Appreciation of the treatment in adult patients with congenital portosystemic connections in relation with their symptoms.

BACKGROUND: portosystemic intrahepatic venous connections (Abernethy syndrome) are rare anatomical variants, which are classified according to the type of union between the portal venous circulation and the central venous system. In adults, the diagnosis is often incidental, although some cases can be presented with an encephalopathy without associated liver disease. CASE REPORTS: here we present two cases of portosystemic shunt, one with encephalopathy development, and the other casually caught. Its treatment by interventionist radiology, was decided in function of clinic symptoms. Both patients were asymptomatic at controls in the outpatient consultation. No complications derived from the therapeutic decision. The control is carried out annually with image tests and blood analysis. DISCUSSION: given the low prevalence of malformation and its usual diagnosis at younger ages (associated with important cognitive alterations) its treatment in adults is not protocolized. In these cases the decision of the treatment would be conditioned to the associated symptomatology, being the minimally invasive treatment (by interventional radiology) a therapeutic option in the symptomatic adult. Observation by imaging tests and control in outpatient consultation (without associated treatment) would be a choice in asymptomatic adults.

[Surgical indications in gallbladder polyps]. / Indicaciones quirúrgicas en los pólipos de vesícula biliar.

INTRODUCTION: The surgery of gallbladder polyps is not well defined due to the lack of evidence-based clinical guidelines. OBJECTIVE: To analyse the management of polyps in Spain, and a review of the literature and treatment standards. MATERIAL AND METHODS: The reports on cholecystectomy with gallbladder polyps (GBP) were extracted from the Pathology data base. Patients subjected to surgery with a diagnosis of GBP were identified in the Surgery data base. A single list was prepared and a review was made of the clinical histories, including, age, gender, clinical data, ultrasound report, and histopathology report. RESULTS: A total of 30 patients, with a median age of 51 years (range 22-83), 21 of whom were female, were included. The ultrasound diagnosis was GBP in 19 patients, GBP and calculi in 7 cases, and calculi with no polyps in 4 cases. Other diagnoses concurrent with GBP were multiple haemangiomas (3), large single simple cyst (1), and multiple simple cysts (1). Eleven patients had typical pain (biliary origin), 5 of which showed no calculi on ultrasound. Eight had non-specific pain, which persisted in 3 cases after the cholecystectomy. Pseudopolyps were found in 20 gallbladders, and true polyps in 4 cases. In 3 cases, polyps were not found in the pathology study. CONCLUSIONS: The ultrasound report must specify the size, shape, and number of polyps. Patients with biliary type pain would benefit from a cholecystectomy. The probability of malignancy is minimum if the GBP is less than 10mm and aged under 50 years, and a cholecystectomy is not required. A GBP greater than 10mm should be an indication of cholecystectomy.

[Gallbladder cancer in a regional hospital]. / Cáncer de vesícula biliar en un hospital comarcal.

OBJECTIVES: To assess the management of gallbladder cancer (GBC) in our region. MATERIAL AND METHODS: Data on 372 patients who underwent cholecystectomy were identified from our database (January 2003 to February 2008) and 6 patients were found to have GBC. RESULTS: Four patients had incidental carcinoma, one case was preoperatively suspected, and one patient presented with jaundice and locally advanced neoplasia. The incidence was 2 per 100,000 inhabitants per year; incidental carcinoma in 1.1% of cholecystecomies. The ultrasonography showed multilithiasis in 2 patients, sludge and neoplasia in 1, gallstones more than 3cm in 2, and tumor mass only in 1 case. T stage: 1 case of T0 (in situ), 1 of T1, 2 of T2 and one T4. Incidental carcinomas were reoperated on when a T2 was established: 2 underwent lymphadenectomy and cystic stump resection, 1 segmentectomy IVb-V and lymphadenectomy. In the preoperative suspected neoplasia a cholecystectomy, lymphadenectomy, and partial hepatic gallbladder bed resection was initially performed. CONCLUSIONS: GBC has a low incidence but it will be found in 1% of cholecystectomies. There is no adjuvant treatment and T-based surgical treatment is the is the only opportunity to reach cure in those patients. A national GBC database would be helpful in the publication of national guidelines for this disease.

[Decrease of serum cholinesterase in colorectal cancer]. / Disminución de la colinesterasa sérica en el cáncer colorrectal.

BACKGROUND AND OBJECTIVE: Cholinesterase is an enzyme with an unknown physiologic function. Some situations are related to a decreased serum cholinesterase activity but those situations are not well defined and the responsible mechanisms are unknown. Malignancy is one of these situations. The aim of the study was to compare the cholinesterase activity between patients with and without colorectal cancer. PATIENTS AND METHOD: Case-control study of patients with colorectal cancer who underwent surgery in our hospital from March 05 to January 07. RESULTS: Patients from the cancer group had a significant decreased serum cholinesterase activity. CONCLUSIONS: Investigation of cholinesterase function in humans may result in new research lines in oncology treatment.