Results of adrenal surgery. Data of a Spanish National Survey.

PURPOSE: Given the availability of laparoscopy and the rising detection of incidentalomas, indications for adrenalectomy may be changing. The Endocrine Surgery Section of the Spanish Association of Surgeons designed a survey to assess its indications, techniques, and results in Spanish Surgical Departments. METHODS: Collected data included hospital and department type, yearly hospital volume of procedures; location studies and preoperative preparation performed, indications, surgical approach and instruments used, and results in terms of morbidity and overall hospital stay. The analysis included a comparison between results of high- or low-volume centers and surgeons, using the Student's t test for quantitative and chi-square test for qualitative variables. Level of significance was set at 0.05. RESULTS: Nineteen centers returned the questionnaire, including 155 adrenalectomies performed in 2008. Most frequent indications were pheochromocytoma (23.2%), aldosteronoma (16.7%), incidentaloma (12.2%), metastasis (10.3%), Cushing adenoma (9.6%), and carcinoma (3.8%). Laparoscopy was performed in 83.9% of cases (9.4% required conversion to laparotomy). Four patients required urgent reoperation. Average hospital stay: 4.6 days (3.3 days after laparoscopy, 7 days after laparotomy). High-volume centers had a greater proportion of laparoscopically treated cases (p = 0.008), more malignant lesions treated (p = 0.03), a shorter overall stay (p < 0.0001), and a shorter stay after laparotomic adrenalectomy (p = 0.01). High-volume surgeons had similar results, and less in-hospital morbidity (p = 0.02). CONCLUSIONS: In Spain, adrenalectomy is performed in hospitals of varying complexity. Laparoscopic approach is the rule, with good results in terms of morbidity and stay. High-volume centers and surgeons had best results in terms of use of minimally invasive surgery and hospital stay.

Obstrucción de intestino delgado por metástasis de carcinoma mamario lobulillar / Small bowel obstruction due to metastatic lobular carcinoma of the breast

Aunque los lugares más frecuentes de metástasis del cáncer de mama son el hueso, el pulmón, la pleura, el hígado, las glándulas suprarrenales y el cerebro, también pueden resultar afectados otros órganos, como el intestino delgado y el ovario, sobre todo si es del tipo lobulillar infiltrante. Se presenta 1 caso de metástasis en el intestino delgado y el ovario por carcinoma lobulillar infiltrante de mama en su variedad pleomorfa, en el que la primera manifestación de la enfermedad fue la obstrucción intestinal. En el tránsito intestinal baritado se evidenció una estenosis yeyunal y otra en el íleon terminal, en la válvula ileocecal. A pesar de que en la endoscopia se observó una formación plana en alfombra en la válvula ileocecal, la biopsia fue negativa, lo cual es bastante frecuente por la ausencia de infiltración de la mucosa intestinal. El estudio anatomopatológico e inmunohistoquímico de las piezas de resección intestinal y ovárica confirmó el diagnóstico de metástasis de un carcinoma lobulillar de mama, lo que fue corroborado con la biopsia mamaria (AU)

Although breast cancer most frequently metastasizes to the bone, lung, pleura, liver, adrenal glands and brain, it can also affect other organs such as the small bowel and ovaries, especially if the type of cancer is infiltrating and lobular. We present a case of metastases to the small bowel and ovaries from pleomorphic type infiltrating lobular breast carcinoma presenting as intestinal obstruction. Barium transit study revealed a stenosis in the jejunum and another in the terminal ileum at the ileocecal valve area. A flat formation in the area of the ileocecal valve was observed on endoscopy but the results of biopsy were negative, a fairly frequent finding due to the absence of infiltration of the intestinal mucosa. Pathological and immunohistochemical study of the intestinal and ovarian surgical specimens confirmed the diagnosis of metastases from lobular carcinoma of the breast, which was corroborated by breast biopsy (AU)

[Small bowel obstruction due to metastatic lobular carcinoma of the breast]. / Obstrucción de intestino delgado por metástasis de carcinoma mamario lobulillar.

Although breast cancer most frequently metastasizes to the bone, lung, pleura, liver, adrenal glands and brain, it can also affect other organs such as the small bowel and ovaries, especially if the type of cancer is infiltrating and lobular. We present a case of metastases to the small bowel and ovaries from pleomorphic type infiltrating lobular breast carcinoma presenting as intestinal obstruction. Barium transit study revealed a stenosis in the jejunum and another in the terminal ileum at the ileocecal valve area. A flat formation in the area of the ileocecal valve was observed on endoscopy but the results of biopsy were negative, a fairly frequent finding due to the absence of infiltration of the intestinal mucosa. Pathological and immunohistochemical study of the intestinal and ovarian surgical specimens confirmed the diagnosis of metastases from lobular carcinoma of the breast, which was corroborated by breast biopsy.

Abdomen agudo en una adolescente diabética. Síndrome de Mauriac / Acute abdomen in an adolescent with diabetes. Mauriac´s syndrome

La glucogenosis secundaria o síndrome de Mauriac es la primera causa de hepatomegalia y alteración de las pruebas de función hepática en adolescentes y adultos diabéticos. Es relativamente frecuente en mujeres jóvenes con diabetes tipo 1 y puede cursar semejando un abdomen agudo con dolor en el hipocondrio derecho, náuseas y vómitos. Estos pacientes deben ser manejados mediante una actitud expectante, ya que con el buen control glucémico y el ajuste de las dosis de insulina, el cuadro se suele autolimitar en una semana (AU)