Efficacy of neoadjuvant therapy and surgical rescue for locally advanced hepatoblastomas: 10 year single-center experience and literature review.

AIM: To report our experience with long-term outcomes after multimodal management therapy. METHODS: An observational retrospective study was performed containing seven patients with hepatoblastoma (Hbl) treated in our institution, a tertiary referral center, from 2003 to 2011. Demographic, preoperative, surgical, and outcome variables were collected. A survival analysis and a review of the current literature related to combination neoadjuvant chemotherapy and surgical resection on Hbl were performed. RESULTS: The median age at surgery was 14.4 mo, with a male to female ratio of 4:3. Pretext staging at diagnosis was as follows: stage I, 4 cases; stage II, 2 patients; and stage III, 1 case. Mean pretreatment tumor volume was 735 cm(3). Five out of seven patients received neoadjuvant chemotherapy according to SIOPEL-3 or SIOPEL-6 protocols. Tumor volume and alpha-fetoprotein levels significantly dropped after neoadjuvant therapy. Surgical procedures performed included hemihepatectomies, segmentectomies and atypical resection. All patients received chemotherapy after surgery. Median postoperative hospital stay was 8 d. All patients were alive and disease-free after a median follow-up period of 23 mo. With regards to the literature review, seventeen articles were found that were related to our search. CONCLUSION: Our series shows how multimodal management of Hbl, exhaustive control and a meticulous surgical approach leads to almost 100% complete resection with optimal postoperative results.

Quiste paratubárico en la infancia. Manejo laparoscópico / Paratubal Cyst in Childhood. Laparoscopic Management

Los quistes paratubáricos son de diagnóstico excepcional en la edad pediátrica. Presentamos el caso de una niña de 12 años con dolor abdominal intermitente de 2 años de evolución a la que se le detectó por pruebas de imagen una masa quística y homogénea en pelvis compatible con quiste paratubárico. Tras completar el estudio diagnóstico se llevó a cabo la quistectomía laparoscópica con bisturí armónico. La resección quirúrgica es el tratamiento de elección, siendo el abordaje laparoscópico la primera opción en la actualidad (AU)

Diagnosis of paratubal cysts in children is exceptional. We present the case of a 12-year-old girl with a 2-year history of intermittent abdominal pain. Imaging studies revealed a homogeneous cystic mass in the pelvis compatible with a paratubal cyst. After completing the diagnostic workup, laparoscopic cystectomy was performed by harmonic scalpel. Surgical resection is the treatment of choice in this entity, the laparoscopic approach currently being the first option (AU)

Emergency adrenalectomy due to acute heart failure secondary to complicated pheochromocytoma: a case report.

Pheochromocytomas are catecholamine producing tumors arising mostly from chromaffin cells of the adrenal medulla. The most common clinical presentation is hypertension, mainly in the form of paroxymal episodes. Cardiovascular manifestations include malignant arrhythmia and catecholamine cardiomyopathy, mimicking acute coronary syndromes and acute heart failure.There are reports of pheochromocytomas presenting as acute coronary syndrome and rapidly leading to cardiogenic shock; the failure of intensive medical treatment in these cases has prompted the need for emergency adrenalectomy as the only remaining option. We report on a case of complicated pheochromocytoma presenting as cardiogenic shock, in which emergency adrenalectomy was performed following a total lack of response to intensive medical treatment.