Duodenal metastasis of alveolar soft part sarcoma.

Aveolar soft part sarcoma is a rare tumor responsible for about 1% of all soft tissue sarcomas, affecting mostly adolescents and young adults. ASPS has curious patterns of metastatic spread, with seldom lymph node involvement. Lung, bone and brain are the most common metastatic places. Small bowel metastasis are infrequent, having found reported only one case of duodenal metastasis with polypous appearance. We describe a case of duodenal metastasis presenting as abdominal mass five years after initial diagnosis of alveolar soft part sarcoma.

Visceral leishmaniasis diagnosed by colonoscopy.

Zoonotic visceral leishmaniasis is common in western Mediterranean countries. A strong link between visceral leishmaniasis and human immunodeficiency virus (coinfection) has been proved, especially in Spain, which is an endemic area. This suggests that Leishmania may behave opportunistically. We report a case of colonic leishmaniasis in a 23-year-old Spanish woman infected with the human immunodeficiency virus.

[Minimally invasive coronary surgery. Thoracostomy-assisted thoracotomy. Apropos a case]. / Cirugía coronaria mínimamente invasiva. Toracotomía asistida por toracoscopia. A propósito de un caso.

UNLABELLED: CLINICAL CASE PRESENTATION: Male, 62 years old with progressive angina. Positive stress test. At catheterization a proximal 90% stenosis of the LAD was found. Not suitable for PTCA. SURGICAL TECHNIQUE: Double lumen endotracheal tube was inserted. Position was 30 degrees right lateral decubitus. The thoracoscope was introduced through the 7th intercostal space and a minithoracotomy was done. The internal mammary artery (IMA) was dissected partially through direct vision and partially with the help of the thoracoscope. The IMA graft was implanted to the LAD without cardiopulmonary bypass with a segmentary occlusion of the vessel with tourniquets. EVOLUTION: Thoracic drainage 575 cc, CK/MB 311/5, final hematocrit 37%. No blood transfusion. Dismissed on the 5th postoperative day.

[Videothoracoscopy in the surgical treatment of pneumothorax: report of 46 cases]. / Videotoracoscopia en el tratamiento quirúrgico del neumotórax: a propósito de 46 casos.

We report our 3-years experience with video-thoracoscopy for pneumothorax. Forty-six endoscopies (34 men, 12 women; mean age 27 +/- 9 years) were performed. Patients were under general anesthesia and intubation was selective. The conventional approach was used, with 3 incisions through which the camera and endoscopic instruments were inserted. Results were good in 39 (84.7%) patients. Pneumothorax recurred in 4 (8.7%) patients during the 3 years of follow-up. Thoracotomy was performed in 3 patients, because of lack of lung expansion in 1, persistent leak in another and encapsulated empyema in the third. Mean hospital stay after surgery was 7.3 days. Video-thoracoscopy can be considered a good therapeutic alternative to thoracotomy in the surgical treatment of patients with pneumothorax.

[Lung resection surgery in patients with functional limits]. / Cirugía resectiva pulmonar en pacientes en el límite funcional.

To determine whether there exists in our area concordance between forced expiratory volume in one second (FEV1) estimated before surgery by ventilation/perfusion scintigraphy and real values after surgery in patients undergoing pneumonectomy and lobectomy. Prospective descriptive study. We studied 15 patients undergoing pneumonectomy (M/F 14:1, age 62 +/- 7.5 years) and 11 undergoing lobectomy (M/F 11:0 age 66 +/- 3.5 years) in the thoracic surgery unit of Hospital de Cruces between 1 March 1990 and 1 March 1993. The FEV1 of all patients before surgery was under 2.1 liters. Tumors were malignant in 23 patients and benign in 3. Ventilation/perfusion gammagrams were obtained for all patients before surgery in order to predict the loss of function after resection of the parenchyma. Two months after surgery spirometric testing was done. The FEV1 calculated based on the results of scintigraphy was compared to the real FEV1 after resection by way of graphic concordance and by calculation of a within-group correlation coefficient. A correlation coefficient of 0.82 (p < 0.001) was obtained for FEV1 estimated by ventilation and real FEV1 in patients who underwent pneumonectomy, indicating good concordance. The correlation coefficient was 0.59 (p < 0.001) indicating moderate agreement between FEV1 estimated by perfusion and real FEV1 after resection. Correlation was statistically insignificant in lobectomy patients (0.28 by the method of Ali and 0.35 by Wernly's; p = 0.19 and 0.13, respectively). Ventilation scintigraphy offers an acceptably reliable prediction of FEV1 after lung resection. The reliability of measurements estimated by scintigraphy in lobectomized patients is not acceptable.

[Infectious meningitis in the adult: 3-year clinical experience]. / Meningitis infecciosas del adulto: experiencia clínica de tres años.

In order to establish the epidemiologic features of infectious meningitis in the adult population in our environment, the experience of the Department of Neurology of the Hospital del Rey during the 3-year period, from 1984 to 1986, has been analyzed. Three-hundred-ninety episodes were handled, of which, 51% were acute bacterial meningitis, 45% were acute lymphocytic meningitis, 26% were tuberculous meningitis, 1% were brucellar meningitis and 0.5% were due to Candida albicans. Acute bacterial meningitis predominated in winter, whereas acute lymphocytic meningitis predominated in summer (p less than 0.001). Forty-seven percent of acute bacterial meningitis were due to Neisseria meningitidis and 14.5% of acute lymphocytic meningitis with virologic study, were due to Herpesviridae. The mortality rate of acute bacterial meningitis was 8.5% and that of tuberculous meningitis was 10%. In order to emphasize the importance of these processes, the main epidemiologic data are compared with that of other studies.

[Tuberculous meningitis and acquired immunodeficiency syndrome]. / Meningitis tuberculosa y síndrome de inmunodeficiencia adquirida.

A series composed by 13 patients suffering Tuberculous Meningitis (TM) and Acquired Immunodeficiency Syndrome (AIDS) is reported. The characteristics of the disease are compared with those obtained from a control group. TM reached a frequency of 18% in the first 66 patients with AIDS and neurologic disorders attended by the authors. The male/female ratio was 12:1. There was lesser frequency of headache in the group with TM and AIDS, but there was a greater frequency of lymph nodes, anemia, leukopenia, hypergammaglobulinemia and elevated ESR that in the control group. These differences were statistically significative. Parabolic and hyperbolic correlations were found between the number of cells and the albumin or glucose concentration in the CSF (and also between the later two parameters) of the patients with TM and AIDS. The treatment was very efficacious, but the proper duration and the long-term results of the therapy are unknown due to the difficult follow-up.