Metástasis digestivas por melanoma maligno cutáneo. Análisis de dos casos / Metastases for cutaneus malignant melanoma. Analysis of two cases

Los sitios metastáticos mas frecuentes del melanoma maligno cutáneo son pulmones, hígado y encéfalo. Las metástasis intestinales por melanoma son raras siendo el intestino delgado el lugar mas afectado, por lo que su diagnóstico es difícil preoperatoriamente, junto con una clínica por lo general anodina, pudiendo presentarse como un cuadro anémico crónico, oclusivo o de perforación, por lo que suele diagnosticarse en el acto operatorio. Presentamos 2 casos de metástasis digestivas en pacientes intervenidos de melanoma maligno cutáneo que debutaron respectivamente con metástasis en duodeno y en ileon erminal. Este último reintervenido por metástasis mesentérica, muy cercana de la resección anterior. Ambos están en este momento con tratamiento oncológico y con estudios de extensión dentro de la normalidad (AU)

The most frequent metastasic sites of cutaneous malignant melanoma are lungs, liver and brain. Intestinal metastases by melanoma are rare. Most cases are located in small intestine, and its preoperative diagnosis is often difficult. Clinical symptoms are often anodyne, frequently appearing as a chronic, occlusive or anemic syndrome, or as a perforation, and to a late diagnosis after surgery. We report here 2 cases of digestive metastases of cutaneous malignant melanoma in duodenum and terminal ileum. The most frequent metastasic sites of cutaneous malignant melanoma are lungs, liver and brain. ntestinal metastases by melanoma are rare. Most cases are located in small intestine, and its preoperative diagnosis is often difficult. Clinical symptoms are often anodyne, frequently appearing as a chronic, occlusive or anemic síndrome, or as a perforation, and to a late diagnosis after surgery. We report here 2 cases of digestive metastases of cutaneous malignant melanoma in duodenum and terminal ileum. This last one underwent further surgery for mesentheric metastasis in the vicinity of previous surgery. Both patients are at the moment on oncology treatment and extension studies have shown so far no further metastasis (AU)

[Abdominal pseudotumor and Whipple's disease]. / Seudotumor abdominal y enfermedad de Whipple.

Whipple's disease is an uncommon systemic disease which most often affects the intestine but may involve any other organ. The case of a woman who consulted for weight loss, fever of unknown origin, cutaneous eruptions and increase in the abdominal perimeter is presented. The ascitic fluid showed exudate infected by E. coli suggesting spontaneous bacterial peritonitis associated with chronic liver disease. Antibiotic treatment and diuretics were administered after which abdominal exploration demonstrated the presence of a mesogastric mass. Echographic and tomographic studies were unable determine the origin of the mass with the final diagnosis being achieved by exploratory laparotomy and biopsy.

[Request for a hemogram as a marker of the quality of health care]. / La solicitud del hemograma como indicador de calidad del proceso asistencial.

The evaluation of markers of the health care activity, such as the reason for requesting a peripheral blood count in everyday practice and its inclusion in the clinical record, constitutes an estimate of the quality of care. To this end, we have reviewed the requests of 160 peripheral blood counts in our center during one month. It was found that the request itself and/or its cause had not been mentioned in the clinical record in 32.5% of instances. In the cases where the indication could be ascertained, it was not justified in 58.4%. Overall 72.5% of peripheral blood counts were normal. It was concluded that peripheral blood count is an over-utilized test, while its request is insufficiently recorded. This makes diagnostic decisions and the evaluation of the quality of care difficult.

[Diagnostic value of anti-mitochondria antibodies]. / Valeur diagnostique des anticorps anti-mitochondries

The histological lesions found in patients with hepatic disease and positive anti-mitochondrial antibodies (AMA) by immunofluorescence were compared with those in 10 subjects of the same age and sex with negative AMA. The majority of the patients with positive AMA were suffering from primary biliary cirrhosis, the diagnosis being based upon the histological appearance (Stage 1 of Scheuer's classification: 40%) or the presence of clinical signs of cholestasis with a compatible histological appearance (40%). None of the remaining patients (20%) with positive AMA nor the 10 individuals with negative AMA showed histological signs suggestive of primary biliary cirrhosis. The absence of certain clinico-biological factors, with the exception of Stage 1 histology, gives a high degree of value to a high level of AMA in the diagnostic of PBC.