[Hepatocellular carcinoma as an incidental hepatic finding: approach to incidental focal hepatic lesions]. / Carcinoma hepatocelular como incidentaloma hepático: actitud frente a la lesión focal hepática incidental.

Nowadays incidental focal hepatic lesions are detected rather frequently by abdominal imaging. A 12 cm diameter liver mass was incidentally found in an abdominal ultrasound in a 26 years old man. Despite an extensive diagnostic workup, the diagnosis of hepatocellular carcinoma could only be attained through the histological study of the surgical specimen. Differential diagnosis of a focal hepatic lesion is reviewed. Radiological assessment and biopsy procedures should follow a protocol. Where doubt exists about the presence of malignancy after fulfilling the diagnostic protocol we believe that it is justified to remove the lesion. This policy allowed to treat successfully our patient. Hepatocellular carcinoma in noncirrhotic occurs much less frequently than in cirrhotic liver, and moreover, it is specially rare to find at such a young age a non fibrolamellar hepatocarcinoma non associated with cirrhosis or a chronic viral infection. Diagnosis, treatment and prognosis of hepatocellular carcinoma are reviewed.

[Liver damage due to normothermic ischemia and reperfusion in the rat. The effects of pentoxifylline pretreatment]. / Daño hepático por isquemia normotérmica y reperfusión en la rata. Efectos del pretratamiento con pentoxifilina.

The effect of pretreatment with pentoxifylline on normothermic liver ischemia was studied in rats. This drug, a dimethylxanthine and fosfodiesterase inhibitor, improves microcirculation, decreases neutrophil activity in experimental sepsis and hemorrhagic shock, and inhibits "in vitro" cytokine production by isolated Kupffer cells. Partial liver ischemia was induced by occlusion of afferent vessels to the median and left lateral lobes for 60', followed by resection of nonischemic lobes just before reperfusion. The rats were divided in 4 groups: I (n = 6) sham operation, II (n = 6) resection of right and caudate lobes, III (n = 42) normal saline pretreatment and 60' ischemia, IV (n = 42) pentoxyfilline pretreatment (50mg/K/i.p. 2 h before clamping) and 60' ischemia. 12 animals were sacrificed 1 h and 6 h after reperfusion respectively (gr III and IV), and 20 rats were observed for a maximum of 24 h after reperfusion. Serum transaminases, LDH, CK (isoenzymes), bilirubin, and total bile acids were determined in each animal. A sample of the left lobe was taken for histological examination. Extent of necrosis 24 h after reperfusion was assessed. Bile output was measured before ischemia and during the first hour of reperfusion. Pentoxifylline pretreatment was associated with a lower rise in serum transaminases and LDH after reperfusion, but it did not modify the changes in either serum CK activity (mainly CKBB), or total bile acid concentration. A reduction of bile output was not avoided by pentoxifylline pretreatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Colorectal carcinoma. Multifactorial analysis of prognostic factors following curative resection]. / Carcinoma colorrectal. Análisis multifactorial de factores pronósticos tras resección curativa.

Cox regression analysis was used in the study of 151 cases of surgically treated colorrectal carcinoma. A "curative" resection was performed in all of them. Clinical data from medical records, histology, biochemical determinations, and intraoperative findings were assessed. Four of the studied variables were significantly related to tumor recurrence: Dukes stage, tumor spread, histological variety and preoperative CEA level. Age, sex, tumor location, surgical technique, lymphocytes in the peripheral blood, preoperative levels of acute phase reactants and hepatic enzymes did not provide information about the final outcome of these patients. An index of prognosis was statistically obtained in order to identify a high risk of recurrence group of patients, who may benefit from adjuvant therapy.

[Acute pancreatitis and afferent loop syndrome]. / Pancreatitis aguda y síndrome de asa aferente.

A new case of afferent loop obstruction presenting as acute pancreatitis is described. It is an uncommon manifestation of the afferent loop syndrome: less than 20 cases found in the literature. The diagnosis of afferent loop obstruction should be suspected in any patient with acute pancreatitis and a previous Billroth II gastrectomy. Duodenopancreatic reflux seems to play an important role in the pathogenesis of acute pancreatitis in this situation. The "closed duodenal loop" experimental model of acute pancreatitis simulates quite closely this clinical situation. The physiopathological principles, diagnosis and treatment of this syndrome is reviewed.

[Liver transplant in fibrolamellar hepatocarcinoma: apropos of a case. Review of the literature]. / Trasplante hepático en hepatocarcinoma fibrolamelar: a propósito de un caso. Revisión de la literatura.

A case is presented of fibrolamellar hepatocarcinoma in a 12 year-old male treated by liver transplantation; there is no evidence of tumoral recurrence at 28 months. Donos and receptor were ABO incompatible. The immunosuppressive regimen used was cyclosporine A and low doses of steroids. Fibrolamellar hepatocarcinoma is an infrequent histologic variety that usually affects young people and is generally not associated with hepatitis B infection or cirrhosis. It is often a single tumor, is more susceptible to surgical resection than other varieties of hepatocarcinoma, and is characterized by a relatively unagressive tumoral biology.