Priapismo de alto flujo: una complicación excepcional de la cirugía del cáncer de recto / High flux priapism, an exceptional complication of rectal cancer surger

No disponible

Carbón activado en la cavidad peritoneal / Activated carbon in the peritoneal cavity

No disponible

Tuberculosis de la vesícula biliar; un dilema diagnóstico con el carcinoma de vesícula metastásico / Tuberculosis of the gallbladder vs metastatic vesicular carcinoma; a diagnostic dilemma

No disponible

MTHFR C677T polymorphism and anatomopathological characteristics with prognostic significance in sporadic colorectal cancer.

Methylenetetrahydrofolate reductase (MTHFR) plays a key role in folate metabolism, and folate is implicated in carcinogenesis due to its role in DNA methylation, repair and synthesis. The MTHFR C677T polymorphism is associated with decreased risk of CRC and increased sensitivity to 5-FU treatment. The present study addressed the relationship between this polymorphism and histopathological and immunohistochemical characteristics of prognostic significance in 50 patients from the Canary Islands. No differences were found between the MTHFR C677T genotypes with respect to tumor budding, tumor necrosis, desmoplastic fibrosis and tumoral eosinophilia. No significant differences were found in Ki-67, bcl-2 (cytoplasmic and nuclear), CD31, CD3+ T lymphocytes (both stromal and intraepithelial) and peritumoral CD20+ B lymphocytes. In carriers of the MTHFR CC variant, tumor margins were infiltrative more frequently (68.7%) than in CT+TT carriers (33.3%, p=0.03). In addition, wild-type CC genotype showed stromal CD20+ B lymphocytes (68.8%) more often than CT+TT carriers (33.3%, p=0.03). Both parameters indicate a better tumor prognosis when the MTHFR 677T variant is present.

Peritonitis por carbón activado / Activated carbon peritonitis

No disponible

C -kit en tumores estromales gastrointestinales y neoplasias asociadas: estudio en población con aislamiento genético / C-KIT in gastrointestinal stromal tumors and associated malignancies: A Study in a population with genetic isolation

INTRODUCCIÓN: Los tumores estromales gastrointestinales (GIST) son los tumores mesenquimales más frecuentes del tracto gastrointestinal. Han surgido numerosas publicaciones de GIST asociados con otras neoplasias. OBJETIVOS: El objetivo de este estudio fue investigar esta posible asociación en una población aislada genéticamente. MÉTODOS: Se realizó un estudio retrospectivo de pacientes con GIST en nuestro centro entre los años 2002-2009. Se compararon datos epidemiológicos, patológicos y familiares de pacientes con GIST sin neoplasias asociadas (grupo A) frente a pacientes con GIST y neoplasias asociadas (grupo B). Se investigó un posible mecanismo genético común entre GIST y las neoplasias asociadas mediante la detección, en todos los tumores, por el marcador inmunohistoquímico CD117. RESULTADOS: Se hallaron 22 pacientes con GIST, 10 del grupo A (45%) y 12 del grupo B (55%). En el grupo B, el tumor asociado fue maligno en 6 pacientes (50%) y benigno en otros 6 (50%). De 22 pacientes con GIST, 8 (36%) presentaron antecedentes familiares de neoplasia maligna. De estos 8 pacientes, 7 eran (87,5%) del grupo B (p = 0,03) y en 3 (37,5%) coincidieron el tipo anatomopatológico de neoplasia padecida por el paciente y su familiar. No hubo GIST en ningún familiar. Todos los GIST mostraron positividad para el CD117, mientras que las neoplasias asociadas fueron negativas para este marcador. CONCLUSIONES: No se ha demostrado positividad inmunohistoquímica para CD117 en las neoplasias asociadas. Dadas las especiales características de la población a estudio, la relación entre GIST y las neoplasias asociadas posiblemente sea casual

INTRODUCTION: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Numerous studies have reported the association between GIST and other neoplasms. OBJECTIVES: The aim of this study was to investigate the possible association between GIST and other tumors in a genetically isolated population. METHODS: A retrospective study was conducted of patients with GIST between 2002 and 2009 at our center. Epidemiological, pathological and family data in patients with GIST alone (group A) were compared with those in patients with GIST associated with other neoplasms (group B). A possible common genetic mechanism was investigated between GIST and associated malignancies by testing the detection of the immunohistochemical marker, CD117, in all tumors. RESULTS: Twenty-two patients with GIST were identified, 10 in group A (45%) and 12 in group B (55%). In group B, the associated tumor was malignant in 6 patients (50%) and benign in another 6 (50%). Of the 22 patients with GIST, 8 (36%) had a family history of malignancies. Of these 8 patients, 7 (87.5%) were in group B (p = 0.03) and 3 (37.5%) showed the same pathological type of neoplasm as their relatives. All GIST were positive for CD117 whereas associated malignancies were negative for this marker. CONCLUSION: We did not find immunohistochemical positivity for CD117 in malignancies associated with GIST. Given the special characteristics of the study population, the association between GIST and associated malignancies may be incidental

[Enterolithotomy and early cholecystectomy, an application of damage control surgery for patients with gallstone ileus]. / Enterolitotomía más colecistectomía precoz, una aplicación de cirugía de control de daños para pacientes con íleo biliar.

BACKGROUND: Recurrent gallstone ileus is an uncommon mechanical intestinal obstruction secondary to occlusion of the intestine by an intraluminal biliary calculus. CLINICAL CASE: Female, 75 years old, ischaemic heart disease (stent), arrived in our department complaining of abdominal pain and vomiting. Computed tomography showed gallstone ileus. The patient underwent an enterotomy with gallstone removal. Three months later, the patient came back with the same clinical symptoms and signs. A new computed tomography highlighted a gallstone ileus again. Enterolithotomy and gallstone removal, cholecystectomy and closure of cholecystoduodenal fistula were performed. The patient had a prolonged hospital stay due to the development of congestive heart failure. Case 2. Male, 71 years old, ischaemic heart disease and aortocoronary bypass, seen in our department complaining of vomiting. Computed tomography showed aerobilia and gallstone ileus. The patient underwent an urgent enterolithotomy. Seven months later, the patient came back with the same clinical symptoms and signs. Computed tomography showed a new gallstone ileus. An enterotomy and gallstone removal, cholecystectomy and closure of cholecystoduodenal fistula were performed. The patient died due to multi-organ failure in post-surgery period. CONCLUSION: In the elderly patients with concomitant medical illnesses with the risk of a second laparotomy, it is justifiable to reconsider the definitive repair in the treatment of gallstone ileus. The enterolithotomy in acute phase followed by early cholecystectomy (4-8 weeks) may be a safe method for eliminating, not only the possibility of recurrent gallstone ileus, and probably the need for a second laparotomy, but also the exceptional possibility of developing a gallbladder carcinoma.

[C-KIT in gastrointestinal stromal tumors and associated malignancies: A Study in a population with genetic isolation]. / C-kit en tumores estromales gastrointestinales y neoplasias asociadas: estudio en población con aislamiento genético.

INTRODUCTION: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Numerous studies have reported the association between GIST and other neoplasms. OBJECTIVES: The aim of this study was to investigate the possible association between GIST and other tumors in a genetically isolated population. METHODS: A retrospective study was conducted of patients with GIST between 2002 and 2009 at our center. Epidemiological, pathological and family data in patients with GIST alone (group A) were compared with those in patients with GIST associated with other neoplasms (group B). A possible common genetic mechanism was investigated between GIST and associated malignancies by testing the detection of the immunohistochemical marker, CD117, in all tumors. RESULTS: Twenty-two patients with GIST were identified, 10 in group A (45%) and 12 in group B (55%). In group B, the associated tumor was malignant in 6 patients (50%) and benign in another 6 (50%). Of the 22 patients with GIST, 8 (36%) had a family history of malignancies. Of these 8 patients, 7 (87.5%) were in group B (p=0.03) and 3 (37.5%) showed the same pathological type of neoplasm as their relatives. All GIST were positive for CD117 whereas associated malignancies were negative for this marker. CONCLUSION: We did not find immunohistochemical positivity for CD117 in malignancies associated with GIST. Given the special characteristics of the study population, the association between GIST and associated malignancies may be incidental.

Clinicopathological analysis of factors related to colorectal tumor perforation: influence of angiogenesis.

Colorectal tumor perforation is a life-threatening complication of this disease. However, little is known about the anatomopathological factors or pathophysiologic mechanisms involved. Pathological and immunohistochemical analysis of factors related with tumoral neo-angiogenesis, which could influence tumor perforation are assessed in this study. A retrospective study of patients with perforated colon tumors (Group P) and T4a nonperforated (controls) was conducted between 2001 and 2010. Histological variables (differentiation, vascular invasion, and location) and immunohistochemical (CD31, Growth Endothelial Vascular Factor (VEGF) and p53) related with tumor angiogenesis were analyzed. Of 2189 patients, 100 (4.56%) met the inclusion criteria. Of these, 49 patients had nonperforated (2.23%) and 51 had perforated tumors (2.32%). The P group had lower number of right-sided tumors (7/51, 13.7%) compared with controls (13/49, 36.7%) (P = .01). The high-grade tumors (undifferentiated) represented only 3.9% of the perforated tumors; the remaining 96.1% were well differentiated (P = .01). No differences between groups in the frequency of TP53 mutation or VEGF and CD31 expression were found. In the P group, only 2 (3.9%) had vascular invasion (P = .01). Of the 12 tumors with vascular invasion, only 2 were perforated (16.6%). The median number of metastatic lymph-nodes in P Group was 0 versus 3 in controls (Z = -4.2; P < .01). Pathological analysis of variables that indirectly measure the presence of tumor angiogenesis (differentiation, vascular invasion, and the number of metastatic lymph nodes) shows a relationship between this and the perforation, location, and tumor differentiation. We could not directly validate our hypothesis, by immunohistochemistry of TP53, VEGF, and CD31, that perforated tumors exhibit less angiogenesis.

Appendiceal diverticulitis and acute appendicitis: differences and similarities.

INTRODUCTION: Acute appendiceal diverticulitis is an unusual cause of acute abdomen, considered clinically indistinguishable from acute appendicitis. MATERIAL AND METHODS: In a historic cohort study with 27 cases of appendiceal diverticulitis and 54 cases of acute appendicitis, we compared clinical characteristics, diagnostic tests and pathology findings of the two processes. RESULTS: Mean age at presentation was lower in acute appendicitis (37.24 +/- 19.98 vs. 54.81 +/- 17.55 years, p < 0.001), with significant differences between men (33.33 +/- 15.89 vs. 57 +/- 18.02 years, p < 0.001) but not between women (41.76 +/- 24.87 vs. 50.44 +/- 16.69 years, p = 0.34). In the diverticulitis group, 48.15 % had leukocytosis vs. 81.48 % in the appendicitis group (p = 0.02); there was no difference in leukocyte count (13770.37 +/- 4382.55 vs. 14279.63 +/- 4268.59, p = 0.61). Patients with appendiceal diverticulitis had a higher incidence of appendiceal mucocele (p = 0.01) and a lower proportion of appendiceal gangrene (p = 0.03). There were no differences in appendiceal perforation or ulceration. Symptom duration before emergency department attendance (71.61 +/- 85.25 hours vs. 36.84 +/- 33.59 hours; Z = -3.1 p = 0.002), duration of surgery (85 +/- 40 minutes vs. 60 +/- 21 minutes, Z = -3.2, p = 0.001) and the presence of appendicular plastron was higher in patients with diverticulitis vs. appendicitis (8 vs. 5 patients [p = 0.01, Odds ratio 2.2]). CONCLUSIONS: Appendiceal diverticulitis presents a series of clinical, epidemiological and pathological differences with respect to acute appendicitis. The former shows a more indolent course with delayed diagnosis.

Diverticulitis apendicular y apendicitis aguda: diferencias y semejanzas / Appendiceal diverticulitis and acute appendicitis: differences and similarities

Introducción: la diverticulitis aguda apendicular es una causa poco frecuente de abdomen agudo, considerada clínicamente indistinguible de la apendicitis aguda. Material y métodos: estudio de cohortes retrospectivo de 27 casos de diverticulitis apendicular y 54 casos de apendicitis aguda. Se analizaron las características clínicas, pruebas diagnósticas y hallazgos anatomopatológicos de ambos procesos. Resultados: la edad de presentación fue más temprana en las apendicitis aguda (37,24 ± 19,98 años vs. 54,81 ± 17,55 años; p < 0,001), con diferencia significativa entre los varones (33,33 ± 15,89 años vs. 57 ± 18,02 años; p < 0,001), pero no entre las mujeres (41,76 ± 24,87 años vs. 50,44 ± 16,69 años; p = 0,34). Un 48,15 % de diverticulitis presentaron leucocitosis por un 81,48 % de las apendicitis (p = 0,02), no hubo diferencias en el recuento leucocitario (13770,37 ± 4382,55 vs. 14279,63 ± 4268,59; p = 0,61). Los pacientes con diverticulitis apendicular tuvieron mayor proporción de mucocele apendicular (p = 0,01) y menor proporción de gangrena apendicular (p = 0,03). No hubo diferencias en la perforación ni en la ulceración apendicular. La duración de los síntomas antes de la asistencia de los pacientes al servicio de urgencias (71,61 ± 85,25 horas vs. 36,84 ± 33,59 horas; Z = -3,1 p = 0,002), la duración de la intervención (85 ± 40 minutos vs. 60 ± 21 minutos; Z = -3,2, p = 0,001) y la presencia de plastrón apendicular fue mayor en los pacientes con diverticulitis apendicular (8 vs. 5 pacientes [p = 0,01; Odds ratio 2.2]). Conclusiones: la diverticulitis apendicular presenta una serie de diferencias clínicas, epidemiológicas y anatomopatológicas en relación con la apendicitis aguda. Estas diferencias muestran un curso más indolente en la DAA con un retraso diagnóstico (AU)

Introduction: Acute appendiceal diverticulitis is an unusual cause of acute abdomen, considered clinically indistinguishable from acute appendicitis. Material and methods: In a historic cohort study with 27 cases of appendiceal diverticulitis and 54 cases of acute appendicitis, we compared clinical characteristics, diagnostic tests and pathology findings of the two processes. Results: Mean age at presentation was lower in acute appendicitis (37.24 ± 19.98 vs. 54.81 ± 17.55 years, p < 0.001), with significant differences between men (33.33 ± 15.89 vs. 57 ± 18.02 years, p < 0.001) but not between women (41.76 ± 24.87 vs. 50.44 ± 16.69 years, p = 0.34). In the diverticulitis group, 48.15 % had leukocytosis vs. 81.48 % in the appendicitis group (p = 0.02); there was no difference in leukocyte count (13770.37 ± 4382.55 vs. 14279.63 ± 4268.59, p = 0.61). Patients with appendiceal diverticulitis had a higher incidence of appendiceal mucocele (p = 0.01) and a lower proportion of appendiceal gangrene (p = 0.03). There were no differences in appendiceal perforation or ulceration. Symptom duration before emergency department attendance (71.61 ± 85.25 hours vs. 36.84 ± 33.59 hours; Z = -3.1 p = 0.002), duration of surgery (85 ± 40 minutes vs. 60 ± 21 minutes, Z = -3.2, p = 0.001) and the presence of appendicular plastron was higher in patients with diverticulitis vs. appendicitis (8 vs. 5 patients [p = 0.01, Odds ratio 2.2]). Conclusions: Appendiceal diverticulitis presents a series of clinical, epidemiological and pathological differences with respect to acute appendicitis. The former shows a more indolent course with delayed diagnosis (AU)

Íleo biliar con perforación secundaria de divertículo sigmoideo / Gallstone ileus and intestinal perforation secondary to sigmoid diverticulum

No disponible

Hypercalcemia associated with adenosquamous pancreatic carcinoma: a reason to initiate palliative treatment.

BACKGROUND: hypercalcemia in patients with diagnosed carcinoma has predominantly a humoral basis mediated by parathyroid hormone-related protein (PTH-rP). Among the reported cases, hypercalcemia associated with the majority of abdominal malignancies indicates an advanced stage of disease. CASE REPORT: we present a case of a 78-year-old patient with an adenosquamous pancreatic carcinoma associated with humoral hypercalcemia mediated by PTH-rP. CONCLUSION: in this case, demonstration of unexpectantly rapid increase in calcium serum correlated with aggressive tumor growth led us to raise the hypothesis that PTH-rP could be a mediator of invasion and dissemination secreted by some tumors, and probably indicates the appropriate time to initiate palliative treatment.