Experience with the surgical treatment of hepatic hydatidosis: case series with follow-up.

AIM: To describe patient characteristics and the results of surgical treatment for hepatic hydatidosis (HH) in the Hospital Hernán Henríquez Aravena from December 2001 to March 2005. METHODS: Subjects older than 16 years with suspected HH were included based on the clinical picture and radiological studies. Variables examined included clinical and laboratory aspects, outcome, features of the parasite and surgical aspects. Descriptive statistics were used, calculating central tendency, dispersion and extreme tendency. RESULTS: The series was comprised of 122 patients, with an average age of 44 +/- 16.9 years. The most frequently used surgical technique was subtotal cystectomy in 90% of the patients, followed by hepatic resection (hepatectomy, segmentectomy and subsegmentectomy) in 5%. In 2%, a combination of subtotal cystectomy and segmentectomy was performed. In addition, 28% of the series presented complications in the postoperative period and mortality was 2%. CONCLUSION: The most frequently used surgical technique for HH was subtotal cystectomy and the morbidity and mortality rates in this Chilean series are comparable to other national and international series.

[Cholangiocarcinoma]. / Colangiocarcinoma: Actualización, diagnóstico y terapia.

Cholangiocarcinoma is a malignant lesion of the bile duct epithelium. Its incidence and prevalence are low. It appears from the sixth decade of life and there is slight male predominance. It is most frequently found in the confluence of the hepatic ducts, where it is called hilar cholangiocarcinoma or Klatskin tumor. Its etiology is unknown but there are predisposing conditions and environmental risk factors such as primary sclerosing cholangitis, Caroli's disease, bile duct malformations, industrial toxins and parasitic infections. The classic presentation of cholangiocarcinoma includes jaundice, weight loss and right upper quadrant pain. These, in addition to laboratory exams, endoscopical and imaging procedures, lead to the diagnosis. Hilar cholangiocarcinoma must be distinguished from other malignant or benign causes of biliary obstruction. Cholangiocarcinoma of the distal common bile duct must be differentiated from other periampullary tumors and intrahepatic cholangiocarcinoma can be confused with a hepatocellular carcinoma. Two classifications are used for clinical staging: TNM and Bismuth-Corlette. The best treatment is the complete surgical excision with negative histological margins, although the resectability index is low. The type and size of surgery depends on the location and extent of the tumor. Patients with unresectable tumors can be subjected to palliative procedures such as biliary-enteric bypass, endoscopic or pecutaneous stent placement. Chemotherapy is not effective. Recently, endoscopic phototherapy has emerged as a better alternative for palliative care.

Colangiocarcinoma: Actualización, diagnóstico y terapia: [revisón] / Cholangiocarcinoma: [review]

Cholangiocarcinoma is a malignant lesion of the bile duct epithelium. Its incidence and prevalence are low. It appears from the sixth decade of life and there is slight male predominance. It is most frequently found in the confluence of the hepatic ducts, where it is called hilar cholangiocarcinoma or Klatskin tumor. Its etiology is unknown but there are predisposing conditions and environmental risk factors such as primary sclerosing cholangitis, Caroli's disease, bile duct malformations, industrial toxins and parasitic infections. The classic presentation of cholangiocarcinoma includes jaundice, weight loss and right upper quadrant pain. These, in addition to laboratory exams, endoscopical and imaging procedures, lead to the diagnosis. Hilar cholangiocarcinoma must be distinguished from other malignant or benign causes of biliary obstruction. Cholangiocarcinoma of the distal common bile duct must be differentiated from other periampullary tumors and intrahepatic cholangiocarcinoma can be confused with a hepatocellular carcinoma. Two classifications are used for clinical staging: TNM and Bismuth-Corlette. The best treatment is the complete surgical excision with negative histological margins, although the resectability index is low. The type and size of surgery depends on the location and extent of the tumor. Patients with unresectable tumors can be subjected to palliative procedures such as biliary-enteric bypass, endoscopic or pecutaneous stent placement. Chemotherapy is not effective. Recently, endoscopic phototherapy has emerged as a better alternative for palliative care.

Tumor osteoclástico del páncreas / Osteoclastic tumour of the pancreas

No disponible

Elementos morfológicos pronósticos en el cáncer de la vesícula biliar / Morphological prognostic factors in gallbladder cancer

Background: The exact survival rates and prognostic factors of gallbladder cancer are still incompletely known. Aim: To report the actuarial survival of patients with gallbladder cancer. Material and methods: Six hundred thirty seven women, aged 59 years old as a mean and 108 men, aged 64 years old as a mean, with gallbladder cancer are reported. Patients were followed for up to 150 months. Results: Two hundred twenty four patients had an early and 521 had an advanced carcinoma. Overall survival was 38 percent at ten years. Sex or ethnic origin did not influence survival. Early tumors had a 92 percent survival at 10 years whereas the survival of advanced tumors was 16 percent at 5 years. Subserous tumors had a 5 years survival of 32 percent whereas serous tumors had a 5 years survival of 11 percent. Well-differentiated advanced tumors had a significantly better survival than moderately or poorly differentiated tumors. Vascular or lymphatic infiltration was also associated to a lower survival. All patients with advanced tumors and vascular infiltration died before 5 years. Conclusions: Tumor infiltration and differentiation degree were the most important prognostic independent factors in gallbladder cancer

Colangiocarcinoma primario asociado a enfermedad de Caroli / Primary cholangiocarcinoma asociated with Caroli disease

A 68 years old male presented with right hypochondrium abdominal pain and jaundice with no other clinical finding. CAT Scan and Ultrasonography showed right lobe bile duct dilatation. Magnetic Resonance Cholangiopancreatography gave an outstanding vision of a restricted right lobe bile duct dilatation associated to choledocholithiasis. A right hepatectomy and bile duct exploration were performed. The histopathological study disclosed a Caroli disease associated to a primary cholangiocarcinoma. Caroli disease is a congenital disorder characterized by intrahepatic cystic bile duct dilatation with a high risk association with cholangiocarcinoma

Hallazgos en reintervenciones quirúrgicas por cáncer de la vesícula biliar en pacientes con y sin quimio-radiación preoperatoria / Pathological findings in surgical reinterventions for gallbladder cancer in patients with and without preoperative chemo and radiotherapy

Background: The usefulness of surgery in the treatment of gallbladder cancer has not been clearly established. The benefits of chemo and radiotherapy are similarly dubious. Aim: To report the pathological findings in patients subjected to surgical reinterventions for gallbladder cancer. Patients and methods: We report 54 patients with gallbladder cancer that were subjected to a second surgical intervention for resection of liver segments IVb and V and lymph nodes corresponding to the liver hilar, portal, peripancreatic, celiac artery and periaortic territories. Thirteen of these patients were subjected to preoperative chemo-radiotherapy (4500 Gy and 5-fluouracil 500 mg/m2). Results: Lymph node metastases were found in 25 and 38 percent, and liver metastases in 25 and 28 percent of patients with or without chemo-radiotherapy respectively. The most frequent pathological findings attributed to radiation in the liver were fatty infiltration in 75 percent of cases, vascular transformation in 83 percent of cases and minimal periportal lymphocyte infiltration in 40 percent of cases. Lymph nodes were atrophic in 67 percent of cases and had foci of cortical necrosis in 46 percent of cases. Three cases had regional lymph node and liver metastases. Most tumor cells were viable. Conclusions: No differences in the number of lymph node or liver metastases were observed between patients with and without chemo-radiotherapy. No effect of the treatment on residual tumor was observed either

Gen supresor de tumores p53 en neoplasias digestivas / p53 tumor supresor gene in digestive cancer

Malignant diseases of the digestive tract cause more than 50 percent of deaths due to cancer in Chile. There is a high incidence of gastric and gallbladder cancer and an increasing frequency of colorectal cancer. P53 tumor suppressor gene has a great importance in carcinogenesis and its alterations are specially important in digestive tract tumors such as colorectal cancer. There is contradictory evidence about the frequency of p53 gene or protein alterations or their biological significance. There is little information about p53 in Chile and it is mostly limited to immunohistochemical studies. This revision analyzes the frequency of p53 alterations in digestive tract tumors in Chile, using immunohistochemical and molecular biology methods. A special emphasis is given to the prognostic importance of this gene

Pancreatitis crónica juvenil / Juvenile chronic pancreatitis

Introducción: la pancreatitis crónica juvenil se considera una enfermedad de baja frecuencia que provoca importante sintomatología y cuyo tratamiento es controversial. Objetivo: conocer nuestra experiencia en el manejo de la pancreatitis crónica juvenil. Personas y método: se evaluó arbitrariamente a la población menor de 30 años con evidencias de pancreatitis crónica, diagnosticada conforme a los criterios de la Sociedad Japonesa de Páncreas, entre 1994 y 1999 en el Hospital Regional de Temuco y Clínica Alemana de Temuco. Se revisaron retrospectivamente las historias clínicas, obteniendo los datos clínicos, de laboratorio, imagenológicos y los procedimientos terapéuticos efectuados. Para el seguimiento se elaboró una encuesta la que fue aplicada a cada paciente. Resultados: se detectaron 7 pacientes con pancreatitis crónica dentro el rango de 15 a 30 años. La etiología fue clasificada como idiopática en 3 pacientes, 1 de tipo familiar, 1 alcohólica mientras que en 2 se confirmó el diagnóstico de Pancreas Divisum. La pancreatografía mostró alteraciones en el 100 por ciento de los pacientes. En dos pacientes se realizaron procedimientos terapéuticos endoscópicos, en uno con Páncreas Divisum incompleto, se realizó una esfinterotomía de la papila menor, en otro, con estenósis de la papila menor, en otro, con estenósis de la papila principal, se realizó también esfinterotomía endoscópica. Se sometieron a tratamiento quirúrgico tres pacientes. Un paciente con Pancreas Divisum completo, se sometió a una esfinteroplastía transduodenal de la papila menor. En los otros, con dolor intratable, y que tenía un conducto pancreático de un calibre mayor a 5 mm, se realizó una pancreaticoyeyunoanastomosis. Ningún paciente presentó complicaciones. Sólo dos pacientes permanecen con tratamiento médico (régimen y enzimas pancreáticas). El seguimiento más alejado alcanzó los 48 meses. Sólo en los 5 pacientes, en que se realizó algún procedimiento terapéutico, hubo una disminución significativa del dolor. Conclusiones: la pancreatitis crónica representa una causa a considerar frente a un paciente portador de un cuadro doloroso abdominal aun cuando este sea menor de 30 años. Los factores etiopatogénicos se clasifican en su mayoría como idiopáticos, sin embargo el páncreas divisum debe ser siempre considerado. El manejo dependerá fundamentalmente del estado del conducto pancreático, obteniéndos buenos resultados cuando la terapia se selecciona conforme a cada caso

Pancreatoduodenectomía tardía más reconstrucción esofágica y manejo por etapas de trauma pancreatoduodenal grave por cáusticos / Later pancreatoduodenectomy, esophageal reconstruction and management of severe pancreatic-duodenal injuries due to caustic intake

Se presenta un caso clínico de una paciente que con fines suicidas ingiere 200 cc de ácido sulfúrico. Durante 464 días, tiempo durante el cual fue tratada, presenta diversas complicaciones gastrointestinales, pulmonares, metabólicas y sistémicas, motivo por el cual fue sometida a diversos tratamientos médico-quirúrgicos. Fue dada de alta en forma definitiva en julio de 1998

Avances en el diagnóstico y tratamiento del cáncer de páncreas / Advances in the diagnosis and treatment of pancreatic carcinoma

Pancreatic carcinoma has a dismal prognosis. In the last years, great efforts have been made to improve diagnosis and preoperative staging of potentially curable carcinomas. Actually, the diagnosis of fairly small tumours is possible. Chemoradiation therapy protocols prior to pancreatectomy, aiming to improve survival, are currently being held. This therapy allows radiation to be distributed into well oxygenated cells before surgical devascularization. This procedure can be done with acceptable morbidity and mortality rates. In selected cases of irresectable carcinoma, surgical palliation allows a better quality of life. Pancreatoduodenal resection, along with other traditional oncological therapies, will continue to be the therapy of choice for patients with carcinoma of the head of the pancreas, without local or regional metastases. However, an intensive search for new therapeutic strategies, specially in the field of molecular biology, is being carried out

Resultados en el tratamiento quirúrgico mediante pancreatoduodenectomía del cáncer de ampolla de Vater / Results in the surgical treatment through pancreatoduodenectomy of the Vater'a ampulla cancer

El cáncer de ampolla de Vater corresponde al tumor periampular con más alto porcentaje de resecabilidad. El objetivo de este trabajo es presentar los resultados obtenidos en pacientes portadores de un cáncer de papila tratados mediante pancreatoduodenectomía. Se revisan los antecedentes clínicos y los resultados obtenidos de una serie de 17 pacientes (10 hombres y 7 mujeres), margen de edad 44-77 años, en el período de tiempo mayo 1988 a mayo 1997. Ocurrieron 2 complicaciones intraoperatorias (11,8 por ciento), la mortalidad intraoperatoria y postoperatoria hasta 30 días es de 0 por ciento, y se produjo una muerte a los 45 días por un cuadro de sepsis. La complicación postoperatoria más frecuente fue la insuficiencia exocrina (1 caso). Se observó recidiva neoplásica en 7 pacientes

Colecistostomía percutánea / Percutaneous cholecystectomy

Se analiza prospectivamente la experiencia del Hospital Regional de Temuco con la introducción de la colecistostomía percutánea como alternativa para manejar pacientes con colecistitis aguda y alto riesgo quirúrgico. Se utiliza la técnica de punción con aguja gruesa bajo visión ecográfica y por vía transhepática. La serie incluye 18 pacientes con edades entre 17 y 71 años. La patología asociada al cuadro biliar fue: infección respiratoria: 10 casos, shock e hipotensión: 2 casos, pancreatitis aguda: 2 casos, infarto agudo miocárdico: 1 caso, diabetes descompensada: 1 caso y tumor de papila de Vater asociado a colangitis: 2 casos. El catéter permaneció in situ un promédio de 9,2 días. El cuadro biliar agudo revirtió en todos los casos. Hubo dos complicaciones tardías: un hematoma subcapsular hepático pequeño autolimitado y un absceso suprahepático drenado percutáneamente. La resolución definitiva fue por colecistectom ía tradicional (12 casos) y por laparoscopia (4 casos). Se concluye que la técnica es segura y efectiva como procedimiento alternativo para abortar una colecistitis aguda en pacientes de riesgo quirúrgico elevado

Cáncer temprano de la vesícula biliar / Early gallbladder cancer

El objetivo de este trabajo es analizar las características clínicas y el pronóstico de una serie de pacientes portadores de un cáncer temprano de la vesícula biliar. El cáncer temprano de la vesícula se define como aquél en que la invasión en la pared de la vesícula no invade más allá de la túnica muscular. Desde 1989 hasta 1996, 52 pacientes portadores de un cáncer temprano de la vesícula fueron atendidos en nuestro hospital. 28 tenían invasión neoplásica restringida a la mucosa o in situ y en 24 pacientes la invasión alcanzaba la túnica muscular. La totalidad de los pacientes fueron sometidos a una colecistectomía como primera intervención. De estos, en sólo 2 el diagnóstico fue sospechado previo a la colecistectomía mientras que durante el post operatorio el diagnóstico fue sospechado sólo en 3 casos. En los restantes pacientes el diagnóstico sólo fue posible posterior al examen de la pieza de colecistectomía. El análisis del tipo macroscópico de estos pacientes mostró que la mayoría de ellos eran de tipo plano e inaparentes. De los pacientes portadores de un tumor muscular, 10 fueron sometidos a una reintervención con el fín de practicar cirugía oncológica (cuña hepática + linfadenectomía locorregional). Tumor residual fue observado en sólo uno de estos pacientes. El seguimiento de los pacientes fluctúa entre 1 y 100 meses con un mediana de 43. Del total de pacientes, 2 con un tumor con invasión de la túnica muscular fallecieron luego de 11 y 19 meses de seguimiento respectivamente. No hubo pacientes fallecidos entre aquellos con invasión in situ o de la túnica mucosa. Como conclusión de este trabajo podemos decir que el cáncer temprano de la vesícula constituye un tipo de tumor asociado a buen pronóstico, generalmente detectado como consecuencia del estudio anatomopatológico de la pieza de colecistectomía. En relación a su tratramiento, la colecistectomía constituye un método terapéutico adecuado para el manejo de este tipo de tumores