Informe de un caso: eosinofilia esofágica asintomática tras esofagitis por virus herpes simple. Controversias en la actitud terapéutica / A case report: asymptomatic esophageal eosinophilia after herpes simplex esophagitis. Controversies in the therapeutic approach

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A case report: asymptomatic esophageal eosinophilia after herpes simplex esophagitis. Controversies in the therapeutic approach.

The coexistence of eosinophilic esophagitis and herpes simplex virus in patients has been published in numerous case reports in the last few years. Both entities can be diagnosed simultaneously or one prior to the other, raising a possible causal relationship. Esophageal eosinophilia is a histological finding, and its underlying cause should be investigated. Eosinophilic esophagitis is one of the most common causes of esophageal eosinophilia. Eosinophilic esophagitis is a clinicopathologic disease, which is characterized by dysphagia and food impaction. We present a case of a patient with asymtomatic esophageal eosinophilia diagnosed after herpetic esophagitis. Other causes of esophageal eosinophilia were ruled out. Given the recent association between eosinophilic esophagitis and esophagitis due to herpes simplex virus, we find ourselves facing a dilemma about assessing the need or not to initiate early treatment.

Cuidados paliativos en enfermedad hepática avanzada / Palliative care in end-stage liver disease

La prevalencia de enfermedad hepática avanzada está aumentando, así como los pacientes que no pueden optar a trasplante hepático. El objetivo de los cuidados paliativos es lograr la mejor calidad de vida posible para el paciente y su familia, cobrando importancia el control de los síntomas y los aspectos psíquicos, sociales y espirituales. MATERIAL Y METODOS: Se realiza una revisión bibliográfica sobre hepatopatía avanzada y cuidados paliativos, asi como de manejo de sus complicaciones y síntomas. RESULTADOS: Para definir pacientes con enfermedad hepática avanzada hay criterios específicos (cirrosis grado Co MELD superior a 30 puntos en los que se ha descartado el trasplante) y criterios generales: estimación clínica de supervivencia, funcionalidad, índice nutricional y comorbilidad. El instrumento NECPAL puede ser de ayuda. El abordaje de los síntomas es muy importante; el dolor es frecuente y hay que tener precauciones con los analgésicos según la función hepática. Asimismo hay algunas complicaciones bastante específicas: ascitis, derrame pleural, encefalopatía hepática, hemorragia por varices esófago-gástricas, síndrome hepatorrenal, peritonitis bacteriana espontanea. Otros síntomas a tener en cuenta son el prurito, la malnutrición, los trastornos del sueño.... CONCLUSIONES: Es muy importante la comunicación con el paciente y su familia (puede haber falta de soporte social, sobrecarga del cuidador). Existe alta necesidad de cuidados médicos y síntomas difíciles de tratar. Los cuidados paliativos deberían ser ofrecidos más frecuentemente para mejorar su calidad de vida...

The prevalence of end-stage liver disease is increasing, and patients who are not eligible for liver transplantation. The goal of palliative care is to achieve the best possible quality of life for patients and their families, being important the control of symptoms and psychological, social and spiritual aspects. MATERIAL AND METHODS: A review of literature on end-stage liver disease and palliative care is performed and also about management of the complications and symptoms. RESULTS: To define patients with end-stage advanced liver disease there are specific criteria (cirrhosis grade C or MELD above 30 points in whom transplant has been ruled out) and general criteria: clinical estimation of survival, functionality, nutritional index and eo morbidity. The NECPAL instrument can be helpful. Management of symptoms is very important: pain is common but we must be careful using analgesics because of liver failure. There are also some specific complications: ascites, pleural effusion, hepatic encephalopathy, bleeding gastric esophageal varices, hepatorenal syndrome, spontaneous bacterial peritonitis. Other symptoms are itching, malnutrition, sleep disorders ... CONCLUSIONS: Communication with the patient and family is very important (there may be a lack of social support, caregiver burden). There is high need for medical care and difficult symptoms to treat. Palliative care should be offered more often to improve their quality of life...

[Pituitary metastases in patients with prior neoplasms]. / Metástasis hipofisarias en pacientes con antecedentes neoplásicos.

The pituitary is an uncommon site for metastases. We report three cases of patients with a history of cancer (breast and lung) who presented with symptoms of headache, ophthalmoplegia, fatigue, diabetes insipidus, nausea, and vomiting. Cranial magnetic resonance imaging was performed, revealing sellar masses with infiltration of the adjacent tissues compatible with pituitary metastases in all three patients. In two of the patients, hormonal analyses were performed, which showed anterior pituitary insufficiency (thyroid-stimulating hormone and adrenocorticotropic hormone deficiency), symptoms which improved with hormone replacement therapy. Other treatments applied were surgery, radiotherapy and chemotherapy, which show no association with increased survival rates but are able to improve symptoms. The prognosis in all patients was poor. The patients developed further metastases and two died soon after diagnosis. Pituitary function study should be performed in patients with a previous neoplasm and symptoms compatible with hormonal dysfunction or local compressive symptoms.

Metástasis hipofisarias en pacientes con antecedentes neoplásicos / Pituitary metastases in patients with prior neoplasms

La hipófisis es un lugar infrecuente para las metástasis. Presentamos 3 casos de pacientes con antecedentes de neoplasias (mama y pulmón) que comenzaron con síntomas de cefalea, diplopía, astenia, diabetes insípida, náuseas y vómitos, motivos por los cuales se realizó resonancia craneal; en todos ellos se evidenció una masa en la silla turca con infiltración de tejidos adyacentes, compatible con metástasis pituitaria. En 2 de los casos se realizaron análisis hormonales con hallazgo de insuficiencia pituitaria anterior (déficit de tirotropina y corticotropina), síntomas que mejoraron con tratamiento hormonal sustitutivo. Otros tratamientos aplicados fueron intervención quirúrgica, radioterapia o quimioterapia, los que no conllevan aumento de la supervivencia, pero mejoran los síntomas. El pronóstico en todos los casos fue pobre, 2 pacientes desarrollaron más metástasis y fallecieron al poco tiempo del diagnóstico. Se debería plantear estudio hormonal en pacientes con neoplasias conocidas que reúnan síntomas compatibles con disfunciones hormonales o síntomas compresivos locales (AU)

The pituitary is an uncommon site for metastases. We report three cases of patients with a history of cancer (breast and lung) who presented with symptoms of headache, ophthalmoplegia, fatigue, diabetes insipidus, nausea, and vomiting. Cranial magnetic resonance imaging was performed, revealing sellar masses with infiltration of the adjacent tissues compatible with pituitary metastases in all three patients. In two of the patients, hormonal analyses were performed, which showed anterior pituitary insufficiency (thyroid-stimulating hormone and adrenocorticotropic hormone deficiency), symptoms which improved with hormone replacement therapy. Other treatments applied were surgery, radiotherapy and chemotherapy, which show no association with increased survival rates but are able to improve symptoms. The prognosis in all patients was poor. The patients developed further metastases and two died soon after diagnosis. Pituitary function study should be performed in patients with a previous neoplasm and symptoms compatible with hormonal dysfunction or local compressive symptoms (AU)