Linfangioma quístico retroperitoneal / Retroperitoneal cystic lymphangioma

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Tratamiento quirúrgico de los adenocarcinomas de la ampolla de Vater / Surgical treatment for adenocarcinoma of the ampulla of Vater

Introducción. Los tumores de la ampolla de Vater constituyen el 10 por ciento de los cánceres periampulares. Son de crecimiento más lento y tienen mejor pronóstico que los del páncreas, por lo que algunos autores recomiendan ampulectomías en determinados casos. En este trabajo analizamos nuestros resultados en el tratamiento de esta enfermedad, para el que se han utilizado diversas técnicas quirúrgicas. Pacientes y método. Estudio retrospectivo de datos perioperatorios, morbimortalidad y supervivencia en un grupo de 20 pacientes intervenidos por adenocarcinoma ampular. Resultados. Fueron intervenidos 14 varones y 6 mujeres, con una edad media de 65 años. El síntoma principal fue la ictericia (75 por ciento); la bilirrubina media fue de 7,67 mg por ciento; la prueba diagnóstica más resolutiva fue la colangiopancreatografía retrógrada endoscópica, con un 78,6 por ciento de verdaderos positivos. Las intervenciones realizadas fueron: 12 duodenopan createctomías cefálicas, 2 duodenopancreatectomías totales, 3 ampulectomías y 3 derivaciones. La mortalidad fue del 5 por ciento. En cuanto a las recidivas se produjeron 1/3 tras ampulectomía a los 10 meses frente a 1/11 tras duodenopancreatectomía cefálica a los 4 años. La supervivencia global fue de 37,11 meses. Conclusiones. El síntoma más frecuente en estos tumores es la ictericia y la prueba diagnóstica más rentable la colangiopancreatografía retrógrada endoscópica. La técnica de elección sigue siendo la duodenopancreatectomía cefálica (AU)

Intestinal leiomyosarcoma as the cause of severe hemoperitoneum.

Leiomyosarcomas represent 10-20% of malignant tumors in the small bowel and 1% of those located in the large bowel. These tumors have aspecific symptoms depending on their size, location and histology. Intestinal leiomyosarcomas may be the cause of numerous types of surgical emergency. We report 2 cases of intestinal leiomyosarcoma in the jejunum and transverse colon. Both were diagnosed during an emergency exploratory celiotomy. The clinical features on admission were similar to those of acute abdomen. The main cause of surgical emergency was an extremely rare complication of gastrointestinal leiomyosarcoma: a severe hemoperitoneum. We briefly describe the surgical emergencies caused by intestinal leiomyosarcomas as well as the surgical methods employed in these cases.

Time-dependent changes of serum gastrin and gastrin receptors in the rat oxyntic mucosa after proximal gastric vagotomy.

Proximal gastric vagotomy (PGV) is a first-choice approach for the surgical treatment of duodenal peptic ulcer. However, a high percentage of recidivism takes place after this surgical strategy. To study the possible involvement of gastrin in ulcer recidivism, serum gastrin levels and gastrin receptors in gastric mucosa were determined at several times after PGV in rats. Gastrin concentration was determined using a commercial radioimmunoassay kit and gastrin receptors were analyzed in oxyntic mucosa membrane preparations using 125I-labeled 15-Leu-gastrin-17 as label. Our results show a significant, time-dependent increase in serum gastrin concentration, reaching highest values at 12 weeks after PGV. Similarly, a significant increase in the number of gastrin receptors (Bmax) and in the dissociation constant (Kd) occurred from 1 to 12 weeks post-PGV. Since gastrin exerts a positive feedback effect on its receptors, the PGV-dependent increase in serum gastrin concentration explains the up-regulation of the gastrin receptors in the rat oxyntic mucosa. Furthermore, an increase in the number of gastrin receptors after vagotomy may be at least partially responsible for the recidivism in duodenal peptic ulcers after this surgical approach.

Small-cell epidermoid carcinoma with melanocyte colonization arising in a mature ovarian cystic teratoma.

A case of small-cell epidermoid carcinoma, a rare tumor of the aerodigestive tract, is presented arising in a mature cystic teratoma of the ovary in a 69-year-old woman. Microscopically the small-cell epidermoid carcinoma had a uniform cell population with focal differentiation into keratinous cells. Both the small and keratinized cells were positive for epithelial membrane antigen and CAM 5.2 but negative for vimentin and neuroendocrine markers. This tumor is different from other recently described primary and metastatic small-cell tumors of the ovary. Furthermore, this small-cell epidermoid carcinoma behaved in a nonaggressive fashion. Melanocyte colonization seen in the small-cell epidermoid carcinoma areas of the tumor was a result of its invasion of preexistent areas of a teratoid blue nevus. The staining pattern of HMB-45 demonstrated that pigment was transferred to, but not produced by, the neoplastic small cells.

A side-to-end choledochoduodenostomy between the common bile duct and the stump of the transected duodenum.

A technique for treating patients with benign pyloric stenosis and associated choledocholithiasis upon a dilated common bile duct is described. The procedure consists in the performance of a Billroth II partial gastrectomy with the Hofmeinster-Finsterer modification and truncal vagotomy and a simultaneous side-to-end choledochoduodenostomy between the common bile duct and the duodenal stump. We have operated two cases in this way up to now without complications and with good postoperative results.