Paciente con ductopenia idiopática del adulto / Patient with adult idiopathic ductopenia

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Paciente con ductopenia idiopática del adulto / Patient with adult idiopathic ductopenia

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Cistoadenocarcinoma mucinoso de apéndice: diagnóstico endoscópico / Appendiceal mucinous cystoadenocarcinoma: endoscopic diagnosis

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[Ulcerative colitis and cytomegalovirus infection]. / Colitis ulcerosa e infección por citomegalovirus.

Colitis ulcerous and citomegalovirus infection association have been reported in medical literature in sometimes, althougth this prevalence have lately increased. We report a case record of this association and do a review of this subject. It is not clear what factors are involved in this association, being necessary hore studies to know them.

[Acute infantile bilateral thalamic necrosis]. / Necrosis talámica bilateral aguda infantil.

INTRODUCTION: Acute necrotizing encephalitis is a clinical entity recently described in previously healthy Japanese children. Following a respiratory or gastrointestinal infection of a viral nature, these patients present a sudden deterioration in the level of consciousness. Since neuroimaging shows a bilateral thalamic disorder in all cases, the name infantile bilateral thalamic necrosis has been put forward to refer to this affection. CASE REPORT: We report the case of an 11 month old Spanish patient who was brought into the hospital with disconnection from the surroundings and hypertonia in the upper extremities, within the context of a febrile gastrointestinal picture. Blood sample analysis revealed haemoconcentration and metabolic acidosis, although it did not suggest an infection. The computerised tomography scan of the brain showed a striking hypodensity of both thalami. The initial hypertonia was followed by a generalised hypotonia, accompanied by haemodynamic and respiratory deterioration. The patient died 40 hours after admission. CONCLUSIONS: Acute necrotizing encephalitis was initially described in Japanese children but in recent years isolated cases have also been reported in the Western world. In the case of the patient we have described, one of the most outstanding points is that evolution was unfavourable in spite of mechanical ventilation and the use of inotropic drugs, together with the clinical state of brain death that occurred on the second day after admission. Since neuroimaging showed a selective disorder of the thalami in all cases, and the fact it is an entity that affects small children, it seems more appropriate to use the term acute infantile thalamic necrosis

Colitis ulcerosa e infección por citomegalovirus / Colitis ulcerous and citomegalovirus infection

La asociación entre colitis ulcerosa de debut e infección por citomegalovirus ha sido descrita en la literatura pero en contadas ocasiones (1), aunque se observa un aumento de la prevalencía en los ultimos años. Presentamos un caso clínico con esta asociación y realizamos una revisión de la literatura médica. No se conocen con claridad los factores implicados ní tampoco el orden causal de esta asociación, precisando estudios más completos para intentar alcanzar soluciones definitivas (AU)

Absceso hepático primario por actinomyces meyeri / Primary hepatic abscess caused by actinomyces meyeri

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[Lower gastrointestinal bleeding due to Dieulafoy's in the upper colon]. / Hemorragia digestiva baja por Dieulafoy de colon ascendente.

Dieulafoy's lesion is a vascular anomaly generally located in the proximal stomach, although it has also been documented in other areas such as the colorectum. It is mainly found in men aged between 50 and 70 years, and represents less than 2% of acute gastrointestinal hemorrhagic episodes.A 66-year-old woman who was undergoing oral Diclofenac treatment presented with black stools. Endoscopy revealed acute duodenal erosions with no signs of bleeding. Black stools persisted after Diclofenac was discontinued and omeprazole treatment was started and the patient was admitted to hospital after 7 days. Colonoscopy revealed active bleeding in the upper colon, which ceased after sclerosis with ethanolamine oleate. The patient was discharged from hospital but was readmitted 10 days later because of rebleeding. The results of upper endoscopy were normal and colonoscopy performed 3 days later detected neither lesions nor bleeding. The pathogenesis of Dieulafoy's lesion is not well known, although it could be caused by erosion of the mucous lining of a vessel. Definitive diagnosis is histologic, although certain endoscopic diagnostic signs have been described. Endoscopic diagnosis is sometimes difficult; in such cases, arteriography should be employed, both for diagnostic and therapeutic purposes. The treatment of choice is endoscopic and the use of two hemostatic methods is advisable. If these procedures fail, surgery is required. Arteriography is the most suitable alternative in patients who are poor candidates for surgery.

Low serum levels of alpha-interferon, gamma-interferon, and interleukin-2 in alcoholic cirrhosis.

The existence of cellular immune deficit in alcoholic cirrhosis, together with the role of alpha- and gamma-interferon and interleukin-2 in the immune system, led us to compare serum levels of these immune system mediators in a group of 40 patients with alcoholic cirrhosis classified according to Child-Pugh's grade of severity of liver disease and 23 healthy volunteers. Serum levels of alpha-IFN, gamma-IFN, and IL-2 were significantly depressed in alcoholic cirrhotics, with no significant differences between the different degrees of hepatic damage. The results suggest a profound alteration in the immune system of alcoholic cirrhotics, which may contribute to the development of the disease and the accompanying immune system deficit.