Giant mesenteric fibromatosis associated with non-Hodgkin lymphoma. A case report and literature review.

BACKGROUND: Mesenteric fibromatosis is a benign locally-aggressive mesenchymal neoplasm that lacks the potential for metastasis. It is related to Gardner's Syndrome, previous trauma, abdominal surgery, and prolonged intake of oestrogen. Differentially diagnosing this from similar tumours is crucial in order for establishing the appropriate treatment and only immunohistochemical features can be used for a definitive diagnosis. Although medical therapies play a role in the treatment of mesenteric fibromatosis, surgical resection is the gold-standard procedure. METHODS: Our case study is a 40-year-old male with a concomitant diagnosis of non-Hodgkin lymphoma and mesenteric fibromatosis, not associated with any of the risk factors mentioned above. We performed CT and PET scans and observed a vascularised and well-defined mesenteric centre-abdominal hypermetabolic solid mass in contact with the gastric body, duodenum, body and tail of the pancreas, transverse colon, and spleen. An ultrasound-guided tru-cut biopsy revealed features suggestive of mesenteric fibromatosis. RESULTS: An elective laparotomy was carried out and a giant mass, arising from mesentery, was excised, including a partial gastrectomy and segmental resection of the transverse colon. Distal pancreatectomy, small bowel resection and successive splenectomy were performed due to a large hypertensive component. The postoperative period was uneventful. The histopathology of the surgical pieces was compatible with intra-abdominal desmoid fibromatosis. CONCLUSION: As far as we know from the literature, this is the largest mesenteric fibromatosis tumour ever to be excised. We also noticed that this is the first reported case of the concomitant presence of mesenteric fibromatosis and non-Hodgkin lymphoma that is not related to any of the described risk factors. Further research is needed to establish what type of association this presentation may indicate.

Right colonic interposition for severe pharyngoesophageal stricture in head and neck patients: A feasible rescue strategy after multiple failed reconstructive options.

Severe pharyngeal stricture is an uncommon complication that may occur afer laryngectomy especially in irradiated patients. Its management is a challenge and high risk of recurrence after reconstruction exists. We present two patients with severe end-stage pharyngoesophageal stricture after several failed attempts of reconstruction with regional and free flaps, in which a right colon transposition was performed. Twenty days after surgery both patients were able to tolerate an oral diet, and no minor or major complications were observed. Right colonic transposition may be a valid option for secondary pharyngeal reconstruction if other less invasive methods such as regional or free flaps have failed to restore the pharyngoesophageal continuity or if the inferior location of stricture makes a tension free anastomosis impossible.

Masa retroperitoneal gigante en el tumor periférico de la vaina neural asociado a neurofibromatosis tipo 1. Reporte de un caso y revisión de la literatura / Giant retroperitoneal mass in peripheral neural sheath tumor associated with neurofibromatosis type 1. Case report and review of the literature

Los tumores malignos de vaina neural periférica (MPNST) se observan con mayor frecuencia en pacientes con neurofibromatosis tipo 1 (NF-1), presentando un crecimiento rápido y unas tasas de supervivencia a los 5 años alrededor del 33%. Presentamos el caso de un varón de 17 años afecto de NF-1 con un MPNST retroperitoneal gigante sometido a tratamiento quirúrgico radical, con recidiva tumoral precoz

Malignant peripheral nerve sheath tumors (MPNST) are most frequently in patients with neurofibromatosis type 1 (NF-1), with a rapid growth and 5-years survival rates around 33%. We present the case of a 17 years old male with NF-1 and a giant retroperi-toneal MPNST who undergoes a radical surgical treatment, with early tumor recurrence

Laparoscopic surgery into mixed hiatal hernia. Results pre-operative and post-operative.

INTRODUCTION: The complications of the mixed hernia need, often, surgical treatment. In the asymtomatic patients this one treatment is controversial, due to her complex repair and the high percentage of relapse informed in the long term. The surgical classic routes, they present raised morbi-mortality related to the extent of the incisions, to long hospitable stays and slow recovery. MATERIAL AND METHODS: Between October, 2001 to November, 2007 we check 39 patients with hernia hiatal mixed with a middle ages of 65 years (35-78 years). In Lloyd-Davies s position, the content diminishes hernia and the redundant sack is resected. The diaphragmatic props are sutured by material not reabsorbable. Mesh of reinforcement intervened in 7/39 repairs. It concludes with a partial or complete antirreflux depending on the report. RESULTS: The operative average time was of 126 min; the hospital stay of 2.46 days. The complications perioperatives are principally cardiorespiratory. A patient died for an intestinal inadvertent perforation during the intervention and of late diagnosis. We realize traffic gastroduodenal to 12 months in 28 patients (71.7%). We find relapse in 8 patients (20.5%). Four asymtomatic patients, with chance find in the radiological control. Three patients with pirosis that needs treatment and one of the relapses needed reintervention for strangulation of a gastric volvulus. CONCLUSIONS: The laparoscopic surgery offers safety and efficiency with rapid postoperatory recovery, minor morbidity and hospitable stay. After the surgery, the long-term relapse presents similar results to the opened surgery, though the interposition of mesh can propitiate her decrease.

Tratamiento quirúrgico laparoscópico en la hernia de hiato mixta. Resultados peroperatorios y del seguimiento a medio plazo / Laparoscopic surgery into mixed hiatal hernia. Results pre-operative and post-operative

Introducción: las complicaciones de la hernia mixta requieren,con frecuencia, tratamiento quirúrgico. En los pacientes asintomáticoseste tratamiento es controvertido, debido a su complejareparación y al elevado porcentaje de recidivas informado a largoplazo. Las vías quirúrgicas clásicas presentan elevada morbimortalidadrelacionada con la amplitud de las incisiones, con largas estanciashospitalarias y lenta recuperación.Material y métodos: entre octubre de 2001 a noviembre de2007 revisamos 39 pacientes con hernia hiatal mixta con unaedad media de 65 años (35-78 años). En posición de Lloyd-Davies,se reduce el contenido herniario y se reseca el saco redundante.Se suturan los pilares diafragmáticos con material no reabsorbible.Se interpuso malla de refuerzo en 7/39 reparaciones. Sefinaliza con un antirreflujo parcial o completo dependiendo del informemanométrico.Resultados: el tiempo operatorio medio fue de 126 min. Laestancia hospitalaria de 2,46 días. Las complicaciones perioperatoriasson principalmente cardiorrespiratorias. Un paciente falleciópor una perforación intestinal inadvertida durante la intervencióny de diagnóstico tardío. Realizamos tránsito gastroduodenal alos 12 meses en 28 pacientes (71,7%). Encontramos recidiva en8 pacientes (20,5%). Cuatro pacientes asintomáticos, con hallaz-go casual en el control radiológico. Tres pacientes con pirosis querequiere tratamiento y una de las recidivas precisó reintervenciónpor estrangulación de un vólvulo gástrico.Conclusiones: la laparoscopia ofrece seguridad y eficacia conrápida recuperación postoperatoria, menor morbilidad y estanciahospitalaria. Tras la cirugía, la recidiva a largo plazo presenta similaresresultados a la cirugía abierta, aunque la interposición demalla puede propiciar su disminución(AU)

Introduction: the complications of the mixed hernia need, often,surgical treatment. In the asymtomatic patients this one treatmentis controversial, due to her complex repair and the high percentageof relapse informed in the long term. The surgical classicroutes, they present raised morbi-mortality related to the extent ofthe incisions, to long hospitable stays and slow recovery.Material and methods: between October, 2001 to November,2007 we check 39 patients with hernia hiatal mixed with amiddle ages of 65 years (35-78 years). In Lloyd-Davies's position,the content diminishes hernia and the redundant sack is resected.The diaphragmatic props are sutured by material not reabsorbable.Mesh of reinforcement intervened in 7/39 repairs. Itconcludes with a partial or complete antirreflux depending on thereport.Results: the operative average time was of 126 min; the hospitalstay of 2.46 days. The complications perioperatives are principallycardiorespiratory. A patient died for an intestinal inadvertentperforation during the intervention and of late diagnosis. Werealize traffic gastroduodenal to 12 months in 28 patients(71.7%). We find relapse in 8 patients (20.5%). Four asymtomaticpatients, with chance find in the radiological control. Three patientswith pirosis that needs treatment and one of the relapsesneeded reintervention for strangulation of a gastric volvulus.Conclusions: the laparoscopic surgery offers safety and efficiencywith rapid postoperatory recovery, minor morbidity andhospitable stay. After the surgery, the long-term relapse presentssimilar results to the opened surgery, though the interposition ofmesh can propitiate her decrease(AU)

[Multivariate analysis of the risk of hemorrhagic recurrence in gastroduodenal ulcer. Study of a prospective series]. / Análisis multivariante del riesgo de recidiva hemorrágica en la úlcera gastroduodenal. Estudio de una serie prospectiva.

AIM: To construct a model to enable calculation of rebleeding risk in patients admitted to a hospital emergency department with upper gastrointestinal bleeding secondary to a gastric or duodenal ulcer. METHODS: We analyzed 317 patients admitted during a 13-month period with an episode of upper gastrointestinal bleeding secondary to a gastroduodenal ulcer. The patients were followed-up for 30 days after discharge. Uni- and multivariate analysis of the clinical and endoscopic variables was performed on variables that could be associated with an increased risk of rebleeding. RESULTS: In the univariate analysis the following variables were significantly associated with an increased risk of rebleeding: the presence of blood in the endoscopically examined tract (p < 0.0001), clean ulcer base (p < 0.0001), low blood flow (p < 0.047) and size of the ulcer > 2 cm (p < 0.004). Independent risk variables identified by multivariate logistic regression analysis were low cardiac output, the presence of blood in the endoscopically examined tract, size of the ulcer, and type of ulcer base. CONCLUSION: Patients with a clean ulcer base, smaller than 2 cm, without blood in the endoscopically examined tract and with stable hemodynamics were at very low risk of rebleeding and could be discharged directly from the emergency room.

La bupivacaína en el dolor postoperatorio de la herniorrafia inguinal / Bupivacaine in the management of postoperative pain associated with inguinal hernia repair

El control del dolor en el paciente operado se obtiene mediante la administración de distintos analgésicos no habiéndose modificado está conducta terapéutica en el tiempo. La anestesia local esta aceptada como parte del procedimiento de reparación de la hernia inguinal. Sin embargo, su uso para el tratamiento del dolor es una anécdota a pesar de tener una eficacia contrastada. Se revisan 68 pacientes con reparación de Shouldice a los que se practicó un bloqueo locorregional y se establecieron dos grupos dependiendo del tipo de infiltración: con suero fisiológico o con bupivacaína. Se cuantificó el dolor con una escala analógica visual a las 6 y 24 h de la intervención, estableciendo tres grupos dependiendo del nivel de dolor cuantificado y de las dosis de analgesia precisadas en las primeras 48 h. Se concluye que la infiltración con bupivacaína puede ser rutinaria en el tratamiento del dolor postoperatorio de la herniorrafia inguinal (AU)