Adenoma hepatocelular con captación de 18 flúor deoxiglucosa en PET-TC SCAN. Una "mini-review" e informe de un nuevo caso / 18-fluoro-deoxyglucose uptake on PET-CT in hepatocellular adenoma. A mini review with a new case Report

RESUMEN La captación de 18 FDG en PET-TC por un adenoma hepatocelular (HCA) es poco frecuente. Esta situación genera dudas en cuanto a los diagnósticos diferenciales y tratamiento. El objetivo de este artículo fue realizar una mini revisión de los últimos 37 años de HCA con avidez por el 18FDG y presentar un nuevo caso. Sobre la base de un estudio realizado por otros autores entre 1984 y 2014, se amplía la búsqueda utilizando las mismas palabras clave hasta el año 2021. Se analizan los datos relevantes. Entre 1984 y 2021 detectamos 38 casos en 37 años. Fue más frecuente en mujeres en edad reproductiva. Los subtipos H-HCA e I-HCA fueron los más frecuentes. El tratamiento quirúrgico fue el más empleado. La diferenciación celular y los trastornos metabólicos de la glucosa y de los lípidos favorecerían la captación de 18FDG. La resección hepática ofrecería mayores garantías permitiendo el estudio completo de la lesión.

ABSTRACT Hepatocellular adenoma (HCA) uptake of 18FDG uptake on PET-CT is rare. This situation poses doubts about the differential diagnoses and treatment. The aim of this article is to perform a mini review of 18FDG avid HCA over the past 37 years and to describe a new case presentation. Based on a study conducted by other authors between 1984 and 2014, we extended the search until 2021 using the same keywords. The relevant data were analyzed. Between 1984 and 2021 we detected 38 cases in 37 years. HCAs were more common in women of childbearing age. The most common types were H-HCA an I-HCA. Surgical resection was the treatment most used. Cell differentiation and glucose and lipid metabolic diseases would favor 18FDG uptake. Liver resection provides better outcomes, allowing for a complete examination of the lesion.

Aplicación de modelos 3D en cirugía hepática / Implementation of three-dimensional printed models in hepatic surgery

RESUMEN La impresión de modelos tridimensionales (M3D) implica obtener una estructura sólida y formada a partir de un modelo digital. Para la reconstrucción 3D se utilizó tomografía computarizada contrastada, realizándose impresión de modelos sobre la base de las principales estructuras anatómicas hepáticas. Se utilizaron M3D en dos pacientes con indicación quirúrgica, una mujer con trombocitopenia familiar y metástasis hepática de adenocarcinoma rectal, sin respuesta a quimioterapia, y un hombre con hepatopatía infecciosa crónica y diagnóstico de carcinoma hepatocelular. La aplicación de M3D resultó de gran utilidad, pues permitió un mejor entendimiento de la relación espacial de las estructuras anatómicas en ambos casos. En nuestra experiencia, la aplicación de M3D fue muy útil para planificar la cirugía y dar una aproximación más certera de los reparos anatómicos. El modelo se obtuvo en 7 días y costó 380 dólares, un valor elevado para nuestro medio.

ABSTRACT Three-dimensional (3D) printing is the construction of a solid structure from a digital model. 3D reconstruction was performed using contrast-enhanced computed tomography scan, and 3D-printed models were built based on the main anatomic structures of the liver. 3D-printed models were used in two patients with indication of surgery; one woman with inherited thrombocytopenia and liver metastases from colorectal adenocarcinoma with no response to chemotherapy, and one man with chronic liver infection and hepatocellular carcinoma. The implementation of 3D printing technology was very useful, as it facilitated the understanding of the spatial relationships among the anatomical structures in both cases. In our experience, the use of 3D-printed models was very useful for preoperative planning and for understanding the anatomic landmarks. The model was built in 7 days, with a cost of 380 dollars which is elevated in our environment.

Programa de recuperación mejorada en cirugía hepática / Enhanced recovery program in liver surgery

RESUMEN Desde la aparición de un programa de Fast Track en cirugía colónica con resultados alentadores, muchos centros se abocaron a su aplicación y mejoramiento. El uso de estos programas en diferentes órganos trajo aparejados los mismos resultados que en cirugía colónica. Las resecciones hepáticas no quedaron excluidas de su uso. En ellas se logró una importante reducción de los días de estancia hospitalaria y de los costos. Entre los puntos que componen estos programas, una adecuada información al paciente y un compromiso de parte de este, la analgesia multimodal, la fluidoterapia y un inicio temprano de la alimentación parecen ser los más importantes.

ABSTRACT Since the development of fast-track programs in colorectal surgery with promising results, many centers started with these programs, and improved them. These programs were applied to different organs with the same results observed in colorectal surgery. Liver resections were not excluded from enhanced recovery programs, with a significant reduction in length of hospital stay and costs. Adequate patient information and commitment, multimodal analgesia, fluid therapy and early oral intake are the most important items of these programs.

Open versus laparoscopic hepatectomies within an ERAS (Enhanced Recovery After Surgery) program. Are there differences?

BACKGROUND: Laparoscopic procedures have gained popularity because they favor a faster recovery. In the same way, the establishment of an enhanced recovery after surgery (ERAS) program in major abdominal surgery has shortened the hospital stay. There are several studies that report the results on ERAS programs applied to open or laparoscopic hepatectomies or comparing one of them with the classic approach but few have compared the results between both within an ERAS program. OBJECTIVE: To compare the results between open and laparoscopic hepatectomies in the same ERAS program. METHOD: Thirty-six patients undergoing hepatectomies were enrolled in this study and were either laparoscopically or open in an identical ERAS program. Hospital stay and the number of complications were taken as primary end points. RESULTS: There were no significant differences between both groups in terms of hospital stay or number of complications. The differences were in a shorter time of surgery and an earlier ambulation in favor of open surgery and a better full recovery in favor of the laparoscopic approach. CONCLUSIONS: Initial data suggest that there would be no benefits in terms of hospital stay and complication rate of laparoscopic hepatectomies over open ones within an ERAS program.

ANTECEDENTES: Los procedimientos laparoscópicos ganaron popularidad porque favorecen una recuperación rápida. El establecimiento de programas ERAS (Enhanced Recovery After Surgery) en cirugía mayor abdominal ha acortado la estancia hospitalaria independientemente de la vía de abordaje. Varios trabajos informan los resultados sobre programas ERAS aplicados a hepatectomías abiertas o laparoscópicas, o comparando una de ellas con el abordaje clásico, pero pocos han comparado los resultados entre ambas dentro de un programa ERAS. OBJETIVO: Comparar, dentro un mismo programa ERAS, los resultados entre hepatectomías abiertas y laparoscópicas. MÉTODO: Se incorporaron a este estudio 36 pacientes sometidos a hepatectomías que fueron abordados por vía laparoscópica o abierta dentro de un programa ERAS. Los objetivos primarios fueron la estancia hospitalaria y el número de complicaciones. RESULTADOS: No hubo diferencias significativas entre ambos grupos en cuanto a estancia hospitalaria ni número de complicaciones. Las diferencias radicaron en un menor tiempo de cirugía y una deambulación más precoz a favor de la cirugía abierta, y una recuperación total mejor a favor del abordaje laparoscópico. CONCLUSIONES: Los datos iniciales sugieren que no habría beneficios en cuanto a estancia hospitalaria e índice de complicaciones de las hepatectomías laparoscópicas sobre las abiertas dentro de un programa ERAS.

[Metástasis hepáticas sincrónicas de cáncer colorrectal. ¿Resección simultánea o diferida?] / Synchronous liver metastases from colorectal origin. Simultaneous or staged resection?

INTRODUCCIÓN: El 20-40% de las metástasis hepáticas de origen colorrectal son de tipo sincrónico. Actualmente existen tres estrategias quirúrgicas; dos de ellas proponen resecciones diferidas, y la otra, la resección simultánea. OBJETIVO: evaluar los resultados a corto y largo plazo de las resecciones simultáneas. MÉTODO: Evaluamos 212 metástasis hepáticas sincrónicas resecadas en dos centros y comparamos las intervenidas de forma simultánea con aquellas de manera diferida. Evaluamos las características demográficas, las resecciones hepáticas y las características de las metástasis. También evaluamos la morbimortalidad. RESULTADOS: Fueron resecados de manera simultánea con el tumor primario 63 pacientes, y no hubo diferencias significativas en las características demográficas. Hubo más resecciones mayores (p = 0.005) en el grupo de las diferidas. La morbimortalidad fue comparable. La insuficiencia hepática (p = 0.037) fue mayor en el grupo de las diferidas. La morbilidad fue del 33.2% en las diferidas y del 10.1% en las simultáneas (p = 0.256). La mortalidad fue del 2.83% en las diferidas y del 0.94% en las simultáneas (p = 0.508). CONCLUSIÓN: Los resultados a corto y largo plazo en ambos grupos son similares. Queda el interrogante de si la necesidad de una hepatectomía mayor favorecería la elección de un tratamiento diferido. INTRODUCTION: Between 20 and 40% of liver metastases from colorectal tumor are synchronous. Three types of surgical approaches are proposed; two of them propose a deferred resection and the other, simultaneous resection. The aim of this analysis is to assess the short- and long-term outcomes of simultaneous resections. METHOD: 212 synchronous liver metastases resected in two centers were evaluated. Comparison between those resected simultaneously with those that were in a deferred way was made. Demographics, liver resections and metastatic characteristics were evaluated. Morbidity and mortality of both alternatives are also evaluated. RESULTS: 63 patients were resected simultaneously with the primary tumor, there were no significant differences in demographic characteristics. There was a greater number of major resections (p = 0.005) in the deferred group. Morbidity and mortality was comparable in both groups. Liver failure (p = 0.037) was higher in the deferred group. Morbidity was 33.2% in the deferred and 10.1% for the simultaneous (p = 0.256). Mortality rate was 2.83% in the deferred and 0.94% in the simultaneous group (p = 0.508). CONCLUSION: Short and long-term outcomes for both groups are similar. A question remains to be answered: the need of a major hepatectomy will favor the election of a deferred treatment?

Hepatectomía en dos tempos con resección colorrectal simultánea abierta en el tratamiento multmodal de las metástasis hepáticas de origen colorrectal / Two stage hepatectomy with simultaneous open colon resecton for multmodal treatment of colorectal liver metastases

Antecedentes: los mejores resultados ante la presencia de metástasis (Mtis) hepáticas de origen co-lorrectal los ofrece la resección hepática. Aproximadamente el 50% de los pacientes afectados de cáncer de colon y recto presentará metástasis hepáticas en el transcurso de la enfermedad. Un grupo de pacientes con metástasis bilobares consideradas irresecables o marginales hace un tempo pueden, en la actualidad, ingresar en protocolos de resecabilidad con estrategias que involucran resecciones hepáticas escalonadas en dos tempos con quimioterapia neoadyuvante o sin ella. Objetivo: mostrar los resultados obtenidos en 3 pacientes con metástasis bilobares de origen colorrectal sometidos a este protocolo con el distintivo de la resección simultánea colónica en el primer paso. Material y métodos: se presentan tres pacientes tratados con una estrategia quirúrgica en dos tiempos por metástasis hepáticas simultáneas de origen colorrectal. Se analizan los datos demográficos, del tumor y los correspondientes a las resecciones. Resultados: los tres pacientes pudieron completar el tratamiento. No hubo mortalidad operatoria. No hubo morbilidad en el primer paso de la resección y sí hubo una complicación en el segundo paso. La supervivencia tene una mediana de 16,3 meses y un período libre de enfermedad de 10,6 meses. Hubo recurrencia en un solo paciente. Conclusión: la estrategia en dos tempos con resección simultánea en el primer paso es segura. Ofrece una alternativa de curación a estos pacientes o en su defecto una franca prolongación de su sobrevida cuando se la asocia a quimioterapia u otras estrategias.

Background: the best Results for hepatic metastasis of colorectal cancer are ofered by hepatic resecton. Approximately 50% of patentis with colon and rectum cancer will develop liver metastases in the course of the disease. Bilobular metastases, previously considered to be unresectable may be treated by two stage stage liver resecton with or without neoadjuvant chemotherapy. Objective: to describe the Results upon treatment of bilobular colorectal metastases with a two stage strategy in which a simultaneous colon resecton was done at the first stage. Material and methods: three patentis were treated with a two stage strategy for simultaneous hepatic metastases of colorectal cancer. Demographic, tumor, and resecton data were analyzed. Results: all three patentis were able to complete the treatment. No operative mortality occurred. There was no morbidity during the frst step of the resecton while a complicaton was seen during the second step. Survival and disease free tme were 16.3 months and 10.6 months, respectively. To date, recurrence was seen in only one patent. Conclusion: the two stage strategy with simultaneous colon resecton in the frst step is safe and may ofer a chance for cure or a prolongaton of survival when associated with chemotherapy or other treatment strategies.

Tratamiento laparoscópico de la hidatidosis hepática: experiencia inicial / Laparoscopic approach to liver hydatidosis: Initial experience

INTRODUCCIÓN: La hidatidosis hepática es una enfermedad que se presenta frecuentemente en algunas provincias de Argentina. El tratamiento quirúrgico sigue siendo aún el que ofrece los mejores resultados. El tratamiento laparoscópico es controvertido debido a la poca experiencia con esta técnica. OBJETIVO: Evaluar la factibilidad y eficacia del tratamiento laparoscópico de esta enfermedad y presentar la experiencia obtenida en un centro de Argentina. Material y métodos Se evaluó de manera prospectiva a los pacientes con hidatidosis hepática no complicada mayores de 15 años cuyos quistes tenían las siguientes características: quiste único, menor de 5 cm, situado en segmentos anteriores o de fácil exposición. Fueron evaluados los siguientes datos: sexo, edad, localización del quiste, tratamiento, tiempo operatorio, morbimortalidad y recurrencia. RESULTADOS: Nueve pacientes fueron operados por laparoscopia, los quistes estuvieron localizados en los segmentos III, IV anterior, V y VI. Seis pacientes fueron operados con neumoperitoneo y 3 con un sistema de tracción parietal, en todos ellos el primer gesto fue realizar un PAIR laparoscópico. Se efectuaron 7 procedimientos de Mabit-Lagrot y 2 periquistectomías. El tiempo operatorio medio fue de 89,7 min y la estancia hospitalaria de 52 h. La morbilidad fue de 22,2% y la mortalidad de 0%. La media de seguimiento fue de 19 meses sin recidivas. CONCLUSIÓN: Un mayor número de casos y un seguimiento más prolongado son necesarios para evaluar mejor su eficacia; el abordaje laparoscópico parece ser seguro. Nuestros resultados coinciden con la mayoría de los publicados

INTRODUCTION: Hepatic hydatidosis is a pathology that has a worldwide distribution, and is frequent in some rural areas in Argentina. Surgical treatment still offers the best results. The laparoscopic approach is controversial because of lack of experience with this technique. OBJECTIVE: To evaluate the feasibility and efficacy of the laparoscopic approach in this pathology and to present the experience obtained in a medical center in Argentina. MATERIAL AND METHODS: We prospectively evaluated patients with a diagnosis of non complicated hydatidosis, over 15 years of age whose cyst had the following characteristics: unique cyst, size less than 5 centimeters, located in the anterior segments or easy access. Analyzed data were: sex, age, cyst localization, treatment, operating time, morbidity and mortality and recurrence. RESULTS: Nine patients were operated using a laparoscopic approach. The cysts were localized in the segments III, IV, V and VI. Six patients were operated with pneumoperitoneum and 3 with a parietal traction device, in all the patients the first approach was a laparoscopic PAIR (punction, aspiration, injection and reaspiration). Seven Mabit-Lagrot procedures were performed and 2pericystectomies. The operative time was a mean of 89.7 min and a hospital stay of 52 h. The morbidity was 22.2% and the mortality was 0%. Mean follow-up of 19 months showed no recurrences. CONCLUSION: A higher number of patients and a longer follow-up are necessary to evaluate the efficacy of approach; the laparoscopic approach seems to be safe. Our results coincide with the majority of other publications

Laparoscopic approach to liver hydatidosis: initial experience.

INTRODUCTION: Hepatic hydatidosis is a pathology that has a worldwide distribution, and is frequent in some rural areas in Argentina. Surgical treatment still offers the best results. The laparoscopic approach is controversial because of lack of experience with this technique. OBJECTIVE: To evaluate the feasibility and efficacy of the laparoscopic approach in this pathology and to present the experience obtained in a medical center in Argentina. MATERIAL AND METHODS: We prospectively evaluated patients with a diagnosis of non complicatedhydatidosis, over 15 years of age whose cyst had the following characteristics: unique cyst, size less than 5 centimeters, located in the anterior segments or easy access. Analyzed data were: sex, age, cyst localization, treatment, operating time, morbidity and mortality and recurrence. RESULTS: Nine patients were operated using a laparoscopic approach. The cysts were localized in the segments iii, iv, v and vi. Six patients were operated with pneumoperitoneum and 3 with a parietal traction device, in all the patients the first approach was a laparoscopic PAIR (punction, aspiration, injection and reaspiration). Seven Mabit-Lagrot procedures were performed and 2pericystectomies. The operative time was a mean of 89.7min and a hospital stay of 52h. The morbidity was 22.2% and the mortality was 0%.Mean follow-up of 19 months showed no recurrences. CONCLUSION: A higher number of patients and a longer follow-up are necessary to evaluate the efficacy of approach; the laparoscopic approach seems to be safe. Our results coincide with the majority of other publications.

Lesión quirúrgica de la vía biliar de la variante anatómica de la confluencia tipo F. Importancia de la colangiografía intra-operatoria sistemática y las alternativas terapéuticas.

Surgical injury of the biliary tract have increased in the laparoscopic cholecystectomy era, anatomic variants of the biliary ducts, mainly the type F, is likely to receive this kind of injury. Cholangiography helps to prevent such complications, so, we recommended the execution of this procedure in a routine way. Treatment usually is complex and requires trained surgeons.

[Liver resections as radical surgery for hepatic hydatidosis: results in 50 patients]. / Resultados de las resecciones hepáticas como tratamiento radical de la hidatidosis hepatica en 50 pacientes.

INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10%) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

Resultados de las resecciones hepáticas como tratamiento radical de la hidatidosis hepatica en 50 pacientes / [Liver resections as radical surgery for hepatic hydatidosis: results in 50 patients].

INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10

) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

Resultados de las resecciones hepáticas como tratamiento radical de la hidatidosis hepatica en 50 pacientes. / [Liver resections as radical surgery for hepatic hydatidosis: results in 50 patients].

INTRODUCTION: Among several regions in the world hepatic hydatidosis can be considered endemic. Currently there are many available treatments for this disease, been surgery the most effective one. Surgical procedures can be divided in two main groups, radical and non-radical procedures. The goal of this work is to evaluate the morbidity, mortality and percentage of recurrence in patients treated with hepatectomies, comparing them with other publications. MATERIAL AND METHODS: This retrospective study was carried out in a series from Spain and Argentina. We analyzed the following data: sex, age, type of resection, associated surgical gestures, presence of liver disease, operative time, blood transfusion, morbidity, mortality, hospital stay, re-hospitalization, recurrence and follow up. Dindo--Clavien classification was used for complications, and International Hepato-Pancreato-Biliary Association (IHPBA) Brisbane classification for hepatectomies. Mortality was considered until 90 days after surgery. To evaluate the recurence we only included patients followed over 6 months. RESULTS: Indications for liver resections were performed in patients with cysts larger than 5 centimeters, multiple cysts, large cysts, with bile duct communicated or suspicion of this communication. Five patients required blood transfusions (10

) with a median for these 5 patients of 740 ml and 74 ml for the complete series. The median operative time was 186 minutes (range 45 to 1,050 minutes). Median hospital stay was 7.7 days. Monitoring more than 6 months was conducted in 38 patients. CONCLUSIONS: We believe that hepatic hydatid disease is a multifaceted disease and requires more than one therapeutic approach. Hepatectomy with complete resection of the parasite offers the possibility of doing so in a controlled and safe way by experienced hands, ensuring good results in the treatment of this disease.

Preparation of a three-dimensional extracellular matrix by decellularization of rabbit livers.

INTRODUCTION: the availability of transplantable livers is not sufficient to fulfill the current demand for grafts, with the search for therapeutic alternatives having generated different lines of research, one of which is the use of decellularized three-dimensional biological matrices and subsequent cell seeding to obtain a functional organ. OBJECTIVE: to produce a decellularization protocol from rabbit liver to generate a three-dimensional matrix. METHODS: a combination of physical, chemical (Triton X-100 and SDS) and enzymatic agents to decellularize rabbit livers was used. After 68 h of retrograde perfusion, a decellularized translucent matrix was generated. To evaluate if the decellularization protocol was successful, with the extracellular matrix being preserved, we carried out histological (light microscopy and scanning electron microscopy) and biochemical (DNA quantification) studies. RESULTS: the decellularization process was verified by macroscopic observation of the organ using macroscopic staining, which revealed a correct conservation of bile and vascular trees. A microscopic observation corroborated these macroscopic results, with the hematoxylin-eosin staining showing no cells or nuclear material and the presence of a portal triad. Wilde´s staining demonstrated the conservationof reticulin fibers in the decellularized matrix. In addition, scanning electron microscopy revealed a preserved Glisson´s capsule and a decellularized matrix, with the DNA quantification being less than 10 % in the decellularized liver compared to control. Finally, the time taken to develop the decellularization protocol was less than 96 hours. CONCLUSIONS: the proposed decellularization protocol was correct, and was verified by an absence of cells. The hepatic matrix had preserved vascular and bile ducts with a suitable three-dimensional architecture permitting further cell seeding.

Cistoadenoma Seroso Microquistico Multifocal de páncreas: reporte de un caso / Multifocal microcystic serous cystadenoma of the pancreas: case report

Presentamos el caso de una paciente cuyo diagnóstico anatomo-patológico fue Cistoadenoma seroso micro-quístico multifocal de páncreas, realizamos una revisión de las alternativas diagnósticas y las diferentes propuestas terapéuticas de este infrecuente tumor pancreático.

Cistoadenoma Seroso Microquistico Multifocal de páncreas: reporte de un caso / Multifocal microcystic serous cystadenoma of the pancreas: case report

Presentamos el caso de una paciente cuyo diagnóstico anatomo-patológico fue Cistoadenoma seroso micro-quístico multifocal de páncreas, realizamos una revisión de las alternativas diagnósticas y las diferentes propuestas terapéuticas de este infrecuente tumor pancreático.(AU)

Preparación de una matriz extracelular tridimensional por descelularización de hígados de conejos / Preparación de una matriz extracelular tridimensional por descelularización de hígados de conejos / Preparation of a three-dimensional extracellular matrix by decellularization of rabbit livers

Introducción: el número de hígados trasplantables es insuficiente para satisfacer las necesidades actuales de la demanda de injerto. La búsqueda de alternativas terapéuticas ha generado diferentes líneas de investigación, una de ellas es la utilización de matrices biológicas tridimensionales descelularizadas y la posterior siembra celular para obtener un órgano funcional. Objetivo: obtención de un protocolo de descelularización de hígado de conejo que genere una matriz hepática tridimensional. Métodos: una combinación de detergentes (Triton X-100 y SDS), agentes físicos y enzimáticos se utilizaron para descelularizar hígados de conejo. Los órganos se pefundieron en forma retrógrada con distintos agentes químicos durante 68 horas. Luego los hígados se examinaron por técnicas morfológicas (microscopía óptica y electrónicade barrido) y bioquímicas (cuantificación de ADN) para evaluar una correcta descelularización así como la obtención de una matriz extracelular preservada. Resultados: la observación macroscópica del órgano permitió inferir la descelularización del mismo. Las tinciones macroscópicas utilizadas mostraron una correcta conservación de los árboles biliar y vascular. Por otro lado, la observación microscópica del hígado permitió corroborar los resultados macroscópicos observados, la tinción de hematoxilina-eosina mostró ausencia de células y de material nuclear así como la presencia de la tríada portal. La tinción de Wilde evidenció la conservación de las fibras de reticulina en la matriz descelularizada. Asimismo, la microscopía electrónica de barrido reveló una cápsula de Glisson conservada y la descelularización de la cuantificación de ADN fue inferior al 10 % en el hígado descelularizado con respecto al hígado control. Finalmente, el tiempo utilizado para la descelularización fue inferior a las 96 horas. Conclusiones: el protocolo de descelularización propuesto fue apropiado ya que se verificó una ausencia de células y una matriz hepática con conductos vasculobiliares conservados y con una arquitectura tridimensional adecuada para una futura siembra celular(AU)

Introduction: the availability of transplantable livers is not sufficient to fulfill the current demand for grafts, with the search for therapeutic alternatives having generated different lines of research, one of which is the use of decellularized three-dimensional biological matrices and subsequent cell seeding to obtain a functional organ. Objective: to produce a decellularization protocol from rabbit liver to generate a three-dimensional matrix. Methods: a combination of physical, chemical (Triton X-100 and SDS) and enzymatic agents to decellularize rabbit livers was used. After 68 h of retrograde perfusion, a decellularized translucent matrix was generated. To evaluate if the decellularization protocol was successful, with the extracellular matrix being preserved, we carried out histological (light microscopy and scanning electron microscopy) and biochemical (DNA quantification) studies. Results: the decellularization process was verified by macroscopic observation of the organ using macroscopic staining, which revealed a correct conservation of bile and vascular trees. A microscopic observation corroborated these macroscopic results, with the hematoxylin- eosin staining showing no cells or nuclear material and the presence of a portal triad. Wilde’s staining demonstrated the conservation of reticulin fibers in the decellularized matrix. In addition, scanning electron microscopy revealed a preserved Glisson’s capsule and a decellularized matrix, with the DNA quantification being less than 10 % in the decellularized liver compared to control. Finally, the time taken to develop the decellularization protocol was less than 96 hours. Conclusions: the proposed decellularization protocol was correct, and was verified by an absence of cells. The hepatic matrix had preserved vascular and bile ducts with a suitable three-dimensional architecture permitting further cell seeding(AU)

[Digestive bleeding and acute abdomen caused by jejunal diverticulosis. Case report]. / Hemorragia digestiva y abdomen agudo peritonítico causado por diverticulitis yeyunal. Presentación de un caso.

We present a patient with acute abdomen and digestive bleeding caused by jejunal diverticulosis. Jejunal diverticulosis, mainly asymptomatic, when is symptomatic have a wide clinical spectrum, ranging from chronic anemic syndrome to acute abdomen. In this communication, we reviewed the clinical presentation, the pathogenesis and the treatment this infrequent pathology.