Giant symptomatic pancreatic cyst mimicking a malignant tumor.

BACKGROUND: Pancreatic cystic lesions found in the literature are estimated between 2.6-19.6%. These neoplasms are almost exclusively benign tumors, and rarely become malignant. The aim of this paper was to report a feasible total pancreatectomy with portal resection in a giant pancreatic serous cystadenoma mimicking a malignant tumor. CASE PRESENTATION: A healthy 52-year-old female patient presented to us with a giant pancreatic cyst with unknown preoperative diagnosis and a secondary dilatation of the Wirsung duct, and unclear vascular invasion. The imaging assessment was not conclusive for malignancy. Furthermore, it was decided to perform a total pancreatectomy with portal vein resection and splenectomy. The pathological findings revealed a microcystic serous cystadenoma of 10 cm with abundant myxoid stromal degeneration and focal papillary proliferation without atypia. CONCLUSION: Unless the diagnosis of serous cystadenoma is certain, cystic tumors with inconclusive clinical and imaging features should be radically treated.

[Application of fibrin sealant in patients operated on for differentiated thyroid cancer. What do we improve?]. / Aplicación de sellante de fibrina en pacientes operados por cáncer diferenciado de tiroides. ¿Qué mejoramos?

BACKGROUND: In recent years, several publications have shown that new adhesives and sealants, like Tissucol(®), applied in thyroid space reduce local complications after thyroidectomies. STUDY AIMS: To demonstrate the effectiveness of fibrin glue Tissucol(®) in reducing the post-operative hospital stay of patients operated on for differentiated thyroid carcinoma in which total thyroidectomy with central and unilateral node neck dissection was performed (due to the debit drains decrease), with consequent cost savings. MATERIAL AND METHODS: A prospective randomised study was conducted during the period between May 2009 and October 2013 on patients with differentiated thyroid carcinoma with cervical nodal metastases, and subjected to elective surgery. Two groups were formed: one in which Tissucol(®) was used (case group) and another where it was not used (control group). Patients were operated on by surgeons specifically dedicated to endocrine surgical pathology, using the same surgical technique in all cases. RESULTS: A total of 60 total thyroidectomies with lymph node dissection were performed, with 30 patients in the case group, and 30 patients in control group. No statistically significant differences were observed in most of the studied variables. However, the case group had a shorter hospital stay than the control group with a statistically significant difference (p<0.05). CONCLUSION: Implementation of Tissucol(®) has statistically and significantly reduced the hospital stay of patients undergoing total thyroidectomy with neck dissection, which represents a significant reduction in hospital costs. This decrease in hospital stay has no influence on the occurrence of major complications related to the intervention.

[Endoscopic lateral parathyroidectomy as surgical treatment for patients with primary hyperparathyroidism]. / Paratiroidectomía lateral endoscópica en el manejo de pacientes con hiperparatiroidismo primario.

BACKGROUND: Most surgeons have rapidly accepted the use of minimally invasive surgical approaches for the treatment of primary hyperparathyroidism. The role of the endoscope in neck surgery is still being discussed due to its technical difficulty and complex patient selection criteria. MATERIALS AND METHODS: A prospective study was conducted between April 2010 and April 2013. It included patients diagnosed with sporadic primary hyperparathyroidism (sPHPT) by locating a single adenoma using ultrasound and sestamibi scintigraphy imaging. All patients agreed to be included in the study. Experienced endocrine surgeons that had been trained in endocrine minimally invasive surgery performed the procedure. The same surgical technique was used in all of the cases. The demographic and clinical variables were evaluated. A descriptive analysis was performed on the data measuring mean, standard deviation, and range. RESULTS: A total of 28 endoscopic lateral parathyroidectomies were performed. All patients were diagnosed with sporadic hyperparathyroidism sPHPT. The mean age was 68 years (59-89). No intraoperative complications were registered. Postoperative morbidity was comparable to that reported in the classical approach. A favourable outcome was observed in 27 of the 28 patients (96%) after a mean follow-up time of 22 (9 - 53) months. CONCLUSIONS: An endoscopic approach for hyperparathyroidism sPHPT is feasible and reproducible, and it obtains comparable results to the classical open surgery. Several factors make this technique suitable for highly specialised hospitals with a high patient volume and specialised endocrine surgery units.

Trasplante hepático en pacientes infectados por el VIH-1 / Liver Transplantation in HIV-1 infected patients

Actualmente la enfermedad hepática es una de las causas más importantes de morbilidad y mortalidad en los pacientes con infección por VIH. La supervivencia de los pacientes con enfermedad hepática terminal es más corta comparada con la de las personas no infectadas. La infección por VIH ha dejado de ser una contraindicación para el trasplante de órganos sólidos...

Currently, liver disease is one of the most important cause of morbidity and mortality in HIV-1 infected patients. Survival of HIV-coinfected patients with end-stage liver disease (ESLD) is poor and shorter than that of the non-HIV-infected population. HIV infections is no longer a contraindication to solid organ transplantation...

Utilización de donantes mayores de 45 años para trasplante ortotópico hepático / Utilization of older than 45 years donors for orthoptic liver transplantation

El trasplante ortotópico hepático TOH, es el tratamiento de elección de enfermedades hepáticas graves en estadio terminal. En los últimos años la sobrevida del TOH se ha incrementado en forma notable y sus indicaciones se han extendido, lo que ha traído como consecuencia una mayor demanda de TOH, sin embargo, por falta de donación, alrededor de un 24 por ciento de pacientes en lista fallecen mientras esperan ser trasplantados. Uno de los aspectos más críticos en la restricción del número de órganos para trasplante es sin duda el límite de edad en el potencial donante de órganos, el que se estableció en 45 años. Para valorar el efecto de la edad de los donantes sobre la función del injerto, se analizan los resultados de 109 TOH en 96 pacientes, 55 hombres y 47 mujeres, edad media 45 ñ 10 años. De éstos 93(85 por ciento) recibieron un hígado de donante menor de 45 años; edad media 25 años, límites 5-45, y 16(15 por ciento) de donantes mayores de 45 años; edad media 55 años, límites 46-65. La función precoz del injerto fue clasificada en tres grupos de acuerdo a un baremo sumatorio de las cifras máximas de ALAT valor medio del débito biliar y menor valor de protrombina obtenida durante los primeros 3 días después del TOH, grado I= buena función, grado II= función regular, y grado III= mala función. De los pacientes que recibieron un injerto de donante menor de 45 años, 54(58 por ciento) pertenecieron al grado I, 21(23 por ciento) al grado II y 18(19 por ciento) al grado III. De los 16 pacientes trasplantados con donantes mayores de 45 años, el grado I de función precoz fue observado en 8(50 por ciento), el grado II en 5(31 por ciento) y el grado III en 3(19 por ciento) x²= 0,64, p= ns. No hubo diferencias estadísticamente significativas en la sobrevida a 30 meses para ambos grupos. Los resultados de este estudio sugieren que la edad por sí sola no constituye un criterio para el rechazo de órganos para trasplante