Carcinoma del uraco / Urachal Carcinoma

Objetivo Revisar la patología tumoral del uraco, haciendo énfasis en su clínica, los métodos diagnósticos empleados y el manejo terapéutico. Métodos Presentamos el caso de un varón de 39 años con carcinoma del uraco que simuló clínicamente un absceso umbilical. Resultados Los hallazgos en la TC fueron sospechosos de patología del uraco. El examen anatomopatológico reveló células atípicas y la PET-TC demostró extensión a pared abdominal y epiplón, requiriéndose la resección completa. Conclusiones El carcinoma del uraco es una neoplasia muy poco frecuente, que tiene su origen en el epitelio que recubre la luz del uraco, un vestigio de la alantoides que conecta la vejiga con el ombligo y normalmente involuciona en la etapa embrionaria. La clínica insidiosa hace que el diagnóstico sea tardío y el pronóstico pobre. Las pruebas de imagen tienen un papel fundamental en su sospecha, así como en la definición de la relación con la pared vesical y posible extensión local o a distancia. Una vez confirmado el diagnóstico histológicamente, está indicada la resección quirúrgica completa.

Objective To review tumoral pathology of urachus, emphasizing its clinical manifestations, diagnostic methods and therapeutic management. Method We present the case of a 39-year-old male with urachal carcinoma who clinically mimicked an umbilical abscess. Result CT findings were suspected of urachus pathology. Histologic analysis of the resected specimen demonstrated atypical cells, and PET-CT showed extension to the abdominal wall and omentum, requiring complete resection. Conclusions Urachal carcinoma is a very rare neoplasm that originates in the epithelium that covers the lumen of the urachus, a vestige of the allantois that connects the bladder with the navel and normally involves in the embryonic stage. The insidious clinic makes late diagnosis and poor prognosis. Imaging tests play a fundamental role in their suspicion, as well as in the definition of the relationship with the bladder wall and possible local or distant extension. Once the diagnosis has been confirmed histologically, complete surgical resection is indicated.

Tuberculosis, un diagnóstico más a tener en cuenta ante una masa pancreática / Tuberculosis, one more consideration in the differential diagnosis of a pancreatic mass

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Early detection of high oxidative activity in patients with adenomatous intestinal polyps and colorectal adenocarcinoma: myeloperoxidase and oxidized low-density lipoprotein in serum as new markers of oxidative stress in colorectal cancer.

OBJECTIVES: To detect whether signs of oxidative stress appear at early stages of colorectal adenocarcinoma (CRC), particularly in the polyp stage. We also aimed to evaluate the specific entities myeloperoxidase (MPO) and oxidized low-density lipoprotein (oxLDL) as novel markers of oxidation in the plasma of patients with CRC and to study the relationship between oxidative status in plasma and patient survival. METHODS: We assayed serum or plasma specimens from healthy control subjects (n = 14), from patients with intestinal polyps (n = 39), and from patients with CRC (n = 128) to calculate the modified oxidative balance score (MOBS) using several serum markers (ß-carotene, lycopene, vitamin A, vitamin E, MPO, and oxLDL). We also assayed the levels of C-reactive protein (CRP) and obtained lipid profiles. Finally, we studied the survival of patients in relationship to oxidative status (antioxidants and pro-oxidants) and inflammation markers, and added theses data to the lipid profile for each patient. RESULTS: Oxidative stress levels increased as disease stage advanced. This increase was detected early in the polyp stage, before polyps progressed to cancer, and could be measured by the increase of such new markers as MPO and oxLDL, the decrease in antioxidants, and the MOBS value. Higher levels of oxidation correlated with lower survival. CONCLUSION: The oxidation process, which can cause mutations leading to CRC, begins development in the polyp stage. This process may be detected early by monitoring serum markers such as MPO and oxLDL.

Hartmann's procedure for obstructive carcinoma of the left colon and rectum: a comparative study with one-stage surgery.

INTRODUCTION AND OBJECTIVES: Despite the criticisms from prestigious expert committees, a high percentage of surgeons continue to use, as the technique-of-choice, Hartmann's procedure for acute malignant intestinal obstruction of the distal colon and rectum, without faecal peritonitis. We have reviewed our results with this technique and compared them with other series of patients in the literature undergoing one-stage surgery (resection with primary anastomosis or sub-total colectomy). MATERIAL AND METHODS: A retrospective and descriptive study using clinical histories and, from which, the variables studied were: median hospitalisation stay, morbido-mortality and reconstruction index. RESULTS: Included in the analysis were 44 patients (24 male; 20 female) with an age range between 37 and 87 years (median age: 67.04 years). The median hospitalisation stay was 15.59 days (range: 8-39). In the 10 patients undergoing reconstruction this was 12.8 days (range: 10-17). The overall stay, therefore, was 28.39 days. The median stay in the series of patients having one-stage surgery was 13.9 days. The morbidity using Hartmann's procedure was 43.18% (19/44) and, in the patients with reconstruction, 40% (4/10). The morbidity in the literature series with one-stage surgery was 22.53%. Mortality in our study was 0%. The mortality in the 16 cases from the literature was close to 5%, although in 3 of the studies this was also 0%. The percentage undergoing reconstruction was 22.72% (10 cases). The median age in the non-reconstructed patients was 71.42 years (range: 46-87) compared to a median age of 52.6 (range 37-67) in the group with reconstruction (p < 0.001). The percentages undergoing reconstruction, according to tumour stage, were Dukes B: 36.84%; Dukes C: 23.07%; Dukes D: 0% (p < 0.001). The median waiting-time for a reconstruction was 15.73 months (range: 8-33). CONCLUSIONS: Comparisons of our results with the outcomes in the series of patients in the literature with one-stage surgery indicate that "one-stage surgery" is the more suitable but, however, with two conditions: a sufficient command of the technique so as to minimise complications and a strict patient selection, with the Hartmann's procedure being retained for patients with high anaesthesia risk.

Hartmann's procedure for obstructive carcinoma of the left colon and rectum: a comparative study with one-stage surgery

Introducción y objetivos. Un número elevado de cirujanos continúa empleando como técnica de elección la intervención de Hartmann en la obstrucción intestinal aguda maligna de colon distal al ángulo esplénico, sin peritonitis fecaloidea, a pesar de las críticas desde las unidades coloproctológicas de prestigio. Nos proponemos revisar nuestros resultados con esta técnica y compararlos con los de otras series con cirugía en un tiempo (resección y anastomosis primaria y colectomía subtotal). Material y métodos. Estudio retrospectivo y descriptivo sobre historias clínicas. Las variables estudiadas son: estancia media, morbimortalidad e índice de reconstrucción. Resultados. Cuarenta y cuatro pacientes (24 hombres y 20 mujeres) forman parte del estudio, con edades comprendidas entre 37 y 87 años (media 67,04). La estancia media hospitalaria fue de 15,59 días (rango: 8-39). En los 10 pacientes reconstruidos la estancia fue 12,8 (rango: 10-17). La estancia acumulada, por tanto, fue 28,39 días. La estancia media de las series consultadas con cirugía en un tiempo es de 13,9 días. El porcentaje de complicaciones en la operación de Hartmann fue del 43,18% (19/44) y en la reconstrucción siguiente del tránsito fue del 40% (4/10). La morbilidad media de las series consultadas en un tiempo es del 22,53% La mortalidad global de nuestra serie fue del 0%. La mortalidad media de las 16 series consultadas es ligeramente superior al 4%, aunque en 3 de ellas fue también del 0%. El porcentaje de reconstrucción fue del 22,72% (10 casos). La media de edad en los pacientes no reconstruidos fue 71,42 años (rango: 46-87), frente a 52,6 (rango: 37-67) en el grupo de los reconstruidos (p < 0,001). El porcentaje de reconstrucción según el estadio tumoral fue: estadio B el 36,84%, C el 23,07% y D el 0% (p < 0,001). El tiempo medio de espera antes de la reconstrucción fue 15,73 meses (rango: 8-33). Conclusiones. El análisis comparativo de nuestros resultados con los propios de las series de cirugía en un tiempo nos invita a aconsejar esta última como la más idónea, aunque siempre bajo dos condiciones: un dominio de su técnica, para minimizar complicaciones, y una rígida selección de los pacientes, procurando la técnica de Hartmann para los más deteriorados

Introduction and objectives. Despite the criticisms from prestigious expert committees, a high percentage of surgeons continue to use, as the technique-of-choice, Hartmann's procedure for acute malignant intestinal obstruction of the distal colon and rectum, without faecal peritonitis. We have reviewed our results with this technique and compared them with other series of patients in the literature undergoing one-stage surgery (resection with primary anastomosis or sub-total colectomy). Material and methods. A retrospective and descriptive study using clinical histories and, from which, the variables studied were: median hospitalisation stay, morbido-mortality and reconstruction index. Results. Included in the analysis were 44 patients (24 male; 20 female) with an age range between 37 and 87 years (median age: 67.04 years). The median hospitalisation stay was 15.59 days (range: 8-39). In the 10 patients undergoing reconstruction this was 12.8 days (range: 10-17). The overall stay, therefore, was 28.39 days. The median stay in the series of patients having one-stage surgery was 13.9 days. The morbidity using Hartmann's procedure was 43.18% (19/44) and, in the patients with reconstruction, 40% (4/10). The morbidity in the literature series with one-stage surgery was 22.53%. Mortality in our study was 0%. The mortality in the 16 cases from the literature was close to 5%, although in 3 of the studies this was also 0%. The percentage undergoing reconstruction was 22.72% (10 cases). The median age in the non-reconstructed patients was 71.42 years (range: 46-87) compared to a median age of 52.6 (range 37-67) in the group with reconstruction (p < 0.001). The percentages undergoing reconstruction, according to tumour stage, were Dukes B: 36.84%; Dukes C: 23.07%; Dukes D: 0% (p < 0.001). The median waiting-time for a reconstruction was 15.73 months (range: 8-33). Conclusions. Comparisons of our results with the outcomes in the series of patients in the literature with one-stage surgery indicate that "one-stage surgery" is the more suitable but, however, with two conditions: a sufficient command of the technique so as to minimise complications and a strict patient selection, with the Hartmann's procedure being retained for patients with high anaesthesia risk