Role of Rhizobium endoglucanase CelC2 in cellulose biosynthesis and biofilm formation on plant roots and abiotic surfaces.

BACKGROUND: The synthesis of cellulose is among the most important but poorly understood biochemical processes, especially in bacteria, due to its complexity and high degree of regulation. In this study, we analyzed both the production of cellulose by all known members of the Rhizobiaceae and the diversity of Rhizobium celABC operon predicted to be involved in cellulose biosynthesis. We also investigated the involvement in cellulose production and biofilm formation of celC gene encoding an endoglucanase (CelC2) that is required for canonical symbiotic root hair infection by Rhizobium leguminosarum bv. trifolii. RESULTS: ANU843 celC mutants lacking (ANU843ΔC2) or overproducing cellulase (ANU843C2+) produced greatly increased or reduced amounts of external cellulose micro fibrils, respectively. Calcofluor-stained cellulose micro fibrils were considerably longer when formed by ANU843ΔC2 bacteria rather than by the wild-type strain, in correlation with a significant increase in their flocculation in batch culture. In contrast, neither calcofluor-stained extracellular micro fibrils nor flocculation was detectable in ANU843C2+ cells. To clarify the role of cellulose synthesis in Rhizobium cell aggregation and attachment, we analyzed the ability of these mutants to produce biofilms on different surfaces. Alteration of wild-type CelC2 levels resulted in a reduced ability of bacteria to form biofilms both in abiotic surfaces and in planta. CONCLUSIONS: Our results support a key role of the CelC2 cellulase in cellulose biosynthesis by modulating the length of the cellulose fibrils that mediate firm adhesion among Rhizobium bacteria leading to biofilm formation. Rhizobium cellulose is an essential component of the biofilm polysaccharidic matrix architecture and either an excess or a defect of this "building material" seem to collapse the biofilm structure. These results position cellulose hydrolytic enzymes as excellent anti-biofilm candidates.

Chylous ascytes secondary to acute pancreatitis: a case report and review of literature.

Chylous ascites is an uncommon finding which is due to the presence of thoracic or intestinal lymph in the abdominal cavity. It is usually caused by a chronic disruption of the lymphatic system. The present report is one of the rare cases in the literature of chylous ascites secondary to idiopathic acute pancreatitis, which showed a complete resolution with a combination of low fat enteral nutrition with MCT and somatostatin analogs.

Chylous ascytes secondary to acute pancreatitis: a case report and review of literature / Ascitis quilosa secundaria a pancreatitis: caso clínico y revisión de la bibliografía

Chylous ascites is an uncommon finding which is due to the presence of thoracic or intestinal lymph in the abdominal cavity. It is usually caused by a chronic disruption of the lymphatic system. The present report is one of the rare cases in the literature of chylous ascites secondary to idiopathic acute pancreatitis, which showed a complete resolution with a combination of low fat enteral nutrition with MCT and somatostatin analogs (AU)

La ascitis quilosa es un hallazgo infrecuente producido por la presencia de linfa de origen torácico o intestinal en la cavidad abdominal. Normalmente es producido por la disfunción crónica del sistema linfático. El caso que presentamos es uno de los pocos casos descritos en la literatura de ascitis quilosa secundaria a una pancreatitis aguda idiopática, que se resolvió completamente con una combinación de dieta enteral baja en grasas con triglicéridos de cadena media y análogos de somatostatina (AU)

Paraesophageal hiatal hernia. Open vs. laparoscopic surgery.

BACKGROUND: paraesophageal hiatal hernia represents 5-10% of hiatal hernias. Its importance is based on the severe complications it may have, including gastric volvulus, and surgical treatment is recommended when a diagnosis is established. MATERIAL AND METHODS: a retrospective study of all patients who underwent surgery for paresophageal hernia between 1985 and 2007. RESULTS: we studied 90 cases, 68 females and 22 males with a median age of 67.6 years (37-96). Forty-five patients reported pyrosis, 34 epigastric postprandial pain, and 15 dysphagia; eight patients were diagnosed with gastric volvulus. Eighty-one patients underwent elective surgery and 9 emergency surgery. Forty-seven cases underwent an open procedure and 43 a laparoscopic one; 5 (11.6%) of them required conversion. The techniques performed were D Or fundoplication in 35 cases, Nissen in 35, Toupet in 14, simple hiatal closure in 2, Narbona in 1, and Lortat-Jakob in 1; in 10 patients a mesh was placed. The complication rate for open procedure was 10.6 and 9.5% for the laparoscopic one (p > 0.05). Median hospital stay was 9.1 days for the open procedure and 3.4 for the laparoscopic one (p < 0.05). As follow-up, we analyzed 84 patients. After a median follow-up of 12 years (1-19), 15 patients were still symptomatic (17.8%), with recurrence in 8 cases (5 required reoperation). The satisfaction rate was 95.5%. CONCLUSION: equivalent results were observed after laparoscopic and open surgery and a significant shorter hospital stay in the laparoscopic one. Therefore, we think that laparoscopic surgery should be considered as the election procedure for paraesophageal hiatal hernia.

Hernia de hiato paraesofágica: cirugía laparoscópica vs. cirugía abierta / Paraesophageal hiatal hernia. Open vs. laparoscopic surgery

Introducción: la hernia hiatal paraesofágica representa el 5-10% de las hernias hiatales. Su importancia radica en las gravescomplicaciones que pueden presentar, como el vólvulo gástrico, yse recomienda el tratamiento quirúrgico una vez establecido eldiagnóstico.Material y métodos: estudio retrospectivo de los pacientesintervenidos en nuestro centro de hernia hiatal paraesofágica entre1985 y 2007.Resultados: estudiamos 90 casos, 68 mujeres y 22 varones,con edad media de 67,6 años (37-96). Cuarenta y cinco pacientespresentaban pirosis, 34 dolor epigástrico postprandial y 15 disfagia;ocho pacientes fueron diagnosticados como vólvulo gástrico.Se realizaron 81 intervenciones programadas y 9 urgentes. En 47casos el abordaje fue abierto y en 43 laparoscópico, de los cuales5 se convirtieron a cirugía abierta. Se realizó funduplicatura D´Oren 35 casos, Nissen en 35, Toupet en 14, cierre simple de pilaresen 2, Narbona en 1 y Lortat-Jakob en 1; en 10 pacientes se colocaronmallas. La tasa de complicaciones en cirugía abierta fue10,6% y en laparoscópica 9,5% (p > 0,05). La estancia media fue9,1 días en cirugía abierta y 3,4 en laparoscópica (p < 0,05). Enel seguimiento, analizamos 84 pacientes, con una mediana de 12años (1-19): 15 continuaban sintomáticos, objetivándose recidivaen 8 (5 fueron reintervenidos). El 95,5% de los pacientes estabansatisfechos con los resultados.Conclusión: se obtuvieron resultados equivalentes tras cirugíalaparoscópica y abierta, con estancia hospitalaria significativamentemenor en los primeros. Por ello creemos que se debe considerarla cirugía laparoscópica como abordaje de elección paratratar la hernia hiatal paraesofágica(AU)

Background: paraesophageal hiatal hernia represents 5-10%of hiatal hernias. Its importance is based on the severe complicationsit may have, including gastric volvulus, and surgical treatmentis recommended when a diagnosis is established.Material and methods: a retrospective study of all patientswho underwent surgery for paresophageal hernia between 1985and 2007.Results: we studied 90 cases, 68 females and 22 males with amedian age of 67.6 years (37-96). Forty-five patients reported pyrosis,34 epigastric postprandial pain, and 15 dysphagia; eightpatients were diagnosed with gastric volvulus. Eighty-one patientsunderwent elective surgery and 9 emergency surgery. Forty-sevencases underwent an open procedure and 43 a laparoscopicone; 5 (11.6%) of them required conversion. The techniques performedwere D´Or fundoplication in 35 cases, Nissen in 35,Toupet in 14, simple hiatal closure in 2, Narbona in 1, and Lortat-Jakob in 1; in 10 patients a mesh was placed. The complicationrate for open procedure was 10.6 and 9.5% for the laparoscopicone (p > 0.05). Median hospital stay was 9.1 days for theopen procedure and 3.4 for the laparoscopic one (p < 0.05). Asfollow-up, we analyzed 84 patients. After a median follow-up of12 years (1-19), 15 patients were still symptomatic (17.8%), withrecurrence in 8 cases (5 required reoperation). The satisfactionrate was 95.5%Conclusion: equivalent results were observed after laparoscopicand open surgery and a significant shorter hospital stay inthe laparoscopic one. Therefore, we think that laparoscopicsurgery should be considered as the election procedure for paraesophagealhiatal hernia(AU)

Late gastrointestinal complications after pelvic radiotherapy: radiation enteritis

INTRODUCTION: Radiation enteritis is a complication of radiation therapy for pelvic tumours. It appears after a variable period of time and is often progressive. MATERIAL AND METHODS: We analyse our experience of 77 cases (52 females and 25 males) diagnosed with radiation enteritis or proctitis between 1986 and 2006. RESULTS: The most frequent location of radiation injury is ileum (55 patients, 71%), followed by rectum (22 patients, 28%). Twenty-eight patients (36%) were medically managed and 49 (64%) required surgical treatment. In 41 (53%) of the patients the affected region was resected, in 5 (7%) a by-pass was performed and in 3 (4%) a terminal colostomy. Surgical mortality was 4% (3 cases) and the complication rate 9% (7 cases). Twelve patients (16%) presented recurrence of radiation-related illness. Excluding those cases deceased because of tumoral progression, 5-year survival rate was 90% and 10-year survival rate 83%. CONCLUSION: Radiation enteritis must be initially conservatively managed, but in those cases without response, surgery is indicated. Surgical treatment should not be delayed fearing postoperative complications, which are more susceptible to appear in deteriorated patients. If technically possible, the affected region should be resected, because complications may appear later at this damaged location (AU)

Jejunal and bladder perforation: complication of intravesical Nd-YAG laser irradiation of bladder tumour.

Nd-YAG laser coagulation is a therapeutic method for the treatment of refractory superficial bladder cancer. Complications resulting from its use are uncommon. We report a case of jejunal and bladder perforation 24 h after Nd-YAG bladder irradiation of a recurrent bladder tumour.

[Multidisciplinary approach to the treatment of rectal cancer: the benefits of neoadjuvant therapy]. / Abordaje multidisciplinar en el tratamiento del cáncer de recto: eficacia del tratamiento neoadyuvante.

OBJECTIVE: the aim of this study was to assess the impact of neoadjuvant treatment on rectal cancer following involvement of a multidisciplinary team (MDT). MATERIALS AND METHODS: between January 2000 and December 2005, 90 patients with rectal adenocarcinoma were evaluated by a MDT and operated on after receiving neoadjuvant treatment with radiochemotherapy (RTCT) -67% were men and 33% were women, with a mean age of 65.04 years (21-83 years). Surgery was low anterior resection in 50% and abdominoperineal amputation in 42.2%. RESULTS: the rate of complications associated with neoadjuvant treatment was 54.4%, with gastrointestinal complications being most frequent. However, this toxicity was tolerated by most patients. It was severe in two cases (2.2%), leading to chemotherapy discontinuation. A histological analysis of specimens showed a complete pathologic response in 10 cases (11.1%) and a partial response (downstaging of T) in 32 cases (35.6%), hence overall response to neoadjuvant treatment was 46.6%. Postoperative complications included anastomotic leakage in 8.3%, perineal wound complications in 34.2%, and urinary disease in 12.2%. The surgical mortality rate was 0%. Local recurrence occurred in 4.4%, and distant metastases were found in 22.2%. Both overall and disease-free survivals were 80 and 64%, respectively. CONCLUSIONS: neoadjuvant treatment results in low local recurrence rates and optimal survival rates, with no increase in morbidity or mortality. A systematic evaluation by a MDT in the context of a clinical protocol offers better cure rates.

Pancreatic neuroendocrine tumours.

INTRODUCTION: Pancreatic neuroendocrine tumours (PNT) are infrequent epithelial neoplasms associated with a better outcome than pancreatic adenocarcinoma. MATERIALS AND METHODS: We analysed our 22 years of experience in managing PNT. Forty-nine patients (27 women and 22 men) with a mean age of 49 years were studied. There were 28 insulinomas, eight glucagonomas, three gastrinomas, one VIPoma and one carcinoid. Eight patients presented with nonfunctional tumours. Enucleation was performed in 20 patients, distal pancreatectomy in 16, middle pancreatic resection in four, cephalic pancreatoduodenectomy in two and total pancreatoduodenectomy in one. In six patients, the tumour was not resected. RESULTS: Postoperative complication rate was 22%: six pancreatic fistulas, three intra-abdominal collections, one remnant pancreatitis and one pancreatic pseudocyst. There was no mortality. 39 cases showed benign histologic features and ten malignant ones. Symptomatic palliation was achieved in 94% of the cases. Five patients presented recurrences: three liver metastases and two pancreatic recurrences. Actuarial mean survival was 163 months and was longer in insulinomas, in those tumours completely resected and in tumours with benign histological features. CONCLUSION: Conservative surgery of the pancreas is preferred, but aggressive surgery is indicated when the primary tumour can be controlled. Despite of minimising pancreatic resection, there is a high complication rate, mainly pancreatic fistulas, though they can often be conservatively managed. Insulinomas are the PNT with better outcome; those completely resected also associate a better prognosis.

Pancreatic neuroendocrine tumours

INTRODUCTION: Pancreatic neuroendocrine tumours (PNT) are infrequent epithelial neoplasms associated with a better outcome than pancreatic adenocarcinoma. MATERIALS AND METHODS: We analysed our 22 years of experience in managing PNT. Forty-nine patients (27 women and 22 men) with a mean age of 49 years were studied. There were 28 insulinomas, eight glucagonomas, three gastrinomas, one VIPoma and one carcinoid. Eight patients presented with nonfunctional tumours. Enucleation was performed in 20 patients, distal pancreatectomy in 16, middle pancreatic resection in four, cephalic pancreatoduodenectomy in two and total pancreatoduodenectomy in one. In six patients, the tumour was not resected. RESULTS: Postoperative complication rate was 22%: six pancreatic fistulas, three intra-abdominal collections, one remnant pancreatitis and one pancreatic pseudocyst. There was no mortality. 39 cases showed benign histologic features and ten malignant ones. Symptomatic palliation was achieved in 94% of the cases. Five patients presented recurrences: three liver metastases and two pancreatic recurrences. Actuarial mean survival was 163 months and was longer in insulinomas, in those tumours completely resected and in tumours with benign histological features. CONCLUSION: Conservative surgery of the pancreas is preferred, but aggressive surgery is indicated when the primary tumour can be controlled. Despite of minimising pancreatic resection, there is a high complication rate, mainly pancreatic fistulas, though they can often be conservatively managed. Insulinomas are the PNT with better outcome; those completely resected also associate a better prognosis (AU)

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[Causes of conversion in laparoscopic surgery for gastroesophageal reflux disease: an analysis of our experience]. / Causas de conversión en la cirugía laparoscópica de la enfermedad por reflujo gastroesofágico: análisis de nuestra experiencia.

BACKGROUND: since its introduction in 1991 laparoscopic antireflux surgery has gained great success and popularity among surgeons, and now it is the gold standard for the treatment of gastroesophageal reflux disease (GERD). AIM: to identify and evaluate the causes of conversion in the laparoscopic surgery of GERD and hiatus hernia. MATERIAL AND METHODS: since January 1993 to August 2007 606 laparoscopic antireflux procedures were performed in our hospital. There were 296 women and 310 men with a median age of 53.5 years. The main indication for surgery was evidence of intractable or recurrent GERD symptoms after adequate medical treatment with associated hiatal hernia. The preoperative workup included manometry, pH-metry, oral endoscopy, and barium swallow. The surgical technique was mainly the Nissen-Rossetti procedure. RESULTS: mean postoperative hospital stay was 2.7 days. The operation had to be converted to an open procedure in 43 cases (7%). Conversions were more frequent in the first decade of the learning curve (26 vs. 17, p < 0.016), and fewer among the group of experts in advanced laparoscopic surgery (15 vs. 28, p < 0.017). In 17 cases conversions were due to an intraoperative complication whereas in 26 cases a conversion was done because of technical difficulties. Esophageal perforation and pneumothorax rates were 0.8 and 1%, respectively, and mortality and morbidity rates were 0.1 and 12%. CONCLUSION: the rate of conversion is acceptable and significantly decreases with surgeon experience.

Abordaje multidisciplinar en el tratamiento del cáncer de recto: eficacia del tratamiento neoadyuvante / No disponible

Objetivo: evaluar el papel de la terapia neoadyuvante en eltratamiento del cáncer de recto en nuestro hospital, tras la implantaciónde un grupo multidisciplinar de trabajo (MDT).Material y métodos: desde enero de 2000 hasta diciembrede 2005 se ha evaluado en sesión clínica por el grupo MDT untotal de 90 pacientes diagnosticados de adenocarcinoma de rectoe intervenidos quirúrgicamente tras recibir tratamiento neoadyuvantecon radioquimioterapia (QMRT). La edad media fue de65,04 años (21-83 años), siendo un 67% varones y un 33% mujeres.Los procedimientos quirúrgicos realizados fueron fundamentalmenteresección anterior baja en un 50% y amputación abdominoperinealen un 42,2%.Resultados: la tasa de complicaciones asociada al uso del tratamientoneoadyuvante fue del 54,44%, siendo más frecuenteslas gastrointestinales. Sin embargo, esta toxicidad fue bien toleradaen la mayor parte de los casos, siendo grave y acarreando lasuspensión del tratamiento quimioterápico en 2 pacientes (2,2%).El análisis anatomopatológico de las piezas resecadas demostróuna respuesta completa en 10 casos (11,1%) y una respuesta parcial(disminución del parámetro T de la clasificación TNM) en 32casos (35,6%), con lo que la respuesta global del tratamiento neoadyuvantefue del 46,6%. Entre las complicaciones postoperatoriasse produjeron un 8,3% de dehiscencias anastomóticas, un34,2% de complicaciones de la herida perineal y un 12,2% decomplicaciones urinarias. La mortalidad quirúrgica fue del 0%. Latasa de recidiva pélvica fue del 4,4% y la sistémica del 22,2%. Lasupervivencia actuarial global y libre de enfermedad a los 5 añosfue del 80 y 64% respectivamente.Conclusión: el tratamiento QMRT neoadyuvante proporcionauna cifras bajas de recidiva pélvica junto con buenas tasas desupervivencia, no añadiendo una morbimortalidad importante alacto quirúrgico. La evaluación sistemática por un grupo MDT enel contexto de un protocolo clínico parece ofrecer al paciente mejoresoportunidades de curación

Objective: the aim of this study was to assess the impact ofneoadjuvant treatment on rectal cancer following involvement of amultidisciplinary team (MDT).Materials and methods: between January 2000 and December2005, 90 patients with rectal adenocarcinoma were evaluatedby a MDT and operated on after receiving neoadjuvant treatmentwith radiochemotherapy (RTCT) –67% were men and33% were women, with a mean age of 65.04 years (21-83 years).Surgery was low anterior resection in 50% and abdominoperinealamputation in 42.2%.Results: the rate of complications associated with neoadjuvanttreatment was 54.4%, with gastrointestinal complicationsbeing most frequent. However, this toxicity was tolerated by mostpatients. It was severe in two cases (2.2%), leading to chemotherapydiscontinuation. A histological analysis of specimens showeda complete pathologic response in 10 cases (11.1%) and a partialresponse (downstaging of T) in 32 cases (35.6%), hence overallresponse to neoadjuvant treatment was 46.6%. Postoperativecomplications included anastomotic leakage in 8.3%, perinealwound complications in 34.2%, and urinary disease in 12.2%.The surgical mortality rate was 0%. Local recurrence occurred in4.4%, and distant metastases were found in 22.2%. Both overalland disease-free survivals were 80 and 64%, respectively.Conclusions: neoadjuvant treatment results in low local recurrencerates and optimal survival rates, with no increase in morbidityor mortality. A systematic evaluation by a MDT in the contextof a clinical protocol offers better cure rates

Rhizobium cellulase CelC2 is essential for primary symbiotic infection of legume host roots.

The rhizobia-legume, root-nodule symbiosis provides the most efficient source of biologically fixed ammonia fertilizer for agricultural crops. Its development involves pathways of specificity, infectivity, and effectivity resulting from expressed traits of the bacterium and host plant. A key event of the infection process required for development of this root-nodule symbiosis is a highly localized, complete erosion of the plant cell wall through which the bacterial symbiont penetrates to establish a nitrogen-fixing, intracellular endosymbiotic state within the host. This process of wall degradation must be delicately balanced to avoid lysis and destruction of the host cell. Here, we describe the purification, biochemical characterization, molecular genetic analysis, biological activity, and symbiotic function of a cell-bound bacterial cellulase (CelC2) enzyme from Rhizobium leguminosarum bv. trifolii, the clover-nodulating endosymbiont. The purified enzyme can erode the noncrystalline tip of the white clover host root hair wall, making a localized hole of sufficient size to allow wild-type microsymbiont penetration. This CelC2 enzyme is not active on root hairs of the nonhost legume alfalfa. Microscopy analysis of the symbiotic phenotypes of the ANU843 wild type and CelC2 knockout mutant derivative revealed that this enzyme fulfils an essential role in the primary infection process required for development of the canonical nitrogen-fixing R. leguminosarum bv. trifolii-white clover symbiosis.

Causas de conversión en la cirugía laparoscópica de la enfermedad por reflujo gastroesofágico: análisis de nuestra experiencia / No disponible

Introducción: desde su introducción en 1991, la cirugía antirreflujopor vía laparoscópica ha ido adquiriendo gran popularidadhasta convertirse en el procedimiento de elección de la enfermedadpor reflujo gastroesofágico.Objetivo: identificar y analizar de forma retrospectiva las causasde conversión del abordaje laparoscópico en la cirugía de laenfermedad por reflujo gastroesofágico y de la hernia de hiato.Material y métodos: desde 1993 a agosto de 2007 se hanefectuado en nuestro centro 606 cirugías antirreflujo por vía laparoscópica,encontrando 296 mujeres y 310 varones con una edadmedia de 53,3 años. La indicación fundamental fue la existenciade un reflujo gastroesofágico resistente al tratamiento médico conhernia de hiato asociada. De forma preoperatoria se van a efectuarestudios manométricos y pH-métricos, endoscopia oral ytránsito esofagogastroduodenal. La técnica quirúrgica de elecciónfue mayoritariamente la funduplicatura tipo Nissen-Rossetti.Resultados: la estancia media postoperatoria fue de 2,7 días,realizándose conversión a cirugía abierta en 43 casos (7%). Lasconversiones fueron más frecuentes en la primera década de lacurva de aprendizaje (26 vs. 17 p < 0,016), y menores en el grupode cirujanos expertos en cirugía laparoscópica avanzada(15 vs. 28, p < 0,017). En 17 casos la conversión fue debida auna complicación intraoperatoria y en 26 casos a dificultades técnicas.Las tasas de perforación esofágica y de neumotórax fuerondel 0,8 y 1%, mientras que la tasa de mortalidad y morbilidad fuedel 0,1 y 12% respectivamente.Conclusión: la tasa de conversión está dentro de los límitesaceptables y ha disminuido con la experiencia

Background: since its introduction in 1991 laparoscopic antirefluxsurgery has gained great success and popularity amongsurgeons, and now it is the gold standard for the treatment of gastroesophagealreflux disease (GERD).Aim: to identify and evaluate the causes of conversion in thelaparoscopic surgery of GERD and hiatus hernia.Material and methods: since January 1993 to August 2007606 laparoscopic antireflux procedures were performed in ourhospital. There were 296 women and 310 men with a medianage of 53.5 years. The main indication for surgery was evidenceof intractable or recurrent GERD symptoms after adequate medicaltreatment with associated hiatal hernia. The preoperativeworkup included manometry, pH-metry, oral endoscopy, and bariumswallow. The surgical technique was mainly the Nissen-Rossettiprocedure.Results: mean postoperative hospital stay was 2.7 days. Theoperation had to be converted to an open procedure in 43 cases(7%). Conversions were more frequent in the first decade of thelearning curve (26 vs. 17, p < 0.016), and fewer among thegroup of experts in advanced laparoscopic surgery (15 vs. 28,p < 0.017). In 17 cases conversions were due to an intraoperativecomplication whereas in 26 cases a conversion was done becauseof technical difficulties. Esophageal perforation and pneumothoraxrates were 0.8 and 1%, respectively, and mortality andmorbidity rates were 0.1 and 12%.Conclusion: the rate of conversion is acceptable and significantlydecreases with surgeon experience

Pseudomyxoma peritonei secondary to epithelial appendicular neoplasms. Experience in a non-specialised centre.

INTRODUCTION: Pseudomyxoma peritonei is an infrequent entity, defined by collections of gelatinous material in the abdomen and pelvis and mucinous implants on peritoneum, secondary to the rupture of a mucinous lesion, usually of ovarian or appendiceal origin. MATERIALS AND METHODS: We present our experience of 11 cases (6 males and 5 females) diagnosed with pseudomyxoma peritonei secondary to epithelial appendicular neoplasms over 27 years. The mean age of the patients was 68 years. Clinical manifestations were abdominal distension (55%), right lower quadrant pain (45%) suggesting acute appendicitis and constitutional syndrome (36%). An abdominal mass was detected at physical examination in 4 patients. CT scan revealed a tumour in right iliac fossa in 4 patients, peritoneal enlargement in 1 and a liquid collection in 1. Preoperative diagnosis was acute abdomen in 5 patients, peritoneal carcinomatosis in 3 and undetermined abdominal mass in 3. RESULTS: Surgical findings suggested pseudomyxoma peritonei in 8 patients and peritoneal carcinomatosis in 3. Appendicectomy was performed in 9 patients, and in 3 of them bilateral anexectomy was also performed. One patient underwent ileocaecal resection and another a right hemicolectomy. In all the cases, mucinous material was eliminated as much as possible. Pathology revealed mucinous cystoadenoma in 6 cases, mucinous cystoadenocarcinoma in 3 and epithelial hyperplasia in 2 patients. Median survival was 54 months, with a 5- year survival rate of 40%. The last case we treated was sent to a reference centre for the treatment of pseudomyxoma peritonei. CONCLUSIONS: There is no consensus on the best treatment for pseudomyxoma peritonei. We recommend avoiding incomplete surgical resections in non-reference centres and submitting patients to a reference centre to undergo adequate treatment.

Peritoneal carcinomatosis secondary to carcinoid tumour.

Carcinoid tumours are neuroendocrine neoplasms that can appear in every location of the digestive tract. They are low aggressive tumours, although they often produce local invasion and hepatic metastases, whose resection allows long-term survival. We report a case of a 64-year-old man with ileal carcinoid tumour, that underwent ileal resection and metastasectomy of one lesion in liver segment II. Surgical findings indicated peritoneal carcinomatosis. Carcinoid dissemination as peritoneal carcinomatosis has been rarely described in the literature. Cytoreductive surgery, always when complete resection is aimed, achieves asymptomatic long-term survivals.

Endometriosis intestinal / No disponible

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Peritoneal carcinomatosis secondary to carcinoid tumour

Carcinoid tumours are neuroendocrine neoplasms that can appear in every location of the digestive tract. They are low aggressive tumours, although they often produce local invasion and hepatic metastases, whose resection allows long-term survival. We report a case of a 64-year-old man with ileal carcinoid tumour, that underwent ileal resection and metastasectomy of one lesion in liver segment II. Surgical findings indicated peritoneal carcinomatosis. Carcinoid dissemination as peritoneal carcinomatosis has been rarely described in the literature. Cytoreductive surgery, always when complete resection is aimed, achieves asymptomatic long-term survivals (AU)

Pseudomyxoma peritonei secondary to epithelial appendicular neoplasms. Experience in a non-specialised centre

INTRODUCTION: Pseudomyxoma peritonei is an infrequent entity, defined by collections of gelatinous material in the abdomen and pelvis and mucinous implants on peritoneum, secondary to the rupture of a mucinous lesion, usually of ovarian or appendiceal origin. MATERIALS AND METHODS: We present our experience of 11 cases (6 males and 5 females) diagnosed with pseudomyxoma peritonei secondary to epithelial appendicular neoplasms over 27 years. The mean age of the patients was 68 years. Clinical manifestations were abdominal distension (55%), right lower quadrant pain (45%) suggesting acute appendicitis and constitutional syndrome (36%). An abdominal mass was detected at physical examination in 4 patients. CT scan revealed a tumour in right iliac fossa in 4 patients, peritoneal enlargement in 1 and a liquid collection in 1. Preoperative diagnosis was acute abdomen in 5 patients, peritoneal carcinomatosis in 3 and undetermined abdominal mass in 3. RESULTS: Surgical findings suggested pseudomyxoma peritonei in 8 patients and peritoneal carcinomatosis in 3. Appendicectomy was performed in 9 patients, and in 3 of them bilateral anexectomy was also performed. One patient underwent ileocaecal resection and another a right hemicolectomy. In all the cases, mucinous material was eliminated as much as possible. Pathology revealed mucinous cystoadenoma in 6 cases, mucinous cystoadenocarcinoma in 3 and epithelial hyperplasia in 2 patients. Median survival was 54 months, with a 5- year survival rate of 40%. The last case we treated was sent to a reference centre for the treatment of pseudomyxoma peritonei. CONCLUSIONS: There is no consensus on the best treatment for pseudomyxoma peritonei. We recommend avoiding incomplete surgical resections in non-reference centres and submitting patients to a reference centre to undergo adequate treatment (AU)

[Diagnosis and treatment of pancreatic insulinoma]. / Manejo diagnóstico y terapéutico del insulinoma pancreático.

INTRODUCTION: insulinoma is the most frequent pancreatic endocrine tumor. Its preoperative diagnosis has been controversial for many years. The aim of this study was to evaluate the experience in the management and treatment of this kind of tumor at Hospital Ramón y Cajal. MATERIAL AND METHODS: between January 1999 and July 2006, 12 patients were operated on in our hospital (9 females and 3 males) who had been diagnosed with insulinoma, with a mean age of 56 years (16-72 years). RESULTS: octreotide scintigraphy allowed a diagnosis in 33.3% of cases, abdominal CT in 83.3%, and echoendoscopy in 100%. Intraoperative ultrasonography confirmed the presence of an insulinoma in 100% of cases. In all cases a complete excision was possible, with 9 enucleations and 3 distal pancreatectomies. Two patients developed a pancreatic fistula, and one a pancreatic pseudocyst that healed spontaneously without surgery. The overall cure rate was 100%. After a mean follow-up of 48 months no recurrences have been reported. CONCLUSION: in our experience, we consider advisable that abdominal CT and echoendoscopy be performed before surgery. However, the initial procedure of choice would be pancreas palpation and intraoperative ultrasonography. Surgery cured 100% of cases, and the procedure selected depends on size, location, distance from the main pancreatic duct, and relation to multiple endocrine neoplasm 1 (MEN-1).