Paraganglioma extraadrenal retroperitoneal. Presentación de dos nuevos casos / Retroperitoneal extraadrenal paraganglioma. Report of two new cases

Presentamos 2 casos de paraganglioma retroperitoneal extraadrenal no diagnosticados preoperatoriamente, ya que simularon una tumoración hepática y pancreática, respectivamente. La ausencia de preparación preoperatoria adecuada y de diagnóstico originó en uno de nuestros pacientes importante labilidad tensional durante las maniobras de extirpación, que fue controlada de manera adecuada. Analizamos los principales aspectos clínicos, diagnósticos, terapéuticos y pronósticos de estos tumores poco frecuentes y realizamos una revisión de la bibliografía (AU)

S-adenosylmethionine in alcoholic liver cirrhosis: a randomized, placebo-controlled, double-blind, multicenter clinical trial.

BACKGROUND/AIM: The efficacy of S-adenosylmethionine (AdoMet) in the treatment of liver cell injury has been demonstrated in several experimental models. The aim of this study was to investigate the effects of AdoMet treatment in human alcoholic liver cirrhosis. METHODS: A randomized, double-blind trial was performed in 123 patients treated with AdoMet (1200 mg/day, orally) or placebo for 2 years. All patients had alcoholic cirrhosis, and histologic confirmation of the diagnosis was available in 84% of the cases. Seventy-five patients were in Child class A, 40 in class B, and 8 in class C. Sixty-two patients received AdoMet and 61 received placebo. RESULTS: At inclusion into the trial no significant differences were observed between the two groups with respect to sex, age, previous episodes of major complications of cirrhosis, Child classification and liver function tests. The overall mortality/liver transplantation at the end of the trial decreased from 30% in the placebo group to 16% in the AdoMet group, although the difference was not statistically significant (p = 0.077). When patients in Child C class were excluded from the analysis, the overall mortality/liver transplantation was significantly greater in the placebo group than in the AdoMet group (29% vs. 12%, p = 0.025), and differences between the two groups in the 2-year survival curves (defined as the time to death or liver transplantation) were also statistically significant (p = 0.046). CONCLUSIONS: The present results indicate that long-term treatment with AdoMet may improve survival or delay liver transplantation in patients with alcoholic liver cirrhosis, especially in those with less advanced liver disease.

Changes of the fibrinolytic system in liver dysfunction: role of portal hypertension.

The contribution of hemodynamic changes to the pathogenesis of accelerated fibrinolysis in liver disease was investigated in rats. In animals with hepatic lesions induced by a 7-week inhalation of carbon tetrachloride there was a significant increase in blood t-PA activity and PAI activity, with no significant change in portal pressure. Following a 10-min portal vein occlusion there was a marked increase in portal pressure and t-PA activity and a significant decrease in PAI activity. Following ligation of both portal vein and hepatic artery, t-PA activity increased to a higher extent and PAI activity was reduced to a lesser extent than changes found in portal-stenosed rats. Our data suggest that high t-PA circulating levels in liver disease could be related not only to the reduced t-PA clearance as a consequence of liver injury but also to hemodynamic changes.

[Alpha-adrenergic receptors in the hepatic sinusoid of the rat and its relation to portal pressure]. / Receptores alfa-adrenérgicos del sinusoide hepático de la rata y su relación con la presión portal.

The presence of alpha-adrenergic receptors in the hepatic sinusoid of the rat, and its relation to portal pressure (PP), by local and systemic infusion of bolus doses of norepinephrine (NE) (1 microgram/100 g) and phentolamine (FA) (25 micrograms/100 g) have been studied. Fifty-five male Wistar rats with intact nerves have been used in 5 experiments. When NE is injected into the portal vein (PV), it provokes an immediate rise in PP, modified subsequently by the systemic effect is induced earlier and more intensely than if injected into PV. If FA is infused into PV, PP decreases and the effect of posterior infusion of NE is less marked. These results suggest the presence of alpha-adrenergic receptors in the hepatic sinusoid of the rat. When they are stimulated PP raises, indicating that basal PP is maintained not only because of hepatic arterial flow, but also through a distinct sympathetic tone.