Study of risk factors for delayed gastric emptying after partial pancretoduodenectomy.

INTRODUCTION: Delayed gastric emptying is one of the most frequent complications after pancreatoduodenectomy. METHODS: We performed an analysis of risk factors for delayed gastric emptying on a prospective database of 390 patients operated on between 2013 and 2021. A comparative retrospective study was carried out between patients with and without delayed gastric emptying and subsequently a study of risk factors for delayed gastric emptying using univariate and multivariate logistic regression models. RESULTS: The incidence of delayed gastric emptying in the overall series was 28%. The morbidity of the group was 63%, and postoperative mortality was 3.1%. Focusing on delayed gastric emptying, the median age (73 years vs 68 years, P < 0.001) and preoperative creatinine (75 vs 65.5, P < 0.001) were higher in the group with this complication. The study of risk factors showed that age over 60 years (P = 0.002) and pancreatic fistula (P < 0.001) were risk factors for delayed gastric emptying. CONCLUSION: The presence of pancreatic fistula is confirmed as a risk factor for slow gastric emptying after pancreaticoduodenectomy. In addition, age over 60 years is shown to be a risk factor for slow gastric emptying.

Metástasis óseas, primera manifestación clínica de un carcinoma productor de calcitonina / Bone metastases as the first clinical manifestation of a thyroid medullar carcinoma

Introducción: el carcinoma medular de tiroides comprende entre el 5%-10% de todos los carcinomastiroideos. La presentación clínica más frecuente es una masa tiroidea. Caso clínico: varón de 32 años, con dolores debidos a múltiples metástasis óseas. Una biopsia de médulaósea mostró un carcinoma con positividad inmunohistoquímica a calcitonina y antígeno carcinoembrionario.Los niveles séricos de calcitonina y antígeno carcinoembrionario estaban muy altos. El paciente murió a los 12 meses del diagnóstico a pesar de ser sometido a quimio y radioterapia. Discusión: las metástasis a distancia son una manifestación inicial infrecuente en el carcinoma medularde tiroides. Pacientes con menos de 45 años tienen mejor supervivencia, pero la existencia de metástasis óseasse correlaciona con mal pronóstico. Las determinaciones inmunohistoquímicas y séricas de calcitonina y antígenocarcinoembrionario son importantes instrumentos diagnósticos. Conclusión: mostramos lo que creemos es un carcinoma medular de tiroides en un varón joven, con una presentación inicial atípica debido a múltiples metástasis óseas y curso fatal. La inmunohistoquimia es fundamentalpara diagnosticar el tumor primario en estas metástasis. En el caso de calcitonina y/o antígeno carcinoembrionarioplasmático elevado y no explicado, es imprescindible descartar un carcinoma medular de tiroides

Purpose: Thyroid medullary carcinoma comprises between 5 and 10 % of all thyroid cancers. The mostcommon clinical presentation is a thyroid mass. Study of a case with bone metastases. Case report: A 32 year old man with pain due to multiple bone metastases. A bone marrow biopsydisclosed a carcinoma immunologically positive to calcitonin and carcinoembryonic antigen. Serum level ofboth, calcitonin and carcinoembryonic antigen, were very high. The patient was treated with chemotherapy andradiotherapy, and died 12 months later. Discussion: Distant metastases are not a usual presentation of thyroid medullary carcinoma. Patientsyounger than 45 years have a better survival, but bone metastases correlate with a very bad prognosis.Immunohistochemistry and blood determination of carcinoembryonic antigen and calcitonin are importantdiagnostic tools. Conclusion: Atypical presentation of a thyroid medullary carcinoma in a young man with bonemetastases and short survival. Immunohistochemistry is very useful to establish the origin of the primarytumour in these metastases. In the event of an unexplained plasma rise of calcitonin and/or carcinoembryonicantigen, it is mandatory to rule out a thyroid medullary carcinoma