RESUMEN
We report the case of a 49-year-old caucasian woman, in whom an endocrine tumor arising in gastric heterotopic pancreas was diagnosed. The patient was treated surgically with a gastric wedge resection. Heterotopic pancreas is a benign anatomic condition, probably widely underdiagnosed because usually asymptomatic. The malignant transformation of aberrant pancreas is very rare and almost always in adenocarcinoma. The endocrine tumors developed in heterotopic pancreas are exceedingly rare. Of our knowledge, only four cases have been published and only one case in the gastric location similar to this reported case.
Asunto(s)
Transformación Celular Neoplásica/patología , Coristoma/patología , Páncreas/patología , Neoplasias Pancreáticas/patología , Gastropatías/patología , Carcinoma de Células de los Islotes Pancreáticos/patología , Femenino , Estudios de Seguimiento , Gastrinas/análisis , Humanos , Islotes Pancreáticos/patología , Persona de Mediana Edad , Somatostatina/análisisRESUMEN
The authors report the case of a 63 year-old woman who developed high-grade fever with chills, nausea, diarrhea, severe pain in the right hypochondrium, and jaundice after one month's treatment with 300 mg of hydroquinidine hydrochloride daily. Serum bilirubin and aminotransferases were slightly increased, while alkaline phosphatases and gamma-glutamyl-transpeptidase serum activities were markedly raised. Histological examination of a liver specimen obtained by the transvenous route showed numerous epithelioid granulomas with giant cell formation and eosinophils in hepatic lobules and portal tracts. Symptoms disappeared three days after withdrawal of the drug, but hepatomegaly and a mild increase in serum gamma-glutamyl-transpeptidase persisted more than eighteen months. Quinidine-induced hepatitis is almost always associated with fever, and, in one-third of the cases, with a pseudo-cholangitis picture. Extrahepatic hypersensitivity manifestations are often present. Histological examination of the liver shows granulomatous or cytolytic hepatitis. Withdrawal of the drug is rapidly followed by a favorable outcome; readministration causes immediate relapse; progression to chronic liver disease has never been reported previously.
Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Quinidina/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Femenino , Humanos , Hígado/patología , Persona de Mediana Edad , Factores de TiempoRESUMEN
A congenital choledochal cyst, type Ia according to Todani's classification, was discovered fortuitously in a 54-year old man by abdominal sonography. The patient had no biliary symptoms, and liver tests were normal. Excision of the cyst was performed because of the theoretical risk of cholangiocarcinoma. Recovery was uneventful.
Asunto(s)
Quiste del Colédoco/diagnóstico por imagen , Colecistectomía , Quiste del Colédoco/cirugía , Dilatación Patológica , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Mediastinal parathyroid adenoma located on the 5th ectopic gland is rare. We report here two new cases diagnosed by scintigraphy. In one case the adenoma was found to be located in the mediastinum prior to cervicotomy. The modern imaging methods capable of locating parathyroid adenomas are evaluated.
Asunto(s)
Adenoma/diagnóstico por imagen , Coristoma/diagnóstico por imagen , Enfermedades del Mediastino/diagnóstico por imagen , Neoplasias del Mediastino/diagnóstico por imagen , Glándulas Paratiroides , Neoplasias de las Paratiroides/diagnóstico por imagen , Adenoma/epidemiología , Adenoma/patología , Adenoma/cirugía , Adulto , Coristoma/epidemiología , Coristoma/patología , Coristoma/cirugía , Femenino , Humanos , Enfermedades del Mediastino/epidemiología , Enfermedades del Mediastino/patología , Enfermedades del Mediastino/cirugía , Neoplasias del Mediastino/epidemiología , Neoplasias del Mediastino/patología , Neoplasias del Mediastino/cirugía , Persona de Mediana Edad , Neoplasias de las Paratiroides/epidemiología , Neoplasias de las Paratiroides/patología , Neoplasias de las Paratiroides/cirugía , CintigrafíaRESUMEN
Free intestinal autograft has been recommended for oesophageal reconstruction following total circular pharyngolaryngectomy for cancer. Coloplasty or gastroplasty are commonly used for reconstruction of cervical and thoracic oesophagus. Necrosis of the plasty or anastomotic leakage can occur and may require the resection or reintegration of the pedicled graft into the abdominal cavity. For later reconstruction another pedicled graft may not be feasible and interposition of a free intestinal autograft can be a helpful method. The authors report a case of successful reconstruction of the cervical and thoracic oesophagus by a free ileal autograft, after the initial failure of a right coloplasty in a patient with previous gastrectomy. The free ileal autograft was interposed between the cervical oesophagus and the previous coloplasty repositioned in the lower part of the anterior mediastinum. The vessels of the graft were implanted onto the left common carotid artery and the innominate venous confluent.
Asunto(s)
Neoplasias Esofágicas/cirugía , Esofagoplastia/métodos , Yeyuno/trasplante , Humanos , Masculino , Persona de Mediana EdadRESUMEN
GOAL OF STUDY: Treatment of splenic injury is not standardized. We conducted an inventory of splenic injury treatment modalities of splenic injury in the Languedoc-Roussillon region of France. METHODS: A questionnaire was sent by e-mail to 33 surgeons practicing in 10 hospitals in that region. Surgeons were asked: how many cases were treated per year (PMSI databank for the last three years), local resources (resuscitation bay or intensive care unit, availability of CT and interventional radiology), indications (surgery, embolization, nonoperative management [NOM]), prognostic criteria, NOM modalities (duration of bed rest, hospital stay, restriction of physical activity, thromboembolic prophylaxis, and imaging schedule). RESULTS: Thirty-one surgeons replied. An average of 185 patients were treated per year. There was consensus concerning the indication for urgent splenectomy, NOM was practiced in the stable patient (even with diffuse hemoperitoneum) and splenic artery embolization was performed for active bleeding (blush on CT) (for the six centers who have interventional radiology at their disposal). Disparities existed between centers concerning the modalities of NOM excepting imaging monitoring, initial surveillance in resuscitation bay or intensive care and in the therapeutic indications when bleeding persisted. CONCLUSION: Based on the consensus observed in this study and an analysis of the literature, a uniform treatment policy can be proposed.