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Acute pancreatitis is common and requires multidisciplinary management. The revised Atlanta classification, published in 2012, defines the terminology necessary to enable specialists from different backgrounds to discuss the morphological and clinical types of acute pancreatitis. Radiologists' role depends fundamentally on computed tomography (CT), which makes it possible to classify the morphology of this disease and to predict its clinical severity by applying imaging severity indices. Furthermore, CT- or ultrasound-guided drainage is, together with endoscopy, the current technique of choice in the initial approach to collections that appear as a complication. This paper aims to disseminate the concepts coined in the revised Atlanta classification and to describe the current role of radiologists in the diagnosis and treatment of acute pancreatitis.

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A 62-year-old female patient was admitted for abdominal pain and vomiting. Imaging tests revealed a solid-cystic lesion at the head of the pancreas communicating with the distal bile duct. A Todani type II choledochal cyst was diagnosed with neoplastic degeneration after cytological diagnosis with endoscopic ultrasound-guided puncture. The patient was treated with a cephalic duodenopancreatectomy with curative intention.

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OBJECTIVE: To investigate the possible association of the mannose binding lectin (MBL) pathway of complement activation with different disease parameters and disease activity in patients with systemic lupus erythematosus (SLE). METHODS: MBL genotype, MBL serum concentration, MBL complex activity and MBL pathway activity were assessed in 53 patients. The activity of the MBL-MASP complex was assessed on the basis of its ability to activate exogenous C4. For MBL pathway activity the formation of the terminal complex of complement activation (C5b-9) was measured. Results were analysed in relation to clinical variables and autoantibody profiles in these patients. RESULTS: MBL complex activity and MBL pathway activity were both reduced in patients carrying MBL variant alleles. Anticardiolipin and anti-C1q autoantibodies were observed significantly more frequently in patients with MBL variant alleles. Furthermore, the presence of these autoantibodies was associated with a decreased MBL concentration and function. In contrast, anti-MBL autoantibodies were not found in patients with MBL variant alleles, possibly related to impaired binding of variant MBL to apoptotic material. CONCLUSION: In patients with SLE, a reduced functional activity of the MBL pathway of complement, in relation to expression of MBL variant alleles, is associated with increased levels of autoantibodies against cardiolipin and C1q, but not against MBL. We hypothesize that an enhanced production of autoantibodies may be related to disturbed clearance of apoptotic material due to impaired MBL function.

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La cirugía endoscópica rinosinusal se ha convertido en una técnica de gran aceptación y respeto para el tratamiento de las sinusitis crónicas y otras patologías relacionadas con alteraciones en la ventilación y fisiología de los senos paranasales. Esta situación clínica en particular, es otro gran ejemplo de la necesaria e imprescindible necesidad de mantener una óptima combinación y sinergia entre las variables: técnicas, destrezas y equipamientos en cirugía y anestesia. Un adecuado estudio del perfil del paciente y tipo de cirugía en cuanto a duración, magnitud, etc., es muy importante para el éxito del procedimiento. El estudio pre-operatorio estándar y rutinario, como es el perfil de laboratorio para todo paciente y la evaluación cardiovascular preoperatoria para los que han alcanzado la tercera década de la vida, resulta elemental e imprescindible. Sobre todo, deben ser identificados aquellos pacientes que reciben medicación con efecto directo cardiovascular así como aquellas drogas moduladoras de la coagulación como la warfarina, heparina, aspirina y analgésicos no-esteroideos, con el fin de realizar las recomendaciones y modificaciones pertinentes

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The harmful effects of smoking on health have been widely documented, although it is as yet unclear whether tobacco dependence is only psychological in nature, or both psychological and physical. We studied plasma concentrations of beta-endorphin, cortisol, and adrenocorticotropic hormone (ACTH) in healthy persons who consumed different numbers of cigarettes per day, and compared the findings with those in a control group of nonsmokers. Beta-endorphin levels were significantly higher than in controls only in persons who smoked fewer than 10 cigarettes per day. Cortisol levels were significantly higher in smokers who consumed more than 20 cigarettes per day. There were no significant differences between any of the groups in plasma ACTH concentrations.

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The most important factor in the management of alimentary tract bleeding is the adequate localization of the lesion. Small bowel bleeding is a rare entity and determination of the specific anatomic site is difficult. Once stomach, duodenum, or colon origin has been discharged through endoscopy, methods such as angiography and Tc99m RBC scans are appropriate. We present a patient with lower gastrointestinal bleeding secondary to jejunal angiodysplasia associated with jejunal diverticular disease. In the present case, Tc99m RBC scans were used to identify the bleeding site. In cases of lower gastrointestinal bleeding of undetermined origin, we suggest the consideration of both diagnoses (angiodysplasia or diverticular disease) with exploratory celiotomy to resolve these pathologies, particularly in the elderly patient.

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A case of acute intestinal anisakiasis has been reported; a nematode larva being found in the submucosa of the ileum of a woman in Jaén (Spain). The source of infection was the ingestion of raw Engraulis encrasicholus. On the basis of its morphology, the worm has been identified as a fourth-stage larva of Anisakis simplex. In Spain, this is the ninth report of human anisakiasis and also probably the first case of anisakiasis caused by a fourth-stage larva of A. simplex.

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We analyze the clinical and histological features of 10 cases of malignant fibrous histiocytoma of soft tissue. Nine belonged to the pleomorphic-verticillate variety and one was myxoid. The initial clinical feature was a palpable mass in all cases except three with retroperitoneal localization, where constitutional symptoms predominated. After therapy (surgery in all, associated with radiotherapy in four), seven patients had local relapse and two had distant metastases. 50% died, with a mean survival of 13 months. We discuss the prognostic factors and the therapeutic approach, with emphasis on aggressive therapy and the need for radical surgery and postoperative adjuvant therapy.

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3 cases of splenic abscess (SA), all of them with similar clinical findings; abdominal pain, liver and splenic enlargement and leukocytosis, are presented. The diagnosis was suspected by abdominal ultrasound and confirmed by CTR. We focused the interest on the etiopathogenesis, diagnosis and the rareness of the bacteria isolated: Salmonella group D (two cases) and Bacteroides Fragilis.

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We report a case of primary pericardial malignant mesothelioma in a 53-year old male with no asbestos previous exposure. The first clinical sign was a massive pericardial effusion causing hemodynamic disturbances. CT confirmed the initial ecochardiographic diagnosis. The patient underwent pericardiocentesis which improved his hemodynamic status as well as showed malignant cellularity in the liquid examination. Surgical treatment, including pericardiectomy and tumor resection, together with chemotherapy restored normal hemodynamics, the patient being now asymptomatic. We want to emphasize the rarity of this tumor and its insidious clinical presentation even leading to hemodynamic impairment, as well as the great value of echocardiography and CT in its diagnosis, although, in some cases, thoracotomy has been the only valid diagnostic procedure.

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A study was made of the incidence of colonorectal tumors in the Autonomous Community of La Rioja (Spain) over 10-year period between 1978 and 1987, inclusive. An increased incidence of these tumors is confirmed, with no decline in the age of presentation or in the frequency of detection of early tumors, which suggests that this disease is on the rise. In view of these results, measures leading to the early diagnosis of colonic tumors are needed, such as screening of the general population, particularly groups at risk.

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