[Symptomatic cervical stenosis due to calcification of the ligamentum flavum after mild cervical trauma]. / Estenosis cervical sintomática por calcificación del ligamento amarillo tras traumatismo cervical leve.

INTRODUCTION: The calcification of ligamentum flavum (CLF) is a rare disease mainly affecting middle or advanced aged Japanese women. Several clinical and radiological features differentiate CLF from the ossification of the ligamentum flavum (OLF). We present a case of symptomatic cervical-dorsal stenosis presenting after mild cervical trauma in a patient with a remarkable CLF who underwent decompressive laminectomy. The literature regarding CLF is reviewed. CASE REPORT: A 65 year-old female suffered mild cervical trauma as a consequence of a car accident. A year later she referred progressive cervical and upper dorsal pain without any sensory or motor defect. Spinal magnetic resonance images showed a well-delineated posterior epidural mass, from C2 to T2, which compressed the spinal cord, without signal of myelopathy. She underwent bilateral laminectomy of the affected levels but no clear improvement occurred. The pathological study of the resected pieces showed a remarkable calcification of the ligamentum flavum. DISCUSSION: The CLF is a kind of dystrophic calcification of unknown pathogenesis but likely related to the spinal degenerative changes. It usually presents in Japanese females. A definite relation between CLF and cervical trauma has not been established so far, although the latter may possibly trigger the symptoms. Typically, CLF presents in women in the seventh decade, affects preferably the cervical region, it shows nodular or diffuse pattern in the computerized tomography, it is hypointense in TI and T2-weighted MR sequences and exhibits minimum enhancement after gadolinium administration. CLF differentiates from OLF easily by demonstrating the presence of mature bone formation in the latter. Clinically, CLF may present as radiculopathy or myelopathy. The treatment of choice in symptomatic patients is posterior decompression. Excellent results after laminectomy are reported. Future similar observations will be important from a medical-legal point of view if a relation between CLF and cervical trauma is established since CLF may potentially turn into a severe condition.

Estenosis cervical sintomática por calcificación del ligamento amarillo tras traumatismo cervical leve / Symptomatic cervical stenosis due to calcification of the ligamentum flavum after mild cervical trauma

Introducción. La calcificación del ligamento amarillo(CLA) es una rara enfermedad que afecta principalmentea mujeres de edad media o avanzada yde etnia japonesa. Diversas características clínicas yradiológicas la diferencian de la osificación del ligamentoamarillo (OLA). Presentamos un caso de estenosiscervical sintomática, aparentemente desencadenadopor un traumatismo cervical de carácter leve, en unapaciente con una extensa calcificación del ligamentoamarillo a nivel cervicodorsal que fue tratada mediantelaminectomía descompresiva. Se revisa la literatura alrespecto.Caso clínico. Mujer de 65 años que sufre traumatismocervical leve como consecuencia de atropello porautomóvil. Al año acude al servicio de Neurocirugíarefiriendo desde entonces cervicalgia y dolor interescapularque progresivamente habían aumentado enintensidad, sin afectación motora ni sensitiva. En laRMN de columna cervical se objetivó una formaciónfusiforme epidural posterior de contorno bien delimitadodesde C2 a D2, que producía compresión de lamédula cervical sin imagen de mielopatía. Se intervinomediante laminectomía descompresiva de los nivelesafectados, sin gran mejoría de los síntomas. El estudioanatomopatológico mostró una calcificación extensa delligamento amarillo.Discusión. La CLA es un tipo de calcificacióndistrófica que tiene una etiopatogenia desconocida peroposiblemente relacionada con cambios degenerativosespinales, siendo más frecuente en mujeres y en poblaciónjaponesa. No se ha descrito una relación causaldefinitiva entre traumatismo cervical y CLA, aunquees posible que aquél actúe como desencadenante de lossíntomas. El paciente tipo con CLA seria una mujeren la séptima década de la vida, que presenta una calcificaciónpreferentemente cervical, de tipo nodularo difuso en la TAC, hipointenso en las secuencias deresonancia potenciadas en T1 y T2, con mínima captaciónde gadolinio periférico y con un patrón histológicogranular. Histológicamente se diferencia de la OLApor la existencia de hueso maduro únicamente en ésta.Clínicamente puede manifestarse como mielorradiculopatía.El tratamiento quirúrgico de elección en los casossintomáticos es la laminectomía descompresiva, técnicaque, según diversos autores, obtiene excelentes resultados.De confirmarse una relación patogénica entreCLA y traumatismo cervical en futuras observaciones,sería de gran importancia medico-legal pues implicaríael desarrollo de una enfermedad potencialmente gravetras un tipo de traumatismo en principio consideradobanal

Introduction. The calcification of ligamentum flavum(CLF) is a rare disease mainly affecting middle oradvanced aged Japanese women. Several clinical andradiological features differentiate CLF from the ossificationof the ligamentum flavum (OLF). We present acase of symptomatic cervical-dorsal stenosis presentingafter mild cervical trauma in a patient with a remarkableCLF who underwent decompressive laminectomy.The literature regarding CLF is reviewed.Case report. A 65 year-old female suffered mildcervical trauma as a consequence of a car accident. Ayear later she referred progressive cervical and upperdorsal pain without any sensory or motor defect. Spinal magnetic resonance images showed a well-delineatedposterior epidural mass, from C2 to T2, which compressedthe spinal cord, without signal of myelopathy.She underwent bilateral laminectomy of the affectedlevels but no clear improvement occurred. The pathologicalstudy of the resected pieces showed a remarkablecalcification of the ligamentum flavum.Discussion. The CLF is a kind of dystrophic calcificationof unknown pathogenesis but likely related tothe spinal degenerative changes. It usually presentsin Japanese females. A definite relation between CLFand cervical trauma has not been established so far,although the latter may possibly trigger the symptoms.Typically, CLF presents in women in the seventh decade,affects preferably the cervical region, it shows nodularor diffuse pattern in the computerized tomography, itis hypointense in TI and T2-weighted MR sequencesand exhibits minimum enhancement after gadoliniumadministration. CLF differentiates from OLF easily bydemonstrating the presence of mature bone formationin the latter. Clinically, CLF may present as radiculopathyor myelopathy. The treatment of choice in symptomaticpatients is posterior decompression. Excellentresults after laminectomy are reported. Future similarobservations will be important from a medical-legalpoint of view if a relation between CLF and cervicaltrauma is established since CLF may potentially turninto a severe condition

[Acute hepatitis due to ingestion of Teucrium chamaedrys infusions]. / Hepatitis aguda por ingestión de infusiones con Teucrium chamaedrys.

Herbal remedies, used for many years for therapeutic purposes, have traditionally been considered safe and effective. Herbal medicine toxicity has been infrequently reported in Spain. We present two cases of acute hepatitis after ingestion of herbal infusions over a period of several months. Among the plants consumed was Teucrium chamaedrys (germander), which has been associated with several cases of hepatotoxicity, mainly in France. After ruling out other causes of hepatitis, we consider that Teucrium chamaedrys provoked the disease. One patient presented acute, cholestatic hepatitis and another presented mixed (hepatocellular and cholestatic) hepatitis. In both patients, the disease was resolved after discontinuing the intake of the herbal teas. We believe that herbal medicine toxicity may be increasing due to the growing consumption of these products. Finally, we emphasize the need to rule out the intake of herbal remedies in patients whose liver tests present abnormalities.

Tumor uterino de los cordones sexuales / Uterine tumor of the sex cords

No disponible

Carcinoma lobulillar en un hamartoma mamario. A propósito de un caso / Lobular carcinoma in a mammary hamartoma. A case report

Presentamos un caso poco frecuente de carcinoma lobulilIar invadiendo un hamartoma mamario.El hamartoma es una lesión benigna de la mama que tiene unas determinadas características clínicas y mamográficas, siendo fácil que la irrupción de un carcinoma pase desapercibida.Analizamos las características de uno y otro tipo de tumor, teniendo en cuenta la rareza de su aparición conjunta y la importancia de su rápido diagnóstico y tratamiento (AU)

Stromal tumors of the digestive tract. Prognostic value of mitotic index.

OBJECTIVE: We analyzed the prognostic factors and evaluated the usefulness of mitotic index to predict the behavior of gastrointestinal stromal tumors (GIST). PATIENTS AND METHODS: Fifty three patients operated on for stromal tumors of the digestive tract were studied retrospectively. Mean follow-up was 6 years. The number of mitosis/10 high power fields was the definitive criterion for classification, regardless of their inmunohistologic differentiation. Twelve tumors had 0 mitoses, 34 from 1 to 9 mitoses, and 7 had > or = 10 mitoses. The survival rate was analyzed and the morphological characteristics and evolution were correlated according to mitotic index. RESULTS: The incidence of advanced illness was related to the number of mitoses: 29% in the group with 1 to 9 mitoses, and 86% when there were > or = 10 mitoses. The recurrence intervals were 44 and 8 months respectively. No tumor with 0 mitoses evolved aggressively. The survival rate was significantly related (p < 0.001), to the mitotic index. The group with 0 mitoses had a survival rate of 100% after 10 years, those with 1 to 9 mitoses 69% and those with > or = 10 mitoses 14%. The other factors which influenced the prognosis (location, size, local invasion and resection) depended, as well, on the mitotic index. CONCLUSION: The classification of digestive tract stromal tumors by mitotic index is an efficient method because it distinguishes 3 entities with different biological behavior in the long term.

Octreotide: effects in experimental severe acute pancreatitis. Analysis of survival, biochemical findings and histomorphometry.

OBJECTIVE: The effect of octreotide in acute experimental pancreatitis was examined. EXPERIMENTAL DESIGN: Acute pancreatitis was induced in 70 male Wistar rats by retrograde injection of 5% sodium taurocholate into the pancreatic duct. Octreotide (50 micrograms = 0.5 ml) or isotonic saline was administered subcutaneously every six hours for 24 hours, beginning at the time of induction of pancreatitis (groups 1 and 2) or 12 hours later (groups 3 and 4). Six hours after the last dose of octreotide or saline, the rats were sacrificed. Ten additional rats were used for basal biochemical determination. For the analysis of survival, another 10 rats were included. The survival rate, serum concentrations of amylase, lipase and lactate dehydrogenase (LDH) and morphometric studies (total area of the pancreas and percentage necrosis) were examined. Statistical analysis involved Student's t test, ANOVA and the Mantel-Haenszel test. RESULTS: No significant differences existed among the groups with respect to survival, morphometric analysis or biochemical determinations, except for a minor increase in LDH levels in the group treated with octreotide at the time of induction. CONCLUSIONS: Octreotide administration has almost no impact on mortality in experimental severe acute pancreatitis. Biochemical and morphometric changes are minimal. Therefore, according to the present study, the efficacy of octreotide administration is very low.

[Leiomyosarcoma of the urinary bladder. A little frequent neoformation]. / Leiomiosarcoma de vejiga urinaria. Una neoformación muy poco frecuente.

Presentation of one case of vesical wall leiomyosarcoma found during exploratory laparotomy due to abdominal pain, where partial cystectomy and lymphadenectomy were performed. Due to the singularity of this tumour, drafting of this clinical communication was undertaken including a brief review of the existing literature relative to the diagnosis and treatment of this neoformation.

[Undifferentiated small cell (oat cell) carcinoma of the esophagus]. / Carcinoma indiferenciado de células pequeñas (oat cell) de esófago.

A case of small cell carcinoma (oat cell) of the esophagus is presented. Esophagectomy and gastroplasty were performed followed by six cycles of combination chemotherapy and radiotherapy. Recovery was uneventful. The patient died nine months later with widespread disease. Literature is reviewed. To date, about 100 cases of this rare tumor have been reported. The aggressive behavior of the tumor is stressed and the different therapeutic modalities are discussed.

[A case of leiomyosarcoma of the spermatic cord]. / Un caso de leiomiosarcoma del cordón espermático.

We report a case of leiomyosarcoma of the spermatic cord that we consider singular because of the excellent outcome. The patient is alive and tumor-free 8 years following the initial diagnosis. We discuss the management of these patients, a controversial subject since there are no definitive therapeutic guidelines because of the very limited series of patients.

Epidermotropic metastatic melanoma. Are the current histologic criteria adequate to differentiate primary from metastatic melanoma?

A case is reported of a patient with a lentiginous acral melanoma of the heel that was excised and recurred 3 years later at the margin of the previous scar. After another 3 years, a group of five small lesions appeared in the thigh that were considered to be junctional and epidermotropic metastases. The authors question the current histologic criteria for differentiating junctional and epidermotropic metastases of previous melanomas from multiple primary melanomas. It is concluded that the clinical history is of primary importance in reaching a correct diagnosis; histologic studies are not sufficient.

[Early gastric and superficial muscle gastric cancer. Contribution of morphology to prognosis]. / Cáncer gástrico precoz y muscular superficial. Aportación de la morfología al pronóstico.

The purpose of the study was to correlate the depth of invasion in the gastric wall with survival in gastric cancer. In order to do so, we reviewed 48 patients harboring 58 gastric adenocarcinomas that did not exceed the superficial half of the muscularis propia. The patients were followed for up to a period of a least 5 years after surgery. The depth of invasion of the tumour in the gastric wall was found to correlate significantly with the invasion of lymphatic capillaries (p < 0.001) and with the finding of lymph node metastasis (mucous cancer 9%, submucous cancer 36% and superficial muscularis propia cancer 40%; p < 0.05). The size of the tumour was directly related with the depth of the cancerous invasion. Survival after 5 years varies significantly according to size of tumour (< 2 cm = 100%, 2-5 cm = 86% and > 5 cm = 33%; p < 0.0001), invasion of lymphatic capillaries (p < 0.01) and depth of the cancerous invasion (mucous cancer 94%, submucous cancer 84% and superficial muscularis propia cancer 67%; p < 0.05). The Lauren diffuse type or the multicentric cancer had a worse prognosis. The depth of invasion in the gastric wall appears to be the most important prognostic factor, since both the size of the tumor and the lymphatic involvement are related to it. When the tumour is limited to the muscularis propia, the survival rate is intermediate between early gastric cancer and advanced cancer.

[Verrucous carcinoma of the penis or Buschke-Löwenstein tumor. A rare tumor. Apropos of a case]. / "Carcinoma verrucoso de pene o tumor de Buschke-Löwenstein". Una tumoración poco frecuente. A propósito de un caso.

An additional case of verrucous carcinoma of the penis is described. This tumor type accounts for approximately 5% of squamous carcinomas of the penis. Today penile verrucous carcinoma is widely considered to be the same tumor as that described by Buschke and Löwenstein in 1925. The histological and clinical features as well as the therapeutical aspects of this tumor type are briefly reviewed herein.

[Fibroepithelial polyp with atypical stromal cells in the trigone of the bladder as a cause of lower obstructive uropathy]. / Pólipo fibroepitelial con células estromales atípicas en el trígono vesical como causa de uropatía obstructiva baja.

Fibroepithelial polyp of the trigone of bladder conditioning an occlusive syndrome at the bladder cervix level causing secondary multidiverticular bladder with ureterohydro-nephrosis and chronic bilateral pyelonephritis. Besides the rare vesical location for the fibroepithelial polyps, the case also presents some atypical stromal cells.

[Bladder adenocarcinoma. Presentation of 3 new cases]. / Adenocarcinoma vesical. Presentación de tres nuevos casos.

Three additional cases of primary adenocarcinoma of the bladder, an uncommon tumor type, seen at our department during the past years are described. These may arise from urachal remnants or metaplastic changes occurring in bladders with cystitis cystica or glandularis. Clinically, their behaviour is not unlike the rest of the infiltrating urothelial tumors. Treatment is by partial cystectomy for urachal adenocarcinoma and radical cystectomy for those arising from other sites of the bladder. Radio- and chemotherapy have a very limited efficacy in this tumor type.

[Inverted papilloma or inverted urothelial carcinoma. A problem not yet resolved in its totality. Contribution of two new cases to the literature]. / Papillome inversé ou carcinome urothélial inversé. Un problème qui encore aujourd'hui n'a pas été résolu dans sa totalité. Apport de deux nouveaux cas à la littérature.

We present two case of inverted vesical papillomas, one of a trabecular histology and the other glandular, which--in view of the appearance in the last few years of inverted papillomas coexisting alongside other urothelium tumorous states, recurring and even malignant inverted papillomas--raise the possibility of them being considered as superficial urothelium carcinomas. We propose the use of post-surgical endo-vesical chemotherapy, above all in the patients affected by the trabecular variety of inverted papillomas, due to their high indices of recurrence and high possibilities of malignancy.

Ollier's disease associated with ovarian juvenile granulosa cell tumor.

A six-year-old girl had Ollier's disease (OD) associated with juvenile granulosa cell tumor (JGCT). The clinical manifestations were right hemicorporal deformity due to multiple skeletal enchondromas and precocious pseudopuberty. After the removal of a Stage Iai JGCT, hormonal symptoms disappeared. Neither the ovarian tumor recurred nor the enchondromas underwent sarcomatous change after a follow-up period of 7 years. A review of the literature showed five previous cases, three associated with OD and two with Mafucci's syndrome (MS). In these cases, patients were young and the ovarian tumors were homolateral to the hemicorporal side involved by enchondromatosis. Data provided from these cases emphasize the notion of a generalized mesodermal dysplasia. JGCT behave in association with the OD in its usual fashion of hormonal production and low-degree aggressiveness.