Role of Peritoneal Cytology in Patients with Early Stage Colorectal Cancer.

The main objective of this study was to investigate the incidence of free tumour cells in peritoneal lavage cytology performed using a standard method before and after the resection of the tumour, and to assess the usefulness of this technique in scheduled interventions on colorectal cancer patients. Peritoneal lavage cytology was performed on a homogeneous sample of 188 patients undergoing colorectal cancer curative resection before and after the resection of the tumour. The procedure was performed systematically in all cases. Malignant cells were detected in the peritoneal lavage cytology performed before the resection of the tumour in three patients. Lymph node affection was the variable most associated with the prognosis of these colorectal cancer patients. Peritoneal lavage cytology can provide additional information for a small group of patients who need to be closely monitored and studied to decide on the most effective type of chemotherapy.

[Complete and inverted esophagastric duplicity]. / Duplicidad esofagogástrica completa e invertida.

CASE REPORT: A 4-month old girl affected by gastric duplication discovered as a palpable abdominal mass displacing the spleen and left kidney. During laparotomy, a yellowish secretion is aspirated and the gastric duplication is excised together with the common muscular Wall of the greater curvature of the stomach. Also excised, a tubular structure starting from the inferior pole of the malformation, and communicating with it, passing superior to the head of the pancreas and the second portion of the duodenum, followed by a posterior course before inserting into the right cruz of the diaphragm. The histology of the tubular formation was compatible with esophagus. CONCLUSION: This type of duplication has not been reported in the literature and reinforces the theory that these malformations could be secondary to genetic transcription errors, in the differentiation of the endoderm of the primitive digestive tract and the notochord.

CASO CLINICO: Niña de 4 meses, afecta de una duplicidad gástrica, descubierta como masa abdominal palpable y que desplazaba el bazo y el riñón izquierdo. Mediante laparotomía, se observa una duplicidad gástrica y, tras aspirar una secreción amarillenta, se realiza su exéresis junto con la pared muscular común con la curvatura mayor del estómago y una estructura tubular que, partiendo del polo inferior de la malformación y comunicada con ella, pasaba por encima de la cabeza del páncreas y de la segunda porción duodenal, siguiendo luego un curso posterior hasta insertarse en la base del pilar diafragmático derecho. La histología de esta formación tubular fue compatible con el esófago. CONCLUSIONES: Este tipo de duplicidad no la hemos visto referida en la literatura y refuerza la teoría de que estas malformaciones pudieran ser secundarias a errores de transcripción genéticas de información en la diferenciación del endodermo del tubo digestivo primitivo y de la notocorda.

Longitudinal changes in maternal serum placental growth factor and soluble fms-like tyrosine kinase-1 in women at increased risk of pre-eclampsia.

OBJECTIVES: To investigate longitudinal changes in maternal serum levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) in pregnant women who develop pre-eclampsia (PE) or gestational hypertension (GH). METHODS: This was a prospective longitudinal study in women with singleton pregnancies identified by screening at 11 + 0 to 13 + 6 weeks' gestation as being at high-risk of PE. Blood samples were taken every 4 weeks until delivery. Values were compared in women who developed preterm PE (requiring delivery before 37 weeks' gestation), term PE or GH and those who remained normotensive. RESULTS: A total of 1069 samples were analyzed in 234 women, including 172 who remained normotensive, 18 who developed GH, 22 who developed preterm PE and 22 who developed term PE. In the preterm PE group, compared to the normotensive group, sFlt-1 levels were significantly higher from 15 weeks' gestation onward and the difference increased with gestational age (P < 0.001). In the preterm PE group, compared to the normotensive group, PlGF levels were significantly lower from 11 weeks' gestation onward and the difference increased significantly with gestational age (P < 0.001). Similarly, in the term PE and GH groups, PlGF levels were lower from 13 and 27 weeks onward, respectively, and the differences increased significantly with gestational age (P < 0.001 for both groups). In the preterm PE group, compared to the normotensive group, the sFlt-1/PlGF ratio was significantly higher from 11 weeks onward and the difference increased significantly with gestational age (P < 0.001). A random slope model provided a significantly better fit to the data than did a single-level model for sFlt-1 (likelihood ratio (LR) = 516; degrees of freedom (df) = 3; P < 0.001), PlGF (LR = 542; df = 3; P < 0.001) and the sFlt-1/PlGF ratio (LR = 468; df = 3; P < 0.001). CONCLUSION: Repeat measurements of the biochemical markers used in this study are likely to be better predictors of PE than are measurements at a single time point during pregnancy, as the differences between normotensive and hypertensive pregnancies increase with gestational age. In screening for preterm PE, maternal serum level of PlGF is a useful marker from the first trimester onward, while the level of sFlt-1 is likely to have a predictive value from the second trimester onward. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Influence of intestinal resections on biliary composition and liver ultrastructure.

BACKGROUND & AIMS: Among the multiple factors that can influence bile acid (BA) metabolism and biliary poles, intestinal resections could do so directly (through absorption alterations) and/or indirectly (bacterial translocation, alterations of the hepato-intestinal hormonal axis). Our aim was to study the influence of partial intestinal resections on bile metabolism and biliary structure in an animal model. METHODS: Dunkin Hartley guinea pigs were used: Group A with only jejunum resection, Group B with only ileum resection, and Group CtrG, the control group. They were monitored for 21 days, with oral nutrition. At the end of this period, samples of the bile were taken from the hepatic duct and vena cava. After liver perfusion, samples of hepatic tissue were taken for optical and electron microscopy. RESULTS: There was a significant decrease in serum cholesterol in both GA & GB. The levels of biliary phospholipids (Ph) and cholic acid decreased only in Group B, but not ketolithocholic acid nor total conjugated BA. Slight liver macrosteatosis was observed in GB, but there were no changes in the biliary poles or canaliculi in the electron microscopy samples. CONCLUSIONS: Ileum resections affect the biliary Ph and BA composition, which could increase bile lithogenicity but do not seem to affect biliary duct anatomy.

[Changes in the fat composition and histomorphology of the liver after partial intestinal resections]. / Cambios en la composición de la grasa y en la histomorfología del hígado tras resecciones intestinales parciales.

BACKGROUND & AIMS: The partial resection of the intestine could affect the liver through alteration in nutrient absorption, loss of the bile acids via the enterohepatic circulation, alterations in the hepato-duodenobilio-pancreatic hormonal complex as well as a bacterial translocation. All these factors could sum up and induce changes in the tissue composition and in hepatic histomorphology. The aim of this experimental study is to acquire a profound knowledge of these hepatic alterations after the partial intestinal resection. M & M: 26 Dunkin Hartley guinea pigs were used: Group A with only jejunum resection, Group B with only ileum resection, and Group CtrG, the control group. They were monitored for 21 days. At the end, blood samples were taken for serum biochemical analysis. Samples of hepatic tissue were taken for histomorphological optical study. All the rest liver was homogenize and the fat liver composition was analysed (total fat, lipid fractions, phospholipids fractions and fatty acids of the liver). RESULTS: There was a significant decrease in serum cholesterol in both GA & GB. There was also a decrease of the total fat/g liver tissue, without changes in the phospholipids fraction and decreases in the C18-2/C18-3 and w6/w3 ratios. There was a minimal macrosteatosis and reduction of the number of mitochondries in GB. CONCLUSIONS: the partial intestinal resection, specially ileum resections, looks like influence the structural fat liver composition. However, these changes could be compensated for by the liver and oral nutrition. These findings help us to improve the liver-intestinal relationships.

[A possible case of superior mesenteric artery syndrome of congenital origin]. / Un posible caso de origen congénito de síndrome de la arteria mesentérica superior (SAMS).

We describe a case of a 10 yr old boy, who suffered from gastroesophageal reflux in the neonatal period and from recurrent abdominal pain, epigastric distension and vomiting since birth, but with an increase in this clinic in the last two years, especially in the last five months, without suffering weight loss, having operations or other illnesses. After the diagnosis of superior mesenteric artery syndrome was confirmed by a superior barium series and a CT-scan, a laparotomy was performed, carrying out the Koecher manoeuvre, cutting the Treitz ligament near of the 4th part of the duodenum until descend that and freeing the aorto-mesenteric space. The follow up after 5 years showed an excellent clinical evolution. In our opinion, this case should be considered to be of congenital origin, but without other associated abdominal anomalies. The possible different interventions are also discussed.

Cholestasis induced by total parenteral nutrition.

Parenteral nutrition is a life-saving treatment for patients who have acute and chronic intestinal failure. Severe cholestasis induced by total parental nutrition (TPN-IC) is characterized by bile duct regeneration, portal inflammation, and fibrosis. Its progression could be very rapid, and in some patients liver cirrhosis may develop in few months. This article describes the definition, incidence, hepatic changes, histopathologic findings, risk factors, pathogenesis, and clinical implications of TPN-IC. The goal is to improve hospital and home management, quality of life, and prognosis of patients requiring parenteral nutrition.

Anomalies of intestinal rotation and fixation: consequences of late diagnosis beyond two years of age.

The malrotation and no well fixation anomalies of the digestive tract is also frequent in older child, young and adult, with characteristic and specific clinical presentation. Actually, the diagnostic and treatment seem to be late, after suffering prolonged symptoms and/or in emergency. We present nine cases of anomalies in the embryonic development of the digestive tract which were diagnosed and treated in infants or young, all above 2 years old. Eight cases were of more or less complete intestinal malrotation; one of them was a complete malrotation with an intrinsic duodenal stenosis associated (no bands of Ladd) and another one was a right paramesocolic hernia, always accompanied by malrotation. The association with other extra-digestive anomalies, especially urological, was 70%. The predominant symptom was intermittent abdominal pain (IAP)-80%-sometimes accompanied by vomiting (35%) and episodes of diarrhoea (25%). In all the cases, while the clinical background was early, diagnosis was late. Indeed, in 60% of the cases diagnosis was made intra-operatively in emergency surgical interventions. The imaging procedures employed were scanning and Doppler ultrasound, CT scan, and contrast gastrointestinal series (GIS). Up to 30% of errors in interpretation occurred, although they were eventually corrected with other tests. The most reliable diagnostic procedures were GIS and CT scan with contrast, although partial interpretation errors occurred with the latter procedure. Surgery was essential in 80% of the pre-operative cases, and in another two it was required as a preventative measure. Post-operatively, there was notable persistence of SBS in the cases of intestinal necrosis, and of other lesser symptoms in the rest. We conclude that: intestinal malrotations and malfixations are still being diagnosed very late, with serious systemic consequences such as intestinal obstructions or necroses, and prolonged clinical suffering. This could all be avoided if more attention were paid to the digestive symptoms associated with IAP, and to subocclusion or other abdominal phenomena (distension,...), together with, in the case of doubt about the findings with the previous procedures, the opportune imaging tests (e.g., abdominal Doppler ultrasound, CT scan with contrast, and barium GIS). Unlike other authors, we consider that the morbidity/mortality associated with cases of late diagnosis of these anomalies is high, and calls for earlier surgical treatment.

[Animal models for the study of systemic inflammatory response and parenteral nutrition]. / Modelos animales para el estudio de la respuesta inflamatoria sistémica y de nutrición parenteral.

The systemic inflammatory response syndrome (SRIS) seems to be due to the activation of the toll-like receptors, specific of the inflammatory response cells, through concrete cytosolic signals which lead to a cascade of reactions acting cytokins, growing factors and others inflammatory mediators. This kind of work revewes and discusses several classifications of animals models to study the SRIS, and propose to divide these models according to concrete goals, which can be the following ones: (1) To study innate and adaptative receptors of regulatory gens in the SRIS. (2) To study signals receptors (cytokines and growing factors). (3) To study the answer to signals. (4) To study treatments through specifics antinflammatory blockage. (5) Specific models of sepsis. (6) Others inducing models of SRIS. (7) Others therapeutical models. -Antinflammatories. -Antiacoagulans: Coagulations inhibition in human assays. Phase II Anticoagulans: Antitrombine III, PCA and TFPI. -Antibiotics. -Replacing Volume Treatments. -Surgical Treatments. As to the animals models to study Parenteral Nutrition, we could make the next classifications and sum it up: (1) Animal models to study the parenteral via of administration. (2) Models to study viability, absorption and local tolerance of the administration via. (3) Study models for complications. (4) Animal models to study pharmacodynamic, metabolization and to investigate the tolerance of new molecules or substrates.

[Acute secundary abdomen to pancreatic hydatid cyst]. / Abdomen agudo secundario a quiste hidatídico pancreático.

The hydatidosis is a frequent zoonosis in Spain, but isolated location in pancreas and their onset as acute abdomen is excepcional. We present a boy 14 years old, with abdominal pain and low-grade fever since 1 month. Hemogram shows eosinophilia, and echography an anechoic mass in tail of pancreas beside of free peritoneal liquid. At surgery procedure: a broken hydatid cyst is verified, surrounded of tissues inflammatory reaction that evolved to pancreatic fistula. The differents forms from clinical presentation of the pancreatic hydatid cyst, as well as the complications related to their location are analyzed.

Abdomen agudo secundario a quiste hidatídico pancreático / Acute secundary abdomen to pancreatic hydatid cyst

La hidatidosis es una zoonosis frecuente en España; sin embargo, la localización única en páncreas y su aparición como abdomen agudo es excepcional. Presentamos un varón de 14 años de edad, con historia de dolor abdominal y febrícula de 1 mes de evolución. En el hemograma se observa una eosinofilia y en la ecografía se comprueba la existencia de una masa anecoica en cola de páncreas, además de líquido libre. Durante la intervención, se comprueba la existencia de un quiste hidatídico (QH) roto, con reacción inflamatoria de los tejidos de alrededor, que posteriormente hizo un pseudoquiste pancreático como consecuencia de una fístula pancreática. Se analizan las diferentes formas de presentación clínica de los QH pancreáticos, así como las complicaciones originadas por su localización (AU)

The hydatidosis is a frequent zoonosis in Spain, but isolated location in pancreas and their onset as acute abdomen is excepcional. We present a boy 14 years old, with abdominal pain and low-grade fever since 1 month. Hemogram shows eosinophilia, and echography an anechoic mass in tail of pancreas beside of free peritoneal liquid. At surgery procedure: a broken hydatid cyst is verified, surrounded of tissues inflammatory reaction that evolved to pancreatic fistula. The differents forms from clinical presentation of the pancreatic hydatid cyst, as well as the complications related to their location are analysed (AU)

[Photopheresis: new immunomodulatory therapy for T-lymphocite mediated diseases]. / Fotoféresis: nueva terapia inmunomoduladora para enfermedades mediadas por linfocitos T.

The photopheresis (ECP) is a therapeutic approach based on the biological effect of psoralen and ultraviolet light A on mononuclear cells collected by apheresis, and reinfused into the patient. In 1988, the treatment was the first FDA-approved selective immunotherapy for any type of cancer. Convincing data taken from over 160 centers in Europe and the U.S.A. over the past few years have documented that ECP is associated with a very low side-effect profile. Evidence shows that this therapy prolongs the mean survival, and also induces 50-75% response rates in patients with advanced cutaneous T-cell lymphoma. In addition, more and more reports indicate that photopheresis is a potent agent in the therapy of solid organ transplant rejection, graft versus host disease, scleroderma, and other autoimmune diseases resistant to conventional therapy. The mechanism of this treatment is likely due to the induction of cell-mediated anticlonotypic immune response against pathogenic clones of T lymphocytes.

[Epidermoid cyst of the mouth floor]. / Quiste epidermoide en el suelo de la boca.

The epidermoid cysts are frequent during childhood, however mouth floor location are very unusual, because of their more difficult diagnosis and therapeutic approach. We present a 5 years old male, symptoms free until a week before, when his parents noticed a well defined mass in the mouth floor. A physical examination leaded to the diagnosis of possible epidermoid cyst. The tumor was excised through an introral approach. A review of different diagnostic means and surgical management are undertaken.

Quiste epidermoide en el suelo de la boca / Epidermoid cyst of the mouth floor

Los quistes epidermoides son una patología frecuente en la infancia, sin embargo, su localización sublingual es excepcional, lo cual origina dificultades diagnósticas y terapéuticas. Presentamos un varón, de 5 años de edad, asintomático, que desde una semana antes, los padres le han observado una tumoración situada en el suelo de la boca, bien delimitada y mediante una exploración detenida se sospecha la existencia de un posible quiste que se extrae mediante un abordaje oral, confirmando el estudio histológico el diagnostico de quiste epidermoide. Se analiza los diferentes medios diagnósticos y las posibles vías de abordaje quirúrgico utilizadas (AU)

[What happens in the liver during artificial feeding?]. / Qué sucede en el hígado durante la alimentación artificial?

The livers of healthy individuals, where different products are synthesized and metabolized, carries out a series of complex metabolic functions. Furthermore, there is an important relationship with the digestive apparatus, such as for the secretion, excretion and re-circulation of bile, and also with the various hormonal systems or the bacterial microflora of the intestine. When artificial feeding (AF) is used, this may lead to changes in the functionality and structure of the liver, which may or may not be reversible depending on the base situation of the patient and the type of AF administered. This would be enough to bring about a series of changes followed by adaptive phenomena in the liver itself. The degree of hepatic damage triggered by artificial feeding will depend on the interaction of all these elements and the specific characteristics of each case.

[Hydatic cyst in mediastinum]. / Quiste hidatídico en mediastino.

The main localization of hydatic cysts (HC) in mediastinum is exceptional. We present the case of a 12 year-old boy who had habitual contact with dogs. He had pain in the right hemithorax and back together with low-grade fever. In the X-rays of the thorax a right retrocardiac image shows an occupied costodiaphragmatic sinus. The CT of the thorax shows a bilateral pleural effusion and a mass measuring 10 x 7.5 x 5 cm in the middle mediastinum. After admission, a new X-ray of the thorax revealed an increase in the right pleural discharge, for which reason an urgent thoracotomy was performed checking for the existence of a mediastinum HC with possible membrane fissures. The HC was removed. The only treatment of HC in mediastinum is surgical, an urgent thoracotomy being necessary whenever a possible rupture is suspected in order to avoid a possible anaphylatic reaction or growth pleural cavity.

Quiste hidatídico en mediastino / Hydatic cyst in mediastinum

La localización primaria de los quistes hidatídicos (QH) en mediastino es excepcional. Presentamos un varón, de 12 años, con contacto habitual con perros, que acude por presentar dolor en hemitóraz derecho y espalda junto con febrícula. En las Rx de tórax se aprecia una imagen retrocardíaca derecha con ocupación de seno costodiafragmático. En la TAC de tórax aparece un derrame pleural bilateral y una masa de 10 x 7,5 x 5 cm en mediastino medio. Tras su ingreso, una nueva radiografía de tórax revela un aumento del derrame pleural derecho, por lo que se realiza una toracotomía de urgencia, comprobándose la existencia de un QH mediastínico con posibles fisuras de la membrana, procediendo a su extirpación. El tratamiento de los QH en mediastino es quirúrgico, debiendo realizar una toracotomía de urgencia, siempre que se sospeche una rotura, para evitar una posible reacción anafiláctica o una siembra en cavidad pleural (AU)

[Retroperitoneal cystic lymphangioma in childhood]. / Linfangioma quístico retroperitoneal en la infancia.

UNLABELLED: Lymphangiomas are very common neoplasms in infancy. However, a retroperitoneal location is seldom observed. We present the case of a male with a history of chronic recurrent pain over a period of several years. An X-ray showed a calcic density in the left upper abdominal quadrant; the histological study revealed it to be a mixoid cystic lymphangioma. Clinical presentation varies greatly from an asymptomatic mass to serious complications. In order to correctly diagnose of these neoplasms it is essential to carry on ultra sound and CT examination although a simple abdominal X-ray may show calcifications as the one presented here. Treatment is always surgical and a complete extirpation should be performed, unless vital structures were are involved. Treatment with laser, fibrin and sclerotherapy have also been used. CONCLUSION: In spite of being benign neoplasms we believe they should be removed to confirm diagnosis and avoid possible complications.

[Hemangioma of the glans penis]. / Hemangioma de glande.

The haemangiomas are benign vascular tumors of frequent apparition in infant, but not very much described in penis glans in the literature. We present a case with location in penis glans, in a short age male, that it was treated through conventional surgery with good results. We accomplish a review of this pathology and we make reference to the different ways of treatment today.

[Superior vesical fissure]. / Fisura vesical superior.

Although vesical extrophy is a well-known anomaly, the variants of vesical extrophy are exceptional. We present the case of a newborn child, who upon exploration, revealed a defect of closure in the infra-umbilical abdominal wall through which vesical mucous membrane protruded. A probe introduced into the urethra appeared externally at the place of the infraumbilical defect. Following the diagnosis of superior vesical fissure, resection of the protruding vesical mucous membrane and closure were carried out. The authors reviewed the bibliography published in order to study the different kinds of variants of vesical extrophy and the associated congenital anomalies. Although these children are usually continent, a urodynamic study and a VCU are recommended in order to discard the existence of a post closure-uretheral-vesical reflux of the umbilical defect.