Acrodermatitis enteropática y desnutrición proteica posterior a cirugía bariátrica / Enteropathic acrodermatitis and proteic nuttrution after bariatric surgery

La utilización de la cirugía bariátrica ha ido en aumento por su efectividad a largo plazo en el mantenimiento del peso perdido, en la reducción drástica de comorbilidades y mortalidad global. El bypass biliopancreático es una de las técnicas bariátricas más eficaces para la pérdida y mantenimiento del peso con menor restricción dietética. Se presenta un caso clínico de una mujer intervenida previamente de by-pass biliopancreático y que presento signos de malnutrición por deficiencia del zinc. Se describe la evolución de la enferma y se discuten las características y repercusiones que la deficiencia produce en la paciente

The use of bariatric surgery has been increasing due to its long-term effectiveness in maintaining lost weight, in drastically reducing comorbidities and overall mortality. Biliopancreatic bypass is one of the most effective bariatric techniques for weight loss and maintenance with less dietary restriction. We present a clinical case of a woman who had previously undergone biliopancreatic bypass and had signs of zinc malnutrition. The evolution of the patient is described and the characteristics and repercussions that the deficiency produces in the patient are discussed

[Scalp metastasis as the first manifestation of mixed follicular-papillary thyroid cancer]. / Metástasis en cuero cabelludo como primera manifestación de cáncer de tiroides mixto folicular-papilar.

Distant metastases are a rare occurrence in differentiated thyroid cancer, and when detected in skin, often arise in the context of disseminated disease after many years of progression since diagnosis. This study presents the case of a 77-year-old female without known thyroid disease, who presented with metastases in the parieto-occipital scalp region, in which thyroid tissue was identified. Thyroid ultrasound identified a nodule reported as a follicular tumour and preoperative investigation of tumour spread was negative. Total thyroidectomy plus central lymph node dissection were performed and histopathology reported mixed papillary-follicular carcinoma without lymph node metastasis. Lung micrometastases were detected in the post-I131 whole-body scan (104.7 mCi dose), and two months after a second dose of 131I (125 mCi), thyroglobulin was undetectable. Thyroid cancer should be included in the differential diagnosis of cutaneous metastases, since with early diagnosis and treatment, prognosis is generally more favourable than in other solid tumours.

Metástasis en cuero cabelludo como primera manifestación de cáncer de tiroides mixto folicular-papilar / Scalp metastasis as the first manifestation of mixed follicularpapillary thyroid cancer

La aparición de metástasis a distancia en los cánceres diferenciados de tiroides es poco frecuente, y cuando se detectan en piel, suelen darse en el contexto de una enfermedad diseminada después de muchos años de evolución desde el diagnóstico. Se presenta el caso de una paciente de 77 años, sin enfermedad tiroidea conocida que debutó con una metástasis en región parietooccipital del cuero cabelludo en la que se identificó tejido tiroideo. En la ecografía tiroidea se identificó un nódulo informado como tumor folicular y el estudio de extensión precirugía fue negativo. Se le hizo tiroidectomía total más vaciamiento ganglionar del compartimento central y el estudio AP fue informado de carcinoma mixto folicular-papilar sin afectación ganglionar. En el RCT post-I131 (dosis de 104,7 mCi) se detectaron micrometástasis pulmonares, y a los 2 meses de una segunda dosis de I131 (125 mCi), la tiroglobulina fue indetectable. El cáncer tiroideo debe incluirse en el diagnóstico diferencial de las metástasis cutáneas, puesto que su diagnóstico y tratamiento temprano, excepto en los casos de enfermedad muy avanzada, el pronóstico de su hallazgo suele ser más favorable que en el resto de tumores sólidos (AU)

Distant metastases are a rare occurrence in differentiated thyroid cancer, and when detected in skin, often arise in the context of disseminated disease after many years of progression since diagnosis. This study presents the case of a 77-year-old female without known thyroid disease, who presented with metastases in the parieto-occipital scalp region, in which thyroid tissue was identified. Thyroid ultrasound identified a nodule reported as a follicular tumour and preoperative investigation of tumour spread was negative. Total thyroidectomy plus central lymph node dissection were performed and histopathology reported mixed papillary-follicular carcinoma without lymph node metastasis. Lung micrometastases were detected in the post-I131 whole-body scan (104.7 mCi dose), and two months after a second dose of 131I (125 mCi), thyroglobulin was undetectable. Thyroid cancer should be included in the differential diagnosis of cutaneous metastases, since with early diagnosis and treatment, prognosis is generally more favourable than in other solid tumours (AU)

[Chronic intestinal pseudo-obstruction due to intestinal neuronal dysplasia type B (IND B), concerning one case]. / Pseudoobstrucción intestinal crónica por displasia neuronal intestinal tipo B (DNI B), a propósito de un caso.

Intestinal neuronal dysplasia type B (IND B) is an infrequent disease due to hyperplasia of the parasympathetic submucous plexus which causes alteration of intestinal motility, giving rise to symptoms of constipation and subocclusive manifestations. The disease is difficult to diagnose. It requires high clinical suspicion and should include differential diagnosis of patients with repeated subocclusive manifestations in order to make an early and correct diagnosis and avoid complications derived from unnecessary surgery that worsens the prognosis. We present the case of a 33-year-old Moroccan male who was admitted to our hospital on 2 occasions in 11 months, requiring total parenteral nutrition (TPN) for five months. The immunohistochemical analysis of the ileostomy and colostomy stoma led to a diagnosis of IND B. Eighteen months later, the patients is leading a normal life and has recovered the 25 kilos lost following the dietary indications and with the enzymatic supplements.

Pseudoobstrucción intestinal crónica por displasia neuronal intestinal tipo B (DNI B). A propósito de un caso / Chronic intestinal pseudo-obstruction due to intestinal neuronal dysplasia type B (IND B), concerning one case

La displasia neuronal intestinal tipo B (DNIB) es una enfermedad poco frecuente debida a la hiperplasia del plexo submucoso parasimpático que cursa con alteración de la motilidad intestinal, ocasionando síntomas de estreñimiento y cuadros suboclusivos 1. Es una enfermedad difícil de diagnosticar que requiere alta sospecha clínica y debería incluirse en el diagnóstico diferencial de los pacientes con cuadros suboclusivos de repetición con el fin de hacer un diagnóstico correcto temprano y evitar complicaciones derivadas de cirugías innecesarias que empeoran el pronóstico. Se presenta el caso de un varón marroquí de 33 años que fue ingresado en nuestro hospital en 2 ocasiones un total de 11 meses, precisando durante 5 meses nutrición parenteral total (NPT). El análisis inmunohistoquímico de la boca de ileostomía y colostomía lleva al diagnóstico de DNIB. Dieciocho meses después, el paciente hace vida normal y ha recuperado los 25 kilos perdidos siguiendo las indicaciones dietéticas y con los suplementos enzimáticos (AU)

Intestinal neuronal dysplasia type B (IND B) is an infrequent disease due to hyperplasia of the parasympathetic submucous plexus which causes alteration of intestinal motility, giving rise to symptoms of constipation and subocclusive manifestations. The disease is difficult to diagnose. It requires high clinical suspicion and should include differential diagnosis of patients with repeated subocclusive manifestations in order to make an early and correct diagnosis and avoid complications derived from unnecessary surgery that worsens the prognosis. We present the case of a 33-year-old Moroccanmale who was admitted to our hospital on 2 occasions in 11 months, requiring total parenteral nutrition (TPN) for five months. The immunohistochemical analysis of the ileostomy and colostomy stoma led to a diagnosis of IND B. Eighteen months later, the patients is leading a normal life and has recovered the 25 kilos lost following the dietary indications and with the enzymatic supplements (AU)