Irritable bowel syndrome and basal serum tryptase: correlation between subtype, severity, and comorbidities. A pilot study

Introduction: the activation of mast cells causes alterations in epithelial and neuromuscular function and is involved invisceral hypersensitivity and dysmotility in gastrointestinal functional disorders.Objectives: primary: to evaluate differences in basal serum tryptase (BST) between patients with irritable bowel syndrome (IBS) and healthy controls. Secondary: BST depending on IBS subtype (diarrhea: IBS-D; constipation: IBS-C), comorbidities and correlation with IBS severity and quality of life.Material and methods: a prospective control-case study in IBS patients (Rome IV criteria). BST (ImmunoCAP-Phadia,Sweden®), IBS Severity Score (IBSSS), pain, bloating and flatulence analogue scales, IBS quality of life (IBSQOL), andpatient health status (PHQ-9) were determined. BST is the primary variable to achieve the primary endpoint. Results: thirty-two patients were included, 21 (65.6 %) with IBS-D and 11 (34.4 %) with IBS-C; 32 controls were also included. Mean IBSSSS: 326.6 (± 71.4), IBSQOL: 76 (± 20.3), and PHQ9: 10.2 (± 5.9). BST was 4.8 ± 2.6 in IBS and 4.7 ± 2.6 in controls (p = 0.875). There were no differences in BST between IBS subtypes (4.7 ± 2.9 in IBS-D and 5 ± 1.8 in IBS-C; p = 0.315) or IBS severity (p = 0.662). However, BST was higher in patients with IBS and extraintestinal comorbidities compared to other patients and controls (p = 0.029). This subgroup also has more severe bloating (p = 0.021). There was no correlation between BST, quality of life (p = 0.9260), and health status (p = 0.3985).Conclusion: BST does not discriminate between IBS patients and controls. However, BST was higher in patients with IBS with extraintestinal comorbidities, which had more severe bloating. This finding is worthy of investigation. (AU)

Hiperglucemia, cetoacidosis y lesión de Armanni-Ebstein: un caso ilustrativo / Hyperglycemia, ketoacidosis and Armanni-Ebstein lesion: an illustrative case

La cetoacidosis es una alteración metabólica que puede conducir a la muerte de forma rápida e inesperada y, por tanto, ser objeto de una autopsia judicial. Histológicamente se caracteriza por el hallazgo de vacuolas subnucleares en los túbulos proximales renales, la denominada lesión de Armanni-Ebstein (AE). Aunque suele ser de etiología diabética también puede tener otro origen, fundamentalmente alcohólico. Presentamos el caso de una mujer de 45 años con una historia de abuso de alcohol, se encuentra fallecida en su domicilio. Se observó hialinosis arteriolar, lesión AE en riñones y esteatosis en hígado; el estudio químico-toxicológico demostró cuerpos cetónicos en sangre y el análisis bioquímico del humor vítreo niveles de glucosa elevados. Se discute el origen más probable de cetoacidosis y la necesidad de un abordaje multidisciplinar en la investigación de las muertes súbitas inesperadas (AU)

The ketoacidosis is a metabolic disorder that may lead to unexpected sudden death and therefore be issued for a forensic autopsy. Its histopathology is characterized by subnuclear vacuoles in the renal proximal tubules, namely the Armanni-Ebstein (AE) lesion. It is usually caused by diabetes, although other origins are possible, mainly alcoholic abuse. We hereby show the case of a 45-year-old woman with a history of alcohol consumption found dead at her home. An arteriolar hyalinosis, AE lesion in kidneys and steatosis in the liver were found; results revealed ketonic bodies in blood and a high glucose value in vitreous humour. The most probable cause of ketoacidosis is discussed and also the need for a multidisciplinary approach in unexpected sudden deaths investigations (AU)

Pseudoaneurisma tras autotrasplante renal. Corrección endovascular / Pseudoaneurysm following kidney autotransplantation. Endovascular correction

Introducción. Los pseudoaneurismas son una rara complicación después de un trasplante renal y prácticamente son excepcionales tras cirugía de banco y autotrasplante. En presencia de dichas lesiones se considera obligatoria su corrección con objeto de evitar el riesgo potencial de complicaciones mortales asociadas a la ruptura diferida del pseudoaneurisma. La reparación convencional es un procedimiento complejo que puede verse dificultado por los problemas inherentes asociados a una redirección. Caso clínico. Mujer de 52 años con un pseudoaneurisma de arteria ilíaca desarrollado tras cirugía ex vivo y autotrasplante renal por aneurisma de arteria renal. Las pruebas de imagen pusieron de manifiesto la lesión arterial en la ubicación de un bypass ilíacorrenal concomitante a la cirugía previa. La corrección endovascular del pseudoaneurisma se llevó a cabo mediante la liberación de un stent cubierto. La arteriografía de control mostró la completa exclusión del pseudoaneurisma de arteria ilíaca y la preservación completa del flujo en la arteria renal reconstruida. Conclusión. La exclusión del pseudoaneurisma con preservación completa del flujo del riñón trasplantado pone de relieve la potencial utilidad del tratamiento endovascular en pacientes seleccionados

Introduction. Pseudoaneurysms are a rare complication after a kidney transplant and are practically unknown following bench surgery and autotransplantation. Such lesions must be corrected in order to avoid the potential risk of fatal complications that are associated with the delayed rupture of a pseudoaneurysm. Conventional repair is a complex procedure that can be further complicated by the problems inherent to any intervention involving redirection. Case report. A 52-year-old female with a pseudoaneurysm in the iliac artery that developed after ex vivo surgery and kidney autotransplantation due to an aneurysm in the renal artery. Imaging tests showed the arterial lesion to be situated at the site of an iliac-renal bypass that had been carried out during the previous intervention. Endovascular correction of the pseudoaneurysm was performed by deploying a covered stent. The control arteriography showed the complete exclusion of the pseudoaneurysm in the iliac artery and full preservation of blood flow in the reconstructed renal artery. Conclusion. The exclusion of the pseudoaneurysm with full preservation of flow in the transplanted kidney highlights the potential value of endovascular treatment in selected patients

Paraganglioma de nervio vago / Paraganglioma of the vagal nerve

Introducción. Los paragangliomas de nervio vago son tumores derivados de células de la cresta neural de muy baja incidencia, normalmente benignos y de crecimiento lento. Caso clínico. Mujer de 74 años con masa laterocervical dolorosa, de crecimiento rápido en el último mes con afectación múltiple de pares craneales y de cadena simpáticocervical. Se realizan exploraciones complementarias, tomografía axial computarizada y arteriografía, y se diagnostica paraganglioma cervical. Previamente a la cirugía, se embolizan las ramas de la arteria carótida externa que nutren el tumor y posteriormente se extirpa el tumor, que tiene su origen en el nervio vago, se reseca éste, así como la arteria carótida externa y la vena yugular interna. La anatomía patológica se informa como paraganglioma de nervio vago. No se sobreañaden lesiones neurológicas después de la cirugía. Conclusión. El paraganglioma de nervio vago es el tumor de esta estirpe que presenta mayor afectación neurológica postoperatoria, y esto también depende del tamaño del tumor. La embolización preoperatoria puede ser beneficiosa, pues reduce la vascularización de la masa y, por tanto, el sangrado operatorio. En ocasiones puede llegar a ser necesaria la realización de reconstrucción arterial

INTRODUCTION. Paragangliomas of the vagal nerve are tumours derived from cells in the neural crest that are normally benign, and have low incidence and slow growth rates. CASE REPORT. We report the case of a 74-year-old female with a painful laterocervical mass which grew quickly over the last month with multiple involvement of cranial nerves and the cervical sympathetic chain. Complementary explorations were conducted including computerised axial tomography scans and arteriography, and a cervical paraganglioma was diagnosed. Prior to surgery, the branches of the external carotid artery that nourish the tumour were embolised and the tumour, which has its origins in the vagal nerve, was later removed. This nerve is then resected, as is the external carotid artery and the internal jugular vein. Clinical pathology reported the case as one of vagal nerve paraganglioma. No further neurological lesions occurred after the intervention. CONCLUSION. Of this kind of strain of tumours vagal nerve paraganglioma is the one that has the greatest post-operative neurological involvement, and this also depends on the size of the tumour. Pre-operative embolisation can have beneficial effects as it reduces the vascularisation of the mass and therefore bleeding during surgery. It sometimes becomes necessary to carry out arterial reconstruction