[Quality of DNA from archival pathological samples of gallbladder cancer]. / ¿Es posible utilizar las muestras de colecistectomías con cáncer en investigación?: Calidad del ADN de muestras obtenidas del sistema público y privado de salud.

BACKGROUND: The quality of the archival samples stored at pathology services could be a limiting factor for molecular biology studies. AIM: To determine the quality of DNA extracted from gallbladder cancer samples at different institutions. MATERIAL AND METHODS: One hundred ninety four samples coming from five medical centers in Chile, were analyzed. DNA extraction was quantified determining genomic DNA concentration. The integrity of DNA was determined by polymerase chain reaction amplification of different length fragments of a constitutive gene (ß-globin products of 110, 268 and 501 base pairs). RESULTS: The mean DNA concentration obtained in 194 gallbladder cancer samples was 48 ± 43.1 ng/µl. In 22% of samples, no amplification was achieved despite obtaining a mean DNA concentration of 58.3 ng/ul. In 81, 67 and 22% of samples, a DNA amplification of at least 110, 268 or 501 base pairs was obtained, respectively. No differences in DNA concentration according to the source of the samples were demonstrated. However, there were marked differences in DNA integrity among participating centers. Samples from public hospitals were of lower quality than those from private clinics. CONCLUSIONS: Despite some limitations, in 80% of cases, the integrity of DNA in archival samples from pathology services in our country would allow the use of molecular biology techniques.

Basaloid carcinoma of the prostate: an extremely rare tumor.

OBJECTIVE: The basaloid carcinoma of the prostate (BC) is a rare malignant neoplasm arising from the basal cells of prostatic ducts and acini. We report a case and review the literature. METHODS: A 76-year-old man presented with symptoms of lower obstructive uropathy, the IPSS score was 29 and prostate specific antigen (PSA)of 0,924 ng /ml. Transurethral resection of prostate (TURP) was performed in September 2008, histopathological diagnosis was BC. In February 2009 laparoscopic radical prostatectomy was performed. RESULTS: Histopathological examination revealed a BC with adenoid cystic growth pattern, perineural infiltration and focal involvement of the left seminal vesicle. Immunohistochemically, the cells were negative for PSA, stained and were strongly positive for specific monoclonal antibodies anti-cytokeratin 34ßE12, p63 and BCL-2. The patient has 23 months of follow-up, with complete continence and no evidence of tumor recurrence. CONCLUSIONS: The BC is an extremely rare subtype of malignant tumors of the prostate, where immunohistochemistry plays a fundamental role in diagnosis.

[Human intestinal spirochetosis: clinical series and literature review]. / Espiroquetosis intestinal humana: serie clínica y revisión de la literatura.

INTRODUCTION: Human intestinal spirochetosis (HIE) is defined as colonization by spirochetes of the large intestine. Is associated with chronic diarrhea. The incidence and prevalence ranges from 0.4% to 12%. OBJECTIVE: To determine the prevalence of HIE in the Salvador's Hospital, between 2003 and 2008 in patients with a history of chronic diarrhea and without abnormalities in colonoscopy, in 2 separate groups: patients with and without a history of HIV infection. MATERIAL AND METHODS: Retrospective morphology evaluation of the large bowel endoscopic biopsies to the selected groups. RESULTS: We reviewed 115 biopsies, 98 were from HIV-negative and 17 HIV from positive patients. Two cases of intestinal spirochetosis were detected, both HIV negative, with a prevalence of 1.7%. COMMENT: The prevalence of HIE is similar to that reported in Western countries. Population studies are needed to determine the real epidemiological impact in our environment.

Bilateral laparoscopic adrenalectomy.

BACKGROUND AND PURPOSE: Laparoscopic adrenalectomy has become the gold standard in the surgical management of adrenal pathology. Bilateral adrenalectomy is indicated in patients with Cushing's disease secondary to macroadenoma or hypophysial hyperplasia in whom medical treatment and transsphenoid surgery have failed. Also, it is the first choice for bilateral benign tumors and metastatic neoplasia. We present our experience with bilateral laparoscopic adrenalectomy, analyzing its indications, feasibility, results, and complications. PATIENTS AND METHODS: Between November 1999 and December 2005, 221 laparoscopic adrenalectomies were performed by the same surgeon (OAC) at our institution. Of the 221 adrenalectomies, 44 were bilateral. A total of 20 patients underwent bilateral synchronic laparoscopic adrenalectomy (91%); the remaining 2 had two-stage procedures. There were 6 cases of bilateral pheochromocytoma, 6 patients with Cushing's disease, 3 cases of metastasis, 3 congenital adrenal hyperplasias, 2 hyperaldosteronisms, and a single case each of adrenal adenoma and myelolipoma. The average patient age was 41.6 years (range 17-72 years), and the male-to-female ratio was 1:2.6. RESULTS: Total laparoscopic adrenalectomy and partial adrenalectomy were performed on 37 and 7 occasions (84% and 16%), respectively. The mean tumor size was 4.15 cm (range 1-11 cm). The mean operative time for each adrenalectomy was 79.2 minutes (range 25-210 minutes). The estimated intraoperative blood loss was on average 65.4 mL (range 0-500 mL). Only one patient required a blood transfusion. There was only one intraoperative complication (2.2%), a renal-vein injury that was controlled with intracorporeal suturing. There were no open conversions. The mean hospital stay was 3.19 days (range 2-5 days). CONCLUSIONS: Bilateral laparoscopic adrenalectomy is technically feasible and can be performed with minimal bleeding in a reasonable surgical time.

Laparoscopic resection of adrenal teratoma.

BACKGROUND: Teratoma is a germ-cell tumor that commonly affects the gonads. Its components originate in the ectoderm, endoderm, and mesoderm. Extragonadal occurrence is rare. Teratomas confined to the adrenal gland are exceptional; only 3 cases have been reported in the English-language literature. We report 2 cases of mature teratomas of the adrenal gland that were laparoscopically excised. METHODS: Two patients (ages 8 and 61 years) were diagnosed with adrenal teratoma at our institution. Radiological examination showed a solid 8-cm adrenal lesion in both cases. Hormonal assessment was normal. Both patients underwent laparoscopic transperitoneal adrenalectomy. RESULTS: Surgical time was 120 minutes and 50 minutes, respectively. One patient was discharged on postoperative day 2, and the other remained hospitalized until day 10. The latter patient required percutaneous drainage of a retroperitoneal collection. Both tumors were identified as mature cystic teratomas. No evidence was present of recurring disease in either patient. CONCLUSIONS: Adrenal teratoma is rare. Laparoscopic transperitoneal adrenalectomy is a feasible, effective technique that enables excellent oncologic results. To our knowledge, this is the first report of laparoscopic adrenalectomy for pure adrenal teratoma.

Manejo quirúrgico de pseudoquiste pancreático gigante: caso clínico / Surgical management of giant pancreatic pseudocyst: case report

Resumen Introducción: Los pseudoquistes pancreáticos (PQP) corresponden al 80% de las lesiones quísticas del páncreas. Se debe descartar un tumor quístico, que representan el 10% al 15% de los quistes del páncreas y 1% de los tumores malignos por lo que es fundamental el estudio y diagnóstico diferencial. El término pseudoquiste pancreático gigante se usa tradicionalmente cuando el tamaño es mayor de 10 cm. Hay pocos casos de PQP gigantes en la literatura nacional. Objetivo: Reportar caso clínico con PQP gigante, analizar el diagnóstico diferencial y las opciones terapéuticas. Materiales y Método: Paciente con distensión abdominal progresiva, pérdida de peso y anorexia, posepisodio de pancreatitis aguda. Tomografía computarizada abdominal y resonancia magnética confirman lesión quística gigante intraabdominal. El paciente fue tratado con una cistoyeyunostomía pancreática abierta en Y de Roux. El análisis del contenido aspirado durante la cirugía sugiere PQP. Para la discusión se revisa la literatura más relevante. Resultados: Excelente resultado clínico postoperatorio, el estudio histopatológico de la pared del quiste confirmó el diagnóstico de pseudoquiste pancreático. Al año de seguimiento, el paciente permanece asintomático. Discusión: El estudio preoperatorio es crucial para determinar el diagnóstico diferencial y descartar lesiones neoplásicas o parasitarias quísticas. Los PSQ gigantes reportados son poco frecuentes y su manejo quirúrgico dependerá fundamentalmente de su tamaño, de las relaciones anatómicas y de la experiencia del equipo tratante.

Introduction: Pancreatic pseudocysts (PQP) correspond to 80% of cystic lesions of the pancreas. A cystic tumor must be ruled out, which represents 10% to 15% of pancreatic cysts and 1% of malignant tumors, so the study and differential diagnosis is essential. The term giant pancreatic pseudocyst is traditionally used when the size is greater than 10 cm. There are few cases of giant PQP in the national literature. Objective: To report a clinical case with giant PQP, to analyze the differential diagnosis and therapeutic options. Materials and Method: Patient with progressive abdominal distension, weight loss and anorexia post episode of acute pancreatitis. Abdominal computed tomography and magnetic resonance imaging confirm a giant intra-abdominal cystic lesion. The patient was treated with an open Roux-en-Y pancreatic cysto-jejunostomy. Analysis of the content aspirated during surgery suggests PQP. The most relevant literature is reviewed for discussion. Results: Excellent postoperative clinical results, the histopathological study of the cyst wall, confirmed the diagnosis of pancreatic pseudocyst. At one year of follow-up, the patient remains asymptomatic. Discussion: The preoperative study is crucial to determine the differential diagnosis and rule out neoplastic or cystic parasitic lesions. Reported giant PSQs are rare and their surgical management will depend fundamentally on their size, anatomical relationships, and the experience of the treating team.

Laparoscopic adrenalectomy for adrenal masses: does size matter?

OBJECTIVES: To examine the impact of adrenal tumor size on perioperative morbidity and postoperative outcomes in patients undergoing laparoscopic adrenalectomy. METHODS: A total of 227 laparoscopic adrenalectomies were divided in three groups according to size as estimated by pathologic specimen maximum diameter: less than 6 cm (group 1, n = 140), between 6 and 7.9 cm (group 2, n = 47), and equal to or larger than 8 cm (group 3, n = 40). We prospectively recorded and analyzed clinical and pathologic data. RESULTS: Average operative time was 60 minutes (range, 50 to 90 minutes) for group 1, 75 minutes (range, 65 to 105 minutes) for group 2, and 80 minutes (range, 65 to 120 minutes) for group 3. Estimated blood loss, median (interquartile range) was 50 mL (range, 20 to 100 mL), 100 mL (range, 48 to 225 mL), and 100 mL (range, 50 to 475 mL) for groups 1, 2, and 3, respectively. We observed a total of 10, 4, and 4 complications in groups 1, 2, and 3, respectively. Average hospital stay was 2 days (range, 2 to 3 days), 2 days (range, 2 to 3 days), and 3 days (range, 2 to 4 days), respectively, for groups 1, 2, and 3. Operative time, average blood loss, and mean hospital stay were significantly higher (P

¿Es posible utilizar las muestras de colecistectomías con cáncer en investigación?: Calidad del ADN de muestras obtenidas del sistema público y privado de salud / Quality of DNA from archival pathological samples of gallbladder cancer

Background: The quality of the archival samples stored at pathology services could be a limiting factor for molecular biology studies. Aim: To determine the quality of DNA extracted from gallbladder cancer samples at different institutions. Material and Methods: One hundred ninety four samples coming from fve medical centers in Chile, were analyzed. DNA extraction was quantifed determining genomic DNA concentration. The integrity of DNA was determined by polymerase chain reaction amplification of different length fragments of a constitutive gene (β-globin products of 110, 268 and 501 base pairs). Results: The mean DNA concentration obtained in 194 gallbladder cancer samples was 48 ± 43.1 ng/µl. In 22% of samples, no amplification was achieved despite obtaining a mean DNA concentration of 58.3 ng/ul. In 81, 67 and 22% of samples, a DNA amplification of at least 110, 268 or 501 base pairs was obtained, respectively. No differences in DNA concentration according to the source of the samples were demonstrated. However, there were marked differences in DNA integrity among participating centers. Samples from public hospitals were of lower quality than those from private clinics. Conclusions: Despite some limitations, in 80% of cases, the integrity of DNA in archival samples from pathology services in our country would allow the use of molecular biology techniques.

Espiroquetosis intestinal humana: serie clínica y revisión de la literatura / Human intestinal spirochetosis: clinical series and literature review

Introduction: Human intestinal spirochetosis (HIE) is defined as colonization by spirochetes of the large intestine. Is associated with chronic diarrhea. The incidence and prevalence ranges from 0.4% to 12%. Objective: To determine the prevalence of HIE in the Salvador's Hospital, between 2003 and 2008 in patients with a history of chronic diarrhea and without abnormalities in colonoscopy, in 2 separate groups: patients with and without a history of HIV infection. Material and Methods: Retrospective morphology evaluation of the large bowel endoscopic biopsies to the selected groups. Results: We reviewed 115 biopsies, 98 were from HIV-negative and 17 HIV from positive patients. Two cases of intestinal spirochetosis were detected, both HIV negative, with a prevalence of 1.7%. Comment: The prevalence of HIE is similar to that reported in Western countries. Population studies are needed to determine the real epidemiological impact in our environment.

Introducción: La espiroquetosis intestinal humana (EIH) se define como la colonización del intestino grueso por espiroquetas. Se asocia a diarrea crónica. Su incidencia y prevalencia van desde 0,4 a 12% Objetivo: Determinar la prevalencia de EIH en el Hospital Del Salvador, de Santiago, Chile, entre los años 2003 y 2008, en pacientes con antecedentes clínicos de diarrea crónica y colonoscopia sin hallazgos patológicos, separados en dos grupos: pacientes con y sin antecedentes de infección por VIH. Material y Método: Evaluación morfológica retrospectiva de las biopsias endoscópicas de intestino grueso de los grupos seleccionados. Resultados: Se revisaron 115 biopsias, 98 correspondieron a pacientes sin infección por VIH y 17 a pacientes seropositivos para VIH. Se detectaron dos casos de espiroquetosis intestinal, ambos en pacientes sin infección por VIH, con una prevalencia de 1,7 %. Comentario: La prevalencia de EIH es similar a la publicada en países occidentales. Se requieren estudios poblacionales para determinar el real impacto epidemiológico en nuestro medio.

Laparoscopic adrenalectomy for adrenal myelolipoma.

OBJECTIVE: [corrected] To evaluate the results of laparoscopic adrenalectomy for adrenal myelolipoma in a single center. METHODS: Between November 1999 and February 2006, 226 laparoscopic adrenalectomies were performed at our institution. 19 specimens corresponded with adrenal myelolipomas (8%). Mean patient age was 53.8 years (range 35 to 75) with male-to-female ratio 2:1. Clinical data was prospectively collected. Patient characteristics, lesion size evaluated by CT scan or MRI, surgical technique, operative time, operative blood loss, complications, conversion to open surgery and hospital stay were reviewed. RESULTS: Nineteen adrenal myelolipomas were laparoscopically treated in eighteen patients. 16 lesions were located on the right adrenal gland (84%). Mean surgical time was 84.7 minutes (range 45 to 150). Average bleeding was 25.8 ml (range 0 to 300). Only one patient required a blood transfusion. There were no intraoperative complications or conversions to open surgery. Average hospital stay was 2.1 days (range 1 to 4); no complications were registered during the immediate postoperative period. Pathology reports confirmed all specimens as myelolipomas. Mean maximum tumor diameter was 8.6 cm (range 4.5 to 14). CONCLUSIONS: Adrenal myelolipoma is an infrequent, benign entity which can occasionally become symptomatic due to spontaneous hemorrhage. Typical radiographic presentation permits conservative management in asymptomatic small masses. In cases where surgical treatment is advocated, laparoscopic surgery is a safe and feasible technique with reasonable operating time as well as limited blood loss, hospital stay and convalescence.

[Inverted papilloma of the bladder]. / Papiloma invertido vesical.

OBJECTIVES: To report a series of patients with bladder inverted papilloma, pointing out the clinical features, presentations, treatment options and outcomes. We also perform a bibliography review oriented to the diagnostic criteria, treatment options and prognosis of the inverted papilloma. METHODS: We reviewed the medical charts of all patients with the diagnosis of bladder inverted papilloma treated by our group between July 1996 and June 2003. RESULTS: 16 cases of inverted papilloma of the bladder were diagnosed in ten males and six females, with a mean age of 53.1 yr. (range 31-72). The most frequent reason for consultation was voiding urgency (43.7%), followed by hematuria (37.5%). In 14/16 patients the lesion was localized in the bladder trigone. Transurethral resection of the lesion was performed in all patients. Two cases (12.5%) presented associated transitional cell carcinoma. CONCLUSIONS: The inverted papilloma is a rare pathologic entity Despite the absence of agreement about its aggressiveness or innocuousness we consider its potential malignancy should be taken into consideration after the evidence of recurrences and its association with transitional cell carcinoma.

[Concordance of Gleason histological scoring for prostatic cancer in needle biopsies and the surgical piece obtained during radical prostatectomy]. / Concordancia diagnóstica del puntaje de Gleason en biopsia por punción y prostatectomía radical y sus consecuencias clínicas.

BACKGROUND: The Gleason histological score is an independent prognostic factor in prostate cancer that helps in therapeutic decisions. AIM: To analyze the concordance between the Gleason score of needle prostatic biopsy and the score from the study of the surgical piece obtained during radical prostatectomy. MATERIAL AND METHODS: Retrospective analysis of 212 cases of prostate cancer, diagnosed between February 1993 and March 2003. All had the Gleason histological scores from needle prostatic biopsies and in the surgical piece obtained during radical prostatectomy. All pathological studies were done by the same observer. RESULTS: There was an exact concordance of Gleason scores between needle biopsy and the surgical piece in 49% of cases and a concordance of +/- 1 unit in 89%. The concordance improved in the second half of the study period. No cases with a Gleason score of less than 5 were detected since 1999 in the surgical piece. CONCLUSIONS: The concordance of Gleason score of needle prostatic biopsies and surgical pieces is good. This concordance increases with the experience of the pathologist.

Carcinoma basaloide de la próstata: un tumor extremadamente raro / Basaloid carcinoma of the prostate: an extremely rare tumor

OBJETIVO: El carcinoma basaloide de la próstata (CB) es una neoplasia maligna poco frecuente derivada de las células basales de los conductos prostáticos y acinos. Presentamos un caso clínico y hacemos una revisión de la literatura. MÉTODOS: Paciente de sexo masculino, de 76 años de edad quien consulta por síntomas de uropatía obstructiva baja con score IPSS de 29 y antígeno prostático (APE) de 0.924 ng/ml. Se practica resección transuretral de próstata (RTUP) en Septiembre de 2008 cuya histopatología concluyó CB. En febrero de 2009 se realiza prostatectomía radical laparoscópica. RESULTADOS: El estudio anatomopatológico revela un CB, con patrón de crecimiento adenoideo quístico, infiltración perineural y extensión extraprostática con compromiso focal de vesícula seminal izquierda y márgenes quirúrgicos negativos. En el estudio inmunohistoquímico las células son negativas para Antígeno prostático específico (APE), siendo fuertemente positivas a anticuerpos monoclonales específicos anti-citoqueratina 34βE12, p63 y BCL-2. El paciente lleva 23 meses de seguimiento, con continencia completa y sin evidencias de recurrencia tumoral. CONCLUSIONES: El CB es un subtipo extremadamente raro de los tumores malignos de la próstata, donde la inmunohistoquímica juega un papel fundamental en su diagnóstico (AU)

OBJECTIVE: The basaloid carcinoma of the prostate (BC) is a rare malignant neoplasm arising from the basal cells of prostatic ducts and acini. We report a case and review the literature. METHODS: A 76-year-old man presented with symptoms of lower obstructive uropathy, the IPSS score was 29 and prostate specific antigen (PSA) of 0,924 ng / ml. Transurethral resection of prostate (TURP) was performed in September 2008, histopathological diagnosis was BC. In February 2009 laparoscopic radical prostatectomy was performed. RESULTS: Histopathological examination revealed a BC with adenoid cystic growth pattern, perineural infiltration and focal involvement of the left seminal vesicle. Immunohistochemically, the cells were negative for PSA, stained and were strongly positive for specific monoclonal antibodies anti-cytokeratin 34βE12, p63 and BCL-2. The patient has 23 months of follow-up, with complete continence and no evidence of tumor recurrence. CONCLUSIONS: The BC is an extremely rare subtype of malignant tumors of the prostate, where immunohistochemistry plays a fundamental role in diagnosis (AU)

Carcinoma renal de los conductos colectores de Bellini con recidiva retroperitoneal por otro tipo histológico de tumor renal / Renal cell carcinoma of the collecting ducts of Bellini with retroperitoneal recurrence by another histological subtype of renal tumor

OBJETIVO: El Carcinoma Renal de los Conductos Colectores (CRCC) o Carcinoma de Bellini esun subtipo histológico raro y agresivo. Presentamos un caso de CRCC con recidiva retroperitoneal por otro subtipo histológico de tumor renal y revisión de la literatura. MÉTODOS: Paciente masculino de 59 años, sin antecedentes médicos de importancia, quien consultó por presentar hematuria macroscópica. Se realizó Tomografía Computada de abdomen (TAC) la cual mostró una masa tumoral que ocupa la pelvis renal izquierda. Se practicó nefroureterectomía radical izquierda laparoscópica con desinserción endoscópica de uréter intramural ipsilateral. RESULTADOS: El diagnóstico anatomopatológico fue CRCC con márgenes quirúrgicos negativos. Se realizó una TAC control 10 meses después, la cual reveló una masa tumoral retroperitoneal izquierda, compatible con una recidiva local. Se realizó una laparotomía subcostal izquierda con resección completa de la masa. El diagnóstico histológico fue un carcinoma renal de células grandes con componentes de células granulares y células claras. CONCLUSIONES: El CRCC es una forma poco frecuente de todos los carcinomas renales y presenta un comportamiento agresivo que se asocia a mal pronóstico. La resección quirúrgica sigue siendo el tratamiento de elección. Presentamos el primer caso descrito de CRCC con recidiva retroperitoneal por otro subtipo histológico de tumor renal (AU)

OBJECTIVE: Collecting Duct Carcinoma or Bellini Carcinoma (CDC) is a rare aggressive histological subtype. We present a case of CDC with retroperitoneal recurrence by another histological subtype of renal tumor and review of the literature. METHODS: A 59-year-old man with no relevant clinical history presented gross hematuria. At the time of diagnosis, a computed tomography (CT) showed a tumor mass occupying the left renal pelvis. Left Laparoscopic radical nephroureterectomy was performed with endoscopic intramural ipsilateral ureter disinsertion. RESULTS: The pathological diagnosis was CDC with negative surgical margins. A CT scan control was performed 10 months later, showed a left retroperitoneal tumor compatible with a local recurrence. We performed a left subcostal laparotomy with complete resection of the mass. Histological diagnosis was large cell carcinoma with components of granular cells and clear cell. CONCLUSIONS: The CDC is a rare subtype of renal cell carcinoma (RCC) and has an aggressive behavior that is associated with poor prognosis. Surgical resection remains the treatment of choice. We present the first reported case of CDC with retroperitoneal recurrence by another histological subtype of renal tumor (AU)

Laparoscopic adrenalectomy for adrenal myelolipoma / Adrenalectomía laparoscópica por mielolipoma suprarrenal

Objetive: To evaluate the results of laparoscopic adrenalectomy for adrenal myelolipoma in a single center. Methods: Between November 1999 and February 2006, 226 laparoscopic adrenalectomies were performed at our institution. 19 specimens corresponded with adrenal myelolipomas (8%). Mean patient age was 53.8 years (range 35 to 75) with male-to-female ratio 2:1. Clinical data was prospectively collected. Patient characteristics, lesion size evaluated by CT scan or MRI, surgical technique, operative time, operative blood loss, complications, conversion to open surgery and hospital stay were reviewed. Results: Nineteen adrenal myelolipomas were laparoscopically treated in eighteen patients. 16 lesions were located on the right adrenal gland (84%). Mean surgical time was 84.7 minutes (range 45 to 150). Average bleeding was 25.8 ml (range 0 to 300). Only one patient required a blood transfusion. There were no intraoperative complications or conversions to open surgery. Average hospital stay was 2.1 days (range 1 to 4); no complications were registered during the immediate postoperative period. Pathology reports confirmed all specimens as myelolipomas. Mean maximum tumor diameter was 8.6 cm (range 4.5 to 14). Conclusions: Adrenal myelolipoma is an infrequent, benign entity which can occasionally become symptomatic due to spontaneous hemorrhage. Typical radiographic presentation permits conservative management in asymptomatic small masses. In cases where surgical treatment is advocated, laparoscopic surgery is a safe and feasible technique with reasonable operating time as well as limited blood loss, hospital stay and convalescence (AU)

Evaluar los resultados de la adrenalectomía laparoscópica por mielolipoma suprarrenal en un único centro. Métodos: Entre noviembre de 1999 y febrero del 2006 se realizaron 226 adrenalectomías laparoscópicas en nuestra institución. Diecinueve casos fueron mielolipomas (8%). La edad media de los pacientes fue de 53,8 años (rango de 35 a 75) con una relación varónes: mujeres de 2:1. Los datos clínicos se recogieron de forma prospectiva. Se revisan las características del paciente, tamaño de la lesión evaluado por TAC o resonancia magnética nuclear, técnica quirúrgica, tiempo operatorio, sangrado estimado, complicaciones, conversión a cirugía abierta y estancias hospitalarias. Resultados: Diecinueve mielolipomas suprarrenales fueron tratados en 18 pacientes. Dieciocho tumores estaban localizados en la glándula suprarrenal derecha (84%). El tiempo operatorio medio fue de 84,7 minutos (rango de 45 a 150). El sangrado estimado medio fue de 25,8 ml. (0-300). Solamente un paciente necesitó transfusión sanguínea. No hubo complicaciones intraoperatorias o conversiones a cirugía abierta. La estancia hospitalaria media fue de 2,1 días (1-4); no se registraron complicaciones en el postoperatorio inmediato. El estudio anatomopatológico confirmó todos los casos como mielolipomas. El tamaño máximo medio fue de 8,6 cm de diámetro (4,5-14). Conclusiones: El mielolipoma suprarrenal es un tumor benigno, poco frecuente, que puede ocasionalmente hacerse sintomático por hemorragia espontánea. La presentación radiológica típica permite un manejo conservador en tumores pequeños asintomáticos. En los casos en los que se recomienda tratamiento quirúrgico la cirugía laparoscópica es una técnica segura y factible, con un tiempo operatorio razonable, un sangrado limitado y unos tiempos cortos de estancia hospitalaria y de convalecencia (AU)

Papiloma invertido vesical / Inverted papilloma of the bladder

OBJETIVO: Presentar una serie de pacientes con papiloma invertido vesical, señalando las características clínicas, formas de presentación, tratamiento y evolución. Se realiza también una revisión de la literatura dirigida a los criterios de diagnóstico, tratamiento y pronóstico del papiloma invertido. MÉTODOS: Se revisan los registros clínicos de los pacientes con diagnóstico de papiloma invertido vesical tratados por nuestro grupo entre julio de 1996 y junio de 2003. RESULTADOS: Se diagnosticaron 16 casos de papiloma invertido de localización vesical, en 10 hombres y 6 mujeres, con edad promedio de 53.1 años (rango 31 - 72). El motivo de consulta más frecuente fue la urgencia miccional (43.7%), seguido de hematuria (37.5%). En 14/16 pacientes la lesión se localizó en el trígono vesical. Se realizó resección endoscópica de la lesión en la totalidad de los pacientes. En dos casos (12.5%) se presentó asociación con carcinoma de células transicionales. CONCLUSIONES: El papiloma invertido es una entidad patológica poco frecuente, y aunque en la actualidad no hay acuerdo sobre la inocuidad o agresividad de su comportamiento, consideramos que se debe tener en cuenta su potencial de malignidad evidenciado por las recurrencias y su asociación con el carcinoma de células transicionales

OBJECTIVES: To report a series of patients with bladder inverted papilloma, pointing out the clinical features, presentations, treatment options and outcomes. We also perform a bibliography review oriented to the diagnostic criteria, treatment options and prognosis of the inverted papilloma. METHODS: We reviewed the medical charts of all patients with the diagnosis of bladder inverted papilloma treated by our group between July 1996 and June 2003. RESULTS: 16 cases of inverted papilloma of the bladder were diagnosed in ten males and six females, with a mean age of 53.1 yr. (range 31-72). The most frequent reason for consultation was voiding urgency (43.7%), followed by hematuria (37.5%). In 14/16 patients the lesion was localized in the bladder trigone. Transurethral resection of the lesion was performed in all patients. Two cases (12.5%) presented associated transitional cell carcinoma. CONCLUSIONS: The inverted papilloma is a rare pathologic entity. Despite the absence of agreement about its aggressiveness or innocuousness we consider its potential malignancy should be taken into consideration after the evidence of recurrences and its association with transitional cell carcinoma

Adrenalectomía laparoscópica: lecciones aprendidas en 110 procedimientos consecutivos / Lapararoscopic adrenalectomy: lessons learned from 110 consecutive procedures

Objetivo: Se presenta una serie personal de 110 adrenalectomías laparoscópicas efectuadas en forma consecutiva, destacando las indicaciones, técnica quirúrgica, complicaciones y resultados. Material y Método: Entre Junio de 1993 y Junio del 2003, se realizaron 110 adrenalectomías laparoscópicas en 102 pacientes, 62 mujeres y 40 hombres con una edad promedio de 47,2 años (8-78 años). Las indicaciones más frecuentes fueron: incidentaloma 23,6 por ciento, cáncer metastásico 22,7 por ciento, hiperaldosteronismo 17,3 por ciento,feocromocitoma 15,5 por ciento, síndrome de Cushing 7,3 por ciento, quiste adrenal 6,4 por ciento, mielolipoma 3,6 por ciento y teratoma 1,8 por ciento. Resultados: El tiempo operatorio promedio fue 94.2 minutos (25-240 minutos), el sangrado intraoperatorio fue de 116,9 mL (0-2500 mL), la conversión a cirugía abierta fue necesaria en 1 paciente (0,9 por ciento) debido a sangrado. La estadía hospitalaria fue de 2,5 días (1-10 días). Se registró complicación en 3 pacientes (2,7 por ciento) y hubo una muerte (0,9 por ciento) durante la cirugía. El tamaño promedio fue de 4,2 cm (1,5- 14 cm) y los diagnósticos anatomopatológicos más frecuentes fueron: adenoma 27,3 por ciento, hiperplasia nodular 18,2 por ciento, cáncer metastático 17,3 por ciento y feocromocitoma 14,5 por ciento. Conclusiones: La adrenalectomía laparoscópica evolucionó durante la década pasada hasta establecerse como la técnica de elección para la cirugía adrenal. Basado tanto en la experiencia personal como en los artículos aparecidos en la literatura, este abordaje reporta resultados quirúrgicos comparables a cirugía abierta, pero con claras ventajas para la cirugía laparoscópica en lo que se refiere a complicaciones, estadía hospitalaria, período de convalecencia y resultado cosmético.

Prostatectomía radical laparoscópica extraperitoneal / Extraperitoneal laparoscopic radical prostatectomy

Objetivo: Presentamos nuestra experiencia en Prostatectomía Radical Laparoscópica Extraperitoneal (PRLE), destacando la técnica quirúrgica, resultados y complicaciones. Material y Método: Se incluyen 106 pacientes con cáncer de próstata tratados en forma consecutiva en nuestra Unidad mediante PRLE entre mayo del 2000 y enero del 2004. Resultados: La edad promedio fue 61 años (rango: 40-78 años) y el valor promedio del antígeno prostático específico fue de 10,31 ng/ml (rango: 1,6-66,8 ng/ml). La técnica quirúrgica fue reproducida en la totalidad de los pacientes. El tiempo quirúrgico promedio fue de 156 min (rango: 80-390 min). El sangrado intraoperatorio promedio fue 577 ml y la tasa de transfusión fue del 26%. Se administró analgesia endovenosa en las siguientes 36 horas a la cirugía y en ningún paciente hubo necesidad de utilizar analgésicos opiáceos. La deambulación ocurrió en las primeras 24 horas del postoperatorio en todos los pacientes y excepto por 3 casos, el drenaje tubular sólo se necesitó en las primeras 24 a 48 horas. La media de la estadía hospitalaria fue 3 días y el tiempo promedio de cateterización vesicouretral fue 7 días. Las complicaciones más frecuentes fueron retención urinaria (6,6%), lesión de recto (5,6%), estrechez de la anastomosis (5,6%), fístula recto-vesical (2.8%) y filtración de la anastomosis (2,8%). Conclusión: Nuestra serie ratifica que la PRLE es un procedimiento bien tolerado, con buenos resultados en lo referente a dolor postoperatorio y tiempo de hospitalización. Cuando ocurren complicaciones, éstas tienden a ser más severas que cuando se presentan en cirugía abierta y son dependientes de la experiencia del cirujano.

Background: The extraperitoenal approach for radical prostatectomy is a minimally invasive technique with a low incidence of complications. Aim: To report a series of patients with localized prostate cancer, managed with extraperitoneal laparoscopic radical prostatectomy (ELRP). Patients and Methods: Report of 106 patients (age range 40-78 years)successively subjected to ELRP between May 2002 and January 2004. Results: Preoperative prostate specific antigen ranged from 1.6 to 66.8 ng/ml. Mean operative time was 156 minutes (range: 80-390 minutes). Mean blood loss was 577 mL and transfusion rate was 26%. Analgesics were used in the first 36 hours after surgical procedure and opiates were not required. Mean hospital stay was 3 days and average urinary catheter use was 7 days. The most common complications were urinary retention in 6.6% , rectal lesions in 5.6%, vesico-urethral anastomosis stricture in 5.6%, vesico-rectal fistula in 2.8% and vesico-urethral anastomosis leak in 2.8% of patients. Conclusions: ELRP is a well tolerated procedure, with good operative results in terms of postoperative pain and hospital stay. However, when complications occur, they tend to be more severe than in open surgery.

Cistoprostatectomía radical laparoscópica con confección extracorpórea de neovejiga ortotópica: comunicación preliminar / Laparoscopic radical cystoprostatectomy and continent orthotopic neobladder performed extracorporeally: preliminary experience

Objetivo: Presentamos un abordaje quirúrgico para el manejo de pacientes con carcinoma vesical en candidatos a cirugía radical, buscando reunir los beneficios de la cirugía abierta tradicional, con las ventajas de la técnica laparoscópica. Material y Método: Se presenta una serie inicial de 5 pacientes de sexo masculino, llevados a cistoprostatectomía radical laparoscópica (CPRL) con confección extracorpórea de neovejiga ortotópica entre junio y septiembre de 2002. La edad promedio fue 50.6 años (rango: 29 a 70 años). La indicación quirúrgica fue carcinoma vesical infiltrante en cuatro de los cinco pacientes, uno de ellos previamente tratado con radioterapia. La técnica quirúrgica se presenta en 3 pasos. En el primero se realiza la linfadenectomía pelviana bilateral y la cistoprostatectomía radical (CPR) por laparoscopía; la segunda parte esta representada por la confección de la neovejiga, realizada completamente extracorpórea, y el tercer paso es la anastomosis uretra-neovejiga, desarrollada con técnica laparoscópica. Resultados: La técnica fue reproducida en los 5 pacientes. El tiempo operatorio promedio fue de 5.4 horas (rango: 4.5-7 horas). El sangrado promedio fue 410 ml (rango: 200-800 ml). Ninguno de los pacientes requirió transfusión sanguínea. El tiempo de hospitalización total varió entre 5 y 12 días, con un promedio de 6.8 días. Conclusión: La CPR puede realizarse completamente con técnica laparoscópica cuando se dispone de un adecuado entrenamiento laparoscópico. Con la técnica combinada que desarrollamos, la parte más complicada de la cirugía, representada por la elaboración de la neovejiga y el neoimplante ureteral, se realiza de forma convencional, haciendo que esta técnica sea totalmente reproducible.

Objective: We present our preliminary experience with laparoscopic radical cystoprostatectomy and continent orthotopic neobladder performed extracorporeally. We believe that this surgical approach combines the advantages of minimally invasive laparoscopy with the speed and safety of open surgery. Material and Method: Between June and September 2002, 5 male patients underwent to laparoscopic radical cystoprostatectomy and continent orthotopic neobladder performed extracorporeally. Average age was 50.6 years (range: 29-70). The operative indication was muscle-invasive carcinoma of the urinary bladder in 4 patients. One of these 4 patients was previously treated with radiotherapy. Our technique has 3 steps. Cystoprostatectomy and pelvic lymph node dissections are performed laparoscopically using five ports by a transperitoneal approach. We remove the surgical specimens through a 5 cm infraumbilical incision and through the same incision an ileal loop is extracted from the abdominal cavity, isolated, detubularized and neobladder is reconfigured. Finally, urethro-neobladder anastomosis is formed with laparoscopic technique. Results: Surgical technique was reproduced in all 5 patients. Mean operative time was 5.4 hours (range: 4.5-7). Mean blood loss was 410 ml (range: 200-800) and not transfusion was indicated. Mean hospital stay was 6.8 days (range: 5-12). Conclusion: Laparoscopic radical cystectomy is feasible when surgical team has experience in laparoscopic surgery. The most technically demanding steps of the procedure are neobladder confection and ureteral neoimplante, which are performed extracorporeally. We believe that with our combined approach, this technique is completely reproducible.