RESUMEN
We present a 41-year-old female who was admitted to our hospital with a history of 2-month epigastric pain and vomiting. Physical examination was normal. Upper gastrointestinal endoscopy showed a sessile submucosal tumor with central ulceration in the gastric body-antrum. Biopsies revealed a gastric mucosa without changes. Nevertheless, endoscopic ultrasound-guided biopsies showed interlacing bundles of spindle cells. The immunohistochemical study was negative for CD117 and smooth muscle actin and positive for S100 protein. A CT scan identified a heterogeneous mass in the stomach wall (AU)
Asunto(s)
Humanos , Femenino , Adulto , Tumores del Estroma Gastrointestinal/diagnóstico , Neoplasias Gastrointestinales/diagnóstico , Neurofibrosarcoma/diagnóstico , Diagnóstico Diferencial , InmunohistoquímicaRESUMEN
We present a 41-year-old female who was admitted to our hospital with a history of 2-month epigastric pain and vomiting. Physical examination was normal. Upper gastrointestinal endoscopy showed a sessile submucosal tumor with central ulceration in the gastric body-antrum. Biopsies revealed a gastric mucosa without changes. Nevertheless, endoscopic ultrasound-guided biopsies showed interlacing bundles of spindle cells. The immunohistochemical study was negative for CD117 and smooth muscle actin and positive for S100 protein. A CT scan identified a heterogeneous mass in the stomach wall.
Asunto(s)
Tumores del Estroma Gastrointestinal , Neoplasias Gástricas , Femenino , Humanos , Adulto , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/patología , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Tumores del Estroma Gastrointestinal/patología , Tomografía Computarizada por Rayos X , BiopsiaAsunto(s)
Cistadenoma Seroso/diagnóstico por imagen , Imagen por Resonancia Magnética , Neoplasias Pancreáticas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Cistadenoma Seroso/patología , Cistadenoma Seroso/cirugía , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: Hypocalcemia is one of the most common complications after total thyroidectomy. Recently, indocyanine green (ICG) angiography of the parathyroid glands (PGs) has been suggested as a reliable tool for predicting postoperative hypocalcemia. The aim of our study was to evaluate the performance of a simple quantitative score based on ICG angiography of the PGs (4-ICG score) for predicting postoperative hypocalcemia. METHODS: Thirty nine consecutive patients who underwent total thyroidectomy for multinodular goiter were included. For each patient, the 4-ICG score was calculated, adding the individual viability value of the four PGs. Discrimination and correlation analyses were performed. RESULTS: In 32/39 patients, the four PGs were identified. Patients with postoperative hypocalcemia (nâ¯=â¯6, 19%) had a lower 4-ICG score (2.5 [1.8-3.3] vs. 4.0 [3.0-6.0]; pâ¯=â¯0.003). The 4-ICG score showed good discrimination in terms of predicting postoperative hypocalcemia (AUCâ¯=â¯0.875 (0.710-0.965); pâ¯=â¯0.001) and a good correlation with postoperative parathyroid function. CONCLUSIONS: The 4-ICG score predicts postoperative hypocalcemia and correlates well with postoperative parathyroid function in patients undergoing total thyroidectomy for multinodular goiter.
Asunto(s)
Angiografía/métodos , Hipocalcemia/etiología , Glándulas Paratiroides/irrigación sanguínea , Glándulas Paratiroides/diagnóstico por imagen , Tiroidectomía/efectos adversos , Adulto , Anciano , Colorantes , Femenino , Humanos , Verde de Indocianina , Masculino , Persona de Mediana Edad , Valor Predictivo de las PruebasRESUMEN
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Humanos , Femenino , Persona de Mediana Edad , Seudoquiste Pancreático/diagnóstico , Pancreatitis/complicaciones , Inhibidores de la Bomba de Protones/uso terapéutico , Endosonografía/métodos , Amilasas/análisis , Neoplasias Hepáticas/diagnósticoRESUMEN
Introducción La lesión de la arteria hepática derecha (AHD) tras colecistectomía laparoscópica (CL) puede pasar desapercibida clínicamente, aunque a veces ocasiona una necrosis del lóbulo derecho. En situaciones excepcionales, cuando la necrosis se extiende al segmento IV, podría ocurrir un fallo hepático fulminante (FHF) y requerir un trasplante hepático urgente (TH).Pacientes y método Presentamos una revisión de la literatura médica de los pacientes en los que se indicó TH debido a una lesión vascular secundaria a lesión biliar por CL. También presentamos el cuarto paciente descrito en la literatura especializada que precisó TH secundario a lesión de la AHD tras CL, el segundo por FHF. Resultados El TH debido a la lesión de la AHD se realizó en 3 de 13 pacientes recogidos en la literatura médica: uno se realizó a los 3 meses de la lesión por FHF, tras realizar una hepatectomía derecha ampliada y los otros 2 debido a cirrosis biliar secundaria. Nuestro paciente se trasplantó a los 15 días de la lesión por FHF. Conclusiones La lesión de la AHD tras CL puede requerir TH por FHF, aunque es excepcional, es necesario pensar en esta posibilidad ante complicaciones de la AHD que requieran su oclusión (AU)
Introduction Right hepatic artery (RHA) injury after laparoscopic cholecystectomy (LC) may go unnoticed clinically, but can sometimes cause necrosis of the right lobe. Exceptionally, when the necrosis spreads to segment IV, fulminant liver failure (FLF) may occur, and an urgent liver transplantation (LT) may be required. Patients and method We provide a review of the literature on patients with indication for an LT due to vascular damage caused by bile duct injury following LC. The case reported herein is the fourth described in the specialized literature of LT due to RHA injury after LC and the second of FLF after RHA injury. Results LT due to RHA injury was performed in 3 of 13 patients reported in the literature: one LT was performed at 3 months due to FLF, after an extended right hepatectomy was performed, and the remaining two were performed due to secondary biliary cirrhosis. Our patient was transplanted due to FLF 15 days after the injury. Conclusions RHA injury after LC may require LT due to FLF. Although exceptional, this possibility should be considered when there are RHA complications that may require occlusion (AU)
Asunto(s)
Humanos , Hemorragia/etiología , Arteria Hepática/lesiones , Colecistectomía Laparoscópica/efectos adversos , Trasplante de Hígado , Enfermedad Iatrogénica , Colelitiasis/cirugía , Fallo Hepático Agudo/cirugíaRESUMEN
INTRODUCTION: Right hepatic artery (RHA) injury after laparoscopic cholecystectomy (LC) may go unnoticed clinically, but can sometimes cause necrosis of the right lobe. Exceptionally, when the necrosis spreads to segment IV, fulminant liver failure (FLF) may occur, and an urgent liver transplantation (LT) may be required. PATIENTS AND METHOD: We provide a review of the literature on patients with indication for an LT due to vascular damage caused by bile duct injury following LC. The case reported herein is the fourth described in the specialized literature of LT due to RHA injury after LC and the second of FLF after RHA injury. RESULTS: LT due to RHA injury was performed in 3 of 13 patients reported in the literature: one LT was performed at 3 months due to FLF, after an extended right hepatectomy was performed, and the remaining two were performed due to secondary biliary cirrhosis. Our patient was transplanted due to FLF 15 days after the injury. CONCLUSIONS: RHA injury after LC may require LT due to FLF. Although exceptional, this possibility should be considered when there are RHA complications that may require occlusion.
Asunto(s)
Colecistectomía Laparoscópica , Conducto Colédoco/lesiones , Hemorragia/etiología , Arteria Hepática/lesiones , Fallo Hepático Agudo/etiología , Fallo Hepático Agudo/cirugía , Trasplante de Hígado , Adulto , Humanos , Enfermedad Iatrogénica , Masculino , Factores de TiempoRESUMEN
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Humanos , Masculino , Anciano , Enfermedades del Esófago/complicaciones , Enfermedades del Esófago/patología , Hematoma/complicaciones , Hematoma/patología , Hemoperitoneo/etiología , Hemoperitoneo/patología , Enfermedades del Esófago/cirugía , Hematoma/cirugía , Hemoperitoneo/cirugía , Rotura Espontánea/cirugía , Rotura Espontánea/complicacionesAsunto(s)
Enfermedades del Esófago/complicaciones , Enfermedades del Esófago/patología , Hematoma/complicaciones , Hematoma/patología , Hemoperitoneo/etiología , Hemoperitoneo/patología , Anciano , Enfermedades del Esófago/cirugía , Hematoma/cirugía , Hemoperitoneo/cirugía , Humanos , Masculino , Rotura Espontánea/complicaciones , Rotura Espontánea/cirugíaRESUMEN
Introducción: La resección de tumores hepáticos del lóbulo izquierdo anatómico suele ser una técnica sencilla, tanto la seccionectomía lateral izquierda (SLI) como la segmentectomía II ó III. Nuestro objetivo es presentar los resultados del abordaje laparoscópico y plantear si podría ser el ¿técnica ideal¿ en las unidades de cirugía hepática con experiencia en cirugía hepática laparoscópica (CHL). Pacientes y método: Presentamos 18 pacientes con resección de tumores sólidos del lóbulo izquierdo anatómico por CHL: 10 casos con SLI y 8 casos con segmentectomía II ó III. Realizamos un estudio comparativo con un grupo control de 18 pacientes intervenidos con la misma técnica quirúrgica por cirugía abierta. Resultados: No hubo mortalidad en ninguno de los 2 grupos (n=36). La morbilidad fue similar (5.5% por grupo). Para la SLI, el grupo CHL (n=10) presentó menor estancia hospitalaria (p=0.005) y menor tiempo quirúrgico (141 vs 159min) (diferencias no e.s), que el grupo de CA. Para las resecciones segmentarias II ó III, el grupo CHL (n=8) presentó mayor empleo de la maniobra de Pringle (p=0.05), mayor tiempo quirúrgico (p=0.05) y una estancia hospitalaria inferior (4.8 vs 5.6 días) (diferencias no e.s), que el grupo de CA. Conclusiones: La SLI debe realizarse por laparoscopia en centros que tengan experiencia debido a una menor estancia hospitalaria y un menor tiempo quirúrgico que la realizada por CA, con la misma morbimortalidad. Las resecciones segmentarias II ó III realizadas por laparoscopia, aunque tienen menor estancia hospitalaria, presentan un mayor tiempo quirúrgico, por lo que las ventajas no son tan evidentes como para la SLI (AU)
Introduction: The resection of tumours of the anatomical left lobe is normally straightforward using either left lateral sectionectomy (LLSEC) or segmentectomy II or III. Our objective is to present the results of the laparoscopic approach and to consider whether this could be the ¿ideal technique¿ in liver surgery units where the surgeons have experience of laparoscopic liver surgery (LLSURG). Patients and methods: We have studied patients with resected solid tumours of the anatomical left lobe using LLSURG (n=18): 10 cases with LLSEC and 8 cases with segmentectomy II or III. We carried out a comparative study with a control group of 18 patients operated on using the same surgical technique using open surgery (OS). Results: There were no cases of mortality in either of the 2 groups (n=36). Morbidity was similar (5.5% per group). For LLSEC, the LLSURG group (n=10) had a shorter hospital stay (p=0.005) and less surgical time (141 vs. 159min) (differences not significant.), than the OS group. For segmentary resections II or III, in the LLSURG group (n=8) there was greater use of the Pringle manoeuvre (p=0.05), greater surgical time (p=0.05) and a shorter hospital stay (4.8 vs. 5.6 days) (differences not significant), than in the OS group. Conclusions: LLSEC should be carried out by laparoscopy in centres where they have considerable experience. The patients may have a shorter hospital stay and spend less time in surgery than when OS is performed, with the same morbidity and mortality rates. Segmentectomy resections II or III carried out by laparoscopy involve a shorter hospital stay but longer surgery time and therefore the advantages are not as evident as they are for LLSEC (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Laparoscopía/métodos , Laparoscopía/estadística & datos numéricos , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/cirugía , Comorbilidad/tendencias , Laparoscopía/normas , Laparoscopía/tendencias , Hepatopatías/cirugíaRESUMEN
INTRODUCTION: The resection of tumours of the anatomical left lobe is normally straightforward using either left lateral sectionectomy (LLSEC) or segmentectomy II or III. Our objective is to present the results of the laparoscopic approach and to consider whether this could be the "ideal technique" in liver surgery units where the surgeons have experience of laparoscopic liver surgery (LLSURG). PATIENTS AND METHODS: We have studied patients with resected solid tumours of the anatomical left lobe using LLSURG (n=18): 10 cases with LLSEC and 8 cases with segmentectomy II or III. We carried out a comparative study with a control group of 18 patients operated on using the same surgical technique using open surgery (OS). RESULTS: There were no cases of mortality in either of the 2 groups (n=36). Morbidity was similar (5.5% per group). For LLSEC, the LLSURG group (n=10) had a shorter hospital stay (p=0.005) and less surgical time (141 vs. 159 min) (differences not significant.), than the OS group. For segmentary resections II or III, in the LLSURG group (n=8) there was greater use of the Pringle manoeuvre (p=0.05), greater surgical time (p=0.05) and a shorter hospital stay (4.8 vs. 5.6 days) (differences not significant), than in the OS group. CONCLUSIONS: LLSEC should be carried out by laparoscopy in centres where they have considerable experience. The patients may have a shorter hospital stay and spend less time in surgery than when OS is performed, with the same morbidity and mortality rates. Segmentectomy resections II or III carried out by laparoscopy involve a shorter hospital stay but longer surgery time and therefore the advantages are not as evident as they are for LLSEC.