Tumor de células epitelioides perivasculares (PEComa) uterino en una paciente pediátrica: reporte de caso / Uterine perivascular epithelioid cell tumor (PEComa) in a pediatric patient: case report

El PEComa es un tumor de células epitelioides, perivascular, de origen mesenquimatoso. Estos tumores corresponden a un grupo raro de neoplasias. Hay cerca de 100 casos reportados de los que solo el 30% son de origen ginecológico y el cuerpo uterino es el sitio más frecuente. Debido a su baja frecuencia de aparición no hay una conducta médica y tratamiento establecidos, por lo cual es un reto el manejo de esta entidad. La presentación en población pediátrica es extremadamente rara, con datos limitados de su frecuencia de presentación en este grupo etario. Presentamos el caso de una paciente de 13 años que consultó por dolor pélvico; se realizaron imágenes diagnósticas que documentaron una masa paraanexial derecha sólida; es llevada a cirugía obteniendo como hallazgo un tumor dependiente del cuerpo uterino cuya histología correspondía a un PEComa con características de comportamiento maligno

PEComa is a perivascular epithelioid cell tumor of mesenchymal origin. These tumors correspond to a rare group of neoplasms. About 100 cases have been reported, of which only 30% are of gynecological origin, and the uterine body is the most frequent site. Due to its low frequency of appearance, there is no established medical conduct and treatment, which is why the management of this entity is a challenge. Presentation in the pediatric population is extremely rare, with limited data on its frequency in this age group. We present the case of a 13-year-old patient who consulted for pelvic pain. Diagnostic images were performed that documented a solid right para-adnexal mass. She was taken to surgery, which evidenced a tumor dependent on the uterine body with histology corresponding to a PEComa with characteristics of malignant behavior

Antibiotic treatment for the sexual partners of women with bacterial vaginosis.

BACKGROUND: Bacterial vaginosis (BV) is an infection that has a prevalence between 10% to 50% worlwide. BV results in an imbalance of the normal vaginal flora. Microorganisms associated with BV have been isolated from the normal flora of the male genital tract, and their presence could be related to the recurrence of BV after antibiotic treatment. Therefore, the treatment of sexual partners could decrease the recurrence of infection and possibly the burden of the disease. OBJECTIVES: To assess the effectiveness in women and the safety in men of concurrent antibiotic treatment for the sexual partners of women treated for BV. SEARCH METHODS: We searched the Cochrane Sexually Transmitted Infections Group Specialized Register (23 July 2016), CENTRAL (1991 to 23 July 2016), MEDLINE (1946 to 23 July 2016), Embase (1974 to 23 July 2016), LILACS (1982 to 23 July 2016), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (23 July 2016), ClinicalTrials.gov (23 July 2016) and the Web of Science™ (2001 to 23 July 2016). We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. SELECTION CRITERIA: Randomized controlled trials (RCTs) that compared the concurrent use of any antibiotic treatment with placebo, no intervention or any other intervention by the sexual partners of women treated for BV. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trials for inclusion, extracted data and assessed the risk of bias in the included studies. We resolved any disagreements through consensus. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: Seven RCTs (1026 participants) met our inclusion criteria, and pharmaceutical industry funded four of these trials. Five trials (854 patients) compared any antibiotic treatment of sexual partners with placebo. Based on high quality evidence, antibiotic treatment does not increase the rate of clinical or symptomatic improvement in women during the first week (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.96 to 1.03; 712 participants, four studies; RR 1.06, 95% CI 1.00 to 1.12; 577 patients, three studies, respectively), between the first and fourth week (RR 1.02, 95% CI 0.94 to 1.11; 590 participants, three studies; RR 0.93, 95% CI 0.84 to 1.03; 444 participants, two studies; respectively) or after the fourth week (RR 0.98, 95% CI 0.90 to 1.07; 572 participants, four studies; RR 1.03, 95% CI 0.90 to 1.17; 296 participants, two studies; respectively). Antibiotic treatment does not led to a lower recurrence during the first and fourth week (RR 1.28, 95% CI 0.68 to 2.43; 218 participants, one study; low quality evidence) or after the fourth week of treatment (RR 1.00, 95% CI 0.67 to 1.52; 372 participants, three studies; low quality evidence) in women, but increases the frequency of adverse events (most frequently gastrointestinal symptoms) reported by sexual partners (RR 2.55, 95% CI 1.55 to 4.18; 477 participants, three studies; low quality evidence). Two trials (172 participants) compared any antibiotic treatment for sexual partners with no intervention. When we compared it with no intervention, the effects of antibiotic treatment on recurrence rate after the fourth week (RR 1.71, 95% CI 0.65 to 4.55; 51 participants, one study), clinical improvement between the first and fourth week (RR 0.93, 95% CI 0.70 to 1.25; 152 participants, two studies) and symptomatic improvement after the fourth week (RR 0.66, 95% CI 0.39 to 1.11; 70 participants, one study) were imprecise and there were no differences between groups. We downgraded the quality of the evidence to low or very low. AUTHORS' CONCLUSIONS: High quality evidence shows that antibiotic treatment for sexual partners of women with BV, compared with placebo, does not increase the rate of clinical or symptomatic improvement during the first, between the first and fourth or after the fourth week into the women. Low quality evidence suggests that antibiotic treatment does not led to a lower recurrence rate during the first and fourth or after the fourth week of treatment into the women, but increases the frequency of adverse events reported by sexual partners. Finally, compared with no intervention, antibiotic treatment does not decrease the recurrence rate after the fourth week and does not increase the frequency of clinical or symptomatic improvement between the first and fourth or after the fourth week into the women, respectively.

Síndrome de Evans y embarazo en la adolescencia: reporte caso y revisión de la literatura / Evans Syndrome and teenage pregnancy: case report and review of the literature

Objetivo: presentar el caso de una gestante adolescente con síndrome de Evans, y hacer una revisión de la literatura respecto a su tratamiento y pronóstico durante el embarazo. Materiales y métodos: se presenta el caso de una paciente adolescente embarazada con síndrome de Evans, manejada en nuestra unidad, ubicada en un hospital de segundo nivel de referencia en Bogotá (Colombia); se describe la historia clínica, su diagnóstico, manejo y desenlace, y se realiza una revisión de la literatura con énfasis en su tratamiento y pronóstico. Se realizó una búsqueda de literatura utilizando las bases de datos Medline vía PubMed, Embase y la Biblioteca Cochrane a mayo de 2016. Las palabras clave utilizadas fueron "anemia hemolítica autoinmune", "trombocitopenia", "síndrome de Evans" y "embarazo", en español o inglés, sin límite por año de publicación. Resultados: se encontraron 79 publicaciones en la búsqueda en Medline y 61 en Embase. De estas, 13 estudios estaban directamente relacionados con el tema. Uno de los artículos corresponde a una revisión sistemática de la literatura y los demás a reportes de caso. Todos los reportes de caso encontrados están incluidos en la revisión sistemática. El síndrome de Evans se debe sospechar cuando se presenta trombocitopenia y hemólisis en la mujer gestante. La patología tiene un curso variable durante el embarazo y amerita un control estricto materno-fetal. Se dispone de alternativas que incluyen el uso de corticoides, gamaglobulina intravenosa y, en algunos casos, el manejo quirúrgico con esplenectomía. Conclusiones: el síndrome de Evans es una patología rara durante la gestación, se requieren más estudios respecto al tratamiento y pronóstico de la enfermedad que permitan guiar su manejo.

Objective: To present the case of a pregnant teenage girl with Evans Syndrome, and to conduct a review of the literature regarding treatment and prognosis during pregnancy. Materials and methods: Case presentation of a pregnant teenage girl with Evans Syndrome managed at our unit in a Level II referral hospital in Bogota, Colombia; description of the clinical history, diagnosis, management and outcome; and review of the literature focusing on treatment and prognosis. A search of the literature was conducted using the Medline database through PubMed, EMBASE and the Cochrane library up to May 2016. The key terms used were "autoimmune haemolytic anaemia", "thrombocytopenia", "Evans Syndrome" and "pregnancy", both in Spanish and English, with no restriction by year of publication. Results: Overall, 79 publications were found in Medline and 61 in EMBASE. Of these, 13 studies related directly to the topic, one was a systematic review of the literature, and the rest were case reports. All the case reports found are included in the systematic review. Evans Syndrome must be suspected when there is thrombocytopenia and haemolysis in the pregnant woman. The course of the disease varies during pregnancy and warrants close maternal and foetal follow-up. Treatment options are available, including steroids, intravenous gamma globulin and, in certain cases, surgical management with splenectomy. Conclusions: Evans Syndrome is a rare disease during pregnancy. Further studies are needed regarding the treatment and prognosis of the disease in order to guide treatment.

Endoloop hecho en casa / Homemade Endoloop

La polipectomía es un procedimiento muy común en endoscopia que no está exento de complicaciones; la más frecuente es el sangrado posterior al procedimiento por lo que se han desarrollado para su prevención numerosas estrategias; una de ellas es el uso de endoloop que ha mostrado buenos resultados para pólipos de pedículo muy largo o grueso. Sin embargo, los kits comerciales para realizar este procedimiento son muy costosos y poco disponibles, lo que hace que en nuestro medio se use muy poco. Aquí presentamos un diseño artesanal de bajo costo diseñado (por el grupo del doctor Sakai en Sao Pablo, Brasil) y la experiencia en nuestro servicio con este.

Although polypectomies are very common procedures in endoscopy, they are not without complications. The most common complication is bleeding following the procedure. Numerous strategies have been developed to prevent bleeding. One of these, the use of an endoloop, has had good results for polyps with very long or thick pedicles. Nevertheless, since commercial endoloop kits for this procedure are very expensive and in short supply, they are not widely used in Colombia. In this article we present a low cost design developed by Dr. Sakai in Sao Paul Brazil for an endoloop that can be made in house, and we present our experience with this tool.

Perforaciones en la CPRE: una complicación para tener en cuenta / Perforations Occurring during ERCP: A Complication to Take into Account

En su introducción, hace más de 40 años, la colangiopancreatografía retrógrada endoscópica (CPRE) se utilizaba para el diagnóstico de las enfermedades biliopancreáticas, pero desde hace más de 10 años, dado sus riesgos, solo se utiliza para procedimientos terapéuticos, en donde tiene una gran utilidad para el manejo de diversas patologías biliopancreáticas. Como la mayoría de procedimientos endoscópicos, la CPRE no está exenta de potenciales complicaciones, con tasas que están alrededor del 5% a 7%. Las perforaciones son una de las complicaciones más temidas, su importancia radica en que es muy difícil realizar un diagnóstico temprano y en la mortalidad a la que puede llevar. Se presenta aquí casos clínicos sobre este tipo de complicación, los cuales fueron manejados en nuestro servicio, y una revisión de la literatura.

When it was introduced 40 years ago, endoscopic retrograde cholangiopancreatography (ERCP) was used to diagnose biliopancreatic diseases. Nevertheless, because of its risks, it has been used only for therapeutic procedures for more than 10 years. It is very useful for handling various biliopancreatic pathologies, but like most endoscopic procedures, ERCP is not without potential risks, and the rate of complications is around 5% to 7 %. Perforations are one of the most feared complications because early diagnosis is very difficult and because they can result in death. We present clinical cases of this type of diagnosis that have been managed in our hospital together with a review of the literature.

Síndrome de Boerhaave: a propósito de dos casos / Two Case Reports of Boerhaave’s Syndrome

El síndrome de Boerhaave es un tipo de ruptura esofágica barogénica, causada por un aumento rápido en la presión intraluminal en un esófago previamente sano, habitualmente, en su tercio distal. Esta enfermedad es muy rara y tiene una alta mortalidad, con muy pocas series de casos reportados en la literatura. Las tasas de mortalidad estimadas van hasta el 40%; aunque el manejo en manos experimentadas en un cuadro diagnosticado a tiempo ha mostrado impactar positivamente el pronóstico de los pacientes. Desafortunadamente, debido a la baja frecuencia de la enfermedad, aún no hay un consenso claro respecto al mejor enfoque terapéutico. Aquí presentamos el cuadro clínico de dos pacientes que fueron diagnosticados en nuestra institución, se describe el cuadro clínico, se presentan las imágenes diagnósticas y se realiza una revisión de tema.

Boerhaave’s syndrome is a type of esophageal rupture caused by a rapid increase in intraluminal pressure in a previously healthy esophagus. The rupture usually occurs in the distal third of the esophagus. This condition has a high mortality rate and is very rare with very few cases reported in the literature. Estimates of mortality rates range as high as 40%, but management by experienced physicians combined with early diagnosis early has been shown to positively impact patients’ prognoses. Unfortunately due to the condition´s low frequency, no clear consensus exists regarding the best therapeutic approach. Here we present the clinical features of two patients who were diagnosed at our institution, present diagnostic images, and review the topic.