Acute abdominal pain due to ruptured ovarian endometrioma with high CA125 and CA19- 9 levels

Una mujer de 47 años fue atendida en el servicio de urgencias por dolor abdominal de 72h de evolución con una elevación de los niveles plasmáticos de leucocitos, CA 19–9 y CA 125. La paciente fue intervenida encontrando un endometrioma roto en el ovario izquierdo. Los altos niveles de ambos marcadores tumorales nos obligaron a descartar una neoplasia de ovario en este caso (AU)

A 47-year-old woman presented to the emergency department complaining of abdominal pain for the last 3 days, with an increase in serum levels of white blood cells, CA19-9 and CA-125. Surgery revealed a ruptured left ovarian endometrioma. In this case, high levels of both antigens forced us to exclude an ovarian neoplasm (AU)

Fournier's gangrene: analysis of prognostic variables in 34 patients.

INTRODUCTION: Fournier's gangrene (FG) is the necrotizing fasciitis of the perineum and genital area. The objective of this study was to assess risk factors for mortality. MATERIALS AND METHODS: We conducted an analytic and retrospective study of the patients with FG treated at our institution between 1998 and 2008. Statistical analysis was performed with the Statistical Package for Social Science for Windows, version 15.0, using the Mann-Whitney test for quantitative variables, and the chi-square and Fisher exact tests for qualitative variables, in univariate analyses. RESULTS: Of the 34 patients treated, 25 survived (74%) and 9 died (26%) with a median timing of 29 days (13, 60). Statistically significant differences were not found in age, sex and predisposing factors, except heart disease (p = 0.034). Admission laboratory parameters and severity criteria showed significant differences in serum urea (p = 0.007), potassium (p = 0.008), alkaline phosphatase (p = 0.014) and Fournier's gangrene severity index score (FGSIS) (p = 0.008). Others factors such as duration of symptoms before hospital admission, extent of body surface area, number of surgical debridements, additional surgical manoeuvers (supra-pubic catheterization or colostomy), microbiological cultures and ICU stay did not show significant differences. CONCLUSIONS: FG is a life-threatening necrotizing fasciitis with a high mortality rate. In our study, prognostic variables were heart disease, admission serum urea, potassium, alkaline phosphatase, and FGSIS. More studies are needed to validate these findings.

[Acute abdomen as a complication of a duodenal duplication cyst]. / Abdomen agudo como complicación de un quiste de duplicación duodenal.

The authors report an exceptional case of acute abdomen caused by the necrosis and perforation of a duodenal duplication cyst in a 23 year-old-patient. The cyst was located at the anterior and lateral surface of the duodenum, between its first and second portion. The patient underwent a cephalic duodenopancreatectomy (Whipple's procedure) because of the intimate adherence of the necrotic and inflammatory mass to duodenum and head of the pancreas. The histological examination of surgical specimen confirmed the diagnosis, showing a cystic structure lined with an epithelium and a common muscle wall shared by the cyst and the duodenum. There was no communication between the cyst and duodenal lumen.

[True pancreatic cysts in adults]. / Quistes verdaderos del páncreas en el adulto.

True or congenital cysts of the pancreas in adults are extremely rare entities. We describe two cases of true cysts located in the head of the pancreas, which presented with symptoms of epigastric pain, palpable mass and jaundice. CT scan was useful to demonstrate the location and extent of the lesion and its relation with neighbouring structures, but failed to determine the nature of the cyst. Diagnosis was obtained by the histological study of the cystic wall at surgery.

[Colorectal polyps. Treatment and clinical course]. / Pólipos colorrectales. Tratamiento y evolución.

We report the results of the treatment and follow up of 61 patients with polyps of the colon and rectum, who underwent surgical intervention between 1983 through 1991. The mean age was 56 years (range from 41 to 56 y.) and 53% of the patients were males. The majority of the polyps were located in the anorectal region, n = 32 (52.4%) and sigmoid colon n = 17 (27.8%). Tubular adenomas in n = 38 patients and villous adenoma in n = 19, were the most frequent histological types. We have found polyps with invasive carcinoma in 15 (24.6%) cases. The polyps were resected by transanal resection in 15 patients, by colectomies in 11, and 10 patients underwent colectomy for removal of their polyps. Surgery was indicated when the polyp had a base too wide to be removed by colonoscopy or when malignancy was demonstrated by biopsy. There were 10 (19.6%) recurrences during the first three years of follow up. The histological examination showed malignant changes in 4 polyps. Villous adenomas, n = 7 constituted the histological type with more recurrences. Recurrences were treated by local resection in half of the cases. The morbidity was 9.8% and mortality was 3.3%. Surgery when indicated, allows to obtain free margins from tumor, to determine lymph node involvement and to establish the stage.