[Surgical treatment of pancreatic and periampullary carcinoma in a specialized unit: a decade later]. / Tratamiento quirúrgico de la neoplasia de páncreas y región periampular en una unidad especializada: una década después.

INTRODUCTION: Results of surgical treatment for pancreatic and periampullary carcinoma have improved in recent years owing to several factors, particularly the concentration of these patients in specialised surgical units. MATERIAL AND METHODS: Retrospective-prospective comparative study of results in 2 groups of patients treated over 2 different periods of time and with different surgical policy: group A, which included 80 patients treated from 1982 to 1992 in a general surgery unit, and group B, which comprised 151 patients treated from 1998 to 2003 in a specialised hepato-biliary-pancreatic surgery unit. RESULTS: Surgical treatment in patients of groups A and B, respectively, was: resection in 20% and 53.6% and by-pass in 62.5% and 36.4%. Postoperative morbidity after resection was similar (75% vs 74.1%) but higher after by-pass in group B (41.8% vs 34%). Postoperative mortality after surgical resection and by-pass was 25% and 14.1%, respectively, for group A and 3.7% and 16.3%, respectively, for group B. Mean survival for all patients was 7.0 +/- 7.1 months for group A and 14.1 +/- 15.3 months for group B. Mean survival for patients with surgical resection was 11.8 +/- 9.8 months and 18.7 +/- 15.8 months for groups A and B, respectively. CONCLUSIONS: Pancreatic and periampullary carcinoma should be surgically treated in specialised pancreatic surgery units in order to offer the best outcome to patients.

Tratamiento quirúrgico de la neoplasia de páncreas y región periampular en una unidad especializada: una década después / Surgical treatment of pancreatic and periampullary carcinoma in a specialized unit: a decade on

Introducción: Los resultados de la cirugía de la neoplasia de páncreas y región periampular han mejorado en los últimos años por diversos motivos, entre los que destaca el tratamiento de esta enfermedad en unidades especializadas. Material y métodos: Estudio retrospectivo-prospectivo de 2 grupos de pacientes tratados en períodos y contextos de unidades de cirugía distintos: grupo A (80 pacientes), tratado entre 1982 y 1992 en un servicio de cirugía general, y grupo B (151 pacientes), tratado entre 1998 y 2003 en una unidad de cirugía hepatobiliopancreática. Resultados: La resección se realizó en el 20 y el 53,6% de los pacientes y la derivación, en el 62,5 y el 36,4% de los pacientes de los grupos A y B, respectivamente. Las complicaciones postoperatorias fueron similares después de la resección (el 75 frente al 74,1%) y más elevadas después de la derivación en el grupo B (el 41,8 frente al 34%). La mortalidad postoperatoria fue del 25 y el 3,7% después de la resección, y del 14,1 y el 16,3% después de la derivación, respectivamente, para los grupos A y B. La supervivencia global media (± desviación estándar) fue de 7,0 ± 7,1 y de 14,1 ± 15,3 meses para los grupos A y B, respectivamente, y la supervivencia después de la resección, de 11,8 ± 9,8 y de 18,7 ± 15,8 meses. Conclusiones: La cirugía de la neoplasia de la región pancreática debería realizarse en unidades quirúrgicas especializadas para ofrecer a los pacientes los mejores resultados

Introduction: Results of surgical treatment for pancreatic and periampullary carcinoma have improved in recent years owing to several factors, particularly the concentration of these patients in specialised surgical units. Material and methods: Retrospective-prospective comparative study of results in 2 groups of patients treated over 2 different periods of time and with different surgical policy: group A, which included 80 patients treated from 1982 to 1992 in a general surgery unit, and group B, which comprised 151 patients treated from 1998 to 2003 in a specialised hepato-biliary-pancreatic surgery unit. Results: Surgical treatment in patients of groups A and B, respectively, was: resection in 20% and 53.6% and by-pass in 62.5% and 36.4%. Postoperative morbidity after resection was similar (75% vs 74.1%) but higher after by-pass in group B (41.8% vs 34%). Postoperative mortality after surgical resection and by-pass was 25% and 14.1%, respectively, for group A and 3.7% and 16.3%, respectively, for group B. Mean survival for all patients was 7.0 ± 7.1 months for group A and 14.1 ± 15.3 months for group B. Mean survival for patients with surgical resection was 11.8 ± 9.8 months and 18.7 ± 15.8 months for groups A and B, respectively. Conclusions: Pancreatic and periampullary carcinoma should be surgically treated in specialised pancreatic surgery units in order to offer the best outcome to patients

Hematologic abnormalities in liver-transplanted children during medium- to long-term follow-up.

OBJECTIVE: Hematologic abnormalities as adverse effects related to immunosuppressive drugs in liver-transplanted children are rarely reported. We have observed anemia, neutropenia, and thrombocytopenia in our pediatric liver-transplant population. The aim of this study was to exclude all suspected etiologies to define the association of immunosuppressants with these abnormalities. METHODS: Patients under 18 years old who still attend periodic controls at liver-transplant outpatient clinics were considered. Seventy patients met the inclusion criteria, 36 girls and 34 boys. Mean patient age was 5.6 years (range: 7 months to 17 years) and mean follow-up 6 years (range: 1-10 years). Medical records were reviewed beginning 1 month posttransplant. Treatment exposures, irradiation, blood product administration, and all laboratory studies were reviewed. When a hematologic abnormality was detected, we recorded the management for its resolution, the clinical response to therapy and the length of treatment. RESULTS: Twenty-five of the 70 children suffered 26 abnormal hematologic episodes (anemia 14, neutropenia 2, thrombocytopenia 3, simultaneous anemia and neutropenia 5, and pancytopenia 2). Eleven episodes (42%) had unclear etiologies and the process of elimination suggested an association with the immunosuppressant. Switching immunosuppressant was required in four patients and dose reduction in seven. CONCLUSIONS: Hematologic abnormalities in liver-transplanted children are common. The etiology is readily attributable to several causes. When the immunosuppressant appears to be a possible cause, the first step is dose reduction. If the hematologic abnormality persists despite dose reduction, a trial switch may be required.

[First orthotopic liver transplantation in patient with biliary atresia and situs inversus in spain]. / Primer trasplante hepático en un paciente con atresia de vías biliares y situs inversus en España.

Biliary atresia is the most common indication for liver transplantation in the pediatric age group. The Kasai portoenterostomy has become established as the primary treatment for biliary atresia. If portoenterostomy fails, death before 2 years of age is likely without liver transplantation. The most common multiple malformation syndrome associated with biliary atresia is polysplenia syndrome, which forms a constellation of defects of body symmetry, splenic development and vascular anomalies, including situs inversus, polysplenia and others. The situs inversus was formerly considered an absolute contraindication for liver transplantation. Recently however, several case reports have been published suggesting that neither situs inversus nor this particular subset of vascular abnormalities should be considered contraindications to liver transplantation. We present one case of liver transplantation performed in patient with biliary atresia, situs inversus and polysplenia. This is the first report described in Spain for a liver transplant in a child with biliary atresia plus situs inversus.

Primer trasplante hepático en un paciente con atresia de vías biliares y situs inversus en España / First orthotopic liver transplantation in patient with biliary atresia and situs inversus in Spain

La atresia de vías biliares es la indicación más frecuente para trasplante hepático en la edad pediátrica. La portoenterostomía de Kasai es el tratamiento primario para la atresia de vías biliares. Si la portoenterostomía falla, el fallecimiento suele ocurrir antes de los 2años de edad sin el trasplante hepático. El síndrome de múltiples malformaciones más comunmente asociado con la atresia de vías biliares es el síndrome de poliesplenia, formado por una constelación de defectos en la simetría corporal, desarrollo del bazo y anomalías vasculares, incluyendo situs inversus, poliesplenia y otros. El situs inversus era considerado como una contraindicación absoluta para el trasplante hepático. Sin embargo recientemente han sido publicados varios casos, sugiriendo que ni el situs inversus ni la presencia de dichas alteraciones vasculares deben ser consideradas como contraindicaciones para el trasplante hepático. Presentamos un caso de trasplante hepático realizado a un paciente con atresia de vías biliares, situs inversus y poliesplenia. Es el primer caso descrito en España (AU)

[Sequential double-lung transplantation. Technique and results in the first 3 cases. Pulmonary Transplant Group]. / Trasplante bipulmonar secuencial. Técnica y resultados de los tres primeros casos. Grupo de Trasplante Pulmonar.

Patients who suffer advanced lung disease associated to respiratory infection and who are candidates for transplantation must have both lungs replaced. Until recently, this procedure was accomplished by transplanting a heart-lung block, a procedure of questionable merit if the heart is healthy, or by carrying out a double-lung transplant requiring extracorporeal circulation and involving a high percentage of complications the tracheal anastomosis. The year 1990 saw publication of the first descriptions of a simpler procedure, sequential double-lung transplantation. After brief experience with good results in single-lung transplantation, we present the first three cases of sequential double-lung replacement carried out in Spain. We describe the consecutive substitution of both lungs, with no need for extracorporeal circulation in most cases. Sequential bilateral lung transplantation combines the advantages of single-lung transplantation with the use of anterior thoracoesternotomy to provide good access to both pleural cavities, facilitating the procedure when pleural adhesion is present.

[Wunderlich syndrome secondary to the rupture of an aneurysm of the renal artery. Review of the literature]. / Síndrome de Wunderlich secundario a rotura de aneurisma de la arteria renal. Revisión de la literatura.

We report a case of Wunderlich's syndrome secondary to spontaneous rupture of a renal artery aneurysm. Wunderlich's syndrome, also called spontaneous perirenal hematoma, may arise from several causes, the most common being renal tumors, particularly angiomyolipoma and hypernephroma. Spontaneous perirenal hematoma secondary to a ruptured renal artery aneurysm is rare and very few cases have been reported in the literature. We discuss the usefulness of the different noninvasive imaging techniques (US, CT and arteriography), our therapeutic approach and those advocated by others.

[First infantile liver transplants in Spain]. / Primeros trasplantes hepáticos infantiles en España.

For the first time in Spain, authors report the experience, started by the Hospital Infantil "Valle de Hebron" of Barcelona on pediatric liver transplant in terminal liver disease in childhood which means a new opportunity for these patients otherwise facing a fatal out come in a short time. We show the 4 first pediatric liver transplants performed in our country and we point out some of the most important factors of a pediatric liver transplant program in a consolidation phase.