Correct preoperative diagnosis of herniation through the Foramen of Winslow: two case reports.

We report two cases of one of the most infrequent types of internal abdominal hernias, i.e. incarcerated herniation through the Foramen of Winslow, with emphasis on appropriate preoperative radiological diagnosis using multidetector row computed tomography (MDCT) in both cases, and their successful surgical treatment.

[Hyponutrition prevalence among patients with digestive neoplasm before surgery]. / Prevalencia de desnutrición en pacientes con neoplasia digestiva previa cirugía.

OBJECTIVE: To analyze the prevalence and degree of hyponutrition among patients with resectable digestive neoplasm that will be submitted to surgery. MATERIAL AND METHODS: Observational cross-sectional descriptive study carried out from november of 2005 to march of 2006, assessing the nutritional status of all patients aged > or = 18 years with resectable digestive neoplasm submitted to scheduled surgery at the General and Digestive Surgery Department of the Hospital Complex of Orense (Spain). Eighty patients were studied, 41 men and 39 women aged 27-92 years. RESULTS: Diagnosis categorization was as follows: colonic neoplasm 27 patients, rectal neoplasm 24, gastric neoplasm 23, and pancreatic neoplasm 6. Fifty-three percent of the patients assessed had lost 5% of their usual weight within the previous 3 months. Serum albumin levels were lower than 3.5 mg/dL in 49% of the cases. Patient-Generated Subjective Global Assessment shows a hyponutrition prevalence of 50% (29% with moderate hyponutrition or at risk for hyponutrition and 21% with severe hyponutrition). Hyponutrition was related to age, increasing with increasing age (p < 0.05), and to the kind of digestive neoplasm (higher prevalence among patients with gastric neoplasm). CONCLUSIONS: Hyponutrition prevalence among patients with resectable digestive neoplasm is high. There is a similarity between the relative data relating to percentage of weight loss, serum albumin levels, and nutritional assessment obtained by applying the Patient-Generated Subjective Global Assessment. Further studies on hyponutrition prevalence among oncologic patients at our setting would be desirable.

Feocromocitoma suprarrenal con extensión endovascular a la cava inferior / Adrenal pheochromocytoma with endovascular extension/invasion of inferior vena cava

Mujer de 26 años con un voluminoso feocromocitoma suprarrenal izquierdo que presentaba invasión endovascular de la vena renal izquierda y cava inferior hasta la aurícula derecha. Fue intervenida en dos tiempos: primero, laparotomía y resección en bloque del tumor, riñón y vena renal izquierda; segundo, endoflebectomía de la vena cava bajo derivación cardiopulmonar. A los 8 años de estas intervenciones, no hay evidencia alguna de recidiva. En la revisión de la bibliografía sólo hemos encontrado otros 3 casos de resección de feocromocitomas con invasión endovascular hasta la aurícula (AU)

[Vascular compression of the duodenum related to a plaster cast (the cast syndrome)]. / Compresión vascular del duodeno relacionada con un corsé de yeso (cast syndrome).

Case report of a 15-year-old girl presenting compression of the duodenum by the superior mesenteric artery, occurring after the application of a body plaster cast for correction of a idiopathic thoracic scoliosis, which required a gastrojejunostomy. The clinical and radiological pictures of this case fall into the rare entity called the "cast syndrome". The salient features of this syndrome are commented.

[Acute pancreatitis associated with primary hyperparathyroidism]. / Pancreatitis aguda asociada a hiperparatiroidismo primario.

A case of acute pancreatitis associated with primary hyperparathyroidism is reported. There was none of usual causes of pancreatitis, which did not recur following the removal of a parathyroid adenoma. There are over one hundred of cases of acute or chronic pancreatitis associated with hyperparathyroidism in the literature, suggesting a causal relationship between the two entities. The pancreatic disease has been attributed either to the hypercalcemia or to the excess of circulating parathyroid hormone. However, some authors have recently questioned any link between these two diseases.

[Upper digestive hemorrhage caused by ulcerated periampullary leiomyoma]. / Hemorragia digestiva alta por un leiomioma periampular ulcerado.

Duodenal leiomyoma represents a very unusual cause for acute gastrointestinal bleeding. The authors report the case of a 49-year-old male with a massive bleeding from an ulcerated duodenal leiomyoma involving the ampulla of Vater. An emergency Whipple's pancreaticoduodenectomy was carried out under suspicion of local malignancy. It is emphasized that the proper diagnosis of smooth muscle tumors is often difficult, both clinically and from the pathological point of view.

Congenital cystic dilatation of the intrahepatic bile ducts (Caroli's disease): report of a case and review of the literature.

A case of congenital cystic dilatation of the intrahepatic bile ducts (Caroli's disease) followed for more than 7 years is reported. This patient presented also with congenital hepatic fibrosis, gallstones, and biliary hypersecretion of more than 3,000 ml in 24 hours. An analysis of the literature relating to Caroli's disease disclosed 46 well-documented cases of both hepatic histopathology and biliary tree studies. Six cases (13%) were found to be isolated forms of intrahepatic cystic dilatations; 16 (34.7%) were associated with congenital hepatic fibrosis; 10 (21.7%) presented with either a choledochal cyst or nonobstructive extrahepatic biliary tree dilatation; and in 14 cases (30%) the three anomalies were found together in the same patient. After these findings, we think that congenital hepatic fibrosis, congenital cystic dilatations of the intrahepatic bile ducts (Caroli's disease), choledochal cyst and other nonobstructive dilatations of the extrahepatic biliary tree are possibly the same congenital disease with different levels of involvement.