Resección de metástasis hepáticas en cáncer de colon: nuevas perspectivas / Resection of liver metástasis in colon cancer: new perspectives

Liver metastasis of colon cancer is a very common clinical entity. Resective surgery can be used to improve the overall survival and disease-free. The problem is that major resections are associated with hepatic failure caused by an inadequate residual volume. Chemotherapy with diagrams as FOLFOX, FOLFIRI associated with antibodies such as bevacizumab, cetuximab or panitumumable added an important role in the conversion of unresectable to resectable tumors. Another widely used technique is portal vein ligation in a first surgical procedure, that generates left hepatic growth, to perform the resection in a second surgical procedure. The liver hypertrophy is achieved in a period of 2 months. The latest new technical procedure is the association of the ligation portal to the liver partition of the hepatic parenchyma without resection, which allows a segmental hypertrophy of the liver remnant between 7 to 10 days. This technique is called ALPPS. Radiofrecuency also has a role in the treatment of liver metastases. However,it is secondary.

La metástasis hepáticas del cáncer de colon es una entidad clínica muy frecuente. La cirugía resectiva permite mejorar la sobrevida global y libre de enfermedad. El problema es que grandes resecciones se asocian a insuficiencia hepática por un inadecuado volumen residual. La quimioterapia con esquemas como FOLFOX, FOLFIRI asociada a anticuerpos como bevacizumab, cetuximab o panitumumable agregan un rol importante en la conversión de tumores irresecables a resecables. Otra técnica utilizada es la ligadura portal en un primer tiempo, que genera crecimiento hepático izquierdo, para realizar la resección en un segundo tiempo quirúrgico. La hipertrofia hepática se logra en un período de 2 meses. La última novedad técnica es la asociación de la ligadura portal a la transección del parénquima hepático sin resección, lo que permite una hipertrofia segmentaria del hígado remanente entre 7 a 10 días. Esta técnica se denomina ALPPS. La radiofrecuencia también tiene un rol en el tratamiento de las metástasis hepáticas, aunque este es secundario.

Medición histológica micrométrica de capa muscular gástrica de pacientes obesos / Histologic micrometer measuring of gastric muscle in obesity patients

Background: The measurement of gastric wall thickness is useful during cutting, suturing and stapling surgical procedures. Aim: To measure gastric wall thickness in stomachs excised during bariatric surgery. Material and Methods: Stomachs excised during gastric bypass and sleeve gastrectomy as treatment for obesity was analyzed. The surgical piece was prepared for pathological study in the usual way and the wall thickness was measured in the fundus, body, proximal and distal antrum, using a photographic camera and Scope Photo Software. Results: A sample of 110 stomachs, 45 coming from gastric bypass and 65 from sleeve gastrectomy, was analyzed. Fundus, body, proximal and distal antrum thicknesses were 1.551 more or less 514, 2.072 more or less 568, 2.348 more or less 637 and 3.742 more or less 967 respectively (p < 0.0001). Conclusions: The distal antrum had the higher gastric wall thickness in this series of excised stomachs.

Consideramos que la medición de la pared del estómago es importante en el desarrollo de la cirugía gástrica, no encontramos estudios histológicos previos en relación al grosor de ella. Considerando que la capa muscular ofrece la mayor resistencia durante los procedimientos de corte y sutura mecánica se plantea la medición histológica en micrones del músculo gástrico de estómagos sanos resecados por técnica bariátrica resectiva. Se realizó un protocolo para recolección de datos clínicos y de puntos de análisis de medición, tomando en cuenta las características de los pacientes y las distintas zonas gástricas: fondo, cuerpo y antro. Se realiza una revisión sistemática de la literatura publicada. Entre diciembre de 2008 y junio de 2009, se recolectaron 110 estómagos provenientes de cirugía bariátrica resectiva. La medida promedio del músculo en el fondo gástrico fue de 1.551, en el cuerpo de 2.072, en el antro, 2.348.

Indicaciones de cirugía antirreflujo: ¿buenos y malos candidatos para la cirugía? revisión bibliográfica y experiencia personal / Indications for antireflux surgery: a clinical experience and review of the literature

Antireflux laparoscopic surgery has excellent results in terms of improvement of symptoms, esophagitis, gastroesophageal sphincter competence and abnormal acid reflux. Indications for surgery are well established, however some of these are controversial. This is a review of the present indications for surgery in gastroesophageal reflux. The surgical indication should be the result of a complex clinical and laboratory work up. Patients with a clear cut surgical indication should be differentiated from those with doubtful indications, that require further analysis and those that are bad candidates for surgery. Young patients with macroscopic esophagitis, an incompetent sphincter, abnormal acid reflux test, that have a partial or negative response to treatment with proton pump inhibitors are those with the best surgical results. Bad candidates are patients with a psychiatric background, with atypical symptoms and those with a normal acid reflux test. In our experience with 935 patients, only 23 percent had a surgical indication.

Glucagonoma: evolución y tratamiento / Glucagonoma: evolution and treatment

Glucagonomas are alpha pancreatic islet cell tumors that, when they are active, produce a syndrome characterized by necrolytic migratory erythema, diabetes mellitus, weight loss, anemia, glossitis, thromboembolism, neuropsychiatric disturbances and hyperglucagonemia. We report a 43 years old male presenting with a five years history of dermatological lesions, associated with weight loss, glossitis and onicodystrophy. Serum glucagon was 2200 pg/ml and a CAT scan showed a tumor in the tail of the pancreas. The tumor was surgically excised but one year later, hepatic metastases were found. These were excised surgically, treated with long acting octeotride and finally treated with radiotherapy using Y-DOTATOC. In the last control in November, 2001, the patient is asymptomatic