Diseminación hematógena y neumonitis por el bacilo de Calmette-Guérin / Bacille Calmette-Guérin induced hematogenous dissemination and pneumonitis

La administración intravesical del bacilo de Calmette-Guérin (BCG) puede producir complicaciones infecciosas locales y sistémicas. Las complicaciones sistémicas son infrecuentes, aunque muy graves. Presentamos el caso de un varón con dicho tratamiento que comienza con fiebre e inicialmente se atribuye a una sepsis urológica. Posteriormente se sospecha una diseminación hematógena y una neumonitis que se diagnostica por una gammagrafía con galio-67. Además, se aísla en orina Mycobacterium bovis (AU)

Intravesical administration of Bacille Calmette-Guérin (BCG) may cause local and systemic infectious complications. Systemic complications are rare but very serious. We report the case of a man with such treatment who began with fever what was initially attributed to a urological sepsis. After, hematogenous dissemination and pneumonitis were suspected, these being diagnosed by gallium-67 scintigraphy. In addition, Mycobacterium bovis was isolated in the urine (AU)

[Spontaneous tumor lysis syndrome in a patient with non-Hodgkin's lymphoma]. / Síndrome de lisis tumoral espontáneo en una paciente con linfoma no Hodgkin.

An 77-year-old woman with no previous history of malignancy was admitted to the hospital with generalized weakness and malaise. Physical examination demonstrate multiple cervical adenopathies. The day after admission the patient developed severe metabolic derangements (hyperuricemia, hypocalcemia, hyperkalemia, hyperphosphatemia and azotemia) and expired. Consent for necropsy was refused. The cytology and molecular studies of cervical adenopathy sample were diagnostic of high-grade non-Hodgkin's lymphoma. A presumptive diagnosis of non Hodgkin lymphoma with spontaneous tumor lysis syndrome was made.

Síndrome de lisis tumoral espontáneo en una paciente con linfoma no Hodgkin / Spontaneous tumor lysis syndrome in a patient with non-Hodgkin´s lymphoma

Presentamos el caso de una mujer de 77 años sin antecedentes de proceso neoplásico que ingresa por la aparición en pocas semanas de múltiples adenopatías cervicales y que fallece a las pocas horas presentado hiperuricemia, hipocalcemia, hiperpotasemia, hiperfosfatemia e hiperazotemia. La citología y estudio molecular de una muestra de una adenopatía cervical fueron compatibles con de linfoma no Hodgkin de estirpe B de alto grado. Se trataría por tanto de un síndrome de lisis tumoral espontáneo como debut de un linfoma no Hodgkin

An 77-year-old woman with no previous history of malignancy was admited to the hospital with generalized weakness and malaise. Physical examination demostrate multiple cervical adenopathies. The day after admission the patient developed severe metabolic derangements (hyperuricemia, hypocalcemia, hyperkalemia, hyperphosphotemia and azotemia) and expired. Consent for necropsy was refused. The cytology and molecular studies of cervical adenopathy sample were diagnostic of high-grade non-Hodgkin’s lymphoma. A presumptive diagnosis of non Hodgkin lymphoma with spontaneous tumor lysis syndrome was made

[Differences between tuberculous spondylitis and brucellar spondylitis]. / Diferencias entre la espondilitis tuberculosa y la espondilitis brucelar.

OBJECTIVE: To identify potential differences in the clinical and laboratory characteristics between tuberculous spondylitis (TS) and brucellar spondylitis (BS). PATIENTS AND METHODS: Retrospective study of patients with TS and BS diagnosed in our hospital between january 1992 and december 1998. RESULTS: TS was diagnosed in 17 patients and BS in 10 patients. In our series, a higher delay in the diagnosis (27.9 +/- 24.6 vs. 16 +/- 5.6 weeks, p = 0.02) was found in TS. There was a higher frequency, but without stadistic significance, of immunosuppression, one or several paravertebral or epidural abscesses, spinal cord compression, anemia and an elevated erythrocyte sedimentation rate in TS, and a higher frequency of fever/febricule and residual vertebral pain in BS. Lumbar location was the most frequent in both groups (58.8% in TS and 70% in BS). CONCLUSIONS: It is possible that there were some differences in the clinical and laboratory characteristics between TS and BS which may be an aid in the differential diagnosis of both entities and orient the empirical treatment in these cases without a definitive microbiological diagnosis or while awaiting the diagnostic confirmation.

Diferencias entre la espondilitis tuberculosa y la espondilitis brucelar / Differences between tuberculous spondylitis and brucellar spondylitis

Objetivo: Identificar posibles diferencias en las características clínicas y analíticas entre la espondilits tuberculosa (ET) y la espondilitis brucelar (EB). Pacientes y métodos: Estudio retrospectivo de los pacientes diagnosticados de ET y EB en nuestro hospital entre enero de 1992 y diciembre de 1998. Resultados: Diecisiete pacientes fueron diagnosticados de ET y 10 de EB. La ET se caracterizó en nuestra serie por un mayor tiempo de evolución de la clínica hasta el momento del diagnóstico (27,9 ± 24,6 vs.16 ± 5,6 semanas, p= 0,02). Encontramos una mayor frecuencia, pero sin alcanzar la significación estadística, de inmunosupresión, de uno o varios abscesos paravertebrales y/o epidurales, de compresión medular, de anemia y de velocidad de sedimentación globular elevada en la ET, y una mayor frecuencia de fiebre/febrícula y de dolor vertebral residual en la EB. La localización lumbar fue la más frecuente en ambos grupos (58,8 por ciento en la ET y 70 por ciento en la EB). Conclusiones: Es posible que existan algunas diferencias en las características clínicas y analíticas de la ET y de la EB que puedan ser de ayuda en el diagnóstico diferencial de ambas entidades y orientar el tratamiento empírico en los casos sin un diagnóstico definitivo microbiológico o a la espera de la confirmación diagnóstica (AU)

[Report of a case of T-cell peripheral lymphoblastic lymphoma in an HIV patient]. / Presentación de un caso de linfoma linfoblástico periférico de células T en paciente VIH.

T-cell lymphomas in human immunodeficiency virus infections are rare, first case have being described in 1987, by Presant. Our purpose is to report the first T-cell Lymphoma case without epidermotropism in an HIV patient in Extremadura, and pioneer in Spain. Clinic extensive and histopathologic studies of cutaneous lesions were realized, including monoclonal antibodies tests. Peculiar clinical features were small bowel disease (MALT), gingiva, pericardium and skin involvement, with spontaneous resolution of skin nodules. Polychemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone was not effective, causing serious myelotoxicity. We outline the rarity of T-cell Lymphomas, the predominance of T4 phenotype, its relation with Epstein-Barr virus, the increase in 6-interleukin production, and the prognostic value of these factors, in correlation with advanced clinical status and unfavorable outcome.

[Importance of arteriography in the localization of insulinomas. Report of 2 new clinical cases]. / Importancia de la arteriografía en la localización de los insulinomas. Aportación de dos nuevos casos clínicos.

Two new clinical cases of insulinomas are reported, confirming the immense value of selective arteriography of the celiac trunk and upper mesenteric artery in localizing the tumor.

[Renal adenocarcinoma. Incidence during the last years]. / Adenocarcinoma renal. Incidencia en los ultimos años.

The authors present 20 cases of kidney adenocarcinomas studied and treated over the last five years. They state the age of presentation, sex, location and time of appearance of the symptoms and examine the symptoms which caused the patients to visit the doctor. They stress the means used for their diagnosis which they consider to be fundamental and the findings which enable the presence of kidney neoplasia to be confirmed as well as the fact that they are not early.