[Fever and recurrent bacteremia as presentation form of secondary aortoenteric fistula]. / Fiebre y bacteriemia recurrente como forma de presentación de una fístula aortoentérica secundaria.

Secondary aortoenteric fistula is a rare complication, although very severe, of aortic revascularization surgery. The major cause is usually infection of the prosthetic material, which may happen short or long after the intervention. The most frequent forms of presentation are digestive hemorrhage, abdominal pain or unpleasantness, shock or other symptoms associated to the compression of adjacent structures. However, as in the present case, symptoms of systemic infection may be the only manifestation, with absence of local signs. This is why a high degree of clinical suspicion is needed. The most useful complementary techniques are computerized tomography, oral endoscopy and, probably, magnetic resonance, along with gammagraphy of indium-marked leukocytes. Therapy must combine long-term systemic antibiotherapy and resection of all infected material, with reconstruction of the vascular continuity following a route far away from the infected area.

[Is the biopsy of the temporal artery necessary? A study of 204 biopsies]. / Es necesaria la biopsia de la arteria temporal? Estudio de 204 biopsias.

Due to the controversy on the need of performing temporal artery biopsies for the diagnosis of giant cell arteritis (GCA), we have reviewed 204 biopsies of temporal arteries as well as the clinical histories of the 190 patients. Patients without local manifestations were excluded from this study. From the 173 remaining patients, 54 presented a diagnostic biopsy of GCA. The 119 patients with a negative biopsy were divided into different groups according to the final diagnosis. From our data we could not find a clinical pattern which could permit the prediction of biopsy positiveness. We could not find either any clinical entity in the nondiagnostic group which would permit to exclude a diagnosis before performing the biopsy. We consider that the biopsy of the temporal artery can not be avoided nowadays and that it represents the only decisive diagnostic method of GCA.

[Nodular lymphoid hyperplasia of the small bowel with IgA deficiency and hemolytic anemia (author's transl)]. / Hiperplasia nodular linfoide del intestino delgado con déficit de IgA y anemia hemolítica.

The syndrome of nodular lymphoid hyperplasia of the small bowel with hypogammaglobulinemia is one of the hypogammaglobulinemic enteropathies. Chronic diarrhea and malabsorption are the most characteristic features of this disease, and they are frequently associated to hypogammaglobulinemia of various types (acquired, congenital non sex-linked) and to selective IgA deficiency. The immunological deficiency gives rise to the more characteristic features of the disease, namely: a) hypogammaglobulinemia; b) respiratory infections and dental caries; c) Giardia lamblia infestation of the small bowel; d) the characteristic radiological features; and, e) the histological aspect of the intestinal mucosa with absence of plasma cells. Periodical follow-up is needed because of the increased incidence of tumors in immunological deficiency states. A new case of nodular lymphoid hyperplasia associated to hemolytic anemia and granulomatous hepatitis is reported, and its possible pathogenesis is discussed.