Superparamagnetic iron oxide as a tracer for sentinel node biopsy in breast cancer: A comparative non-inferiority study.

AIMS: The gold standard for detection of Sentinel Lymph Nodes (SLN) is a combined radioisotope and blue dye breast injection, using a gamma probe (GP). A new, non-radioactive method was developed, using a tracer (Sienna+(®)) of superparamagnetic iron oxide (SPIO) nanoparticles and a manual magnetometer (SentiMag(®)) (SM). The IMAGINE study was designed to show the non-inferiority of SM compared to GP, for the detection of SLN in breast cancer patients with SLN biopsy indication. METHODS: From November 2013 to June 2014, 181 patients were recruited, and 321 nodes were excised and assessed ex-vivo. Readings from both SM and GP devices were recorded during transcutaneous, intraoperative, and ex-vivo detection attempts. RESULTS: At the patient level, ex-vivo detection rates (primary variable) with SM and GP were 97.8% and 98.3% (concordance rate 99.4%). Transcutaneous and intraoperative detection rates were 95.5% vs 97.2%, and 97.2% vs 97.8% for SM and GP respectively (concordance rates > 97%). At the node level, intraoperative and ex-vivo detection rates were 92.5% vs 89.3% and 91.0% vs 86.3% for SM and GP respectively. In all cases the non-inferiority of SM compared to SM was shown by ruling out a predefined non-inferiority margin of 5%. CONCLUSIONS: Our study showed the non-inferiority of SM as compared to GP. Moreover, the ex-vivo and intraoperative detection rates at the node level were slightly higher with SM.

Tratamiento quirúrgico conservador del síndrome de HELLP (ELLP) asociado a hematoma hepático subcapsular / Conservative surgical treatment of HELLP syndrome (ELLP variant) associated with a subcapsular liver hematoma

Las complicaciones hemorrágicas graves asociadas al embarazo suelen ocurrir en el tercer trimestre del mismo y se relacionan frecuentemente con situaciones de preeclampsia y síndrome HELLP. El síndrome HELLP solo incide en el 0,5-0,9% de las gestaciones, pero su elevada morbimortalidad maternofetal nos obliga a tener en cuenta su diagnóstico en sus diversas formas de presentación clínica. Aunque la gran mayoría de las alteraciones hepáticas que ocurren en el embarazo tienen relación con las escasas hepatopatías inherentes al mismo, la duda diagnóstica ocurre con cierta frecuencia. Presentamos un caso de síndrome HELLP incompleto (variante ELLP) tratado efectivamente mediante actitud quirúrgica conservadora y cuyas peculiaridades inciden en diversos aspectos de esta entidad(AU)

Severe hemorrhagic complications associated with pregnancy usually occur within the third trimester and are frequently linked to preeclampsia and HELLP syndrome. HELLP syndrome affects only 0.5-0.9% of pregnancies but, because it causes high maternal-fetal mortality, a correct diagnosis of the various forms of presentation of this syndrome is essential. Although most of the liver alterations observed during pregnancy are related to pregnancy itself, diagnostic doubts are not infrequent. We present a case of incomplete HELLP syndrome (ELLP variant) associated with a subcapsular liver hematoma, which was successfully treated with a conservative surgical approach(AU)

Comunicación pancreático-pleural secundaria a pseudoquiste pancreático. Una complicación de evolución variable / No disponible

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Angiomiolipoma hepático: una entidad de difícil diagnóstico preoperatorio / No disponible

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Neoplasia epitelial pseudopapilar sólido- quística de páncreas (tumor de Frantz). Estudio de dos nuevos casos / No disponible

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[Solitary hepatic carcinoid tumor in a man with prior treatment for rectal adenocarcinoma. Rapid growth without carcinoid syndrome]. / Tumor carcinoide hepático único en un paciente tratado por adenocarcinoma de recto. Crecimiento rápido sin síndrome carcinoide.

We describe a case of hepatic carcinoid tumor that was diagnosed after right hepatectomy. The tumor was initially believed to be metastases from a rectal adenocarcinoma for which surgery had been performed seven years earlier. We highlight the localization of the tumor in the liver only, its large size and rapid growth, as well as the absence of carcinoid syndrome. Diagnostic studies of function and localization are presented. The absence of neoplasia in other locations suggested that this neoplasm was probably a primary hepatic carcinoid tumor. The association of carcinoid tumors with other neoplasms is well-known. However, because of our patient's history and the absence of symptoms, the preoperative diagnosis was incorrect. The definitive diagnosis was confirmed by pathological analysis, allowing specific studies of function and localization to be performed and therapeutic and follow-up measures to be adopted. Although surgery plays a crucial role in the treatment of these tumors, it should be performed in the context of the multidisciplinary management recommended for this disease.

Hipertiroidismo y cáncer de tiroides concurrente / Concurrent hyperthyroidism and thyroid carcinoma

Introducción. Se han llevado a cabo varios estudios para evaluar la incidencia y la relevancia clínica de la asociación entre hipertiroidismo y cáncer de tiroides, demostrando que dicha asociación no constituye un hallazgo infrecuente. Pacientes y métodos. Revisamos retrospectivamente las historias clínicas de 245 tiroidectomías realizadas en pacientes hipertiroideos. Se encontró cáncer de tiroides en 9 pacientes (3,7 por ciento).Resultados. Se demostró cáncer de tiroides en 5 de 163 pacientes con enfermedad de Graves (3 por ciento), en 3 de 21 pacientes con adenomas tóxicos (14,3 por ciento), y en uno de 61 pacientes con bocio multinodular hipertiroideo (1,6 por ciento). Todos los tumores se correspondían microscópicamente con cánceres papilares. Cuatro de ellos tenían un diámetro inferior a 1 cm (cánceres ocultos). Todos los pacientes fueron tratados mediante tiroidectomía total y 131I en los casos en los que se consideró oportuno. Durante un seguimiento entre 12 y 120 meses no se constató ninguna muerte ni recidiva de la enfermedad. Conclusiones. La prevalencia de cáncer de tiroides en el contexto del hipertiroidismo debe ser tenida en cuenta, especialmente en aquellos pacientes con adenomas tóxicos, con el fin de adecuar los métodos diagnósticos y considerar mejor las opciones de tratamiento quirúrgico (AU)

Metástasis en tiroides / Metastases to thyroid gland

Introducción. El cáncer secundario de la glándula tiroides es una enfermedad muy poco frecuente y poco conocida en la clínica, y por ello en ocasiones condiciona problemas de manejo diagnóstico y terapéutico. Pacientes y métodos. Se estudian de forma retrospectiva los 210 pacientes intervenidos por cáncer de la glándula tiroides intervenidos entre 1981 y 1998. Presentamos 3 casos clínicos de cánceres metastásicos en glándula tiroides, con origen en recto, ovario y mediastino. Conclusiones. A pesar de la escasa frecuencia con la que se presentan las metástasis en la glándula tiroides, esta posibilidad deberá ser considerada como primera ante un paciente con nódulo tiroideo e historia previa más o menos remota de neoplasia maligna. Un diagnóstico precoz y un tratamiento quirúrgico agresivo contribuyen probablemente a prolongar la supervivencia y mejorar la calidad de vida de algunos pacientes (AU)

Obstrucción intestinal en una mujer de 89 años / Intestinal obstruction in an 89-year old woman

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[Cancer of the operated stomach: a descriptive study on the experience of the last 12 years]. / Cáncer de estómago operado: estudio descriptivo sobre la experiencia de los últimos doce años.

BACKGROUND: The incidence of gastric remnant carcinoma ranges between 1% and 9%. We report here our experience in a sanitary area in which, on account of different social and working reasons, the surgical indication for treatment of peptic disease was very common in previous decades. PATIENTS AND METHODS: An analysis was made of the 52 cases of patients operated over the last 12 years, which represents 7.13% of 729 gastric cancers operated over the same time period. RESULTS: In 67% of cases the carcinoma sat on a type-II stump, in 25% on a B-I type stump, and in the remaining 8% on stomachs with vagotomy and pyloroplasty. Seventy-five percent of patients had two characteristics: to be older than 60 years and to have undergone primary surgery at least 15 years before. Over half of patients were admitted on an emergency basis with no diagnosis and had received prolonged symptomatic therapies without previous examinations. The carcinoma involved the anastomotic mouth in 56% of cases and the histologic intestinal type predominated. Twenty-seven percent of patients had stages I and II, whereas almost half of patients had stage IV. Surgical resection was feasible in 42 cases (81%), with a surgical mortality rate of 21% for resections. The overall survival rate estimated at 5 years was 23%. CONCLUSIONS: The possibility of performing surgery with a curative aim is the main prognostic factor for the gastric remnant carcinoma. The endoscopic study of patients at risk allows for diagnosis in earlier stages and therefore and improvement in results.

High-output external duodenal fistula: treatment with percutaneous transhepatic biliary/duodenal drainage.

Percutaneous transhepatic drainage was successfully performed on a patient with a high-output duodenal fistula as a complication of Billroth II surgery, resulting in closure of the fistula.

Bronchial migration of pulmonary arterial coil.

Transcatheter embolization was performed with stainless steel coils in a patient with bilateral pulmonary arterial aneurysms of unknown etiology. After a successful initial procedure, endobronchial migration of one of the coils was found which required surgical treatment. Indications of embolization and different types of materials are discussed.

High-dose intra-arterial urokinase for the treatment of hepatic artery thrombosis in liver transplantation.

Two recipients of orthotopic liver transplants (OLT) underwent intra-arterial thrombolytic treatment for hepatic artery thrombosis. Complete clot lysis was achieved in both using infusion of high-dose urokinase directly into the thrombus for 12 and 3 hours, respectively. Percutaneous transluminal angioplasty (PTA) was later carried out successfully on various strictures. Doppler ultrasonography confirmed arterial permeability one month after treatment. Liver transplantation is now an accepted therapeutic option in some patients with irreversible liver failure. Although the results of this procedure have improved radically since cyclosporine was introduced in 1978, life-threatening postoperative complications still occur. The one with the worst prognosis is hepatic artery thrombosis (HAT), with 64% mortality despite retransplantation. HAT was found in 7.4% of liver transplant recipients in a recent review of the most important group of these patients. Fibrinolytic treatment using an exogenous plasminogen activator, urokinase (UK), is effective and safe in the thrombotic obstruction of acute pulmonary embolism, acute myocardial infarction, and graft or peripheral arterial occlusion. We used intra-arterial thrombolysis in two patients with HAT of the liver graft, to avoid retransplantation and to treat a complication secondary to percutaneous transluminal angioplasty (PTA) of an anastomotic stricture, respectively. To our knowledge, this is the first report of treatment of HAT by direct infusion of urokinase in liver transplantation.

Hepatic artery anastomotic stenosis after transplantation: treatment with percutaneous transluminal angioplasty.

Two orthotopic liver transplant recipients underwent percutaneous transluminal angioplasty (PTA) for stricture of the hepatic arterial anastomosis. In both, arterial revascularization was effected by end-to-end anastomosis between the donor common hepatic artery and the recipient's hepatic artery. Both patients had elevated liver enzyme levels, abnormal results on duplex Doppler images, and severe stricture on angiograms. In one patient, percutaneous biopsy revealed graft ischemia. PTA was performed successfully without complications. PTA produced substantial improvement in biochemical, duplex Doppler, histologic, and angiographic patterns. Both patients were asymptomatic 5 and 6 months after PTA.