[SPECT-CT in sentinel node detection in patients with melanoma]. / SPECT-TAC en la localización del ganglio centinela en pacientes con melanoma.

INTRODUCTION: The prognosis of patients with cutaneous melanoma is greatly influenced by the presence of lymph node metastases. One of the most innovative and fascinating concepts to emerge in the field of oncology in recent years is the use of sentinel lymph node biopsy (SLNB). AIM: The aim of this study was to determine what SPECT-CT images contribute to the search for sentinel nodes in patients with melanoma. METHODS: From March 2007 to October 2008, 18 patients were examined for sentinel nodes using dynamic scintigraphy, planar images, and SPECT-CT in the Nuclear Medicine Department of San Carlos University Hospital. The group contained 10 women and 8 men, age range 14-83 years, mean age 57 years (57+/-20.1). RESULTS: The sentinel node was located by conventional imaging techniques (dynamic scintigraphy and planar images) in 16 of 18 patients (88.88%). SPECT-CT identified the sentinel node in 18 of 18 patients (100%) and detected clinically relevant findings in 6 of 18 patients (33.33%) CONCLUSIONS: SPECT-CT imaging contributed clinically relevant information on sentinel nodes of melanoma, which is particularly important in patients with melanoma of the trunk or head and neck.

[Intestinal pneumatosis]. / Neumatosis intestinal.

Intestinal pneumatosis is an infrequent disease of difficult clinical and radiologic diagnosis. It may be accompanied by pneumoperitoneum in up to 30% of the cases leading to differential diagnosis with pictures of visceral perforation. We herein present 4 cases of intestinal pneumatosis in whom pneumoperitoneum was associated in 3 patients. Diagnosis was intraoperative in 2 patients submitted to emergency surgery because of an associated acute gastrointestinal event (intestinal volvulus and acute cholecystitis). The other 2 cases were diagnosed by computerized tomography and colonoscopy, respectively, and given their satisfactory clinical evolution they received conservative treatment. The course of the disease was favorable in all the patients with the radiologic signs of pneumatosis disappearing.

[Necrotizing gastroenteritis associated with inflammatory bowel disease]. / Gastroenteritis necrotizante asociada a enfermedad inflamatoria intestinal.

Gangrene of the stomach is a rare and catastrophic event, usually attributed to local pathologic conditions. Although there are no cases documented in the literature, non-occlusive arterial ischemia is sometimes listed among the causes of necrotizing gastritis. We report a case of necrotizing gastroenteritis associated with a low flow state secondary to an episode of fulminant colitis, fecal peritonitis and septic shock. The patient recovered after staged resection of the involved segments of the gastrointestinal tract.

[Laparoscopic surgery in the treatment of complicated gastroesophageal reflux]. / Cirugía laparoscópica en el tratamiento del reflujo gastroesofágico complicado.

Laparoscopic antireflux surgery has quickly developed since Bernard Dallemagne carried out the first laparoscopic fundoplication in 1991. However, only preliminary results from institutional series are available. The authors review the indications for laparoscopic antireflux surgery. In addition, technical aspects of several reported laparoscopic antireflux procedures are evaluated. Data from institutional series show that morbidity and mortality rates after laparoscopic antireflux surgery are similar to those reported for open surgery, with a perioperative morbidity rate ranging between 4% and 26% and a mortality rate under 0.6%. Endoscopic dilation for postoperative dysphagia is required in 7%-11% of the cases. In summary, preliminary data show that laparoscopic antireflux surgery may play a predominant role in the treatment of complicated gastroesophageal reflux. Meanwhile, controlled trials with open surgery and medical therapy should be done before the laparoscopic approach is generalized.

[Enteral nutrition in seriously ill patients with digestive tract surgery]. / Nutrición enteral en pacientes graves con cirugía de aparato digestivo.

The results of an enteral nutritional pattern used in 40 seriously ill patients who underwent gastrointestinal tract surgery, are described. The most frequently used route of administration (97.5% of the cases) was a jejunal catheter. We review the types of formula used, the method and time of perfusion, and the association with parenteral nutrition. The mean time of perfusion was 8.6 (5) days and the morbidity rate due to enteral nutrition was 20%. In all cases the complications were minor (externalization of the catheter in 2 cases, proximal reflux of the formula in 1 patient, a catheter break, which was eliminated through the stool without any consequences, in 1 case, diarrhoea in 2 patients, and catheter obstruction in 2 cases). The nutritional results, evaluated by means of clinical chemistry (total proteins, albumin, prealbumin, and transferrin), showed a stabilization of the catabolic process in patients with a poor preoperative nutritional state under severe surgical stress. It can be concluded that enteral nutrition is a useful manner of postoperative feeding in seriously ill patients who undergo gastrointestinal surgery, and that it must often be added to parenteral nutrition to ensure an adequate caloric intake.

[Acute cholecystitis and laparoscopic cholecystectomy. Comparison with non-complicated cholelithiasis]. / Colecistitis aguda y colecistectomia laparoscópica. Comparación con la colelitiasis no complicada.

Laparoscopic cholecystectomy has become the treatment of choice for symptomatic cholelithiasis. However, the indication of the laparoscopic approach for acute inflammation of the gallbladder in unclear and further analysis of the results is required. The aim of our study was to compare the results of laparoscopic cholecystectomy after uncomplicated cholelithiasis and after acute cholecystitis. Data from 201 patients who underwent laparoscopic cholecystectomy were collected prospectively. Uncomplicated cholelithiasis was present in 149 patients and 52 individuals had acute cholecystitis. No differences in age, sex distribution or associated diseases were observed between groups. The mean operative time was significantly higher in patients with acute cholecystitis. However, no difference was observed regarding conversion rate (7.3%-7.6%) and morbidity rate (8.7%-9.6%). No mortality has occurred in any group. The average hospital stay after laparoscopic cholecystectomy was greater when acute cholecystitis was present (2.6 days-4.9 days; p < 0.01). But in this case hospitalization was shorter than after elective conversion (8 days; p < 0.001 and p < 0.05). We conclude that patients with acute cholecystitis can undergo laparoscopic cholecystectomy safely, with low morbidity and mortality rates and reduced hospital stay.

[Laparoscopic cholecystectomy: 3 years of experience at a university hospital]. / Colecistectomía laparoscópica: tres años de experiencia en un Hospital Universitario.

We analyse the first 174 patients treated with laparoscopic cholecystectomy (LC) and their follow-up results. Average age was 57 years. Intraoperative cholangiography was not done in anyone. Conversion rate into other forms of intervention was 6.3%. The rate of common bile duct injury has been null. Total morbidity was 6.3%. Two cases of pulmonary embolism and two biliary leakages stand out in the postoperative morbidity. There was no death. After a follow-up period of up to 36 months, only 1 case of residual choledocholithiasis was registered, and it was cured with endoscopy. In this series morbid-mortality figures are low. LC is a safe procedure in the treatment of cholelithiasis, even in older patients.

[Hemoptysis caused by a bronchial artery aneurysm. Apropos a case]. / Hemoptisis por aneurisma de la arteria bronquial. A propósito de un caso.

We discuss the case of a right bronchial artery aneurysm in its intrapulmonary trajectory which manifested itself by repeated mild hemoptysis. Diagnosis was made through selective angiography of bronchial artery and during the same procedure it was treated through transcatheter embolization. We have reviewed the literature and found 17 cases of bronchial artery aneurysms with intrapulmonary or mediastinal localization.