[Epithelioid angiosarcoma of the gallbladder. Case report and review of the literature]. / Angiosarcoma epitelioide de vesícula.

Angiosarcoma of the gallbladder is an infrequent pathology but has a high morbidity and mortality. There are only 10 references in the international literature. We present a case treated in our center and we review the cases published since 1956. An 81 year-old male patient with abdominal pain, asthenia and dyspnea. Analytically anemia and leukocytosis. Exploration found a distended abdomen, right hypochondrium pain, with defense. Abdominal echography and a CT were requested with a diagnosis of acute cholecystitis and he was admitted for antibiotic treatment. The patient did not evolve favorably and was subjected to emergency surgery, which found a haemoperitoneum and a gallbladder with a tumoral appearance that could not be totally extirpated. He died 20 days after the operation. The report from pathological anatomy was compatible with epithelioid angiosarcoma of the biliary gallbladder. Gallbladder angiosarcoma is a neoplasia with a bad prognosis, whose clinical presentation can be mistaken for acute cholecystitis. Improving the prognosis of this disease involves carrying out early diagnosis and surgical treatment.

Valor pronóstico de la afectación del margen circunferencial en pacientes con cáncer de recto localmente avanzado / Prognostic value of circumferential resection margin involvement in patients with locally-advanced rectal cancer

Introducción. La afectación del margen circunferencial (MC) en los pacientes intervenidos por neoplasia de recto es un factor de mal pronóstico en cuanto a posibilidad de recidiva local, recidiva a distancia y supervivencia, y esta afectación se ha relacionado con la calidad de la cirugía. Analizamos la tasa de afectación del MC en pacientes con cáncer de recto localmente avanzado, sometidos a tratamiento neoadyuvante, y su relación con la supervivencia libre de enfermedad (SLE) y la supervivencia específica (SE). Material y métodos. Se incluye a 101 pacientes diagnosticados de adenocarcinoma de recto entre enero de 2001 y diciembre de 2005, e intervenidos tras recibir radioquimioterapia neoadyuvante. El MC se consideró positivo cuando la distancia del tumor al borde quirúrgico fue menor de un milímetro. La afectación del MC se relaciona con la SLE y la SE mediante el test log-rank. Resultados. La media de edad fue de 66,6 años. La tasa de afectación del MC fue del 10,8% (11 casos), en 7 casos por cercanía o contacto del MC con el tumor, en 2 por cercanía de adenopatías, en un caso por infiltración perineural en el MC y en otro por crecimiento discontinuo del tumor. Con un seguimiento medio de 25,4 meses, se diagnosticó recidiva de la enfermedad en 13 pacientes: en 3 (2,97%) como recidiva local y en 10 (9,9%) como metástasis a distancia. Once (10,8%) pacientes fallecieron por evolución de la enfermedad. La afectación del MC se relacionó significativamente con la SLE (p = 0,0167) y con la SE (p = 0,0176). Conclusión. En pacientes intervenidos por cáncer de recto después de tratamiento neoadyuvante con radioquimioterapia, la afectación del MC es un factor pronóstico negativo para SLE y SE (AU)

Introduction. Circumferential resection margin (CRM) involvement in patients undergoing surgery for rectal tumors is a factor predicting poor prognosis in terms of the possibility of local recurrence, distant recurrence, and survival. CRM involvement has been related to the quality of the surgery. We analyzed the rate of CRM involvement in patients with locally-advanced rectal cancer undergoing neoadjuvant therapy and its relation with disease-free survival (DFS) and disease-specific survival (DSS). Material and methods. A total of 101 patients diagnosed with rectal adenocarcinoma between January 2001 and December 2001 who underwent surgery after receiving neoadjuvant radiochemotherapy were included. The CRM was considered positive when the distance between the tumor and the surgical border was less than 1 mm. The relation between CRM involvement and DFS and DSS was evaluated using the log-rank test. Results. The mean age was 66.6 years. The rate of CRM involvement was 10.8% (11 patients); CRM involvement was due to proximity or contact of the CRM with the tumor in 7 patients, proximity of enlarged nodes in 2 patients, perineural invasion in the CRM in 1 patient and discontinuous tumoral growth in 1 patient. With a mean follow-up of 25.4 months, disease recurrence was diagnosed in 13 patients: local recurrence occurred in 3 (2.97%) patients and distant metastases in 10 (9.9%). Eleven (10.8%) patients died from disease progression. CRM involvement was significantly related to DFS (p = 0.0167) and DSS (p = 0.0176). Conclusion. In patients undergoing surgery for rectal cancer after neoadjuvant radiochemotherapy, CRM involvement is a negative prognostic factor for DFS and DSS (AU)

Valoración inmunohistoquímica de la expresión de c-erb B2 como variable independiente en el carcinoma mamario T2N1 patológico / Immunohistochemical evaluation of c-erb B2 expression as an independent variable in T2N1 breast carcinoma

Introducción. La incidencia de carcinoma mamario oscila entre 11 y 80 casos por 100.000 mujeres/año. El desarrollo de técnicas de inmunohistoquímica, para la determinación de marcadores tumorales ha posibilitado la realización de trabajos retrospectivos que nos permitan valorar su utilidad como factores pronósticos. Diversos trabajos relacionan la sobreexpresión de c-erb B2 con factores pronósticos. El objeto de nuestro estudio es determinar si la sobreexpresión de c-erb B2 es un factor pronóstico independiente en el grupo de pacientes seleccionado. Pacientes y métodos. Se trata de 83 pacientes intervenidas entre 1980 y 1990 por carcinoma ductal infiltrante de mama,T2N1 patológico. Hemos utilizando el kit Super Sensitive Immunodetection System de Biogenex, para la determinación de c-erb B2. El análisis estadístico de los datos obtenidos se ha realizado mediante las pruebas de 2 para variables cualitativas y la t de Student y análisis de la variancia para variables cuantitativas. Resultados. El 35 por ciento de las pacientes mostró sobreexpresión de c-erb B2. El 48 por ciento de las pacientes prasentó progresión de la enfermedad. No hemos encontrado diferencias significativas al comparar sobreexpresión de c-erb B2 con ningún parámetro estudiado salvo una relación inversa, estadísticamente significativa, entre c-erb B2 y receptores estrogénicos (p = 0,0403). Conclusiones. El c-erb B2 determinado mediante inmunohistoquímica no es un factor independiente de pronóstico en carcinomas ductales infiltrantes de mama T2N1. Los receptores estrogénicos presentan una relación inversa con c-erb B2 con significación estadística (AU)

[Gastric necrosis caused by acute gastric distention and superior mesenteric artery syndrome]. / Necrosis gástrica por distensión aguda del estómago y síndrome de la pinza mesentérica.

We report the case of a 14 year-old female patient who was admitted complaining of abdominal pain due to gastric distension after an episode of bulimia. The patient was diagnosed as having gastric intramural necrosis by CT. An emergency laparotomy was performed and a massive gastric necrosis and duodenal compression due to the superior mesenteric artery syndrome was found. The patient did well after total gastrectomy and Roux-en-Y procedure.

[Risk for injuries in traffic accidents among drivers under the effect of alcohol in Navarra]. / El riesgo de lesión en accidente de tráfico por conducir bajo los efectos del alcohol en Navarra.

We conducted a retrospective analysis of the levels of alcohol in the blood of a group of 54 drivers who required hospital emergency care after having suffered a traffic accident on roads in the Health Area III of Navarra (Spain) from June to September 1989, and compared them to another group of 219 drivers, not victims of traffic accidents, submitted to the breathalyser (test of alcoholaemia) on the roads of the same Health Area over the same period of time. In the group of 54 accident victims, the median alcoholaemia was 100 mg/dl, with a quartile deviation of 88 mg/dl, and the percentage of positives (alcoholaemia equal to or greater than 80 mg/dl) was 50.9%. In the group of 219 drivers not victims of traffic accidents, the median alcoholaemia was 16 mg/dl, the quartile deviation 18.5 mg/dl and the percentage of positive alcoholaemia was 1.8%. Drivers with a level of blood alcohol equal to or greater than 80 mg/dl have an estimated risk (Odds Ratio) of being injured in a traffic accident 55.82 times higher than drivers with a lower level.

[Variceal hemorrhage on the colostomy area in a patient with portal hypertension]. / Hemorragia por varices a nivel de colostomía en un paciente con hipertensión portal.

A 68 years old patient who had a colostomy done for an abdomino-perineal resection, started episodes of bleeding seven years later from varices at the colostomy site secondary to portal hypertension. Direct suture of the varices and distal colonic resection were ineffective to stop the bleeding. Sclerotherapy with polidocanol, however permitted the patient to remain asymptomatic during 14 months.