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Objectives: We present the management with partial nephrectomy and interposition of the greater omentum in case of urinary fistulas in renal allograft., Material and Method: We present a patient with necrosis at the inferior pole of the renal graft that affected calyceal system but with pyeloureteral vascularization preserved. The patient's condition was satisfactorily managed with a partial nephrectomy of the necrotic renal segment and primary suturing of the collecting system with interposition of the greater omentum. We reviewed the cases published to date of partial nephrectomy in renal allograft, and examined their outcomes by analyzing the patient presentation, diagnostic tools, and surgical techniques used., Results: There are few cases in the current literature that describe conservative surgical management of urinary fistulas caused by segmental necrosis after renal transplantation. Surgical approach using partial nephrectomy in these cases produces favorable outcomes in our experience and reported cases., Conclusions: Despite its obvious surgical complexity, this nephron-sparing management is feasible and should be implemented in cases where the prior renal function and the quantity of healthy parenchyma indicate a favorable subsequent evolution for the renal graft., (Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.)

A case of a 78-year-old female who presented with clinical, ultrasonographic and laboratory findings typical of acute cholecystitis is presented. Diagnostic laparoscopy revealed a hemorrhagic infrahepatic mass and free blood within the peritoneal space; the procedure was then converted to an open one, which identified a 15 x 5 cm mass corresponding to a gallbladder volvulus. The final histopathologic study confirmed the diagnosis. A gallbladder volvulus should be suspected in elderly patients, particularly in those with a previous history of significant weight loss, who additionally present positive clinical and paraclinical data of acute cholecystitis. There are no still biochemical exams that may preoperatively identify patients at high risk for this infrequent abnormality.

Lipomas are well-differentiated, encapsulated masses composed of adipocytes. Intrathoracic lipomas are rare, but found most commonly in the pleura or anterior mediastinum. Computed tomography shows fatty, homogenous content of the mass and will establish the diagnosis. Areas with a higher fat density are suggestive of liposarcoma. We describe a case of lipoma in the posterior mediastinum that contained solid areas on computed tomography. Histology showed that these areas were fat necrosis.

Objective: We report the case of a young patient without known cardiovascular risk factors, complaining of lumbar colic pain due to renal infarction., Methods: Differential diagnosis of lumbar colic pain must include some rare events. We performed a review of the current knowledge on the topic., Results/conclusion: The increasing difficulty in the diagnosis of these pathology lies on its clinical suspect, which can be clear when having cardiovascular risk factors. Its diagnosis, on a rare scenario, needs leucocytosis and LDH rising as suspicious indicators. Computed tomography, MRI, radionuclids and arteriography may confirm diagnosis. Treatment is based on thrombolytic therapy, anticoagulants and ontiagregants.

It is presented the case of the second pregnancy of a 36 year-old patient with antecedent of preeclampsia that was solved, at full-term, with a Caesarean operation by means of which was obtained a healthy new born. The patient began her prenatal control at 29th week. Ultrasound made at her admittance showed a fetus with an approximated weight of 451 grams. The patient was hospitalized until completing protocol of study for restriction of severe fetal growth. At 34.5 weeks, an ultrasonographical control showed an alteration in venous duct; for that reason it was decided to interrupt pregnancy abdominally. There were no surgical complications and was obtained a phenotypically normal new born, male, weight of 820 grams and size of 33 cm, who was referred to the Instituto Nacional de Perinatologia. At 43.3 weeks he was discharged from hospital with a weight of 1,840 grams. At the present he's fed with fortified milk.

Introduction: One of the fundamental lines followed by Neuropsychology today focuses on rehabilitation processes and their effectiveness. Cognitive rehabilitation is an eclectic process that is dependent on a number of variables. This variability makes it necessary to establish a work plan that guides the intervention carried out by professionals and also makes it clear what objectives are to be achieved, as well as the strategies and tools that must be used to reach them. The purpose of this study is to offer a practical examination of the different points that must be developed in a cognitive rehabilitation process--exemplified here in a case of bithalamic infarction., Case Report: From a single case and from the specific needs of the individual, a thorough work plan is drawn up. This plan includes a description of everything from the choice of a practical framework for intervention and its underlying principles up to the different training processes, learning techniques and tools that were used and finally proved to be effective. The efficacy and safety of the different strategies and tools used are demonstrated by the short and long term results of the different neuropsychological examinations carried out, which at the same time proved the effectiveness of the work plan that was selected for application., Conclusions: A clear understanding of the value of the cognitive rehabilitation processes chosen for use helps to improve the way clinical work is carried out, with the common purpose of restoring neuropsychological deficits and increasing the individual's independence and quality of life.

Introduction: Spinal cord injuries in newborn infants following a traumatic delivery are well known, but occasionally cord damage is appreciated in children whose birth did not involve any complications; in some of them there has been proof of an ischemic process that originated inside the uterus., Case Report: We describe the case of a newborn female with atrophy of the cervical spinal cord compatible with an intrauterine ischemic infarct. It extended to the C4-C6 territory of the anterior spinal artery, with greater participation on the left side. Clinical symptoms were apparent from the moment of birth and took the form of an asymmetric pseudoarthrogryposis in the upper limbs. The left arm was held in abduction at the height of the shoulder, with complete flexion of the elbow and the hand at the height of the chin was hypotonic, inactive and hypotrophic; the right arm was extended and in adduction. The patient presented episodes of hyperthermia that remitted on cooling the body., Conclusions: When faced with a newborn infant with symptoms that are compatible with chronic cervical spinal cord damage and in the absence of any perinatal traumatic injury, other causes, including prenatal ischemic infarct, must be taken into account.

Objectives: To report the clinical case of a male with acute onset right flank pain and significant deterioration of his general status., Methods: 40-year-old male patient with acute onset of flank pain, progressive worsening, and fever up to 40 degrees C. Blood analysis (hemogram, coagulation tests, and serum ions), urine analysis, and abdominal x-rays, ultrasound and CT scan were performed. After the diagnosis of segmental renal infarction treatment with low molecular weight heparin was started., Results: Patient improved clinically and was discharged from hospital 10 days later and received final discharge as outpatient after 6-month follow-up visit., Conclusions: Renal infarction should be taken into consideration in the differential diagnosis of acute flank pain, when more frequent causes as renal colic or inflammatory-infectious diseases are ruled out, mainly in patients with cardiovascular diseases because the most frequent cause is embolism.

Susac's syndrome is an extremely rare clinical manifestation characterized by the triad of fluctuating sensorineural hearing loss, sudden visual loss and encephalopathy. Probably underdiagnosed, it affects young women who start the clinical history with headache, visual and hearing disturbances, with neurological findings in MRI. With unknown aetiology, pathogenesis is based on arteriolar microinfarcts in retina, cochlea, and grey and white matter in the brain. Treatment is, as stated in the bibliography and our experience, intravenous high doses of steroids followed by oral steroids together with hyperbaric oxygen to minimize ischaemic lesions. Aspirin associate to nimodipine has been useful to date in the treatment of our patient. We present a case and review the existing literature.

The incidence, pathophysiology, symptoms, differential diagnosis and treatment of ophthalmoplegic and retinal migraines are reviewed. We describe three cases: one recurrent, painful ophthalmoplegia alternating between the III and VI nerves, one recurrent migraine associated with internal ophthalmoplegia, and one migraine with visual aura and retinal infarction. In our review we emphasize their infrequency (ophthalmoplegic migraine, 0.7 per million; retinal migraine 0.5-7% of migraines with aura), their uncertain pathophysiology and the possibility of causing permanent oculomotor or visual deficits. Differential diagnoses, including all causes of painful ophthalmoplegia and amaurosis fugax are discussed, with special attention to the difficulty of differentiating Tolosa-Hunt syndrome and forms without headache.

Migraine is a risk factor for cerebral stroke, particularly in young women. Whether the migrainous process is a triggering or contributing factor in the ischemic profile, or is the sole cause of stroke, is impossible to establish with certainty. Epidemiological, pathophysiological and clinical evidence are in no way conclusive. The symptoms and lesions of migrainous stroke suggest the involvement of a mechanism similar to that of migrainous aura, although the infarction process is of greater intensity and lasts longer. Migrainous stroke should be considered an evolutionary complication of aura. Thus, the best treatment consists of adequate control of migraine attacks with the reduction of frequency, intensity and duration. The avoidance of migraine drugs with marked vasoconstrictive action, and the removal of other vascular risk factors (smoking and oral contraceptives) are additional measures for the prevention of migrainous stroke.

We present a case of gastric greater curvature necrosis after acute gastric dilatation. The lesion was treated by vertical resection of the greater curvature and the distal end of the gastric fundus. This is the first case described in the Spanish medical literature.

Authors describe characteristics of this rare disease, as cause of acute abdomen in infancy. They base this on the study of two cases. They establish criteria for differential diagnosis of acute appendicitis, as well as surgical treatment and pathological conditions found during surgery.