Masa abdominal como forma de presentación de linfoma no hodgkiniano. Diagnóstico laparoscópico / Non-Hodgkin’s lymphoma presenting as an abdominal mass. Diagnostic laparoscopy

Se presenta el caso de una paciente de 75 años con una masa abdominal de gran tamaño, sin sintomatología acompañante. Con técnicas de imagen y punción-aspiración con aguja fina no se pudo filiar el diagnóstico, por lo que se realizó laparoscopia con toma de biopsias, cuyo resultado anatomopatológico fue de linfoma no hodgkiniano de células grandes. Se revisa la literatura médica y se observa que es infrecuente esta forma de presentación, así como el uso de la laparoscopia bajo anestesia local que, como en este caso, puede evitar procedimientos del ámbito quirúrgico que comportan un mayor riesgo

We report the case of a 75-year-old woman who presented with a large abdominal mass of recent onset without accompanying symptoms. Precise diagnosis was not available through imaging techniques and fine-needle aspiration. Laparoscopy and biopsies were performed and pathological finding revealed large cell non-Hodgkin’s lymphoma. We review the literature and discuss this unusual form of presentation and the use of laparoscopy under local anaesthesia which, as in this case, can avoid the need for higher risk surgical procedures

[Is mucinous colorectal adenocarcinoma a distinct entity?]. / Es el adenocarcinoma colorrectal mucinoso una entidad diferente?

INTRODUCTION: Several publications have demonstrated that mucinous carcinomas of the colon and rectum are associated with certain clinicopathological and genetic peculiarities that distinguish them from non-mucinous carcinomas. The principal aim of this study was to evaluate whether the biological behavior of mucinous carcinomas differs from that of intestinal carcinomas in patients undergoing surgery for colorectal cancer. PATIENTS: Between January 1993 and December 2000, 215 patients. underwent surgery in our hospital for colorectal cancer. The patients were divided into two groups according to histological type: tumors were intestinal in 169 patients (82%) and mucinous in 36 (17.6%). Patients undergoing non-resective surgery and those with tumors of other histological types (n = 10) were excluded. RESULTS: The percentage of patients aged less than 50 years in the group with mucinous carcinoma was 19% (7/36) compared with 4% (7/169) in the non-mucinous group (p = 0.001). Regarding presenting symptoms, anemia was more frequent in patients with mucinous carcinoma (18.2% [n = 6] vs 5.7% [n = 8]) and a change in bowel habits was less frequent (15% [n = 5] vs 34.3% [n = 48]; p < 0.05). A total of 63.9% of mucinous carcinomas (n = 23) were located in the proximal colon (cecum, ascending and transverse colon) compared with 21.3% (n = 36) of non-mucinous carcinomas (p < 0.001). Surgical intention was palliative in 41.7% (n = 23.7) of mucinous carcinomas and in 23.7% (n = 40) of non-mucinous carcinomas (p < 0.05). The mean tumoral size was 6.2 2.5 cm in mucinous carcinomas and 4.7 2 in non-mucinous carcinomas (p = 0.001). Patients with mucinous carcinoma presented a higher percentage of nodal and distant metastases and a lower percentage of early stage tumors (p < 0.05). However, no differences were found in survival between the two histological types. CONCLUSION: Mucinous tumors were more frequently located in the right colon and in patients less than 50 years old and were more likely to be in more advanced stages than non-mucinous tumors but no differences were found in survival according to tumor type.

El rendimiento diagnóstico del 99mtc-sestamibi cambia según la localización y el tipo de hiperparatiroidismo. análisis multivariante / The diagnostic yield of 99mTc sestamibi changes according to localization and type of hyperparathyroidism. Multivariate analysis

El rendimiento diagnóstico del 99mTc-sestamibi cambia según la localización y el tipo de hiperparatiroidismo. Análisis multivariante Objetivos. Analizar el rendimiento diagnóstico preoperatorio del 99mTc-sestamibi en el hiperparatiroidismo teniendo en cuenta diversos factores que pueden influir en el resultado, con la finalidad de determinar si es fiable la exploración quirúrgica selectiva en el tratamiento de esta enfermedad basada en los hallazgos obtenidos en la prueba.Material y método. Se estudian mediante regresión logística los resultados en 92 glándulas de 22 pacientes con hiperparatiroidismo primario y secundario. Se calcula la sensibilidad, la especificidad y los valores predictivos introduciendo como variables independientes el tipo de hiperparatiroidismo, la localización de las glándulas afectadas, los valores de calcemia y de paratohormona y la enfermedad tiroidea concomitante.Resultados. Hubo diferencias acusadas en magnitud y estadísticamente, según el tipo de hiperparatiroidismo y la localización superior, inferior o ectópica de las glándulas patológicas. Otras variables no demostraron ninguna influencia significativa. Para los adenomas, los índices diagnósticos fueron suficientemente elevados: sensibilidad del 71-94 por ciento, especificidad del 90-97 por ciento. Para las hiperplasias secundarias la sensibilidad fue muy baja (8-37 por ciento), pero con especificidades del 100 por ciento.Conclusiones. En el caso de adenomas paratiroideos, el sestamibi puede ofrecer suficiente seguridad diagnóstica como para poder justificar una exploración cervical selectiva sobre la base de los hallazgos que proporciona. En el hiperparatiroidismo secundario la prueba es poco fiable. (AU)

Perforaciones colónicas. Factores pronósticos / Colonic peforations. Prognostic factors

Objetivos. El objetivo principal del estudio fue valorar la influencia de diferentes factores de riesgo sobre la mortalidad de los pacientes, la influencia de dichos factores sobre la supervivencia en las perforaciones tumorales y finalmente comparar los resultados del grupo de perforaciones de etiología maligna con el de etiología benigna. Pacientes y métodos. En el presente estudio retrospectivo multicéntrico se presenta la experiencia de tres hospitales de la Comunidad Valenciana (Hospital General de Castellón, Hospital Gran Vía de Castellón y Hospital Comarcal de Vinaroz) en perforaciones de colon durante el período de tiempo comprendido entre enero de 1994 y abril de 1998. Fueron incluidos en el estudio un total de 68 pacientes, 38 varones y 30 mujeres con una edad media de 68 ñ 14 años (rango, 29-90). Se recogieron datos referentes a etiología, comorbilidad, clínica de presentación, exploraciones, hallazgos, técnica operatoria, morbimortalidad y seguimiento. Resultados. Se recogieron 13 etiologías diferentes, siendo la diverticulitis (n = 26; 38,2 por ciento) y las neoplasias (n = 21; 29,4 por ciento) las causas más frecuentes. En cuanto a los hallazgos (grado de contaminación), 17 pacientes (25 por ciento) presentaron abscesos, 15 (22,1 por ciento) peritonitis localizada, 21 (30,9 por ciento) peritonitis purulenta difusa y 15 (22,1 por ciento) peritonitis fecaloidea difusa. La estancia media hospitalaria fue de 18,3 ñ 13,8 días. Presentaron complicaciones postoperatorias 45 pacientes (66,2 por ciento), siendo las más frecuentes la infección de la herida quirúrgica (15; 22,1 por ciento), la evisceración (7; 10,3 por ciento) y el fallo multiorgánico (5; 7,4 por ciento). La mortalidad operatoria fue del 26,6 por ciento (14 pacientes). Conclusiones. La mortalidad perioperatoria es más elevada en aquellos pacientes de mayor edad, con clínica de diarrea al ingreso y a los que no se les practica resección de la zona perforada. La perforación es una complicación grave del cáncer de colon, con una mortalidad alta y mal pronóstico, presentando los pacientes con perforaciones tumorales mayor frecuencia de clínica de distensión abdominal y de complicaciones postoperatorias que aquellos con perforaciones benignas (AU)

Estudio Delphi de la Sociedad Valenciana de Cirugía: tratamiento quirúrgico del cáncer gástrico / A Delphi study by the Surgical Society of Valencia, Spain: surgical treatment of gastric cancer

Se presentan los resultados del primer estudio de consenso auspiciado por la Sociedad Valenciana de Cirugía sobre el tratamiento quirúrgico del cáncer gástrico. Se trata de un esudio tipo Delphi, con la participación de 31 expertos pertenecientes a la mayoría de hospitales de la Comunidad Valenciana. Los temas consensuados han versado sobre los siguientes aspectos: nutrición artificial, métodos de estadificación preoperatoria, tipo de resección y de linfadenectomía, técnicas de reconstrucción, criterios de resecabilidad y temas de organización (AU)

[A new method of studying gastric emptying in gastrectomized patients]. / Nuevo método de estudio del vaciado gástrico en pacientes gastrectomizados.

OBJECTIVE: We present a new method of assessment of gastric emptying in gastrectomized patients. PATIENTS AND METHODS: The gastric emptying of non digestible solids were studied in two groups of gastrectomized patients, the Billroth II (n = 25) and the Roux-en-Y (n = 36) to relate the gastric emptying with the postgastrectomy symptoms. RESULTS: The food retained in the gastric stump is related with significance with the presence (p = 0.01) and the absence (p = 0.02) of markers. The patients operated on with the Billroth II technique present a higher frequency of markers in the gastric stump (40% over 19.4% with the Roux-en-Y). The markers in the gastric stump are more common with the symptoms of pyrosis, nausea, bilious vomit, diarrhea and the postoperative gastritis of alkaline reflux. CONCLUSIONS: The method of gastric emptying of non digestible solids is a valid and reliable study of the gastric emptying and should be carried out in all candidates for endoscopy because it is harmless and easy to perform and evaluate.

'Hybrid' Bariatric Surgery: Bilio-pancreatic Diversion and Duodenal Switch- Preliminary Experience.

BACKGROUND: Hybrid, combined or mixed bariatric surgery is the combination of a degree of 'malabsorption' (as achieved by the intestinal bypass) with a 'restriction' (as achieved by gastric bypass or gastroplasty), thereby simultaneously reducing the absorption of fats in the small bowel and decreasing the intake of food. METHODS: A modification of the bilio-pancreatic diversion (BPD) with a duodenal switch procedure, vertical lineal gastrectomy and preservation of the pylorus, has been used in 23 patients. The antropyloric pump and 4 cm of the duodenum are left intact to preserve physiologic gastric emptying and to prevent anastomotic ulcer. The use of staplers and continuous running sutures reduces surgical risks and operative time. RESULTS: One patient, converted from a vertical gastroplasty, had an intrathoracic esophageal perforation and died of multi-systemic organ failure, a mortality rate of 4.5%. One patient had a partial dehiscence of the laparotomy wound. Three patients developed subcutaneous seromas. Mean weight losses during the first 4 months were 13, 11, 6 and 5 kg, with a loss of 70% of excess weight in patients approaching 1 year. No patient needs treatment for diarrhea. No serious secondary side-effects have been detected. CONCLUSION: This operation appears to result in very satisfactory weight loss, improved quality of life, and a low incidence of complications.

[Value of endoscopy in the diagnosis of postoperative gastritis caused by alkaline reflux]. / Valor de la endoscopia en el diagnóstico de la gastritis postoperatoria por reflujo alcalino.

OBJECTIVE: A long term retrospective study comparing endoscopic lesions and their relationship with symptoms and histological lesions of postoperative Alkaline Reflux Gastritis (ARG) between partial gastrectomy Billroth II (n = 25) and the Roux-en-Y (n = 36) is presented. PATIENTS AND METHODS: In patients operated on with both techniques the clinical, endoscopic and histological aspects are studied. RESULTS: The patients operated on with the Billroth II technique present a higher frequency of bile in the gastric remnant and mucosal lesions in the endoscopic study (p < 0.001) compared with the Roux-en-Y group. Bile and mucosal lesions on the gastric stump are more common with symptoms and histological lesions of postoperative ARG. CONCLUSIONS: The endoscopic evaluation is a valid and reliable examination in the diagnosis and follow up of postoperative ARG.

[Corynebacterium pseudotuberculosis adenitis in a shepherd]. / Adenitis por Corynebacterium pseudotuberculosis en un pastor.

Corynebacterium pseudotuberculosis causes suppurative lymphadenitis in sheep and other domestic animals. Human infection has been reported in few instances. We report on a case of Corynebacterium pseudotuberculosis lymphadenitis in a human being. A 34-years old previously healthy shepherd was attended for presenting a painful lymph node in right groin with one year of evolution. Cultures of an aspirate and ganglionar tissue yielded growth of Corynebacterium pseudotuberculosis in pure culture. Histological examination of the excised lymph node showed a suppurative granulomatous lymphadenitis with areas of necrosis in which there were clusters of bacillary organisms. After surgical excision and administration of erythromycin clinical signs disappeared without complications. We have carried out a review of the literature and we have found no case reported in Spain. Corynebacterium pseudotuberculosis lymphadenitis in human beings is a rare entity that principally affects persons in contact with animals, principally sheep. Most cases have been reported in Australia. In accordance with the reviewed literature this is the first time this disease is reported in Spain. Corynebacterium pseudotuberculosis infection should be considered in the differential diagnosis of localized granulomatous lymphadenitis.

[Aneurysm of the abdominal aorta]. / Aneurisma de aorta abdominal.

OBJECTIVE: Three clinical cases of Aneurysm in the abdominal Aorta are presented, in order to make a clinical review of aneurysms in the abdominal Aorta (AAA) and underline the importance of their early diagnosis in Primary Care, given the risk factors. DESIGN: A retrospective, descriptive analysis of three cases of AAA from 1991. SITE. The patients studied had attended the hospital emergency department in the Alcoy Health area. MAIN MEASUREMENTS AND RESULTS: Case 1: A patient, who attended because of three days of bilateral lumbar pain of a colic type spreading to the mesogastrium, which did not respond to treatment for nephritic colic. The patient died in a few hours, with the diagnosis of hypovolaemic shock caused by a burst AAA. Case 2: A patient with generalised continuous abdominal pain, which over 12 hours had been located in the lower right hemiabdomen, who was admitted with the provisional diagnosis of acute pyelonephritis. Case 3: A patient who, after an emergency surgical intervention where the diagnosis of AAA was confirmed, presented after a month a clinical picture consistent with a cerebral vascular accident and died afterwards because of renal failure. CONCLUSION: Given the present increase of patients diagnosed in hospital as suffering AAA in our Health Area, we urge that special attention be paid to the early diagnosis of this pathology. It is important to look actively for this pathology in patients with chronic pathologies of high prevalence and include it in Primary Care preventive programmes.