Manejo del quiste hidatídico en centro con alta prevalencia. Serie descriptiva / Management of a hydatid cyst in a center with high prevalence. Descriptive series

Hydatidosis is a zoonosis caused by the larval stage of the genus Echinococcus. Humans are an accidental intermediate host. The main organ affected is the liver (70%). The incidence increases in endemic regions such as North Africa, Eastern Europe and South America. We present a descriptive series of cases treated in our hospital in the last 5 years. Demographic variables, cyst characteristics, as well as preoperative and postoperative variables are collected.(AU)

Management of a hydatid cyst in a center with high prevalence. Descriptive series.

Hydatidosis is a zoonosis caused by the larval stage of the genus Echinococcus. Humans are an accidental intermediate host. The main organ affected is the liver (70%). The incidence increases in endemic regions such as North Africa, Eastern Europe and South America. We present a descriptive series of cases treated in our hospital in the last 5 years. Demographic variables, cyst characteristics, as well as preoperative and postoperative variables are collected.

Peritoneal tuberculosis mimicking colonic carcinomatosis.

Pulmonary Tuberculosis (TB) has increased in Spain in recent years due to multiple factors. Peritoneal tuberculosis represents the sixth cause of extrapulmonary tuberculosis, accounting for 11% of tuberculosis cases. We report a 28-year-old male from Mali, who arrived at our hospital with an acute abdomen due to intestinal perforation with a computed tomography scan (CT) performed peritoneal tuberculosis mimicking primary carcinomatosis. This presents a diagnostic and therapeutic challenge, since the surgical approach differs in both cases, and the prognosis is very different between them.

Monitoreo continuo de glucosa durante la gestación en pacientes con diabetes mellitus tipo 2 pregestacional

La diabetes pregestacional requiere un control glicémico estricto durante el embarazo. Los dispositivos de monitoreo continuo de glucosa (MCG) miden niveles de glucosa intersticial sin necesidad de punción capilar. Se estudió 4 gestantes con diabetes mellitus tipo 2 pregestacional con la ayuda del MCG durante 2 semanas de su gestación. Ellas tuvieron sesiones nutricionales semanales y controles médicos con un endocrinólogo. El promedio de nivel de glucosa osciló entre 82 y 171 mg/dL. El MCG permitió cambios tempranos en el tratamiento de una paciente con hipoglicemia. Todas las pacientes manifestaron que el MCG les ayudó en la selección de sus alimentos. En conclusión, el MCG ayudó en el reconocimiento de carbohidratos y en el reajuste del tratamiento. El MCG tuvo buena aceptación de su uso.

Pregestational diabetes requires strict glycemic control during pregnancy. Continuous glucose monitoring (CGM) devices measure interstitial glucose levels without the need for capillary puncture. Four pregnant women with pregestational type 2 diabetes mellitus were studied with the aid of CGM during 2 weeks of their gestation. They had weekly nutritional sessions and medical controls with an endocrinologist. The average glucose level ranged from 82 to 171 mg/dL. The CGM allowed early changes in the treatment of one patient with hypoglycemia. All patients stated that the GCM helped them in their food selection. In conclusion, the GCM helped in carbohydrate recognition and treatment readjustment. The CGM was well accepted for use.

Giant cavernous mesenteric lymphangioma in an adult.

We report the exceptional case of a 71-year-old patient with a giant mesenteric mass causing mass effect, dyspnea and abdominal pain. After surgical resection and histopathological analysis of the specimen, the result was a cavernous lymphangioma, an unusual diagnosis due to both the location and age of presentation.

Myolipoma of the round ligament of the liver: a diagnosis to be considered.

A 39-year-old patient consulted for an incidental finding of a mesenteric-epiploic mass measuring 11x6x9.5 cm. Laparoscopic excision of the lesion and cholecystectomy were indicated, revealing a myolipomatous mesenchymal neoplasm in the hepatic round ligament.

Emphysematous hepatitis: a very rare entity with a poor prognosis.

A 67-year-old female, with no alterations in glucose metabolism or other relevant history, presented to the Emergency Department due to abdominal pain and vomiting after a syncopal episode. Physical examination revealed a poor general condition, mild stupor and a distended abdomen, painful on palpation in the right hypochondrium, with localized rigidity. On arrival at the Emergency Department, the patient's blood pressure (BP) was 150/66 mmHg, heart rate (HR) was 110 beats/minute and temperature 35 °C.

Filariasis mamaria / Breast filariasis

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Síndrome de Lynch: genética y cirugía / Lynch syndrome: genetics and surgery

El cáncer colorrectal hereditario no polipósico o síndrome de Lynch, causado por mutaciones germinales en genes reparadores de bases desapareadas de ácido desoxirribonucleico (ADN), es la forma más frecuente de cáncer colorrectal hereditario. La identificación de estos individuos no es fácil y se basa en criterios clínicos y moleculares. Se expone a continuación una revisión sobre genética y diagnóstico en el síndrome de Lynch, así como sobre su manejo quirúrgico y prevención (AU)

Hereditary nonpolyposis colorectal cancer or Lynch Syndrome, caused by germinal mutations in mismatch deoxyribonucleic acid (DNA) repair genes, is the most common form of hereditary colorectal cancer. The identification of these individuals is not easy and is based on clinical and molecular criteria. A review is presented on the genetics and diagnosis in Lynch Syndrome, as well as on its surgical management and prevention (AU)

[Lynch syndrome: genetics and surgery]. / Síndrome de Lynch: genética y cirugía.

Hereditary nonpolyposis colorectal cancer or Lynch Syndrome, caused by germinal mutations in mismatch deoxyribonucleic acid (DNA) repair genes, is the most common form of hereditary colorectal cancer. The identification of these individuals is not easy and is based on clinical and molecular criteria. A review is presented on the genetics and diagnosis in Lynch Syndrome, as well as on its surgical management and prevention.

Gastric leak after laparoscopic sleeve gastrectomy.

Sleeve gastrectomy is a recently developed technique for treating morbid obesity. Since it is a simple procedure, the number of surgeons using it has grown in recent years. The patients who present fistulas after surgery often undergo a harrowing postoperative period as well as increased morbidity and mortality. Our aim was to assess the incidence, causes, diagnosis, management, and prevention of leaks after sleeve gastrectomy.

Influencia de la cirugía bariátrica en esteatosis hepática no alcohólica. Evaluación histológica / Influence of bariatric surgery on the non-alcoholic liver steatosis. A histological evaluation

Introducción El hígado graso no alcohólico (HGNA) presenta una alta prevalencia entre los pacientes obesos. Él objetivo de este estudio es conocer la evolución de las lesiones histológicas de estos pacientes a los que se trata mediante derivación biliopancreática. Material y métodos Se intervino de cirugía bariátrica a 76 pacientes obesos en los que se realizó una biopsia hepática. Entre los 12 y 24 meses tras la cirugía se volvió a obtener una nueva biopsia hepática en 39 de ellos. Se analizaron variables clínicas y analíticas en el momento de la intervención y a los 18 meses. Resultados Sesenta y siete pacientes (88,1%) presentaban HGNA en el momento de la intervención. Cuarenta y un pacientes (61,2%) tenían esteatosis simple y 26 pacientes (38,8%) tenían esteatohepatitis no alcohólica (EHNA). Durante el seguimiento se observó una mejoría tanto de la enfermedad asociada como de las evaluaciones analíticas. En la segunda biopsia realizada en 39 pacientes se observó una mejoría importante tanto en el grado de esteatosis como en la EHNA. Ningún paciente mostró empeoramiento de las lesiones .Conclusiones El HGNA presenta una alta prevalencia entre los pacientes obesos. La cirugía bariátrica (Scopinaro) induce una pérdida de peso que se asocia a una mejoría de la enfermedad asociada a la obesidad, así como un descenso significativo de los valores de los parámetros de función hepática. Tras la pérdida de peso, casi la totalidad de estos pacientes presentaron mejoría de las lesiones histológicas hepáticas, y destacó que la EHNA desapareció en el 85% de ellos (AU)

Introduction Non-alcoholic fatty liver (NAFL) is highly prevalent in obese patients. The aim of this study is to look at the development of the histological lesions in these patients that we treated using biliopancreatic diversion. Material and methods A liver biopsy was performed on 76 obese patients who were operated on using bariatric surgery. Another liver biopsy was performed on 39 of them between 12 and 24 months after the surgery. The clinical and analytical variables at the time of the surgery, and at 18 months were analysed. Results A total of 67 patients (88.1%) had NAFL at the time of the operation. Simple steatosis was seen in 41 (61.2%) patients and 26 (38.8%) had non-alcoholic steatohepatitis (NASH). An improvement was seen in both the associated pathology and the analytical evaluations. A significant improvement was observed in the degree of steatosis as well as the NASH in the second biopsy performed on 39 patients. There were no deteriorations in the lesions in any of the patients. Conclusions There is a high prevalence of NAFL among obese patients. Bariatric surgery (Scopinaro) leads to weight loss which is associated to an improvement in the pathology associated with obesity, as well as a significant decrease in the liver function values. After weight loss, almost all our patients showed an improvement in the histological hepatic lesions, and in particular, that NASH disappeared in 85% of them (AU)

[Influence of bariatric surgery on the non-alcoholic liver steatosis. A histological evaluation]. / Influencia de la cirugía bariátrica en esteatosis hepática no alcohólica. Evaluación histológica.

INTRODUCTION: Non-alcoholic fatty liver (NAFL) is highly prevalent in obese patients. The aim of this study is to look at the development of the histological lesions in these patients that we treated using biliopancreatic diversion. MATERIAL AND METHODS: A liver biopsy was performed on 76 obese patients who were operated on using bariatric surgery. Another liver biopsy was performed on 39 of them between 12 and 24 months after the surgery. The clinical and analytical variables at the time of the surgery, and at 18 months were analysed. RESULTS: A total of 67 patients (88.1%) had NAFL at the time of the operation. Simple steatosis was seen in 41 (61.2%) patients and 26 (38.8%) had non-alcoholic steatohepatitis (NASH). An improvement was seen in both the associated pathology and the analytical evaluations. A significant improvement was observed in the degree of steatosis as well as the NASH in the second biopsy performed on 39 patients. There were no deteriorations in the lesions in any of the patients. CONCLUSIONS: There is a high prevalence of NAFL among obese patients. Bariatric surgery (Scopinaro) leads to weight loss which is associated to an improvement in the pathology associated with obesity, as well as a significant decrease in the liver function values. After weight loss, almost all our patients showed an improvement in the histological hepatic lesions, and in particular, that NASH disappeared in 85% of them.

[Prevalence and associated factors to non-alcoholic steatohepatitis in obese patients subjected to bariatric surgery]. / Prevalencia y factores asociados a la esteatohepatitis no alcohólica en pacientes obesos sometidos a cirugía bariátrica.

INTRODUCTION: Non-alcoholic fatty liver disease has a high prevalence among obese patients. It has been difficult to identify clear predictors of chronic liver damage, which could help in selecting patients for liver biopsy and therapeutic options. The aim of the study is to describe the liver damage in these obese patients and identify predictors of liver damage progression. PATIENTS AND METHOD: 76 obese patients submitted to bariatric surgery were included. Liver biopsies were taken at the time at the time of the surgery. Clinical and biochemical variables were analyzed. RESULTS: 67 patients (88.1%) were found to have non-alcoholic fatty liver disease; 41 (61.2%) had simple steatosis, and 26 (38.8%) had non-alcoholic steatohepatitis. Patients with non-alcoholic steatohepatitis had significantly higher values of GGT. Non-alcoholic steatohepatitis was associated with diabetes (p < 0.01) in these patients. CONCLUSIONS: Non-alcoholic fatty liver disease is highly prevalent in morbidly obese patients. Non- alcoholic steatohepatitis seems to be associated with diabetes and high values of GGT in obese patients.