Teratoma testicular y coristoma adrenal epididimario / Testicular teratoma and epididymal adrenal choristoma

Se describe un caso de teratoma quístico maduro testicular en un varón de 28 meses de edad. Debido a sus características a la palpación y su eventual transiluminación, puede ser confundido con un hidrocele. Aunque se considera una rara lesión benigna, sobre todo en niños menores de 2 años, se debe descartar siempre la presencia de células inmaduras en el estudio histológico. Mediante abordaje inguinal, se practicó orquiectomía izquierda al no existir un límite claro de sepa-ración entre el tumor y el resto del parénquima testicular. El estudio histológico confirmó la benignidad de la lesión y la coexistencia de un coristoma adrenal situado en la cabeza del epidídimo. Evolución post-operatoria favorable (AU)

Linfangioma de cordón espermático / Spermatic cod lymphangioma

Se describe un nuevo caso de linfangioma de cordón espermático en un niño de 2 años de edad, catalogado inicialmente como quiste de cordón, siendo un hallazgo intraoperatorio. El tratamiento consistió en la exéresis del tumor, y el diagnóstico fue histológico. Evolución postoperatoria favorable. Debe practicarse transiluminación, sistemáticamente, ante toda masa inguino-escrotal, aunque presente características típicas de hidrocele, así como conviene descartar la extensión y profundidad del linfangioma de cordón espermático, para evitar recurrencias postoperatorias (AU)

[Testicular teratoma and epididymal adrenal choristoma]. / Teratoma testicular y coristoma adrenal epididimario.

We report a case of mature testicular cystic teratoma in a 28-month old boy. Due to the characteristics of the palpation and its partial transillumination, it may be confused with a hydrocele. They emphasize on the rarity and benign nature of the peculiarities and refer to its prognosis, usually benign, when is diagnosed at about 2 years of age, providing that a very careful examination of the histological sections rules out the presence of anaplastic cells. A left inguinal orchiectomy was performed because it was not possible to establish a line of cleavage between the tumor and the normal tissue. The pathologic examination revealed a benign lesion. An adrenal choristoma in the caput epididymis was also observed. Postoperative course was satisfactory.

[Experimental testicular torsion: its effect on the contralateral testicle]. / Torsión testicular experimental: efecto en el testículo contralateral.

The purpose of this project is to determine the lesion in contralateral testis after unilateral testicular torsion. For that is reproduced the lesion in an experimental model animal using 35-45 days old Wistar rats. The study of the contralateral testis is performed 30-35 days after lesion, once orchiectomy with histopathological and ultrastructural analysis, was made. We observed zonal tubular atrophy, alteration of spermatogenesis, abnormal formation of spermatozoa and death cellular by apoptosis.

[Gastric tuberculosis: a report of 2 cases]. / Tuberculosis gástrica: presentación de dos casos.

Two patients with gastric tuberculosis are described. The first presented toxic syndrome, multiple abdominal adenopathies, microcytic anemia and a subcardial ulcer with malignant characteristics at endoscopy. Diagnosis was based on the positivity of Ziehl-Neelsen staining and on the growth of Mycobacterium tuberculosis in the culture of the gastric mucosa. The second patient presented toxic syndrome, fever and a miliary pattern on thoracic radiography. Endoscopy demonstrated an ulcerated nodular lesion with granulomas with acid alcohol resistant bacillus being observed on biopsy. Mycobacterium tuberculosis was found in both the sputum and bronchoaspirate. The evolution of both cases was favorable with specific treatment.

Multivariate discriminant analysis of normal, intraepithelial neoplasia and human papillomavirus infection of the uterine cervix samples.

The present investigation studies the role of multivariate statistical methods on quantitative histopathological features of cells in uterine cervix epithelium to discriminate between normal and abnormal uterine cervix samples. 143 histological specimens were included in the study involving normal cervix, cervical intraepithelial neoplasia (CIN) lesions and cervical human papillomavirus (HPV) infection with and without CIN (condyloma-CIN and condyloma-NCIN groups, respectively). Deep, middle and superficial regions of the cervical squamous epithelium were morphometrically analyzed. Identification of normal cervix from pathological cases was highly achieved with a specificity of 100%. The application of discriminant statistical method within pathological specimens showed an acceptable percentage of cases correctly classified; thus, an efficiency of 83.0% and 74.6% was obtained in order to discriminate within CIN and condyloma-CIN grades respectively. These percentages increased when differentiation between each grade of CIN versus condyloma-CIN were considered, using only 1-3 morphometrical parameters. Our findings indicate that the combination of nuclear and cytoplasmic quantitative features, specially size parameters, permit a high correct percentage classification of cervix samples. The discrimination process was better when few diagnostic categories were included; however, 100% specificity for normal samples was always reached.

Histomorphometry of normal and abnormal cervical samples.

We quantitatively studied the nuclear and cytoplasmic characteristics of cells in the normal cervix, squamous intraepithelial lesions (cervical intraepithelial neoplasia [CIN]) lesions and cervical human papillomavirus (HPV) infection with and without CIN (condyloma-CIN and condyloma-NCIN groups, respectively). The morphometric features of the deep, middle and superficial layers of the cervical epithelium were calculated on 143 cervical samples. The morphometric parameters selected for the analysis were area; perimeter; maximal, minimal and equivalent circle diameters; nuclear/cytoplasmic ratio; and several shape factors. Our quantitative findings support the opinion of other authors that HPV infection is associated with shape and size modifications of the nucleus and cytoplasm in CIN. In relation to cellular size, there were no differences between a normal cell, regardless of its region, and a virus-infected cell. The nuclear differences are predominantly in the deep layer areas. The CIN samples showed changes in both cellular and nuclear form and size but lacked substantial differences in the tumor grades and areas studied. The condyloma-CIN samples revealed more notable differences in both tumor grade differentiation and different cellular layers.

[Solitary intestinal fibromatosis: an unusual cause of neonatal intestinal obstruction]. / Fibromatosis intestinal solitaria: una causa rara de obstrucción intestinal neonatal.

We report a new case of solitary intestinal fibromatosis (SIF) in a neonate with intestinal obstruction in the first day of life. At the laparotomy was found to be due to a solid mass in the jejunum. A segmental jejunal resection with anastomosis was performed. Histologic examination showed a SIF. The postoperative course was excellent in contrast to cases of congenital fibromatosis with multiples lesions, which carries a poor prognosis.

[Appendicular carcinoid tumor in childhood]. / Tumor carcinoide apendicular en la infancia.

Apendicular Carcinoid tumors are very infrequent, being lower than 0.1% of the appendicectomies carried out. We report on the case of a 13 year-old girl, with Acute Appendicitis picture. The appendix was removed and the histological study revealed the presence of the carcinoid tumor with a diameter of a 6 mm. Where non-invasive treatment was decided on, and at present, after two years follow-up, there has been no recurrence.

Morphometry and discriminant analysis of the endometrium.

The authors dated 100 normal endometrial biopsies. Only endometrial specimens with histologically confirmed subphases and no evidence of organic disease were accepted for study. The morphometry and stereologic measures of the glands, lumina and endometrial epithelium were assessed. Quantitative assessment of the normal endometrium supported the histologic events that occur in the endometrial cycle (proliferative and secretory phases). There was a progressive increase in morphometric and stereologic values of the glands, epithelium and lumina during the endometrial cycle. Using stepwise discriminant analysis, 94% of the specimens were correctly classified into the categories of proliferative and secretory phase; two quantitative parameters were required, the epithelial volume density and longest luminal diameter. When three subphases within proliferative and secretory endometrium were considered, the overall accuracy was 90% and 78%, respectively.