Oxidative stress influence on renal dysfunction in patients with obstructive jaundice: A case and control prospective study.

BACKGROUND: Obstructive Jaundice (OJ) is associated with a significant risk of developing acute renal failure (ARF). The involvement of oxidative stress in the development of cholestasis has been demonstrated in different experimental models. However, its role in the morbidity of human cholestasis is far to be elucidated. The aim of the study was the evaluation of oxidative stress markers in blood from patients with OJ and its relation to complications and benign/malignant evolution of cholestasis. METHODS: A prospective cross-sectional study of 105 patients with OJ and 34 control subjects were included. Several markers of liver function and oxidative stress, such as lipoperoxides (LPO), as well as reduced glutathione (GSH), catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were assessed. RESULTS: The patients with OJ showed a marked increase in plasma levels of LPO, SOD and GSH, while GSH-Px levels were decreased. The increase in lipid peroxidation products and the depletion of SOD activity in blood were also related to renal dysfunction. The highest level of LPO was associated with malignant etiology of the disease. The logistic regression analysis showed that the age of the patient and the levels of LPO in blood were predictors of renal dysfunction in OJ patients. CONCLUSIONS: This study demonstrates a correlation between oxidative stress and renal dysfunction patients with OJ.

Validation of the NASA-TLX Score in Ongoing Assessment of Mental Workload During a Laparoscopic Learning Curve in Bariatric Surgery.

BACKGROUND: Fatigue and mental workload are directly associated with high-complexity tasks. In general, difficult tasks produce a higher mental workload, leaving little opportunity to deal with new/unexpected events and increasing the likelihood of performance errors. The laparoscopic Roux-en-Y gastric bypass (LRYGB) learning curve is considered to be one of the most difficult to complete in laparoscopic surgery. We wished to validate the National Aeronautics and Space Administration Task Load Index (NASA-TLX) in LRYGB and identify factors that could provoke a higher mental workload for surgeons during the learning curve. METHODS: A single surgeon was enrolled to undertake 70 consecutive LRYGB procedures with two internal surgeons mentoring the first 35 cases. Patients were consecutive and ranked from case 35 to case 105 according to the date of the surgical procedure ("case rank"). Self-ratings of satisfaction, performance, and fatigue were measured at the end of surgery using a validated NASA-TLX questionnaire. The procedure was recorded for later viewing by two external evaluators. General data for patients and surgical variables were collected prospectively. RESULTS: A moderate correlation between the NASA-TLX score, BMI, operative time, and volumes of blood drainage was observed. There was no correlation between the NASA-TLX score and duration of hospital stay or time of drain removal. BMI ≥50 kg/m(2), male sex, inexperienced first assistant, and type 2 diabetes mellitus were identified as independent predictive factors of a higher NASA-TLX score. CONCLUSIONS: The NASA-TLX is a valid tool to gauge mental workload in LRYGB.

Intraabdominal bronchogenic cyst.

INTRODUCTION: Bronchogenic cyst is pathology of the respiratory track. It consists of a defect during the embryological development of the tracheobronchial tree. Most common presentation is as a solid or cystic mass located in mediastinum, and it is usually diagnosed in relation to respiratory problems or recurrent infections in children. In adulthood, it is a rare pathology, and its diagnosis is usually incidental. CASE REPORT: We present a case of a patient with a paraesophageal cystic mass suggestive of intraabdominal esophageal duplication cyst but, after the histopathological examination, was discovered to be a bronchogenic cyst, something extremely rare as in most cases of subdiaphragmatic location; bronchogenic cysts appear as retroperitoneal lesions. DISCUSSION: After we review the current literature, surgical extirpation appears to be the treatment of choice due to potential complications, and laparoscopic approach is a feasibily and safe procedure for this pathology up to date.

Conservative management of perforated duodenal diverticulum: a case report and review of the literature.

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.

Complications of extrahepatic echinococcosis: fistulization of an adrenal hydatid cyst into the intestine.

Echinococcal cysts are usually found in liver and lungs, but any other organ can potentially be involved. Extrahepatic disease due to hydatid cyst may develop in the abdominal and pelvic cavity, aside from in other less common locations, which may make both diagnosis and treatment more complex. We present a rare case of extrahepatic echinococcosis in a 70-year old patient with a 4-d history of dull abdominal pain, anemia within the transfusion range and fever. She underwent surgery for left renal hydatid cysts 30 years ago. After non operative treatment, imaging studies showed a calcified hydatid cyst in a retrogastric location communicating with a proximal jejunal loop. En-block resection of the mass together with the adrenal gland was performed including closure of the enteric fistula. Anatomic pathology confirmed the diagnosis of a calcified hydatid cyst of left adrenal origin. Surgery is the treatment of choice and most authors recommend removal of cyst and adrenal gland.

Carcinoma suprarrenocortical. Abordaje terapéutico en estadio avanzado / Adrenal cortical carcinoma: therapeutic approach in advanced-stage disease

Presentamos el caso clínico de una mujer de 33 años diagnosticada de carcinoma suprarrenocortical en estadio avanzado. Describimos la forma de presentación clínica, los métodos diagnósticos empleados y el tratamiento, especialmente en su aspecto quirúrgico, que puede precisar en determinadas ocasiones conocimientos y habilidades en cirugía hepática y vascular para intentar conseguir la resección completa del tumor y mejorar la supervivencia en estos pacientes, generalmente muy jóvenes; asimismo, realizamos una actualización bibliográfica diagnosticoterapéutica de esta neoplasia, rara en su frecuencia pero agresiva en su evolución (AU)