Tuberculosis pulmonar con signo de cúmulo sarcoideo en la tomografía computarizada de tórax de alta resolución. Respuesta de los autores / No disponible

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[Successful treatment of surgically induced necrotizing sclerokeratitis (SINS) with systemic immunosuppresive agents and amniotic membrane grafting]. / Tratamiento inmunosupresor sistémico y trasplante de membrana amniótica en escleritis necrotizante inducida por cirugía (ENIC).

CLINICAL CASE: We report the case of a 74-year-old female who developed a necrotizing sclerokeratitis affecting her left eye after uncomplicated cataract surgery. She had no previous history of systemic autoimmune disease. Histopathology of the lesion revealed necrotic granulomatosis with an increased number of plasma cells. DISCUSSION: Surgically induced necrotizing sclerokeratitis (SINS) is a serious entity which requires prompt and aggressive therapy to prevent its potential devastating ocular consequences. Conjunctival resection and amniotic membrane grafting may be necessary to temporarily interrupt local immunologic events in severe cases. However, associated systemic immunomodulatory therapy seems to be mandatory (Arch Soc Esp Oftalmol 2009; 84: 577-580).

Tratamiento inmunosupresor sistémico y trasplante de membrana amniótica en escleritis necrotizante inducida por cirugía (ENIC) / Succesful treatment of surgically induced necrotizing sclerokeratitis (SINS) with systemic immunosuppresive agents and amniotic membrane grafting

Caso clínico: Presentamos el caso de una mujer de74 años que desarrolló una escleroqueratitis necrotizanteen su ojo izquierdo tras cirugía de cataratano complicada. No tenía antecedentes de enfermedadautoinmune sistémica. El análisis histopatológicode la lesión mostró granulomatosis necrotizantecon abundantes células plasmáticas.Discusión: La escleroqueratitis necrotizante inducidapor cirugía (ENIC) es una grave afección querequiere tratamiento precoz y agresivo tratando deprevenir sus potencialmente devastadoras consecuencias.La resección conjuntival junto conimplante de membrana amniótica pueden ser necesariaspara interrumpir temporalmente el procesoinmunológico local. No obstante, es esencial asociarun tratamiento inmunosupresor sistémico(AU)

Clinical case: We report the case of a 74-year-oldfemale who developed a necrotizing sclerokeratitisaffecting her left eye after uncomplicated cataractsurgery. She had no previous history of systemicautoimmune disease. Histopathology of the lesionrevealed necrotic granulomatosis with an increasednumber of plasma cells.Discussion: Surgically induced necrotizing sclerokeratitis(SINS) is a serious entity which requiresprompt and aggressive therapy to prevent its potentialdevastating ocular consequences. Conjunctivalresection and amniotic membrane grafting may benecessary to temporarily interrupt local immunologicevents in severe cases. However, associated systemicimmunomodulatory therapy seems to be mandatory(AU)

El "cúmulo sarcoideo". Un nuevo signo en tomografía computarizada de tórax de alta resolución / The "sarcoid cluster sign". A new sign in high resolution chest CT

Objetivos: Valorar la presencia de múltiples nodulillos puntiformes formando un grupo en el pulmón periférico en pacientes con sarcoidosis y describir este hallazgo como el nuevo "signo del cúmulo sarcoideo" en tomografía computarizada de alta resolución (TCAR).Material y métodos: Estudio retrospectivo de las TCAR de 91 pacientes diagnosticados de sarcoidosis torácica en el Hospital de León. Se valoró la presencia de grupos de múltiples nodulillos puntiformes en el pulmón periférico ("signo del cúmulo sarcoideo"), su morfología redonda o alargada y su distribución en los campos pulmonares. Se utilizaron reconstrucciones de máxima intensidad de proyección. Se realizó correlación radiopatológica en 3 pacientes. Material y métodos: Posteriormente, se valoró la presencia de este signo en TCAR en 120 pacientes consecutivos estudiados por sospecha de enfermedad pulmonar infiltrativa difusa (EPID). Resultados: De los 91 pacientes con sarcoidosis, 9 (6 varones y 3 mujeres, con edad media de 29 años) presentaban el "signo del cúmulo sarcoideo" en TCAR. La mayoría de los cúmulos mostraban morfología redondeada y su distribución fue predominante en la zona periférica no subpleural de los campos pulmonares superiores y medios; cuando los cúmulos tenían distribución periférica subpleural, nodulillos subpleurales formaban parte del cúmulo. Los cúmulos correspondían a granulomas no caseosos, no coalescentes, con predominio de linfocitos CD4+, sin fibrosis y con distribución linfangítica. Resultados: Únicamente 2 de los 120 pacientes con sospecha de EPID mostraban grupos periféricos de múltiples nodulillos puntiformes ("signo del cúmulo sarcoideo"); los 2 correspondían a sarcoidosis. El total de sarcoidosis diagnosticadas en este grupo fue de 1. Conclusión: El nuevo “signo del cúmulo sarcoideo” en TCAR solamente se ha observado en pacientes jóvenes con sarcoidosis pulmonar. Puede ser un hallazgo radiológico útil en el diagnóstico de esta enfermedad (AU)

Objectives: To evaluate the presence of clusters of multiple small punctiform nodules in the peripheral regions of the lung in patients with sarcoidosis, and to report this finding as a new sign "the sarcoid cluster sign" in high-resolution chest CT (HRCT). Material and methods: This is a retrospective study of the HRCT findings in 91 patients diagnosed with lung sarcoidosis at our hospital. We evaluated the presence of clusters of multiple small punctiform nodules in the periphery of the lungs (the "sarcoid cluster sign"), whether these were rounded or long in shape, and their distribution in the lung fields. We used reconstructions of maximum intensity projections (MIP). We correlated the imaging and histopathological results in three patients. Material and methods: Afterward, we evaluated the presence of the “sarcoid cluster sign” on high resolution CT findings in 120 consecutive patients studied for suspected diffuse lung disease. Results The "sarcoid cluster sign" was present at HRCT in 9 of the 91 patients with sarcoidosis (6 men and 3 women; mean age 29 years). Most clusters were rounded and most were located in the non-subpleural peripheral regions of the upper and middle fields of the lungs. When the clusters were located in the subpleural peripheral regions, the clusters contained small subpleural nodules. The correlation between the imaging and histopathological results revealed that the clusters corresponded to non caseous, noncoalescing granulomas with a predominance of CD4+ lymphocytes, without fibrosis, that were distributed in the lymph vessels. Results Only 2 of the 120 patients with suspected diffuse lung disease had peripheral clusters of multiple small punctiform nodules (the "sarcoid cluster sign"); these two patients had sarcoidosis, and a total of 21 cases of sarcoidosis were diagnosed in this group. Conclusion: The "sarcoid cluster sign" on HRCT has been observed only in young patients with lung sarcoidosis. This finding could be useful in the diagnosis in the diagnosis of this disease (AU)

[The "sarcoid cluster sign". A new sign in high resolution chest CT]. / El "cúmulo sarcoideo". Un nuevo signo en tomografía computarizada de tórax de alta resolución.

OBJECTIVES: To evaluate the presence of clusters of multiple small punctiform nodules in the peripheral regions of the lung in patients with sarcoidosis, and to report this finding as a new sign "the sarcoid cluster sign" in high-resolution chest CT (HRCT). MATERIAL AND METHODS: This is a retrospective study of the HRCT findings in 91 patients diagnosed with lung sarcoidosis at our hospital. We evaluated the presence of clusters of multiple small punctiform nodules in the periphery of the lungs (the "sarcoid cluster sign"), whether these were rounded or long in shape, and their distribution in the lung fields. We used reconstructions of maximum intensity projections (MIP). We correlated the imaging and histopathological results in three patients. Afterward, we evaluated the presence of the "sarcoid cluster sign" on high resolution CT findings in 120 consecutive patients studied for suspected diffuse lung disease. RESULTS: The "sarcoid cluster sign" was present at HRCT in 9 of the 91 patients with sarcoidosis (6 men and 3 women; mean age 29 years). Most clusters were rounded and most were located in the non-subpleural peripheral regions of the upper and middle fields of the lungs. When the clusters were located in the subpleural peripheral regions, the clusters contained small subpleural nodules. The correlation between the imaging and histopathological results revealed that the clusters corresponded to noncaseous, noncoalescing granulomas with a predominance of CD4+ lymphocytes, without fibrosis, that were distributed in the lymph vessels. Only 2 of the 120 patients with suspected diffuse lung disease had peripheral clusters of multiple small punctiform nodules (the "sarcoid cluster sign"); these two patients had sarcoidosis, and a total of 21 cases of sarcoidosis were diagnosed in this group. CONCLUSION: The "sarcoid cluster sign" on HRCT has been observed only in young patients with lung sarcoidosis. This finding could be useful in the diagnosis in the diagnosis of this disease.

[The adenoid cystic carcinoma]. / Carcinoma adenoide quístico de CAE.

The adenoid cystic carcinoma arising in the external auditory canal is a rare tumor, as other malignant neoplasias of the EAC and middle ear. The early diagnosis of these malignant tumors of the ear is very important to improve the prognosis. In this sense, the clinic experience is frequently the most useful diagnosis instrument to suspect this pathology when we have a confrontation with chronic otorrea and otalgia, common presentation form of this disease. In this report we show a new case of adenoid cystic carcinoma of external auditory canal and review the most significant medical literature existing in relationship with this pathology.

Carcinoma adenoide quístico de CAE / The adenoid cystic carcinoma

El carcinoma adenoide quístico con origen en el conducto auditivo externo es un tumor infrecuente, como ocurre en general con otras neoplasias malignas que asientan en el CAE y oído medio. El diagnóstico precoz de estos tumores malignos del oído es fundamental para mejorar su pronóstico. En este sentido, la experiencia clínica es muchas veces el instrumento diagnóstico más útil para sospechar esta patología cuando nos enfrentamos ante una otorrea y una otalgia crónicas, modo de presentación frecuente de esta enfermedad. En este artículo recogemos un nuevo caso de carcinoma adenoide quístico del conducto auditivo externo y revisamos la literatura médica más relevante que existe en relación con esta patología

The adenoid cystic carcinoma arising in the external auditory canal is a rare tumor, as other malignant neoplasias of the EAC and middle ear. The early diagnosis of these malignant tumors of the ear is very important to improve the prognosis. In this sense, the clinic experience is frequently the most useful diagnosis instrument to suspect this pathology when we have a confrontation with chronic otorrea and otalgia, common presentation form of this disease. In this report we show a new case of adenoid cystic carcinoma of external auditory canal and review the most significant medical literature existing in relationship with this pathology

[Sarcoma of the larynx. Report of two cases]. / Sarcomas de laringe. A propósito de 2 nuevos casos.

In relation with other laryngeal neoplasms, sarcomas are uncommon tumours. With the object to put in knowledge one chondrosarcoma and one liposarcoma located in the larynx seen in our hospital in a small period of time, we decided to do this publication, discussing the differential clinical aspects of these laryngeal cancers.

Sarcomas de laringe / Two cases of sarcomas of the larynx

Los sarcomas, en relación con otras neoplasias laríngeas, son tumores de presentación infrecuente. Con el objeto de dar a conocer un condrosarcoma y un liposarcoma de localización laríngea aparecidos en nuestro hospital en un corto período de tiempo, nos decidimos a realizar esta publicación, discutiendo los aspectos clínicos diferenciales de estos cánceres laríngeos (AU)

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[Infantile dyspnea due to pyogenic laryngeal granuloma]. / Disnea infantil por "granuloma piogénico" laríngeo.

Two appearances are outstanding in this case report. First is the clinical picture of chronic laryngeal stridor of a child due to an acquired haemangioma. And that the anatomopathologic subtype of angioma is a pyogenic granuloma noteworthy, as we shall see, the use of the term "pyogenic granuloma" based only on anatomopathological findings in order to circumscribe this lesion.

[Evaluation of the safety of stress echocardiography in Spain and Portugal]. / Evaluación de la seguridad de la ecocardiografía de estrés en España y Portugal.

UNLABELLED: INTRODUCTION. There are few studies that evaluate the safety of stress echocardiography with discordant results. They are done in well-trained centers with highly selected populations leading to selection bias. OBJECTIVE: To assess the safety of the different modalities of stress echocardiography in Spain and Portugal. METHOD: Severe complications were retrospectively analyzed during the stress echocardiography performed in 29 hospitals in Portugal and Spain, from the beginning of their activity to September, 1999. In this period 22,105 stress echocardiograms were performed: 10,975 exercise echos, 2,969 low dose dobutamine echos, 6,832 high dose dobutamine echocardiograms, 1,276 dypiridamole echocardiograms, 41 paced echocardiograms and 12 with adenosine. A complication was defined as severe when it was life-threatening or led to hospital admission. RESULTS: We registered 26 complications, one death, 3 ventricular fibrillations, 10 sustained ventricular tachycardias, 2 complete atrioventricular blocks, 6 acute myocardial infarctions, 2 ruptures of the free wall or ventricular septal defects, 1 transient ischemic attack and 1 severe symptomatic hypotension. We had one severe complication for every 2,743 exercise stress, 1 every 1,231 dypiridamole, 1 every 325 high dose dobutamine without any complications with low dose dobutamine stress. We found a relationship between experience in dobutamine stress echocardiography and the frequency of complications. Three complications appeared once the test was finished. CONCLUSIONS: The stress echocardiography is a safe technique, but not harmless. The exercise stress echo is the safest of all the modalties of stress echocardiography. There is a relation between experience and the number of complications.

Symmetric lipomatosis of the tongue: report of a case and review of the literature.

Lipomatosis of the tongue is an extremely rare condition. To date, only 5 cases have been reported in the literature. An additional example, confirmed by biopsy, is presented. This appears to represent only the second instance of a nonoriental person who has been described with this condition.

[Basal cell parotid adenoma. Report of an unusual case and review of literature]. / Adenoma parotídeo de células basales. Presentación de un caso inusual y revisión de la bibliografía.

Basal cell adenoma is a subtype of salivary monomorphic adenoma that usually appears in the parotid gland. Its pathological differentiation from adenoid cyst carcinomas is difficult. It is treated by surgical excision. In this study we describe the clinical and pathological features of a case in an atypical patient.

[Squamous carcinoma of the esophagus with extensive pagetoid dissemination]. / Carcinoma escamoso de esófago con extensa diseminación pagetoide.

A case of squamous carcinoma of the esophagus with pagetoid spreading in a 59-year-old male in presented. Signs of glandular differentiation (PAS-diastase, Alcian blue) and CEA were negative in the Paget-like cells. Pagetoid spreading of squamous carcinoma and true Paget's disease are very similar histologically and very rare in the esophagus (only 6 cases reported) and they must be differentiated from each other. Paget's disease demonstrates glandular differentiation and the cells are CEA positive. The absence of glandular differentiation in the Paget-like cells of pagetoid spreading versus Paget's disease may be a good criteria to differentiate these diseases.

[A change in the prescription of thrombolytic treatment in elderly patients. The experience of the Hospital de León]. / Cambio en la prescipción de tratamiento trombolítico en pacientes ancianos. Experiencia del Hospital de León.

INTRODUCTION AND OBJECTIVES: Most deaths caused from AMI occur in elderly patients, and it is know that these patients way also benefit from the type treatment normally offered to younger patients. We proposed to analyse how our therapeutic strategy has evolved for patients of advanced age related to the admission in the CCU and the prescription of thrombolytic treatment. METHODS: In order to carry our investigation, we compared the clinical profile, the treatment and the results of patients over the age of 70 who were hospitalized in our Service with suspected AMI during last 3 years. A total number of 366 which were divided into two consecutive periods of 18 months; 176 patients from January'91 to June'92 (Period I--former--) and 190 patients from July'92 to December'93 (Period II--latter--). RESULTS: In both periods, nearly all patients with suspected AMI and < 48 hours of since symptoms began were hospitalized in the CCU irrespective of their age. In both periods, over 40% of the total number of patients admitted to CCU were > 70 years (I: 45.2% vs II: 42.6%). We observed that in the latter group a major part of patients had complicated AMI at the moment of admittance (I: 15.3% vs II: 24.2%; p < 0.05). This is probably related to a less favorable clinical profile. Despite this, a parallel increase in hospital death rate was not observed (I: 21% vs II: 17%; p: NS). Over time, the ratio of patients prescribed with thrombolysis > 70 was nearly doubled (I: 13.7% vs II: 24.7%; p < 0.01), without a detected increase in complications of hemorrhages. CONCLUSIONS: For a variety of factors, the number of elderly patients admitted with complicated AMI has increased. In our experience the simple modification in the way thrombolysis is prescribed is capable of restraining the hospital death rate ratio.

Atrial rupture and sudden death following atrial infarction.

We present a sudden-death case secondary to a right atrial rupture, occurring as a result of a myocardial infarction with very subtle clinical and electrocardiographical signs. This atrial infarction case illustrates the difficulty of diagnosis and also the serious consequences that can result from this medical condition. We review other potential complications which, in clinical practise, are not always attributed to their true origin.

[Myocardial infarct during pregnancy. Treatment of the acute phase and of labor. Apropos a case and a review of the literature]. / Infarto de miocardio durante el embarazo. Tratamiento de la fase aguda y del parto. A propósito de un caso y revisión de la literatura.

An acute myocardial infarction, is an infrequent complication in pregnant women. We present the case of a 29-years-old patient who suffered 2 acute myocardial infarction in relation with her two pregnancies. The first acute myocardial infarction occurred the third day after delivery, and the second, during the seventh month of the second pregnancy. In the latter, delivery was vaginal, with epidural anaesthesia. A coronary angiogram showed coronary arteries without significant narrowings, as well as an aneurysm of the left ventricle. A review of the literature published so far is made in the discussion.

[Postoperative fusiform cell nodule. Relationship with other benign fibrous proliferations]. / Nódulo de células fusiformes postquirúrgico. Relación con otras proliferaciones fibrosas benignas.

We report on a patient who developed postoperative spindle cell nodule one month following TURP for prostatic adenocarcinoma. The foregoing was compared with other benign fibrous lesions from our records: one case of nodular fasciitis and one case of proliferative myositis. Although they were all well-defined and clinically distinct disease entities, a very close relationship concerning their origin was demonstrated histologically and immunohistochemically.