Diagnóstico y tratamiento de las complicaciones biliares postrasplante hepático / No disponible

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Efectividad diagnóstica de la tomografía por emisión de positrones con18fluorodeoxiglucosa asociada a tomografía axial en la discriminación de benignidad o malignidad de las lesiones suprarrenales / Diagnostic efficacy and discriminatory capacity of positron emission tomography combined with axial tomography of adrenal lesions

Introducción: Se analiza la utilidad de la tomografía por emisión de positrones asociada a la tomografía axial computarizada (PET-TAC) en el diagnóstico de benignidad o malignidad de lesiones suprarrenales. Material y métodos: Estudio retrospectivo, entre junio de 2005 y mayo de 2009, de una serie consecutiva de pacientes a los que se les realizó una PET-TAC para el estudio de patología suprarrenal con sospecha de malignidad. Se valoraron la presencia de captaciones focales, su valor estándar de máxima captación (SUV), y la ratio del valor máximo suprarrenal/hepático. Se analizó la sensibilidad, especificidad, valor predictivo positivo y negativo de la prueba, y los valores de captación máxima adrenal y la ratio para los que la rentabilidad diagnóstica fue máxima. Resultados: Se incluyeron 15 pacientes. El diagnóstico final reveló malignidad en ocho y benignidad en siete. Diez pacientes presentaron captación suprarrenal: tres en lesiones benignas y siete en neoplasias, con un valor de captación medio de 6,3 (3,2 en benignas y 9 en malignas). La ratio media suprarrenal/hepático fue de 1,8 (0,9 en lesiones benignas y 2,6 en malignas). Cuando se relaciona la presencia de captación suprarrenal con el diagnóstico final de malignidad, obtuvimos una sensibilidad del 87,5%, especificidad del 57,1%, valor predictivo positivo del 70% y negativo del 80%. Un valor de corte de SUV de 6, o una ratio de captación suprarrenal/hepática de 2, proporciona una sensibilidad de 75%, especificidad de 100%, valor predictivo positivo de 100% y negativo de 77,7%. Conclusiones: La PET-TAC posee una alta capacidad para discriminar entre benignidad o malignidad en la patología adrenal estudiada (AU)

Introduction: The usefulness of 18fluorodeoxyglucose positron emission tomography combined with axial tomography (PET-CT) in diagnosing whether adrenal tumours are benign or malignant is assessed. Material and methods: A retrospective study conducted between June 2005 and May 2009 on a consecutive series of patients on whom a PET-CT scan was performed to study suspected malignant adrenal disease. Focal uptakes were assessed, along with the maximum standard uptake value (SUV), and the ratio of the maximum adrenal/hepatic value. The sensitivity, specificity, positive and negative predictive value of the test, the maximum adrenal uptake values and the ratio for those where the diagnostic yield was maximum. Results: Fifteen patients were included. The final diagnosis showed malignancy in eight and seven were benign. Ten patients had adrenal uptake: three in benign lesions and seven in neoplasias, with a mean uptake value of 6.3 (3.2 in benign lesions and 9.0 in malignant lesions). The mean adrenal/hepatic ratio was 1.8 (0.9 in benign and 2.6 in malignant lesions). When the presence of adrenal uptake is associated with a final diagnosis of malignancy, we obtained a sensitivity of 87.5%, a specificity of 57.1%, and a positive and negative predictive value of 70% and 80%, respectively. An SUV cut-off value of 6, or an adrenal/hepatic uptake ratio of 2, gave a sensitivity of 75%, a specificity of 100%, and a positive and negative predictive value of 100% and 77.7%, respectively. Conclusions: PET-CT has a high ability to discriminate between benign and malignant lesions in the adrenal disease studied (AU)

[Diagnostic efficacy and discriminatory capacity of positron emission tomography combined with axial tomography of adrenal lesions]. / Efectividad diagnóstica de la tomografía por emisión de positrones con (18)fluorodeoxiglucosa asociada a tomografía axial en la discriminación de benignidad o malignidad de las lesiones suprarrenales.

INTRODUCTION: The usefulness of 18fluorodeoxyglucose positron emission tomography combined with axial tomography (PET-CT) in diagnosing whether adrenal tumours are benign or malignant is assessed. MATERIAL AND METHODS: A retrospective study conducted between June 2005 and May 2009 on a consecutive series of patients on whom a PET-CT scan was performed to study suspected malignant adrenal disease. Focal uptakes were assessed, along with the maximum standard uptake value (SUV), and the ratio of the maximum adrenal/hepatic value. The sensitivity, specificity, positive and negative predictive value of the test, the maximum adrenal uptake values and the ratio for those where the diagnostic yield was maximum. RESULTS: Fifteen patients were included. The final diagnosis showed malignancy in eight and seven were benign. Ten patients had adrenal uptake: three in benign lesions and seven in neoplasias, with a mean uptake value of 6.3 (3.2 in benign lesions and 9.0 in malignant lesions). The mean adrenal/hepatic ratio was 1.8 (0.9 in benign and 2.6 in malignant lesions). When the presence of adrenal uptake is associated with a final diagnosis of malignancy, we obtained a sensitivity of 87.5%, a specificity of 57.1%, and a positive and negative predictive value of 70% and 80%, respectively. An SUV cut-off value of 6, or an adrenal/hepatic uptake ratio of 2, gave a sensitivity of 75%, a specificity of 100%, and a positive and negative predictive value of 100% and 77.7%, respectively. CONCLUSIONS: PET-CT has a high ability to discriminate between benign and malignant lesions in the adrenal disease studied.

Hemosuccus pancreaticus causado por un seudoaneurisma de la arteria esplénica / Haemosuccus pancreaticus caused by a splenic artery pseudoaneurysm

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Retroperitoneoscopy to extract dropped gallstones after laparoscopic cholecystectomy.

Complications resulting from gallstones left in the peritoneal cavity are most often reported after laparoscopic treatment of cholelitiasis. Gallstones are frequently dropped in the posterior subhepatic space, which can lead to the development of abscesses that usually require laparotomy for extraction of the stones. We present a novel technique for treating collections associated with dropped gallstones, using retroperitoneoscopy with two 10-mm ports after ultrasound localization of the abscess. We carried out this procedure in two patients and successfully extracted the gallstones without postoperative complications or recurrences. We consider this approach to be technically feasible, safe, and effective. It avoids the usual inefficacy of simple percutaneous drainage of these collections and the complications associated with the drainage of intra-abdominal abscesses by laparotomy.

Application of modern imaging methods in diagnosis of gallbladder cancer.

The poor prognosis of gallbladder cancer (GBC) is related to its dissemination capacity and usually late diagnosis due to its non-specific clinical appearance. Recent improvements in hepatobiliary surgery have underlined the importance of an early specific diagnosis, which requires a multidisciplinary approach and, when possible, specialized equipment. The first step in an early diagnosis is to identify patients in the appropriate epidemiological setting (e.g., incidental finding, chronic cholecystitis) for the correct interpretation of test results. It is desirable to enhance the sensitivity of the initial ultrasound (US) examination by use of the appropriate technology in skilled specialist hands. When GBC is suggested by US findings, FDG-PET can be considered complementary to establish the benign/malignant nature of the lesion and to obtain a primary staging study. If GBC is confirmed, thin slice spiral CT can contribute valuable information on local spread. In this regard, recent hybrid PET-CT systems provide structural and functional information simultaneously and may offer early and accurate T, N, and M staging with an improved specificity.

Rotura traumática del diafragma / Traumatic diaphragmatic rupture

La rotura traumática del diafragma es una lesión infrecuente que ocurre como consecuencia de traumatismos cerrados y penetrantes del abdomen o del tórax. Su diagnóstico precoz continúa siendo un desafío y se asocia con una elevada morbimortalidad. El diagnóstico preoperatorio es difícil y sólo un alto nivel de sospecha, un examen minucioso de la radiografía simple de tórax y la intervención quirúrgica inmediata son determinantes para el éxito en el tratamiento de estos pacientes. Presentamos el caso de un paciente con rotura del hemidiafragma izquierdo, diagnosticado y tratado con éxito en las primeras horas, y se revisan los aspectos controvertidos del diagnóstico y tratamiento en la bibliografía (AU)

Traumatic diaphragmatic rupture is an infrequent lesion that can result from penetrating or blunt trauma to the abdomen or chest. Early diagnosis continues to be a challenge and this type of injury is associated with high morbidity and mortality. Preoperative diagnosis is difficult and a high level of suspicion, careful scrutiny of the chest x-ray, and early surgical treatment are required for successful management. We present a case of rupture of the left hemidiaphragm that was diagnosed and treated successfully within the first few hours. We also review the literature on controversial issues in the diagnosis and treatment of this injury (AU)

[Traumatic diaphragmatic rupture]. / Rotura traumática del diafragma.

Traumatic diaphragmatic rupture is an infrequent lesion that can result from penetrating or blunt trauma to the abdomen or chest. Early diagnosis continues to be a challenge and this type of injury is associated with high morbidity and mortality. Preoperative diagnosis is difficult and a high level of suspicion, careful scrutiny of the chest x-ray, and early surgical treatment are required for successful management. We present a case of rupture of the left hemidiaphragm that was diagnosed and treated successfully within the first few hours. We also review the literature on controversial issues in the diagnosis and treatment of this injury.

Positron-emission tomography with fluorine-18-fluoro-2-deoxy-D-glucose for gallbladder cancer diagnosis.

BACKGROUND: Recent advances in hepatobiliary surgery have underscored the need for presurgical diagnosis of gallbladder cancer. Frequently, clinical presentation, biochemical analysis, and structural ultrasound or computed axial tomography images do not enable definitive differentiation of cholecystitis or cholethiasis from gallbladder cancer. The aim of this study was to evaluate the role of fludeoxy glucose-positron-emission tomography (FDG-PET) in establishing the benign or malignant nature of gallbladder lesions. METHODS: A case series of 16 patients with clinical symptoms suggestive of biliary colic or chronic cholecystitis and with inconclusive ultrasound and/or computed axial tomography findings for presence of gallbladder cancer were studied by FDG-PET. RESULTS: FDG-PET showed a sensitivity of 0.80, a specificity of 0.82, and positive and negative predictive values of 0.67 and 0.90, respectively. There was 1 false- negative result in 1 patient with mucinous adenocarcinoma and 2 false-positive results in 1 patient with tuberculoid granulomatous reaction and 1 patient with polypoid lesion with adenomyomatosis. CONCLUSIONS: FDG-PET may be of utility to establish the diagnosis of gallbladder cancer in patients with nonspecific clinical and imaging findings.

Effect of pretreatment with interleukin-1 beta on inflammatory infiltrates and tissue damage after experimental endotoxic challenge.

OBJECTIVE: To evaluate the effect of treatment with murine recombinant interleukin-1 beta on inflammatory infiltrate and tissue damage after experimental endotoxic challenge. DESIGN: Randomized, controlled study. SETTING: Experimental Unit, Virgen de las Nieves University Hospital. SUBJECTS: Seventy-two female CBA/H mice, 20-21 g, supplied by the animal center of the Experimental Unit. INTERVENTION: The mice were randomized into three groups of 24. Group 1 (sham) received two intraperitoneal doses of 0.1 mL of phosphate-buffered saline; group 2 (lipopolysaccharide) was injected with 125 mg/kg lipopolysaccharide (Escherichia coli, intraperitoneally) 24 hrs after 0.1 mL of phosphate-buffered saline; group 3 was pretreated with 80 ng of recombinant interleukin-1 beta per mouse (intraperitoneally) 24 hrs before the endotoxic challenge. MEASUREMENTS AND MAIN RESULTS: At 1, 2, 4, and 24 hrs after the endotoxic challenge, we studied inflammatory infiltrate and tissue damage in lung, liver, and intestine by determining myeloperoxidase and malondialdehyde tissue concentrations. When we compared the pretreated group with the lipopolysaccharide group, myeloperoxidase concentrations decreased significantly in lung (p <.001) and liver (p <.001) at all study times, and in intestine (p <.001) at 2, 4, and 24 hrs; malondialdehyde concentrations significantly decreased in lung at 1 (p <.05), 2 (p <.01), and 24 (p <.001) hrs, in liver at 2 (p <.001), 4 (p <.01), and 24 (p <.001) hrs, and in intestine at 1 (p <.001), 2, 4 (p <.05), and 24 (p <.001) hrs. CONCLUSION: Pretreatment with recombinant interleukin-1 beta significantly reduces inflammatory infiltrate and tissue damage in mouse lung, liver, and intestine after an experimental endotoxic challenge.