Rotura pancreática completa secundaria a traumatismo abdominal cerrado / Complete rupture of the pancreas due to blunt abdominal trauma

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[Invasive aspergillosis: a study of 20 cases]. / Aspergilosis invasiva: estudio de 20 casos.

OBJECTIVE: To assess the epidemiology of invasive aspergillosis (IA) and the frequency of recognition of this clinical entity. PATIENTS AND METHODS: Retrospective analysis of patients with the diagnosis of IA in the last three years. The diagnostic criteria of the American Institute of Infectious Diseases Mycoses Group were followed. RESULTS: During this period, 20 patients were diagnosed of IA: 9 (45%) had a hematologic malignancy, 14 (70%) had received corticosteroids, five (25%) had neutropenia, and three (15%) had no factors for immunosuppression. The disease was suspected in 15 cases (75%). Aspergillus spp. was recovered from sputum samples of the 16 patients who had the sample obtained. Seventeen patients (85%) died, 12 of them in spite of receiving antifungal therapy. Time relapsed since the beginning of symptoms and therapy was 14 days. CONCLUSIONS: The proportion of patients without neutropenia or severe immunosuppression is higher than usually thought. IA is a clinical entity of difficult diagnosis and occasionally it is diagnosed only at post-mortem examination. The high sensitivity of sputum culture may be due to the selection of cases with more severe infections as stringent diagnostic criteria were used. To improve the prognosis of IA it is necessary to initiate antifungal therapy early in the course of the disease and therefore, a high suspicion index is required, not only of the immunocompromised but also of the immunocompetent patient.

[Neoplasms of the extrahepatic bile ducts. A clinical study of 44 cases]. / Neoplasias de vías biliares extrahepáticas. Estudio clínico de 44 casos.

44 clinical cases, histologically diagnosed as suffering from extrahepatic bile duct neoplasia, admitted at the "Hospital Foral de Navarra" during the years 1976 to 1985 and at the "Hospital Clinico Universitario de Salamanca" during the period from 1981 to 1987, were analysed. Our results showed a higher incidence in the female sex. The most important antecedent was biliary stone lithiasis (45.45%). Jaundice and abdominal pain were the most frequent symptoms and liver enlargement accompanied by jaundice were the most frequent clinical signs on physical examination. The data obtained did not show specificity at the diagnosis. The ERCP showed a high rate of diagnosis (71.43%) followed by CT scanning (70%) and percutaneous transhepatic cholangiography (52.63%). The types of surgery most frequently performed were cholecystectomy and choledochoduodenostomy, and the diagnosis of well-differentiated carcinoma was found in 63.64% of the cases. Any therapy performed (surgery, radiotherapy and/or chemotherapy) improved the survival rate.