Trasplante hepático en tumor carcinoide de páncreas metastático / Liver transplantation for pancreatic carcinoid tumor with metastasis

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Continuous subcutaneous insulin infusion versus multiple daily injections in pregnant women with type 1 diabetes.

BACKGROUND: Continuous subcutaneous insulin infusion (CSII) may be an alternative to multiple daily injections (MDI) in pre-gestational diabetes during pregnancy. However, no clear improvement in obstetric and perinatal outcome has so far been established for CSII treatment. METHODS: In a case-control study, 35 pregnancies treated with CSII and 64 pregnancies treated with MDI treatment were evaluated. Metabolic control and obstetric and perinatal outcome were compared. RESULTS: Women in the CSII group improved their metabolic control (hemoglobin A1c before CSII, 7.83 +/- 0.97%; 3-6 months after, 6.77 +/- 0.61%; P < 0.05). Hemoglobin A1c before pregnancy was lower in the CSII group (6.62 +/- 0.60%) than in the MDI group (7.59 +/- 1.61%) (P < 0.05). No other significant differences, either in metabolic control of diabetes or in obstetric and perinatal outcome, were found. CONCLUSIONS: CSII treatment is safe in pregnancy, but it has not yet been associated with any improved pregnancy outcome.

[Development and evolution of laparoscopic adrenalectomy in an specialized team: from the beginning to the outpatient setting]. / Desarrollo y evolución de la suprarrenalectomía laparoscópica en una unidad especializada: de los casos iniciales al hospital de día.

BACKGROUND: After the first reports in 1992, laparoscopic adrenalectomy (LA) has evolved technically until becoming the standard approach for the treatment of most of the adrenal gland diseases. MATERIAL AND METHODS: Retrospective and descriptive study of 67 patients who underwent 68 LA between January-1998 and December-2008 in the Laparoscopic Surgery Unit of the General and Digestive Surgery Service in a third level hospital (only one case of bilateral LA). The group was divided in 2 periods, P-1 (1998-2003, 22 cases) and P-2 (2004-2008, 45 cases), which have been compared to evaluate the evolution of the LA technique. RESULTS: Indications for LA were: 19 incidentalomas, 19 primary hyperaldosteronism, 18 pheocromocitoms, 5 cases of symptomatic and non-functioning adrenal masses, 4 Cushing adenomas and 2 metastases. There was no mortality, only 4 patients had minor complications (6%) and conversion rate was only 3% (2 cases). Mean size of adrenal glands resected was 3.83 cm and the mean operative time was 86 minutes. Mean postoperative hospital stay was 3 days and in P-2 seventeen patients were discharged on an outpatient basis (hospital stay less than 23 hours). CONCLUSIONS: In our experience, LA for the treatment of adrenal diseases has shown to be safe, effective and reproducible with low complications and excellent tolerance by patients. When the learning curve is overcome, hospital stay and operative time clearly decrease. As a consequence, LA can be planned in selected cases as outpatient surgery with good results.

Desarrollo y evolución de la suprarrenalectomía laparoscópica en una unidad especializada: de los casos iniciales al hospital de día / Development and evolution of laparoscopic adrenalectomy in an specialized team: from the beginning to the outpatient setting

Introducción: Desde su descripción inicial en 1992, la suprarrenalectomía laparoscópica (SL) ha evolucionado como técnica hasta convertirse en el abordaje estándar para el tratamiento de la patología quirúrgica adrenal.Material y métodos: Realizamos un estudio observacional descriptivo de 67 pacientes sometidos a 68 SL entre enero de 1998 y diciembre de 2008 en la unidad de cirugía laparoscópica del servicio de cirugía general y digestiva de un hospital de tercer nivel (sólo 1 caso de SL bilateral). Igualmente, la serie se ha dividido en dos periodos: P-1 (1998-2003, 22 casos) y P-2 (2004-2008, 45 casos), que se han comparado para valorar la evolución de la técnica.Resultados: Las indicaciones para la realización de SL fueron: 19 incidentalomas, 19 aldosteronomas, 18 feocromocitomas, 5 casos de masa adrenal no funcionante, 4 adenomas de Cushing y 2 metástasis. La mortalidad fue nula, sólo 4 pacientes presentaron complicaciones menores (6%) y la conversión sólo fue necesaria en 2 casos (3%). El tamaño medio glandular de nuestra serie fue de 3,83 cm y la duración media de la cirugía, 86 min. La estancia hospitalaria media fue de 3 días, y en el P-2 hasta 17 pacientes fueron dados de alta en régimen de cirugía mayor ambulatoria (menos de 23 h de estancia). Conclusiones: En nuestra serie, el abordaje laparoscópico para el tratamiento de la patología quirúrgica suprarrenal se ha demostrado seguro, efectivo, reproducible, con escasas complicaciones y muy bien tolerado por los pacientes. Cuando se supera la curva de aprendizaje, el tiempo quirúrgico y la estancia hospitalaria se reducen, lo cual permite, en casos seleccionados, plantear esta técnica en régimen de cirugía mayor ambulatoria (AU)

Background: After the first reports in 1992, laparoscopic adrenalectomy (LA) has evolved technically until becoming the standard approach for the treatment of most of the adrenal gland diseases.Material y methods: Retrospective and descriptive study of 67 patients who underwent 68 LA between January-1998 and December-2008 in the Laparoscopic Surgery Unit of the General and Digestive Surgery Service in a third level hospital (only one case of bilateral LA). The group was divided in 2 periods, P-1 (1998-2003, 22 cases) and P-2 (2004-2008, 45 cases), which have been compared to evaluate the evolution of the LA technique.Results: Indications for LA were: 19 incidentalomas, 19 primary hyperaldosteronism, 18 pheocromocitoms, 5 cases of symptomatic and non-functioning adrenal masses, 4 Cushing adenomas and 2 metastases. There was no mortality, only 4 patients had minor complications (6%) and conversion rate was only 3% (2 cases). Mean size of adrenal glands resected was 3,83 cm and the mean operative time was 86 minutes. Mean postoperative hospital stay was 3 days and in P-2 seventeen patients were discharged on an outpatient basis (hospital stay less than 23 hours).Conclusions: in our experience, LA for the treatment of adrenal diseases has shown to be safe, effective and reproducible with low complications and excellent tolerance by patients. When the learning curve is overcome, hospital stay and operative time clearly decrease. As a consequence, LA can be planned in selected cases as outpatient surgery with good results (AU)

Efectos de la amiodarona en el tiroides / Effects of amiodarone on the thyroid gland

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[Adrenal carcinoma: 7 year disease free survival after complete primary tumor resection and repeated resection of local-regional and distant recurrences. Review after one case with poor initial life expectancy]. / Carcinoma suprarrenal: supervivencia a 7 años libre de enfermedad tras resección completa del tumor primario y resecciones repetidas de recidivas locorregional y a distancia. Revisión a raiz de un caso con una pobre esperanza de vida inicial.

OBJECTIVES: We report the case of a female patient with adrenal carcinoma who had undergone surgery and presented with local-regional and distant recurrences, emphasizing the importance of the aggressive surgical treatment to achieve long-term survival which is unexpected sometimes. Currently, it represents the gold standard and all cases should be reported to stimulate other groups to work in this line. METHODS/RESULTS: We report the case of a 29-year-old female patient who consulted for left flank pain, being diagnosed of an adrenal tumor by radiological tests; she underwent surgical excision of a left adrenal carcinoma (stage II). Later on she presented with local-regional recurrences (2 times) and distant metastases (liver) undergoing excision in three procedures. Currently, the patient is alive and free of disease 7 years after diagnosis. CONCLUSIONS: Adrenal cancer recurrences have been considered lethal in the short-term. Nevertheless, an aggressive surgical approach of local recurrences and metastasic disease may significantly prolong patient's survival and, sometimes, leave the patient disease free several years after the diagnosis of the primary tumor.

Carcinoma suprarenal: supervivencia a 7 años libre de enfermedad tras resección completa del tumor primario y resecciones repetidas de recidivas locorregional y a distancia. Revisión a raíz de un caso con una pobre esperanza de vida inicial / Adrnal carcinoma: 7 year disease free survival after complete primary tumor resection and repeated resection of local-regional and distant recurrences. Review after one case with poor initial life expectancy

OBJETIVO: Comunicamos el caso de unapaciente con un cáncer suprarrenal intervenido que presentóposteriormente recidivas locorregional y a distancia,enfatizando la importancia del tratamiento quirúrgicoagresivo para lograr supervivencias a veces noesperadas a largo plazo. En la actualidad, representael “gold standard” y todos los casos deben comunicarsepara estimular a los distintos grupos a trabajar enesta línea.MÉTODO/RESULTADOS: se presenta el caso de unapaciente de 29 años que consultó por dolor en flancoizquierdo, diagnosticándose en los estudios de imagenun tumor suprarrenal; fue intervenida, realizándoseresección de un carcinoma suprarrenal izquierdo(Estadio II). Posteriormente presentó recidiva locorregional(en dos ocasiones) y a distancia (en hígado), siendoresecada la enfermedad en las tres ocasiones en sutotalidad. En el momento actual, 7 años después deldiagnóstico, está viva y libre de enfermedad.CONCLUSIÓN: la recidiva del cáncer suprarrenal seha considerado letal a corto plazo desde el punto devista pronóstico. Sin embargo, un abordaje quirúrgicoagresivo de la enfermedad recurrente y metastásicapuede prolongar de forma significativa la supervivenciadel paciente y lograr, en ocasiones, “status” de libre deenfermedad varios años después del diagnóstico deltumor primario

OBJECTIVES: We report the case of afemale patient with adrenal carcinoma who had undergonesurgery and presented with local-regional and distantrecurrences, emphasizing the importance of theaggressive surgical treatment to achieve long-term survivalwhich is unexpected sometimes. Currently, it representsthe gold standard and all cases should be reported tostimulate other groups to work in this line.METHODS/RESULTS: We report the case of a 29-yearoldfemale patient who consulted for left flank pain,being diagnosed of an adrenal tumor by radiologicaltests; she underwent surgical excision of a left adrenalcarcinoma (stage II). Later on she presented with localregionalrecurrences (2 times) and distant metastases(liver) undergoing excision in three procedures.Currently, the patient is alive and free of disease 7 yearsafter diagnosis.CONCLUSIONS: Adrenal cancer recurrences havebeen considered lethal in the short-term. Nevertheless,an aggressive surgical approach of local recurrencesand metastasic disease may significantly prolongpatient’s survival and, sometimes, leave the patient diseasefree several years after the diagnosis of the primarytumor