Multiple synchronous adenocarcinomas of the small bowel in a young patient: A case report.

INTRODUCTION: Adenocarcinoma of the small bowel is a rare neoplasm presented usually in elder patients as a single tumor. Its presentation as multiple tumors and in young patients is exceptional and there aren't any guidelines to orient its therapy. PRESENTATION OF CASE: We present the rare case of a sixteen-year-old woman that presents to the emergency department with an intussusception due to a small bowel tumor. The resected specimen showed multiple adenocarcinomas. A complete endoscopic and PET-CT study showed other 5 lesions from the duodenum to the ileum that were resected. Genetic counseling showed no pathogenic changes. The final staging was T2N0M0 and only surveillance was indicated. The patient is now 3 years without any recurrence. DISCUSSION: Multiple adenocarcinomas of the small bowel are a very infrequent presentation of the disease. Most common risk factors include Crohn disease and adenomas. Its presentation is usually vague with a delay in its diagnosis. The treatment remains mainly surgical with limited use of adjuvant therapy. The most important prognostic factor is lymph node involvement with 5-year survival that can range from 3%-60% depending on the stage. CONCLUSION: This case represents an exceptional presentation of a very rare pathology with few cases described in the literature. There isn't one single best study to stage the patient and surgery is still the standard of treatment while adjuvant therapies studies are being conducted. The young age and lack of predisposing factors or mutations leaves an open field for investigation.

Thiazolidinediones and risk of repeat target vessel revascularization following percutaneous coronary intervention: a meta-analysis.

OBJECTIVE: Thiazolidinediones (TZDs) (rosiglitazone and pioglitazone) are a class of antidiabetes agents that have a high affinity for peroxisome proliferator-activated receptor-gamma. TZDs initiate a multitude of physiologic processes that may elicit benefits as systemic agents for the prevention of restenosis requiring revascularization following percutaneous coronary intervention (PCI). Numerous trials have evaluated the impact of TZDs on repeat target vessel revascularization (TVR) in patients following PCI; however, several limitations (small sample size, inconclusive results, and risk factor stratification) complicate definitive conclusions. A meta-analysis was performed to evaluate the impact of TZDs on repeat TVR following PCI. RESEARCH DESIGN AND METHODS: Included trials met the following criteria: 1) prospective, randomized controlled trials evaluating available TZDs versus standards of care; 2) well-described protocol; 3) minimum of 6 months of follow-up; and 4) data provided on repeat TVR. Data are presented as relative risks (RRs) with 95% CIs. RESULTS: Seven clinical trials (n = 608) met the inclusion criteria. Upon meta-analysis, the risk of repeat TVR was significantly reduced in patients who received TZD therapy compared with standards of care (RR 0.35 [95% CI 0.22-0.57]). In studies using rosiglitazone (0.45 [0.25-0.83]) and pioglitazone (0.24 [0.11-0.51]), risk of repeat TVR was significantly reduced. Risk of repeat TVR was also significantly reduced among patients with (0.34 [0.19-0.63]) and without (0.37 [0.18-0.77]) diabetes. CONCLUSIONS: Results from this meta-analysis suggest that TZDs effectively reduce the risk of repeat TVR following PCI.

[Liver transplantation in adults: a caseload from Clínica Alemana de Santiago, Chile]. / Trasplante hepático en adultos: casuística de Clínica Alemana de Santiago.

BACKGROUND: The success of orthotopic liver transplantation (OLT) has resulted in its widespread use for different liver diseases. AIM: To report our 8 years experience with adult OLT at Clinica Alemana de Santiago. PATIENTS AND METHODS: In all transplantations done at the center, we recorded patient's overall data and survival, postoperative medical and surgical complications and causes of death. RESULTS: Between November 1993 and September 2001, 51 consecutive OLT were performed in 44 patients (22 females, median age 45 years old). Thirty eight patients presented with chronic and 6 with acute or sub-acute liver failure. Cryptogenic cirrhosis and hepatitis C infection were the most common causes for OLT. Postoperative bleeding and extrahepatic biliary complications were seen in 17.6 and 21.5% of cases respectively. Acute rejection, bacterial infections, CMV infection or disease and post OLT hemodialysis were the most common medical complications (51, 31, 19.6 and 19.6% of cases respectively). The overall 1 and 5 years survival rates were 80% and 73% respectively. Considering exclusively the last 22 OLT performed since January 1999, the 1 year survival rate has improved to 91%. CONCLUSIONS: Liver transplantation in Chile provides a good long term survival with acceptable morbidity, due to a multidisciplinary approach management. The survival rates have improved over the last few years probably due to better surgical techniques, ICU care and immunosuppression. These overall results are comparable with those from other Centers in developed countries.

Pancreatitis aguda en el servicio de urgencia del Hospital San Juan de Dios (1994-1999) / Acute pancreatitis al the emergency service in San Juan de Dios Hospital

Se analizan las fichas clínicas de 78 pacientes con diagnóstico de egreso de pancreatitis aguda provenientes del Servicio de Urgencia del Hospital San juan de Dios. La pancreatitis aguda se confirmó en 61 casos. El 54 por ciento de los pacientes eran hombres y el grupo etario más afectado fue el comprendido entre los 20 y 40 años. En un 39.3 por ciento el diagnóstico de pancreatitis aguda se planteó al ingresar al Servicio de Urgencia. En el 45 por ciento de los casos la pancreatitis fue severa. El 26 por ciento de los pacientes que consultaron después de 24 horas de iniciado los síntomas tuvieron una pancreatitis aguda severa. Se observó que el 65 por ciento de los pacientes requirió de una hospitalización de más de 10 días y que un 13 por ciento de ellos fallecieron. Se concluye que, en la serie revisada, la pancreatitis aguda se presenta como una patología que afecta principalmente a gente jóven, se asocia en forma importante a complicaciones locales y/o sistémicas; que a pesar del manejo terapéutico, el porcentaje de muertes es elevado

Tratamiento quirúrgico del dolor refractario en la pancreatitis crónica: presentación de un caso clínico y revisión bibliográfica del tema / Surgical treatment of refractory pain in chronic pancreatitis: clinical case and literature review

Se presenta un caso clínico de una paciente de dieciocho años, portadora de una pancreatitis crónica, cuyo dolor fue refractario al tratamiento médico por lo que debió manejarse quirúrgicamente practicándose la operación de Puestow modificada con buena respuesta clínica. Se analizarán los aspectos teóricos de la fisiopatología del dolor en la pancreatitis crónica abordándola principalmente desde el punto de vista del síndrome compartamental, para explicar la utilidad del manejo quirúrgico. Junto a lo anterior se revisan los distintos tipos de manejo terapéuticos existentes, haciendo hincapié en los quirúrgicos entre los cuales se señalan los procedimientos derivativos, resectivos y de denervación quirúrgica