Poliarteritis microscópica en un paciente con esclerosis sistémica / Microscopic polyangiitis in a patient with systemic sclerosis

La coexistencia de esclerosis sistémica (ES) y vasculitis se ha comunicado en pocas ocasiones. Presentamos a un paciente de 65 años, con ES limitada diagnosticada 6 años antes, que desarrolló una glomerulonefritis necrosante focal con proliferación extracapilar asociada a anticuerpos anticitoplasma de neutrófilo con patrón perinuclear (p-ANCA) de especificidad antimieloperoxidasa (anti-MPO) en ausencia de exposición a la D-penicilamina(AU)

The coexistence of systemic sclerosis (SSc) and vasculitis has been infrequently reported. We present a 65-year-old man who, 6 years previously, had been diagnosed with limited SSc, and who developed a focal segmental necrotizing crescent glomerulonephritis associated with perinuclear antineutrophil cytoplasmic antibodies with antimyeloperoxidase specificity in the absence of Dpenicillamine exposure(AU)

[Microscopic polyangiitis in a patient with systemic sclerosis]. / Poliarteritis microscópica en un paciente con esclerosis sistémica.

The coexistence of systemic sclerosis (SSc) and vasculitis has been infrequently reported. We present a 65-year-old man who, 6 years previously, had been diagnosed with limited SSc, and who developed a focal segmental necrotizing crescent glomerulonephritis associated with perinuclear antineutrophil cytoplasmic antibodies with antimyeloperoxidase specificity in the absence of Dpenicillamine exposure.

[Inguinal silicotic adenopathy: presentation of a case]. / Adenopatía inguinal silicótica: presentación de un caso.

Silicosis is a sistemic occupational disease, including in the group of pneumoconiosis, because is resulting from the inhalation of microscopic particles of crystalline silica, which deposition and histologic changes take place in lung tissue. A 30 year-old male, construction worker who presented many mediastinal, abdominal and groinal adenopathies without lung damaged. A groinal adenophaty biopsy showed the presence of numerous noncaseating granulomas containing scattered polarizable particles compatible with silica. This case has the particular feature of the exclusive extrapulmonary presentation of silicosis.

Adenopatía inguinal silicótica: presentación de un caso / Groinal silicotic adenopathy: presentation of a case

La silicosis es una enfermedad sistémica, ocupacional, incluída dentro de las neumoconiosis, porque la principal vía de entrada es la aérea y, en consecuencia, el depósito de partículas de sílice y las reacciones tisulares se producen en el parénquima pulmonar. Hombre de 30 años, trabajador de la construcción que presentaba múltiples adenopatías mediastínicas, abdominales e inguinales en ausencia de lesión parenquimatosa pulmonar. La biopsia de una adenopatía inguinal mostró numerosas formaciones granulomatosas, no necrosantes, con material acicular birrefringente con luz polarizada compatible con sílice. Este caso tiene la peculiaridad de la presentación exclusivamente extrapulmonar de la silicosis (AU)

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Immunohistochemical prognostic index for breast cancer in young women.

AIMS: Women under 35 years of age comprise a small proportion of patients with breast cancer, but determining their prognosis can be difficult. This prospective, multivariate study looked at several factors with the aim of obtaining a useful index to evaluate the prognosis of these women. METHODS: In total, 108 patients below 35 years of age affected by invasive ductal carcinoma without distant metastasis were studied. The mean duration of the follow up period was six years. Histopathological (tumour size, histological grade, and lymph node stage) and immunohistochemical (c-erbB-2, p53, oestrogen receptor, and progesterone receptor) factors were measured in all patients, and the Nottingham prognostic index (NPI) was then calculated. An immunohistochemical prognostic index (IHPI) was created using the arithmetic sum of the four individual immunohistochemical factors. RESULTS: In univariate assessment of survival, all the studied factors yielded a significant association with either overall survival or disease free survival, except for c-erbB-2 and p53 with disease free survival. In univariate calculation of risk, all the factors gave significant results; however, in multivariate analysis only tumour size, histological grade, and progesterone receptor were significant. Both NPI and IHPI correlated significantly with prognosis. In multivariate regression analysis, IHPI correlated with tumour size and there was a significant interaction between both variables. CONCLUSION: IHPI is very useful in determining the prognosis of tumours < or = 2 cm and of moderate use for tumours > 2, although it has no use in tumours > 5 cm.

Duodenal carcinoid tumor and esophageal carcinoma associated to a high chronic intake of sodium bicarbonate. Possible pathophysiological mechanisms

Los tumores carcinoides son frecuentemente asociados a situaciones de hipocloridria de diferente etiología. Se presenta aquí un caso de dos tumores metacrónicos, un carcinoide y un cáncer de esófago, en un paciente con una ingesta crónica de bicarbonato sódico extraordinariamente elevada. Casos como este permiten integrar una gran cantidad de datos, desde básicos a clínicos, apoyando la hipótesis de que un pH microambiental crónicamente elevado, tanto en estas como en otras situaciones similares pueden, a través de mecanismos directos e indirectos, facilitar la aparición de diversos tumores malignos del tracto gastrointestinal (AU)

Is carbohydrates-deficient transferrin the best test of the alcoholic etiology in acute pancreatitis?

AIM: To demonstrate if carbohydrates deficient transferrin (CDT) is the best marker to detect an excessive alcohol consumption as a cause of acute pancreatitis. MATERIAL AND METHODS: Prospective study of 60 patients consecutively admitted in our hospital. Acute pancreatitis were classified according to their different etiologies, alcoholic (11), probably alcoholic (4), biliary (25) and others (20). In all cases, we have compared CDT with classical quemical markers of alcohol abuse such as mean corpuscular volumen (MCV), gamma-glutamyltransferase (GGT) and aspartateaminotransferase (AST). Statistic correlations were done between the quantity of alcohol consumed and CDT, GGT, AST and MCV variables. RESULTS: Correlation between CDT and MCV with the excessive alcohol consumption was statistically significant. The acute pancreatitis caused by alcohol and the suspicious alcoholic group had a average CDT higher than the rest of the groups (p < 0.05). Taking a cut point with a CDT value of 20, the diagnosis capacity of the test to detect the alcoholic etiology was 82 and 92% of specificity. Taking a cut point with a MCV value higher than 95, sensibility was 67% and specificity was 82%. CONCLUSION: In our experience, the most efficient marker of the alcoholic etiology in acute pancreatitis was CDT.

¿La transferrina deficiente en carbohidratos es el mejor test de la etiología alcohólica en la pancreatitis aguda? / Is carbohydrates-deficient transferrin the best test of the alcoholic etiology in acute pancreatitis?

Objetivo: demostrar si el test de la transferrina deficiente en carbohidratos (CDT) es la mejor prueba para detectar la ingesta excesiva de alcohol como causa de la pancreatitis aguda. Material y métodos: estudio prospectivo de 60 pacientes con pancreatitis aguda ingresados consecutivamente en nuestro hospital. Las pancreatitis agudas se clasificaron según las diferentes etiologías en alcohólicas (11), probablemente alcohólicas (4), biliares (25), y otras (20). Comparamos en todos los casos la CDT con los marcadores bioquímicos clásicos de la toma excesiva de alcohol como son el volumen corpuscular medio (VCM), gammaglutamil-transpeptidasa (GGT) y aspartato-aminotransferasa (AST).Se realizaron las correlaciones estadísticas entre la cantidad de alcohol consumida y las variables CDT, GGT, AST y VCM.Resultados: la correlación entre la CDT y el VCM con la toma excesiva de alcohol fue estadísticamente significativa.Las pancreatitis agudas por el alcohol y el grupo de sospecha alcohólica tuvieron una CDT media mayor que los demás grupos (p<0,05). Tomando como punto de corte un valor de CDT de 20, la capacidad diagnóstica de la prueba para detectar la etiología alcohólica fue del 82 por ciento y 92 por ciento de especificidad. Tomando como punto de corte un VCM mayor de 95 la sensibilidad fue de un 67 por ciento y la especificidad de un 82 por ciento. Conclusión: en nuestra experiencia, el marcador más eficiente de la etiología alcohólica en las pancreatitis agudas fue la CDT (AU)

Acute pancreatitis: evaluation of the prognostic criteria of the latest Balthazar tomographic classification.

The use of prognostic criteria to detect potentially acute pancreatitis can allow us to select patients most in need of special attention. Of the many possible criteria, we used Ranson's clinical analytic criteria and Balthazar's tomographic criteria, and compared them to the latest criteria of Balthazar, in which pancreatic necrosis figures as the principal prognostic factor. Tomographic evaluation of pancreatic necrosis was shown to be the best prognostic marker in acute pancreatitis, with the greatest sensitivity and specificity of all methods used with one-hundred consecutive patients admitted with acute pancreatitis.

[Cholestasis caused by Fasciola hepatica]. / Colestasis por Fasciola hepática.

Human infestation with Fasciola hepatica is observed occasionally. Cholestasis due to parasitic obstruction of the common duct is an infrequent complication. A case of fascioliasis is described in a 56 year-old male with symptoms of biliary colic and biochemical cholestasis. The diagnosis was based on the indirect hemagglutination test and the evidence of Fasciola hepatica in the extrahepatic biliary tract shown by ultrasound and ERCP. The patient presented an acute pancreatic reaction during an attempt at therapeutic endoscopic sphincterotomy. Medical treatment was initiated then with Bithionol. Cholestasis as well as the parasitosis were eliminated. Recovery was demonstrated by the normality of the titres of hemagglutination and of the biliary tract by ERCP.

Haemolytic-uraemic syndrome with thrombotic microangiopathy of the retina following cytomegalovirus infection: postmortem findings.

Haemolytic-uraemic syndrome is characterized by thrombotic microangiopathy of the glomeruli and smaller arterial vessels of the kidney. Extrarenal thrombotic microangiopathy occurs, but ocular involvement is rarely demonstrated microscopically. We describe a 33 year old woman with a 3 week febrile episode and seropositivity for cytomegalovirus infection who developed acute renal failure, blindness and severe encephalopathy which was the cause of death. Thrombotic microangiopathy of retinal vessels may be more common than is expected from the literature. The exclusion of ocular structures in postmortem examinations explains the lack of anatomoclinical correlation.

[Intrasplenic pseudocyst and ascites as complications of exacerbated chronic pancreatitis]. / Pseudoquiste intraesplénico y ascitis como complicaciones de una pancreatitis crónica reagudizada.

A patient with chronic alcoholism displayed significant ascites and a splenic pseudocyst, after relapsing chronic pancreatitis. The pathogenic possibilities are commented. The break of pancreatic ducts, with extravasation of enzymes, that would reach adjacent structures, is a common mechanism to both complications. The authors suggest aspirative puncture for the definitive diagnosis, following splenectomy and distal pancreatectomy as the safest treatment.

[Rosai-Dorfman disease of the mesenteric lymph nodes and appendix. Secondary to salmonellosis?]. / Enfermedad de Rosai-Dorfman en ganglios mesentéricos y apéndice. Secundaria a salmonelosis?

A 28 year-old female patient was operated for acute abdominal pain. At the surgical intervention the mesenteric nodes turned out to be enlarged and the appendix was apparently normal. Microscopically, the changes observed were of the Rosai-Dorfman disease type in the appendix as well as in the nodes. A salmonella D was cultivated in the mesenteric nodes. This association, which has not been described in the literature, permits us to comment clinicopathological aspects, poorly defined, with special reference to the possibility that some instances of Rosai-Dorfman disease could be secondary to an infectious process.

[Crohn's disease associated with Berger's disease. A rare complication]. / Enfermedad de Crohn asociada a enfermedad de Berger. Una rara asociación.

We report the case of a male patient with Crohn's disease associated with IgA nephropathy. He was treated surgically for the intestinal disorder and then with corticoids and sulfasalazine. Six years after treatment the patient was asymptomatic. As the intestinal situation improved there was concomitant normalization of urinary sediment, maintaining renal function. The fact that the digestive mucosa is one of the body's major sources of secretory IgA may account for the existence of a common for Crohn's disease and certain forms of IgA nephropathy.