Obstrucción intestinal por Strongyloides Stercolaris: A propósito de un caso / Intestinal obstruction due to strongyloides stercolaris: About a case

RESUMEN La estrongiloidiasis comúnmente produce problemas gastrointestinales. Presentamos el caso de un varón, cadete en la marina de guerra del Perú, de 30 años, procedente de lima; que desarrolló síndrome de hiperinfección por Strongyloides Stercoralis, teniendo como antecedente el diagnóstico presuntivo de polimiositis, por lo cual recibió un ciclo corto de corticoesteroides. No portador del virus htlv 1/2. Presentó al ingreso hiporexia, debilidad generalizada, caquexia, diarrea intermitente autolimitada, intolerancia oral y leve distensión abdominal. El paciente llegó a la etapa de diseminación, lo que resultó en un daño severo a nivel intestinal. La baja excreción de larvas en las heces dificultó el diagnóstico. Se brindó tratamiento con ivermectina parenteral a dosis de 1.2ml vía subcutánea cada 48 horas por tres dosis, con buena respuesta clínica y posteriormente con buena tolerancia oral. La importancia de presentar el caso es comentar sobre el abordaje diagnóstico y terapéutico de esta geohelmintiasis endémica del Perú.

Abstract Strongyloidiasis commonly causes gastrointestinal problems. We present the case of a male, a 30-year-old cadet in the peruvian navy from lima, who developed a hyperinfection syndrome due to strongyloides stercoralis, having a presumptive diagnosis of polymyositis for which he received a short cycle of corticosteroids. He was not a carrier of the htlv 1/2 virus. Upon admission, he presented with hyporexia, generalized weakness, cachexia, intermittent self-limited diarrhea, oral intolerance, and mild abdominal distension. The patient reached the dissemination stage, resulting in severe intestinal damage. The low excretion of larvae in the feces made the diagnosis difficult. Treatment was provided with parenteral ivermectin at a dose of 1.2ml subcutaneously every 48 hours for three doses, with a good clinical response and subsequently good oral tolerance. The importance of presenting the case is to comment on the diagnostic and therapeutic approach to this endemic geohelminthiasis of peru.

[Renal allograft rupture: case report and bibliographic review]. / Estallido renal. Caso clínico y revisión de literatura.

OBJECTIVE: To improve the knowledge about complications of renal transplantation and, in particular, graft rupture. METHODS: Case report and literature review. OUTCOME: We present the case of a 37 year-old patient receiving a second renal transplant. In the third postoperative day, he suffered an abrupt change from the correct evolution, with intense pain in the left iliac fossa (the side of the implant) and hemodynamic instability. Imaging tests suggested retroperitoneal collection and adjacent to the implant. In this situation we decided reoperation, we found a ruptured renal unit and transplant nephrectomy was carried out. The pathologic study confirmed that the cause of this rupture was acute rejection of the implant. CONCLUSION: The rupture of the graft is one of the most serious complications in renal transplantation. Rapid diagnosis and surgical treatment are required. Conservative management is the treatment of choice for possible preservation of the renal unit, but there are some situations in which it is dangerous and removal of the graft must be carried out.

Estallido renal. Caso clínico y revisión de literatura / Renal allograft rupture: case report and bibliographic review

OBJETIVO: Mejorar el conocimiento acerca de las complicaciones del transplante renal y en concreto la rotura del injerto. MÉTODO: Presentación de caso clínico y revisión de la literatura. RESULTADO: Presentamos un caso de una paciente de 37 años de edad sometida a su segundo injerto renal. En el tercer día del postoperatorio, sufrió un cambio brusco en la correcta evolución, con dolor intenso en fosa iliaca izquierda (donde se había instaurado el injerto) e inestabilidad hemodinámica. Las pruebas de imagen sugieren colección retroperitoneal y adyacente al injerto. En esta situación se decide reintervención donde se objetiva la ruptura de la unidad renal practicándose transplantectomía. El estudio anatomopatológico confirma que la causa de dicha ruptura viene establecida por un rechazo agudo del injerto. CONCLUSIONES: La ruptura del injerto es una de las complicaciones más graves en un transplante renal. Ante este acontecimiento se precisa un diagnóstico rápido y tratamiento quirúrgico. El manejo conservador es la medida a tomar para la posible preservación de la unidad renal, pero existen algunas situaciones en las que la conservación es peligrosa y se debe llevar a cabo la extirpación del injerto (AU)

OBJECTIVE: To improve the knowledge about complications of renal transplantation and, in particular, graft rupture. METHODS: Case report and literature review. OUTCOME: We present the case of a 37 year-old patient receiving a second renal transplant. In the third postoperative day, he suffered an abrupt change from the correct evolution, with intense pain in the left iliac fossa (the side of the implant) and hemodynamic instability. Imaging tests suggested retroperitoneal collection and adjacent to the implant. In this situation we decided reoperation, we found a ruptured renal unit and transplant nephrectomy was carried out. The pathologic study confirmed that the cause of this rupture was acute rejection of the implant. CONCLUSION: The rupture of the graft is one of the most serious complications in renal transplantation. Rapid diagnosis and surgical treatment are required. Conservative management is the treatment of choice for possible preservation of the renal unit, but there are some situations in which it is dangerous and removal of the graft must be carried out (AU)

[Stab wounds of the kidney: conservative management. Two new cases and review of the literature]. / Manejo conservador de los traumatismos renales por arma blanca. Presentación de dos nuevos casos y revisión de la literatura.

INTRODUCTION: Stab wounds of the kidney have traditionally been managed by open surgery. Nowadays the conservative management of stab wounds injuries is extended in order to avoid unnecessaries nephrectomies and laparotomies without increasing morbidity and mortality. Although there is no a strong evidence to recommend when to operate or what sort of follow up we must do. MATERIAL AND METHODS: We present two new cases of stab wounds injuries managed conservatively. We performed a systematic review of the literature. RESULTS: Both patients evolved favorably although one of them presented hematuria 7 days after the traumatism and we performed an embolization of an arteriovenous fistula. Most of the articles are based on series of cases or retrosprospective studies. CONCLUSIONS: The diagnosis and staging of stab wounds of the kidney must be done with clinic and CT scan. Conservative management is required when the patient is not hemodinamically unstable and injuries do not require inmediate repair. These patients require a long-term follow up to prevent the appearance of complications. Randomized prospective multicenter trials are needed to support the optimum management for each kidney injury degree.

Manejo conservador de los traumatismos renales por arma blanca. Presentación de dos nuevos casos y revisión de la literatura / Stab wounds of the kidney: conservative management. Two new cases and review of the literature

Introducción: El tratamiento de los traumatismos renales por arma blanca ha sido tradicionalmente quirúrgico. Desde hace más 20 años se aboga por un tratamiento conservador con el fin de evitar laparotomías innecesarias y preservar unidades renales. Los criterios para intervenir de forma urgente o las pautas de seguimiento no están establecidos debido a la falta de estudios de calidad. Material y métodos: Presentamos dos nuevos casos de traumatismo renal por arma blanca en los que se llevó a cabo un manejo conservador y realizamos una revisión de la literatura. Resultados: Los dos pacientes evolucionaron favorablemente, si bien uno de ellos presentó hematuria durante el postoperatorio inmediato y fue necesaria una embolización selectiva de una fístula arterio-venosa. La mayor parte de los artículo se basan en series de casos o estudios observacionales retrosprospectivos. Conclusiones: En los traumatismos renales por arma blanca el diagnóstico es clínico y el estadiaje de las lesiones radiológico con una tomografía computarizada. El manejo conservador es de elección cuando el paciente está estable hemodinámicamente y las lesiones no requieren reparación inmediata. Estos pacientes requieren un seguimiento a largo plazo para monitorizar la aparición de complicaciones. Son necesarios estudios de mayor calidad que aporten una mayor evidencia científica (AU)

Introduction: Stab wounds of the kidney have traditionally been managed by open surgery. Nowadays the conservative management of stab wounds injuries is extended in order to avoid unnecessaries nephrectomies and laparotomies without increasing morbidity and mortality. Although there is no a strong evidence to recommend when to operate or what sort of follow up we must do. Material and methods: We present two new cases of stab wounds injuries managed conservatively. We performed a systematic review of the literature. Results: Both patients evolved favorably although one of them presented hematuria 7 days after the traumatism and we performed an embolization of an arteriovenous fistula. Most of the articles are based on series of cases or retrosprospective studies. Conclusions: The diagnosis and staging of stab wounds of the kidney must be done with clinic and CT scan. Conservative management is required when the patient is not hemodinamically unstable and injuries do not require inmediate repair. These patients require a long term follow up to prevent the appearance of complications. Randomized prospective multicenter trials are needed to support the optimum management for each kidney injury degree (AU)

[Renal leiomyoma: case report]. / Leiomioma renal: aportación de un nuevo caso.

OBJECTIVES: To report a new case of asymptomatic capsular leiomyoma. METHODS: 68-year-old male asymptomatic patient who was diagnosed of solid mass after a radiological study (ultrasound and CT scan). RESULTS: The treatment of this neoplasia was radical nephrectomy, with an uneventful postoperative course and a pathology report of renal leiomyoma. CONCLUSIONS: Renal leiomyoma is a rare benign mesenchymal tumor that should be taken into consideration for the differential diagnosis of renal masses, because it would be an indication for nephron-sparing surgery; nevertheless, due to the difficulties to differentiate it from renal cell carcinoma it is not rare that the diagnosis is achieved after histological study of the nephrectomy specimen.

Leiomioma renal: aportación de un nuevo caso / Renal leiomyoma: case report

OBJETIVO: Aportar un nuevo caso de leiomiomacapsular asintomático.MÉTODO: Paciente de 68 años asintomático que tras estudioradiológico (ECO y TAC ) es diagnosticada de masa sólida.RESULTADO: El tratamiento de este proceso neoformativo renal , fue nefrectomía radical, con curso postoperatorio sin incidencias y anatomía patológica, leiomioma renal.CONCLUSIÓN: El leiomioma renal es un tumor mesenquimatosobenigno poco frecuente que debe tenerse en cuenta ante el diagnóstico de masa renal , dado que sería subsidiario de una cirugía renal conservadora, no obstante ante la dificultad para diferenciarlo del carcinoma renal, no es infrecuente que el diagnóstico se produzca tras el análisis histológico de la pieza de nefrectomía

OBJECTIVES: To report a new case of asymptomatic capsular leiomyoma.METHODS: 68-year-old male asymptomatic patient who was diagnosed of solid mass after a radiological study (ultrasound and CT scan).RESULTS: The treatment of this neoplasia was radicalnephrectomy, with an uneventful postoperative course and a pathology report of renal leiomyoma.CONCLUSIONS: Renal leiomyoma is a rare benignmesenchymal tumor that should be taken into consideration for the differential diagnosis of renal masses, because it would be an indication for nephron-sparing surgery; nevertheless,due to the difficulties to differentiate it from renal cell carcinoma it is not rare that the diagnosis is achieved after histological study of the nephrectomy specimen

[Paratesticular rabdomyosarcoma: report of one case in an adult patient]. / Rabdomiosarcoma paratesticular: a propósito de un caso en el adulto.

OBJECTIVES: To report one case of right paratesticular rabdomyosarcoma in a 21-year-old young adult. METHODS: After treatment with right radical orchiectomy through an inguinal incision it was classified as clinical group I A following the IRS-III (localized disease completely excised) and received adjuvant treatment with Vincristine and actinomicin D. RESULTS/CONCLUSIONS: The patient is disease free 18 months after surgery. We emphasize the importance of adjuvant treatment in the posterior evolution of the tumoral disease.

[Renal brucelloma: an exceptional pathology]. / Bruceloma renal: patología excepcional.

OBJECTIVES: To report one case of renal brucelloma, an extraordinarily rare pathology in our environment. METHODS: 51-year-old completely asymptomatic patient who was referred from his primary care physician for the study of a calcified image on the right renal area discovered in a x-ray control. RESULTS: Radiological studies (US + CT scan + IVU) showed an irregular calcified mass in the lower pole of a non-functional right kidney. Microbiological diagnosis was negative. Radical nephrectomy was performed. Purulent material came out from the kidney during the operation, which cultured (+) to Brucella Melitensis. Pathologic study was compatible with renal brucelloma. CONCLUSIONS: Genitourinary involvement by Brucella is second in frequency after osteoarticular, being orchyoepididymitis the most common clinical presentation, followed by prostatitis. Renal involvement is exceptional.

Prevalence of left ventricular hypertrophy in patients with mild hypertension in primary care: impact of echocardiography on cardiovascular risk stratification.

BACKGROUND: Left ventricular hypertrophy (LVH) is an important predictor of cardiovascular risk, and its detection contributes to risk stratification. The aims of the present study were to estimate the prevalence of echocardiographic LVH and to evaluate the influence of echocardiography (ECHO) on cardiovascular risk stratification in hypertensive patients presenting in primary care. METHODS: In this cross-sectional study, 250 patients recently diagnosed with mild hypertension underwent clinical evaluation including electrocardiography (ECG), microalbuminuria measurement, 24-h blood pressure monitoring and ECHO. Level of cardiovascular risk was stratified, initially using routine procedures including ECG to assess target organ damage and then again after detection of LVH by ECHO. RESULTS: The frequency of echocardiographic LVH was 32%, substantially higher than that detected by ECG (9%). Initial cardiovascular risk stratification yielded the following results: 30% low risk, 49% medium risk, 16% high risk, and 5% very high risk subjects. The detection of LVH by ECHO provoked a significant change in the risk strata distribution, particularly in those patients initially classified as being at medium risk. In this group, 40% of subjects were reclassified as high risk subjects according to ECHO information. The new classification was as follows: 23% low risk, 30% medium risk, 42% high risk, and 5% very high risk subjects. CONCLUSIONS: A substantial proportion of mildly hypertensive patients presenting in primary care have LVH determined by ECHO. Our results suggest that this procedure could significantly improve cardiovascular risk stratification in those patients with multiple risk factors, but no evidence of target organ damage by routine investigations.

Hematoma peneano por rotura de vena dorsal profunda durante el coito / Rupture of the deep dorsal vein of the penis during sexual intercourse

OBJETIVO: Presentar un caso clínico de rotura de la vena dorsal profunda del pene durante el coito, patología poco frecuente pero que hay que tener en cuenta dentro del diagnóstico diferencial del pene agudo. MÉTODO: Se trata de un paciente de 21 años, sin ningún antecedente patológico previo, que acudió a urgencias por un cuadro de pene agudo tras un coito vigoroso y que por su presentación clínica pensamos que se trataba de una rotura de cuerpos cavernosos. RESULTADO: La intervención quirúrgica nos puso de manifiesto la rotura completa de la vena dorsal profunda del pene, procediendo a la ligadura de sus extremos y permitiéndonos la confirmación de la indemnidad de los cuerpos cavernosos. CONCLUSIONES: Ante un caso de pene agudo, la conducta terapéutica más razonable es la intervención quirúrgica precoz, ya que nos permite establecer un diagnóstico correcto y tratar el problema evitando futuras secuelas. La rotura de la vena dorsal profunda del pene es un proceso más a tener en cuenta en el diagnóstico diferencial del pene agudo. Clínicamente se comporta como la rotura de los cuerpos cavernosos. Tanto la ecografía como la cavernosografía no son capaces de poner de manifiesto esta patología (AU)