Mastectomia: reconstruccion inmediata con colocacion de expansores mamarios / Mastectomy: immediate reconstruction with placement of mammary expansors

La reconstrucción mamaria es parte fundamental del tratamiento de la mujer mastectomizada por cáncer de mama. Tras comprobarse que la reconstrucción no influye negativamente sobre la enfermedad neoplásica, sino que es trascendental para la rehabilitación física y psicológica de la paciente, su desarrollo se ha visto favorecido. Este trabajo monográfco muestra el trababjo en equipo dentro del quirófano y el rol del isntrumentador(AU)

Mammary reconstruction is a fundamental part of the treatment of women mastectomized for breast cancer. After confrming that the reconstruction does not negatively influence the neoplastic disease, but is transcendental for the physical and psychological rehabilitation of the patient, its development has been favored. Tis monographic work shows teamwork within the operating room and the role of the isntrumentor(AU)

A reconstrução mamária é parte fundamental do tratamento de mulheres mastectomizadas para câncer de mama. Após confrmar que a reconstrução não influencia negativamente a doença neoplásica, mas é transcendental para a reabilitação física e psicológica do paciente, seu desenvolvimento tem sido favorecido. Este trabalho monográfco mostra o trabalho em equipe dentro da sala de cirurgia e o papel do instrumental(AU)

[Solid pseudopapillary tumor of the pancreas: a case report and a review of the literature]. / Tumor sólido pseudopapilar de páncreas: presentación de un caso y revisión de la literatura.

The solid pseudopapillary tumor of the pancreas is a rare neoplasm, representing 0.13% to 2.7% of all pancreatic tumors. This neoplasm is more common in young women between the third and fourth decade of life. It may produce nonspecific symptoms and in many cases is asymptomatic, being diagnosed incidentally. A 28-year-old woman with no previous medical history presented epigastric pain for the last 3 months. Physical examination was normal. When an upper gastrointestinal endoscopy was performed, a submucosal lesion was observed in the posterior wall of the stomach. A computed tomography and a magnetic resonance imaging were done and both showed a 2.8 cm-diameter tumor in the body of the pancreas. She underwent a spleen-preserving distal pancreatectomy (Warshaw surgery), evolved favourably and was discharged at the sixth postoperative day. The pathological diagnosis of the surgical specimen was a solid pseudopapillary tumor of the pancreas. Surgery is the gold-standard treatment for this condition, given the facts that no other treatment have proven being effective and often surgical treatment is curative because of the tumor's low malignant potential.

[Mesenteric panniculitis: a case report and a review of the literature]. / Paniculitis mesentérica: presentación de un caso y revisión de la literatura.

Mesenteric panniculitis is a rare entity of benign features that affects the intestinal mesenteric fat tissue and can progress in different ways, from spontaneous resolution to fibrosis. The etiology is still uncertain, probably caused by trauma, infection or surgery. We report a case of a 64-year-old male patient who suddenly began with abdominal pain and leukocytosis. Diagnosis of mesenteric panniculitis was made by a CT scan and the patient evolved with spontaneous resolution within two months.

Tumor sólido pseudopapilar de páncreas: presentación de un caso y revisión de la literatura / [Solid pseudopapillary tumor of the pancreas: a case report and a review of the literature].

The solid pseudopapillary tumor of the pancreas is a rare neoplasm, representing 0.13

of all pancreatic tumors. This neoplasm is more common in young women between the third and fourth decade of life. It may produce nonspecific symptoms and in many cases is asymptomatic, being diagnosed incidentally. A 28-year-old woman with no previous medical history presented epigastric pain for the last 3 months. Physical examination was normal. When an upper gastrointestinal endoscopy was performed, a submucosal lesion was observed in the posterior wall of the stomach. A computed tomography and a magnetic resonance imaging were done and both showed a 2.8 cm-diameter tumor in the body of the pancreas. She underwent a spleen-preserving distal pancreatectomy (Warshaw surgery), evolved favourably and was discharged at the sixth postoperative day. The pathological diagnosis of the surgical specimen was a solid pseudopapillary tumor of the pancreas. Surgery is the gold-standard treatment for this condition, given the facts that no other treatment have proven being effective and often surgical treatment is curative because of the tumor’s low malignant potential.

Paniculitis mesentérica: presentación de un caso y revisión de la literatura / [Mesenteric panniculitis: a case report and a review of the literature].

Mesenteric panniculitis is a rare entity of benign features that affects the intestinal mesenteric fat tissue and can progress in different ways, from spontaneous resolution to fibrosis. The etiology is still uncertain, probably caused by trauma, infection or surgery. We report a case of a 64-year-old male patient who suddenly began with abdominal pain and leukocytosis. Diagnosis of mesenteric panniculitis was made by a CT scan and the patient evolved with spontaneous resolution within two months.

Tumor sólido pseudopapilar de páncreas: presentación de un caso y revisión de la literatura. / [Solid pseudopapillary tumor of the pancreas: a case report and a review of the literature].

The solid pseudopapillary tumor of the pancreas is a rare neoplasm, representing 0.13

to 2.7

of all pancreatic tumors. This neoplasm is more common in young women between the third and fourth decade of life. It may produce nonspecific symptoms and in many cases is asymptomatic, being diagnosed incidentally. A 28-year-old woman with no previous medical history presented epigastric pain for the last 3 months. Physical examination was normal. When an upper gastrointestinal endoscopy was performed, a submucosal lesion was observed in the posterior wall of the stomach. A computed tomography and a magnetic resonance imaging were done and both showed a 2.8 cm-diameter tumor in the body of the pancreas. She underwent a spleen-preserving distal pancreatectomy (Warshaw surgery), evolved favourably and was discharged at the sixth postoperative day. The pathological diagnosis of the surgical specimen was a solid pseudopapillary tumor of the pancreas. Surgery is the gold-standard treatment for this condition, given the facts that no other treatment have proven being effective and often surgical treatment is curative because of the tumors low malignant potential.

Paniculitis mesentérica: presentación de un caso y revisión de la literatura. / [Mesenteric panniculitis: a case report and a review of the literature].

Mesenteric panniculitis is a rare entity of benign features that affects the intestinal mesenteric fat tissue and can progress in different ways, from spontaneous resolution to fibrosis. The etiology is still uncertain, probably caused by trauma, infection or surgery. We report a case of a 64-year-old male patient who suddenly began with abdominal pain and leukocytosis. Diagnosis of mesenteric panniculitis was made by a CT scan and the patient evolved with spontaneous resolution within two months.

[Submucosal gastric tumour: heterotopic pancreas. A case report and review of the literature]. / Tumor submucoso gástrico: páncreas heterotópico. Presentación de un caso y revisión de la literatura.

Heterotopic pancreas is the presence of pancreatic tissue outside the anatomical location of the pancreas. It is a rare condition and can occur anywhere in the gastrointestinal tract with the stomach and small bowel as the most common sites. It is usually asymptomatic but may become clinically evident when complicates by pathologic changes such as inflammation, bleeding, obstruction and malignant transformation. We report the case of a 49-year-old man who presented with recurrent epigastric pain. The upper gastrointestinal endoscopy revealed a submucosal tumour in the antrum. The histopathology study after surgery showed a heterotopic pancreatic tissue. Ectopic pancreas should be considered in the differential diagnosis of a submucosal gastric tumour.

Suboclusión intestinal secundaria a endometriosis en paciente con Síndrome de V. A. T. E. R. L. S. / Intestinal sub-occlusion secundary to endometriosis in a patient with

We report a case of acute small bowel obstruction occurring secondary to endometriosis of the terminal ileum. Ileal endometriosis is a rare condition that can cause acute small bowel obstruction. As this cse and others in the literture highlight, establishing a preoperative diagnosis is very difficult due to the vagueness of symptoms and similarity in presentation to other causes of obstruction, and is based on a high index of suspicion. However, this disorder should be considered in the differential diagnosis of women of child-bearing age who present with symptoms of obstruction. The definiteve treatment includes resection of the involved segment with primary anastomosis, and adjuvant hormonal therapy may prevent recurrence. VATER association is an acronym for the fllowing non-random association of defects: Vertebral defects, Anal atresia, tracheoesophageal fistula with Esophageal atresia, and Renal or Radial defects. VACTERL association is an expanded acronym to include Cardiac defects and Limb defects. Diagnosis of VACTERL association is made if theree out of seven above defects are present in an infant. The incidence is estimated to be 1.6 cases in 10,000 live births.

Suboclusión intestinal secundario a melanoma amelánico metastásico / Intestinal subocclusion following metastatic melanoma: case report

El Melanoma Amelánico (MA) es una de las variantes clínicas de Melanoma Melánico (MM), encontrándose aproximadamente en el 2% de los casos de (MM). El melanoma es el tumor con mayor predilección por metastizar en el intestino delgado. El diagnóstico de estas lesiones se hace con la ayuda del examen histopatológico y marcadores de inmunohistoquímica. El pronóstico de (MA) no muestra variación en relación con el (MM) pigmentado y continua dependiendo de la edad del paciente, sexo, localización y espesor de la lesión. Se debe tener en cuenta que el (MA) a menudo tiene un nivel de invasión Clark IV o V en el momento del diagnóstico debido a que sus características clínicas retardan la sospecha diagnóstica. La cirugía se considera útil en pacientes con metástasis de melanoma en el tracto gastrointestinal, ya que, a pesar de una media de superviviencia de 6-12 meses, que proporciona buen alivio con baja morbilidad y mortalidad. Se presenta un caso de un hombre de 56 años de edad que a los 53 años se le resecó nevus en región costal izquierda sin estudio de anatomía patológica, reingresando a dicha edad por cuadro de suboclusión intestinal por melanoma amelánico secundario a lesión primaria cutánea. Se realizó resección radical intestinal cutánea y dacarbacina 5 ciclos de 5 días. Después de unos cuantas semanas, demostró múltiples nódulos dispersos en ambos pulmones y una RM cerebral mostró múltiples nódulos delimitados en ambos hemisferios cerebrales. Su condición clínica comenzó a deteriorarse rápidamente con evidencia de enfermedad metastásica generalizada. El paciente murió 5 meses después de iniciado el diagnóstico.

The Amelanic Melanoma (AM) is one of the clinical variants of the Melanic Melanoma (MM), corresponding to the 2% of the cases of MM. The malanoma is the tumor with major predilection for metastases in the small intestine. The diagnosis of these injuries can be made with the help of the histopathology examination and immunohistochemical markers. The prognosis of the AM does not show change as regards the pigmentate MM and continue depending in the age of the patient, sex, location and thickness of the injury. You must know that the MA often has a level of invacion Clark IV or V at the moment of the diagnostic because his clinical characteristics slow down the diagnostic suspicion. The surgery is useful in patients with gastrointestinal tract metastasis of melanoma, due to provides good mitigation with low morbidity and mortality in the 6-12 months of survival. We present a case of a 56 -year-old man who at the age of 53 was resected a nevus in the left costal region without study of pathological anatomy, re-entering at the above mentioned age for a subocclusion intestinal syndrome for amelanic melanoma secondary to primary cutaneous injury. Radical intestinal resection and cutaneous resection was made and 5 cycles of dacarbacine for 5 days. After few weeks, it demonstrated multiple nodules dispersed in both lungs and a cerebral RM showed multiple nodules delimited in both cerebral hemispheres. His clinical condition began to deteriorate rapidly with evidence of widespread metastatic illness. The patient died 5 months after initiated the diagnosis.

Tratamiento quirúrgico de la obesidad mórbida / Evaluation of laparoscopic sleeve gastrectomy in the treatment of morbid obesity

Objetivo: determinar los resultados obtenidos en cuanto a la pérdida de peso, porcentaje de exceso de peso perdido (%EPP) y descenso del IMC a los 18 meses del postoperatorio de GML y resolución de las comorbilidades asociadas a la obesidad. Evaluar complicaciones postoperatorias. Material y método: estudio prospectivo desde el año 2004 al 2009. Se realizó GML según técnica estándard. Se evaluaron los resultados a 1,3, 6, 12 y 18 meses. Resultados: n = 65. El peso postoperatorio obtenido fue de 115,3, 102,1, 95,3, 89,5 y 80,03 kg al 1,3,6,12 y 18 meses respectivamente. El IMC fue de 38,89, 34,33, 31,5, 29,96 y 28,72 kg/m2 al 1, 3, 6, 12 y 18 meses respectivamente. El % de EPP fue de 30,62, 40,25, 51,36, 58,63 y 63,4% al 1, 3, 6, 12 y 18 meses respectivamente. El % de complicaciones postoperatorias fue de 4,6 %. El % de comorbilidades fue de 27,66 % se resolvieron en el 92 % de los pacientes. De los 65 pacientes estudiados 42 de ellos llegaron a ser controlados a los 18 meses. En estos pacientes no se consideró necesario un segundo procedimiento bariátrico. Conclusión: la GML es una técnica quirúrgica con buenos resultados en el descenso de peso y control de las comorbilidades en el período estudiado. Se deberían reevaluar los resultados a largo plazo para determinar la eficacia de la GML.

Objective: Determine the effectiveness of laparoscopic sleeve gastrectomy in terms of weihgt loss, percentage of excessive weight loss, rduction of BMI and comorbidities associated to obesity within 18 months of surgery. Evaluate postoperative complications. Material and method: Prospective study of 68 patients who underwent LSG performed according to standard technique from 2004 to 2009. Follow up was done by measuring the above mentioned variables 1, 3, 6, 12 and 18 months after surgery. Results: n = 65. The post operative weight obtained was 115.3, 102.1, 95.3, 89.5 and 80.03 kg to the 1, 3, 6, 12 and 18 months respectively. The BMI was 38.89, 34.33, 31.5, 29.96 and 28.72 kg/m2 to the 1, 3, 6, 12 and 18 months respectively. % EWL was 30.62, 40.25, 51.36, 58.63 and 63.4% to the 1, 3, 6, 12 and 18 months respectively. % of complications was 4.6%. % of comorbidities was 27.66 % and was resolved in 92 % of the patients. From 65 studied patients 42 of them arrived to be controlled to the 18 months. In these patients a second bariatric procedure was not considered necessary. Conclusion: The LSG is a surgery technique with good results in terms of weight reduction and controlled comorbidities in the time period evaluated. Further follow up is needed to prove LSG efficacy in the long term.

Neumatosis intestinal asociada a neumatosis portal intrahepática por oclusión intestinal: presentación de un caso / Pneumatosis intestinalis and intrahepatic portal venous gas associated with small bowel occlusion: case report

La neumatosis intestinal es una entidad muy infrecuente asociada a varias patologías, como el infarto intestino-mesentérico, la enterocolitis necrotizante y la enfermedad pulmonar obstructiva crónica. Se caracteriza por la presencia de gas en la subserosa o submucosa a través del tracto gastrointestinal. Presentamos el caso de un paciente de sexo masculino de 63 años de edad que consultó por dolor en abdomen superior, vómitos y fiebre elevada (39º) nueve días después de una gastrectomía total por cáncer. La radiografía directa de abdomen constató distensión intestinal y la tomografía computada (TC) demostró distensión intestinal, edema mesentérico, neumatosis intestinal a través del intestino delgado y neumatosis portal, preferentemente en el lóbulo hepático izquierdo. Se realizó una laparotomía de urgencia que reveló únicamente distensión intestinal por adherencias, sin evidenciar necrosis intestinal. El paciente evolucionó desfavorablemente, falleciendo posteriormente. Reportamos un nuevo caso y revisamos la literatura de la neumatosis intestinal asociada con neumatosis portal.

The pneumatosis intestinalis is a very infrequent condition associated with a number of diseases, such as mesenteric infarction, necrotizing enterocolitis, and obstructive pulmonary disease characterized by the presence of subserosal or submucosal gas cyst throughout the gastrointestinal tract. A 63- year- old man complained of upper abdominal pain, vomiting and high fever (39º C) on the nine day after total gastrectomy for cancer. Abdominal X-ray revealed intestinal distension. The abdominal Computed Tomography (CT) showed intestinal dilatation, mesenteric oedema, diffuse pneumatosis throughout the small intestine and gas in the portal venous system predominantly in the left hepatic lobe. It was performed emergency activity that revealed intestinal distension secondary to adhesion without intestinal necrosis. The patient had a downhill course and died thereafter. We report a new case and reviewed the literature of pneumatosis intestinalis associated with hepatic portal venous gas.