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Kaposi sarcoma (KS) was first described in 1872 by Moritz Kaposi. Its epidemiology is suggestive of an infectious disease and in 1994 Chang and coworkers identified DNA sequences corresponding to a previously unidentified herpes virus--human herpes virus 8 (HHV-8)--in AIDS-associated KS biopsies. It is now believed that the presence of HHV-8 is a necessary condition but not sufficient on its own to cause KS. Other factors such as immunosuppression should also be considered and it is known that immunosuppressive therapy increases the risk of KS. We describe a patient who developed KS after prolonged prednisone therapy for temporal arteritis.

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El diagnóstico de íleo mecánico secundario a fractura pélvica es difícil debido a su baja frecuencia frente al íleo para lítico. El peor pronóstico que conlleva el tardío o erróneo diagnóstico requiere recordar esta complicación, a menudo olvidada. Presentamos un caso de atrapamiento y perforación de intestino delgado por fractura pélvica que se complicó con una gangrena gaseosa. Así mismo, revisamos los casos publicados, entre los que se han encontrado 12 pacientes, con edades entre 13 y 80 años. La fractura acetabular y el intestino delgado son los más frecuentemente implicados en el íleo mecánico. Los diagnósticos se efectuaron entre el segundo y el vigésimo primer día tras la fractura. El tratamiento quirúrgico empleado con más asiduidad ha sido la resección segmentaria del intestino afecto, anastomosis primaria, junto con desbridamiento de los bordes fracturarios y reperitonización. La mortalidad ha sido de un 41 por ciento. El diagnóstico de íleo mecánico secundario a fractura pélvica es difícil y casi siempre tardío, lo que agrava el pronóstico del paciente. La TAC, ante un cuadro clínico de fractura pélvica con obstrucción intestinal, hipotensión no hipovolémica, taquicardia y afectación del estado general, será habitualmente diagnóstica(AU)

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Los divertículos son una entidad rara dentro de la enfermedad apendicular. Se clasifican en falsos y verdaderos, siendo éstos muy infrecuentes. Presentamos el caso de una diverticulosis verdadera que fue un hallazgo quirúrgico e histológico sobre un cuadro clínico de apendicitis aguda. El tratamiento debe ser la apendicectomía, bien en el curso de la laparotomía, o de forma profiláctica para evitar sus posibles complicaciones, como son la diverticulitis, la perforación o la hemorragia (AU)

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INTRODUCTION: Cerebral gliomatosis (CG) is a diffuse infiltrating glial neoplasia which may affect any part of the central nervous system (CNS). Its diffuse infiltrating growth leads to difficulty with clinical suspicion and imaging technique diagnosis. Magnetic resonance (MR) is more sensitive than computerized tomography (CT) for the detection of lesions. However, the extent of the infiltration may be roughly evaluated using current imaging techniques. OBJECTIVE: In this article we describe histological aspects of this rare condition, its biological behavior and correlation with radiological findings, and review the contribution of other techniques (positron emission tomography, immunohistochemical examination) in its diagnosis and delimitation. CLINICAL CASE: We present a case of CG in a 26 year old man. On CT no alterations were seen. On MR there was diffuse involvement of the white matter extending to the cortex. The patient worsened rapidly and later developed two focal masses of glioblastoma multiform in areas with the most neoplastic infiltration. CONCLUSIONS: MR is more useful than CT in establishing the diagnosis and extent of CG. Although it is a rare condition, it should be included in the differential diagnosis of conditions which affect the white matter in a diffuse manner. Poor delimitation between white and grey matter helps in diagnosis of this condition.

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The appearance of procedures derived from video assisted thoracoscopy (VAT) has fostered new breakthroughs in the treatment of spontaneous pneumothorax. Our early experience with a study protocol using this technique is described. Patients admitted to our hospital in 1995 with a diagnosis of spontaneous pneumothorax were enrolled consecutively. Diagnosis was based on symptoms and pneumothorax was quantified by measuring the interpleural distance observed on the chest film. The initial treatment was pleural drainage; VAT was ordered in cases of recurrence, when lung reexpansion failed or when air leakage was persistent. Forty-five cases (30 men, 15 women) are reported. Mean age was 29 years. Eleven (24%) patients had had earlier pleural drainage but were suffering recurrences. The right side was involved in 14 (54%) cases. Initial treatment was pleural drainage and in 32 cases no other treatment was given. VAT was performed on 11 patients. In 1 (9%) patient the procedure became a minithoracotomy, or video-assisted thoracoscopic surgery. In 2 patients conventional thoracotomy was performed. Mean time the procedure lasted was 80 min. Mean follow-up was 3 months. There were no recurrences among patients treated with VAT and surgery. Our initial experience demonstrates that VAT is the technique of preference for the definitive treatment of spontaneous pneumothorax. There is less postoperative pain, increased comfort, no noteworthy morbidity, shorter postoperative hospital stays and prompt return to normal activity for the patient; these advantages lead us to choose this treatment over open surgery.

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OBJECTIVES: Adrenal hemangiomas are rare tumors that are difficult to diagnose preoperatively. A case of retroperitoneal hemorrhage arising from adrenal hemangioma is described. This uncommon clinical manifestation prompted us to report on the present case and briefly review the scant literature on the diagnostic and therapeutic aspects. METHODS: The case described herein is that of a male patient who presented with hematoma in scrotum and penis that had appeared progressively with no previous trauma. The diagnosis was made by abdominal US and CT, which showed a retroperitoneal mass that appeared to be solid. An enlarged adrenal gland with tumoral "blush" was shown on selective vascular evaluation. RESULTS: En bloc excision of the adrenal gland, left kidney and spleen was performed. The histological analysis revealed adrenal hemangioma. CONCLUSIONS: Adrenal hemangioma is a rare tumor type with no clinical or biological symptoms of a functioning tumor that is generally diagnosed with difficulty preoperatively. The differential diagnosis must be made to distinguish adenoma, carcinoma, nonfunctioning adrenal pheochromocytoma and spontaneous hemorrhage.

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