Recurrent giant Brunner's gland adenoma.

Benign duodenal tumours are extremely rare, with an incidence of 0.008% among general population; those originating from Brunner's Gland represent 11% of this neoplasms. Most cases remain asymptomatic and are often diagnosed during routine endoscopic procedures, however their clinical presentation may be variable making resection treatment of choice in order to prevent complications. Recurrence has not been reported previously on literature. 59-year-old male presented to the emergency department nine months following endoscopic resection of a 2x1.5cm Brunner's gland adenoma complaining of bloating, weight loss and gastro intestinal bleeding, diagnostic approach revealed a 10x4cm mass occupying the duodenum. Tumour size did not allow for endoscopic resection and surgical removal was performed with excellent outcome and no further recurrence at 30 months.

Contrast-enhanced swallow study sensitivity for anastomotic leak detection in post-esophagectomy patients. / Sensibilidad del estudio contrastado para la detección de fuga de la anastomosis en pacientes post-esofagectomía.

INTRODUCTION AND AIMS: Esophagectomy is a highly invasive surgery and one of its postoperative complications is anastomotic leakage, occurring in 53% of cases. The aim of the present study was to determine the sensitivity of the contrast-enhanced swallow study as a method for diagnosing anastomotic leak in patients that underwent esophagectomy. MATERIAL AND METHODS: The present retrospective study included the case records of patients that underwent esophagectomy with reconstruction and cervical anastomosis at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán within the time frame of January 1, 2000 and May 31, 2016. Demographic, clinical, and laboratory data emphasizing clinical and radiographic anastomotic leak detection were identified. Descriptive statistics were carried out and contrast-enhanced swallow study sensitivity for diagnosing leakage was calculated. RESULTS: Seventy patients were included in the analysis. The mean age of the patients was 50.6 years, 51 of the patients were men (72.86%), and 19 were women (27.14%). Indications for surgery were benign lesion in 29 patients (41.4%) and malignant lesion in 41 (58.6%). A total of 44.3% of the patients presented with a comorbidity, with diabetes mellitus and high blood pressure standing out. Thirty patients (42.85%) presented with anastomotic leak. Contrast-enhanced swallow study sensitivity for leak detection was 43.33%. CONCLUSIONS: The diagnostic sensitivity of the contrast-enhanced swallow study was very low. Therefore, we recommend the discontinuation of its routine use as a method for diagnosing anastomotic leaks.

Clinicopathological characteristics of gastric carcinoma in young and elderly patients: a comparative study.

BACKGROUND: Gastric cancer is one of the most common gastrointestinal malignancies world-wide. Some studies have suggested that it has a worse prognosis in young than in elderly patients. METHODS: All young and elderly patients treated for gastric adenocarcinoma during the period 1988 to 1994 in a tertiary referral center in Mexico City were included. Demographic, clinical, and pathologic features of young patients (less than 40 years of age) with gastric cancer were compared with those of elderly patients (70 years of age or older) with the same diagnosis. Overall survival was the main outcome measure. RESULTS: There were 38 patients in each group. The mean age of the young and elderly groups was 33 and 77 years, respectively. Family history of gastric cancer was reported by 6 patients of the younger group and by 1 patient in the older group (P < .05). Most patients in both groups were symptomatic and had an advanced stage of the disease. With a mean follow-up of 17 months, the overall median survival for all patients was 12 months. By group, the median survival was 13 and 12 months for the young and elderly patients, respectively (P = .38). Variables with significant impact on survival were the stage of the disease, possibility of surgical resection, location of the tumor, and a family history of gastric cancer. CONCLUSIONS: Young patients represent a significant proportion of patients with gastric cancer in Hispanic populations. There were no significant differences in clinicopathological characteristics and outcome of gastric adenocarcinoma between young and elderly patients. Survival was determined by the stage of the tumor and the possibility of complete surgical resection.

[Giant acinic cell parotid gland adenocarcinoma of the papillary- cystic type]. / Adenocarcinoma gigante de células acinares de tipo quístico papilar en parótida.

A case of a 38-year-old male having an acinic cell adenocarcinoma of the parotid gland is reported. The tumor measured 22 cm and histologically it was of the papillary-cystic type. The following features were of interest: 1) the tumor size surpassed the size of previous reported acinic cell adenocarcinomas by 9 cm; and 2) the rarity of its histological variety (cystic papillary) demanded immunohistochemical and electron microscopic studies to confirm the diagnosis.

[Esophageal cancer]. / Cáncer de esófago.

Esophageal cancer is a pathology with a remarkable geographical variety, considered to be a disease of the poor. The common incidence reported in western countries of 3 per 100,000 per year, contrasts with 140 per 100,000 reported in Central Asia in an area that is known as the "esophageal cancer belt". Among a wide spectrum of potential etiologic agents, the use of alcohol and tobacco remain the most frequently reported. The most common pathologic type is squamous cell carcinoma, although is important to consider that in the past decades, a shift to adenocarcinoma has been consistently observed. This phenomenon might have an explanation in the inclusion of tumors of the cardia and the importance of metaplasic Barret's epithelium and gastroesophageal reflux. As it happens in the majority of gastrointestinal tumors, diagnosis is often done late in esophageal cancer. The most common presenting symptoms of esophageal cancer are dysphagia and weight loss. Others are, odynophagia, upper GI bleeding, hoarseness and respiratory symptoms. In patients with advanced disease, diagnostic studies are confirmatory in nature. The combined use of contrast esophagogram and endoscopy yield to a diagnostic accuracy above 95%. These studies have to be complimentary. Computed tomography is the best modality for staging tumors of the esophagus. Although its accuracy varies from one study to another, demonstration of disease beyond the esophagus precludes surgical treatment. Endoluminal ultrasound has assumed an important role as part of the staging studies, considered by some authors superior to CT scanning. Its use is not considered rutinary because of the difficulty on passing the instrument through an obstructive lesion, and to the fact that this technology is not widely available. In the majority of patients, surgical treatment is considered to be palliative, due to the presence of advanced disease at the time of diagnosis. From the multiple surgical options available, transhiatal esophagectomy without thoracotomy is one of the more widely accepted techniques. Controversy persists regarding the optimal surgical approach to the disease. It is well accepted that prognosis depends more in the biology of the tumor and the stage of the disease rather than the surgical procedure. Overall five year survival after esophageal resection is 20%, regardless of the surgical option. Other alternatives are standard transthoracic esophagectomy, the thoraco-abdominal approach and the triple approach with extensive lymphadenectomy of cervical, mediastinal and abdominal areas. These latter procedures carry more morbidity and mortality rates. It is probably the multimodality approach with pre or postoperative chemotherapy and radiotherapy what can impact in further improvement of the poor survival rates for this disease. This combined approach is currently being investigated under control prospective randomized trials.

[Surgical treatment of pharyngoesophageal or Zenker's diverticulum]. / Tratamiento quirúrgico del divertículo faringoesofágico o de Zenker.

BACKGROUND: The different surgical approaches of Zenker's diverticulum are controversial. AIM: To analyze the results of the surgical management of Zenker's diverticulum. METHODS: The charts of patients with surgical treatment of Zenker's diverticulum were reviewed in a retrospective fashion. The demographic and clinical data, surgical indication and procedures, operative morbidity and mortality and results were analyzed. RESULTS: There were 15 patients, 12 men and 3 women with an average age of 68 years. All of them reported cervical dysphagia, 93 per cent regurgitation and 60 per cent upper airway symptoms. The barium esophageal study was diagnostic in all patients. Cricopharyngeal myotomy was performed in all patients and diverticulopexy (60 per cent) or diverticulectomy (40 per cent) was accomplished. There were one mucosal perforation during the myotomy but three esophageal fistula were developed during the first postoperative week. All three received medical treatment with healing between the 7th to 21st postoperative day. One patient suffered acute myocardial infarction and there were no deaths. During the follow-up in 14 patients (93.3 per cent) disappearance of symptoms were reported, in the remaining patient minimal dysphagia was present. CONCLUSIONS: The surgical treatment of Zenker's diverticulum should be performed in symptomatic patients. The esophageal X-ray study is the best diagnostic tool. The cricopharyngeal myotomy is the keystone in the surgical treatment and may be complete with inversion, diverticulectomy or diverticulopexy according with the physical and clinical characteristics of diverticulum and the patient. There were excellent results in more than 90 per cent of the operated patients, with a low morbidity and no mortality.

[Immunoreactive urinary thromboxane B2 in experimental mesenteric thrombosis in dogs]. / Tromboxano B2 urinario inmunorreactivo en trombosis mesentérica experimental en perros.

Thromboxane B2 (TxB2) the stable metabolite of thromboxane A2 may be released as a response to ischemia. With the aim of investigating its role as an early diagnostic test in mesenteric thrombosis, immunoreactive TxB2 was measured in urine aliquotes in six sham operated dogs, nine dogs subjected to superior mesenteric artery ligation, and twelve dogs with superior mesenteric vein ligation. One hour urine volumes were collected before surgery and during the eight hours after the experimental procedures, and urinary osmolarities were also determined in each sample. Basal TxB2 levels were comparable in all groups. Although all groups showed a significant and rapid (one hour) increase in TxB2 as a response to surgery, in the controls it returned to normal after six hours, whereas in the rest a continuously increased production persisted throughout the study period. There was no difference in t-test comparisons depending on the sort of thrombosis. In spite of the urinary dilution induced during the study, a persistent increase in TxB2 excretion was found. We conclude that urinary TxB2 levels could prove useful in the early diagnosis of mesenteric ischemia.