We report the case of a 27 year-old patient with acute lymphoblastic leukemia who presented severe lactic acidosis as a metabolic complication. She presented with severe malnutrition, marked anemia and consuming syndrome. There was no reticuloendothelial system compromise and an initial myelogram was normal. These factors delayed the diagnosis and forced the extent of the differential diagnosis. The suspicion of lactic acidosis-associated hematologic neoplasia needed reassessing the case with new myelogram to establish the diagnosis.

Rapunzel syndrome is a rare form of gastric trichobezoar extending to the bowel. It is composed of hair, mucus and decaying food particles. We report the case of an 18 year-old girl who was admitted to our institution with past history of irregular treatment of major depression during the previous year and history of five months of nauseas, vomiting and 15 kg weight loss. On examination findings included abdominal tumor mass, distention and pain. She presented severe anemia and the gastroduodenal x-rays showed gastric filling defects. Diagnosis was confirmed by gastroscopy and gastrotomy revealed a large tricobezoar with duodenal projection, that was removed. She did not present complications on discharge.

We present a case of a 35 year-old woman who had multiple bony fractures, short size, left xyphoescoliosis, blue sclerae, functional limitation of the hips, dentinogenesis imperfecta, severe osteoporosis and conduction hypoacusia. We review the types of osteogenesis imperfecta, clinical presentation, differential diagnosis, treatment and prognosis.

En nuestro medio no son infrecuentes las intoxicaciones por órganos fosforados (OF) y, por lo general, no constituyen un problema diagnóstico ni de tratamiento. La casi totalidad de estos casos son intoxicaciones agudas debido a la ingestión con fines suicidas, a la exposición durante fumigaciones y ocasionalmente, a la ingestión accidental.El compromiso neurológico en las intoxicaciones agudas por órganos fosforados es conocido (1-5). En cambio, los reportes de compromiso neurológico tardío son infrecuentes. En nuestro medio se reportó una polineuropatía con carácter epidémico y se asumió que la causa fuera una intoxicación por OF´s usados en fumigaciones sin contar con pruebas concluyentes (6).A continuación se presenta una paciente que desarrolló una polineuropatía tardía y los estudios evidenciaron una exposición a un OF.

We present the case of a multiparous and obese woman of 59 years with partial hypopituitarism having an empty sella syndrome. We describe the clinical, radiological and biochemical findings. The diagnosis of empty sella was confirmed by computarized tomography. The levels of thyroxine, cortisol and growth hormone were decreased, with pituitary hyporresponsiveness to hypoglicemia induced with insulin. The replacement therapy was successful.