[Pancreatic cancer: the surgeon's point of view]. / Cáncer de páncreas; el punto de vista del cirujano.

INTRODUCTION: Pancreatic adenocarcinoma (PA) is not only one of the most common gastrointestinal tumors, but also the most lethal. OBJECTIVE: Give a comprehensive and up-to-date panorama on pancreatic cancer with a surgical focus. METHODS: A critical search was performed in Medline focusing on recent relevant publications, renowned authors, high impact publications and a preference for surgical literature in English. RESULTS: In this article we review PA epidemiology, some aspects of molecular biology, clinical presentation, work-up, staging and current treatment options. CONCLUSIONS: Patients affected must be studied appropriately and referred to specialized centers for surgical treatment, when indicated, in order to offer them the best chance for cure. Breakthroughs in management will probably include prevention, early diagnosis and molecular therapy.

[Renal cell carcinoma metastatic to the duodenum and Vater ampulla: report of two cases]. / Metástasis de cáncer renal a duodeno y ámpula de Vater; informe de dos casos.

These two cases of metastatic renal cell carcinoma to the duodenum, adds to the limited experience reported in the literature. Both patients initially presented with upper gastrointestinal bleeding years after they had a nephrectomy. After an extensive diagnostic work-up, they were both submitted to a classic pancreaticoduodenectomy (Whipple's procedure). Only the final histopathological report revealed the diagnosis. Basic recommendations on diagnosis and treatment are discussed in this article and a review of the literature is given.

Hammering versus drilling of sharp and obtuse trocar-point k-wires.

Kirschner wire characteristics affect the heating of bone during insertion and the subsequent strength of fixation. We inserted 90 sharp and 90 obtuse trocar-tip K-wires into 90 fresh frozen human cadaver metacarpals using either a drill or a pneumatic hammer. The temperature elevation, insertion time and extraction force were measured for four K-wire insertion combinations: drilling sharp; drilling obtuse; hammering sharp; hammering obtuse. Hammering resulted in significantly lower temperature elevations than drilling. Hammering sharp K-wires resulted in the highest extraction forces. The first and fifth metacarpals showed significantly lower temperature elevations than the other metacarpals, while the insertion time was significantly higher in the second and third metacarpal than in the other metacarpals. Hammering sharp trocar-tip K-wires minimises thermal damage to bone and gives the strongest fixation.

Keeping osteocytes alive: a comparison of drilling and hammering k-wires into bone.

In this study, the insertion time and histological effects of drilling and hammering K-wires into bone are described. The insertion time was measured while drilling or hammering K-wires into the femurs and tibias of ten rabbits. Four K-wires, inserted into one hind limb, were used for histological examination directly after insertion and four K-wires inserted into the contralateral hind limb were used for the same measurements 4 weeks later. The specimens were scored for presence, or absence, of osteocytes, fragmentation of the bone edges, haemorrhage, microfractures, cortical reaction and callus formation around the pin track. The insertion time needed for drilling in K-wires was significantly longer than that of hammering. Drilling also resulted in the disappearance of the osteocytes in almost all sections while hammering did not have this effect but did result in more microfractures. Hammering K-wires may be a superior technique because it prevents osteonecrosis and requires a shorter insertion time.