Osteoclastoid giant cell carcinoma of the pancreas.

Osteoclastoid (osteoclast-like) giant cell carcinoma of the pancreas is an infrequent entity. There has long been discussion concerning its epithelial or mesenchymal origin. Whether its prognosis is better than that of other exocrine tumours of the pancreas has not yet been established. We present a case of this rare entity. The patient has remained disease-free now for 30 months.

Agenesis of the gallbladder confirmed by nuclear magnetic resonance cholangiogram.

We present a case of gallbladder agenesis, an uncommon bile duct malformation, which was found on attempting to perform a laparoscopic cholecystectomy. The diagnosis was confirmed postoperatively on a nuclear magnetic resonance cholangiogram.

[Left paramesocolic hernia with retroperitoneal incarceration of jejunum]. / Incarceración retroperitoneal del yeyuno en una hernia paramesocólica izquierda.

We present a case left paramesocolic hernia and review the literature. The patients was a 14 years old male and had suffered periods of relapses into abdominal pain from the age of three. When for years old he was operated on using the Nisses technique. Also a laparoscopy had already been performed on this same patient when he was 13 years old, without discovering any pathological conditions. In a new upper gastrointestinal serie, realized one year later, a retroperitoneal incarceration and a paraduodenal loop of jejunum was observed, which obstructed, partially the second part of the duodenum. We have not found the anatomical characteristics of this case in any previous report. In the ample literature pressured, it was confirmed that almost all the clinical cases, previously published had suffered a relapse abdominal pain crisis, diagnosed in advanced states and in/or emergency situations. This produces a mortality rate higher than 20% and or irreparable digestive damage. In cases involving paraduodenal hernias, there exists a low rate of diagnostic suspicion. These delays and diagnostic errors cause irreparable damage. In those patients who suffer relapses into abdominal pain syndrome, one should always include the differential diagnosis of PMH, applying a complete gastrointestinal serie or a CT-Scan with contrast.

Liver lipid composition and intravenous, intraperitoneal, and enteral administration of intralipid.

We studied the variations arising in plasma and liver lipids after intravenous (i.v.), intraperitoneal (IP), and intragastric (IG) administration of a fat overdose on the order of 4 g.kg-1 body wt.day-1 in the form of Intralipid (ITL) 20% to 33 New Zealand rabbits for 15 days. The control group was submitted for surgery but did not receive an ITL supplement. The results show weight gain in all animals and normal liver enzyme values. There was an increase in plasma lipids in groups supplemented by the parenteral route (i.v. and IP), and fatty acids showed a similar distribution, in terms of percentages, to that for ITL. In liver tissue, there was an increase in the fractions related to ethanolamine and a decrease in phospholipids of choline and serine. In the i.v. group, neutral lipids predominated compared with other groups. The livers of all supplemented animals (i.v., IP, and IG) showed a higher content of stearic and linoleic acid and a reduction in oleic acid. Study with optical microscopy showed a microvacuolization affecting the three areas of the hepatic acini in the i.v. group, seen with electron microscopy as vacuoles lacking membranes and surrounded by mitochondria. In conclusion, there is an increase in hepatic steatosis in parenteral groups and a greater deposit of neutral lipids in the i.v. group, related to the administration route, without biochemical signs of liver dysfunction.

[Parenteral nutrition-associated cholestasis: the effect of diets free of taurine and its metabolic precursors on bile composition and liver structure]. / Colestasis asociada a nutrición parenteral: influencia de las dietas exentas de taurina y de sus precursores metabólicos sobre la composición biliar y la estructura hepática.

PURPOSE: To study the morphological and biliary alterations associated with taurine-free parenteral nutrition and its other precursors. EXPERIMENTAL GROUPS: One fed a standard taurine-free amino acid formula, a group fed without taurine or its metabolic precursors, and a control group. At the beginning and end of the experiment, analyses were made of nutritional parameters, hepatic enzymes, biliary composition, plasmatic aminogram and optical and electronic microscopy of the liver. RESULTS: Significant increases of threonine, glutamine, alanine, lysine, histidine and arginine, and insignificant increases of taurine, serine, isoleucine and leucine in groups with PN. Increased Non-conjugated AB, particularly lithocholic and taurolithocholic acid in groups without taurine precursors. Fat microsteatosis in area 3 of the acinus in the group without taurine, and in the three areas in the group without precursors. Standard taurine-free PN causes changes in the biliary composition and liver histology, which increase in the absence of taurine precursors.

[Intrahepatic cholestasis associated with parenteral nutrition: an experimental study in rats]. / Colestasis intrahepática asociada a nutrición parenteral: estudio experimental en ratas.

Intrahepatic cholestasis is a condition often observed in patients receiving parenteral nutrition, especially in new born babies who are underweight (< 1,000 g.) Some authors find an alteration in the amino acids transulphuration passage, which gives rise to a deficit of taurina. This makes it impossible to achieve a correct conjugation of toxic biliary acids. The access of nutrients to the liver may have an effect on this. An experimental study on rats was performed, administering an oral diet at the expense of lipids (20% Intralipid, 60% of caloric needs) and glucose (40% of caloric needs) in one group, another group received amino acid supplements to this diet (16N) at a proteic rate of 2 gr/kg of weight and day orally, with an identical diet to the above, except that the proteic intake was intraperitoneal. Two control groups were established. We found a microvacuolization in hepatic fat with the help of an electronic microscope in the groups lacking proteins and those with oral or intraperitoneal supplements of amino acids, as well as an increase in plasmatic AST.