[Conservative treatment of a chronic rupture of Achilles tendon: case report]. / Tratamiento conservador de rotura crónica de tendón de Aquiles: reporte de caso.

We report a case of a 64 years-old-female patient with ruptured left Achilles tendon within two months of evolution that has gone unnoticed. By the application of a conservative treatment recovered complete and symmetrical functionality in five months time after the injury.

Presentamos el caso clínico de una paciente de 64 años con rotura de tendón de Aquiles izquierdo y dos meses de evolución que ha pasado desapercibida. Con la aplicación de un tratamiento conservador se consiguió una funcionalidad completa y simétrica a cinco meses de la lesión.

[Atraumatic hip pain in young adults]. / Dolor atraumático de cadera en adulto joven.

Hip pain in the young adult is a disabling pathophysiological process may be related to multiple etiologies. The process must be determined in order to make a diagnosis and follow-up treatment. The case is presented of a 29 year old woman with anemia, atraumatic hip pain on the right side, and a limp of one month onset. The differential diagnosis includes infectious, rheumatological, tumor, avascular necrosis of hip, hip impingement, hip dysplasia, osteoarthritis and other syndromes.

[Adenosquamous carcinoma of the pancreas: diagnosis with ultrasonography-guided percutaneous needle biopsy]. / Carcinoma adenoescamoso de páncreas: diagnóstico por punción citológica percutánea bajo control ecográfico.

Pancreatic adenosquamous carcinoma is an unusual histologic subtype of nonendocrine cancer of the pancreas. Diagnosis is usually made after surgery or necropsy. We report a case of adenosquamous cell carcinoma of the pancreas diagnosed by ultrasonically guided fine-needle aspiration biopsy.

[Acute viral hepatitis A and C: report of a case]. / Hepatitis viral aguda A y C: a propósito de un caso.

We present a case of acute hepatitis by simultaneous A and C virus infection. The coinfection was suspected due to the high levels of transaminases lasting more than 9 months after onset of the illness. During the early stages of the illness, the patient had IgM antibodies to hepatitis A virus. Serological tests for hepatitis B and C viruses, cytomegalovirus and Epstein-Bar virus were negative. Due to the persistently high transaminase levels, we repeated the serology, detecting positive results for hepatitis C antibody, while hepatitis B serology remained negative as well that for all other virus tested. With these findings, we believe that a patient with hepatitis A of long duration, requires additional serological examinations to determine the possibility of coinfection by another virus.

[Digestive hemorrhage caused by gastric varices: usefulness of the techniques of endoscopic sclerosis]. / Hemorragia digestiva por varices gástricas: utilidad de las técnicas de esclerosis endoscópica.

Upper gastrointestinal hemorrhage secondary to gastric varices still has a high death rate. Fourteen patients were admitted to our unit with bleeding gastric varices from November 1989 to August 1991. Endoscopic injection sclerotherapy obtained control of the bleeding in 92.3%; however, recurrences occurred in 33% of these cases in the first 24-48 hours, with a death rate of 50% during the second stage of the upper gastrointestinal hemorrhage. Total mortality rate was 21.4%. Of the fourteen patients, nine exhibited junctional varices, while five hand fundic varices. In ten of the fourteen patients, gastric varices developed during esophageal sclerotherapy. While hospitalized, it was observed that patients with gastric varices in the fundus had more recurrences and mortality, than those located next to the cardio-esophageal junction. Sclerosis of the varices only obtained temporary control of the bleeding with greater frequency of recurrences and mortality.

[The prognostic value of the endoscopic signs in the recurrence of peptic ulcer hemorrhage]. / Valor pronóstico de los signos endoscópicos en la recidiva de la hemorragia por ulcus péptico.

The endoscopic signs of hemorrhage in bleeding peptic ulcers are considered as prognostic factors for rebleeding and mortality. The value of these signs has been examined in several studies of patients with known high risk factors. In this survey, we studied the prognostic value of the endoscopic signs of hemorrhage in bleeding peptic ulcer in a group of patients without clinical risk factors such as age > 60 years, concomitant malignancy or respiratory and heart disease. Endoscopic findings were examined in fifty patients without rebleeding (group I) and twenty five with rebleeding (group II). Endoscopic findings results were spurting arterial bleeding in 9.3% of the cases, oozing hemorrhage in 17.3% of the cases, visible vessel in 9.3% of the cases, and adherent clot in 82.3% of the cases. In 9.3% of the cases endoscopic findings were negative. No statistical differences were found in the endoscopic signs among the two groups. The visible vessel and the spurting arterial bleeding cases presented in more than 50% of the rebleeding, (visible vessel and spurting arterial 57.1%). Oozing hemorrhage and the adherent clot were present in 30% of the cases. The endoscopic signs of bleeding can assist in choosing the group of patients with prospective high risk of rebleeding and possible candidates for the new treatment of endoscopic hemostatic therapy.

[Upper digestive hemorrhage in the operated stomach (Billroth I and II): clinical course and prognosis]. / Hemorragia digestiva alta en el estómago operado (Billroth I y II): curso y pronóstico.

AIM: To determine course and prognosis of upper gastrointestinal bleeding in gastrectomized patients. MATERIALS AND METHODS: We have conducted a retrospective study on 34 patients (one female, mean age 38.2 +/- 12.14 years) admitted with upper gastrointestinal bleeding between November 1989 and August 1991. All patients had been previously gastrectomized because of benign gastric pathology. Eight had a Billroth I type gastrectomy, and 26 a Billroth II. RESULTS: The causes of gastrointestinal bleeding were recurrent ulcer in 20 patients and alkaline reflux gastritis in 13 patients, both located at the surgical anastomosis; in one case it was not possible to determine the lesion responsible of the bleeding. Initial symptoms were maelena in 16 patients (47%), hematemesis in 12 patients (35.2%) and hematemesis and maelena in 6 (17.6%). Only one patient developed hemodynamic changes (systolic arterial tension < 10 mm Hg and pulse > 100 pm). After admission 3 patients rebled (8.8%) and the mortality reached 8.8%. Although rebleeding and mortality rates were higher than the rates for peptic ulcer in non gastrectomized patients, mortality and rebleeding occurred in patients with severe diseases (chronic hepatopathy), whose evolution conditioned in 2 of 3 patients the course of the upper gastrointestinal bleeding. CONCLUSIONS: The evolution of bleeding was not influenced by the causal lesion or the gastric resective procedure. We conclude that the course and prognosis of upper gastrointestinal bleeding in gastrectomized patients is not severe; hemostatic surgical procedures are indicated in only a minority of patients.

Tratamiento conservador de rotura crónica de tendón de Aquiles: reporte de caso / Case report: conservative treatment of a chronic rupture of Achilles tendon

Resumen: Presentamos el caso clínico de una paciente de 64 años con rotura de tendón de Aquiles izquierdo y dos meses de evolución que ha pasado desapercibida. Con la aplicación de un tratamiento conservador se consiguió una funcionalidad completa y simétrica a cinco meses de la lesión.

Abstract: We report a case of a 64 years-old-female patient with ruptured left Achilles tendon within two months of evolution that has gone unnoticed. By the application of a conservative treatment recovered complete and symmetrical functionality in five months time after the injury.

[Extraintestinal manifestations of chronic inflammatory intestinal disease]. / Manifestaciones extraintestinales de la enfermedad inflamatoria crónica intestinal.

Intestinal Inflammatory Chronic Disease includes a series of pathological entities of unknown etiology, basically characterized by inflammatory lesions in the digestive tube. Importance of this disease, which frequency has grown in the last few years, lies in the fact that not only affects the intestine but also other organs, originating systemic manifestations which, occasionally, modify the evolution and therapy of these patients. Because of this fact, we try, in this work, to provide a general overview of the extra-intestinal pathology associated with Crohn's disease and ulcerative colitis.