Metástasis pancreáticas por carcinoma renal. Nuestra casuística y revisión de la literatura / Pancreatic metastases due to renal carcinoma. Our cases and a literature review

Analizar los casos de metástasis pancreáticas por carcinoma renal intervenidos en nuestro hospital entre los años 2000 y 2011.Material y métodos Estudio retrospectivo donde se recogen diferentes variables de 8 pacientes con metástasis pancreáticas por carcinoma renal intervenidos. Comparación de nuestros datos con los de la literatura. Resultados La enfermedad metastásica del páncreas por carcinoma renal en nuestra serie ha sido de 1,2%. Todas las metástasis han sido metacrónicas. La afectación por sexo ha sido igual. El tiempo medio entre la resección del tumor renal y el diagnóstico de las metástasis ha sido de 12,42 años (rango: 1,62-30,13 años). La actitud terapéutica ante las lesiones pancreáticas ha sido quirúrgica en todos los casos. Hasta la fecha, 7 pacientes continúan vivos. Conclusión La enfermedad metastásica del páncreas por carcinoma renal es poco frecuente (1-2,8%). El intervalo entre la resección primaria y las metástasis puede ser bastante largo. Siempre debe sospecharse metástasis pancreática en los pacientes que presenten masa pancreática e historia de carcinoma renal. Se recomienda un tratamiento quirúrgico agresivo en casos seleccionados. La cirugía en estos casos mejora la supervivencia y la calidad de vida (AU)

Objective: To analyse the cases of pancreatic metastases due to renal carcinoma operated on in our hospital between the years 2000 and 2011.Material and methods: A retrospective study using the variables of 8 patients who were subjected to surgery of pancreatic metastases due to renal carcinoma, and a comparison of our data with those from the literature. Results: The incidence of metastatic disease of the pancreas due to renal carcinoma in our series was 1.2%. All the metastases were metachronous, with both sexes being affected equally. The mean time between resection of the renal tumour and the diagnosis of the metastasis was 12.42 years (range: 1.62-30.13 years). The therapeutic approach to the pancreatic lesions was surgical in all cases. Seven patients are currently still alive. Conclusion: Metastatic disease of the pancreas due to renal carcinoma is uncommon(1%-2.8%). The interval between the primary resection and the metastasis can be quite long. Pancreatic metastasis must always be suspected in patients who present with a pancreatic mass and a history of renal carcinoma. Aggressive surgical treatment is recommended in selected cases. The surgery in these cases improves survival and the quality of life (AU)

Proctitis actínica, hemorrágica crónica y refractaria. Experiencia con formaldehído al 4% / Radiation proctitis and chronic and refractory bleeding. Experience with 4% formaldehyde

Introducción: La hemorragia es una complicación frecuente de la proctitis secundaria a radioterapia de tumores pélvicos. Entre el 5 y el 10% pueden ocasionar cuadros graves y rebeldes a los tratamientos tópicos y endoscópicos. Se presenta la experiencia con la aplicación de formaldehído al 4%.Pacientes y método Estudio retrospectivo y descriptivo de una cohorte de pacientes con proctitis actínica grave ingresados en el Hospital Universitario Donostia entre enero de 2003 y septiembre de 2009. Todos los pacientes fueron diagnosticados por colonoscopia e ingresados por su severidad para tratamiento. Se empleó formaldehído al 4% tanto con la técnica de la gasa como mediante enemas, en los casos rebeldes al tratamiento tópico y endoscópico con argón. La técnica se realizó en quirófano con anestesia regional. Se realizaron controles clínicos y endoscópicos. Resultados Veinticinco varones (73,5%) y 9 mujeres (26,5%), con una edad media de 69 años (32–80) presentaron rectorragia por proctitis actínica y precisaron ingreso. En 6 pacientes (28,5%) fracasaron todos los tratamientos y se empleó formaldehído al 4%. La respuesta a la hemorragia fue completa en los 6 pacientes, 3 casos con una sesión y otros 3 con 2 sesiones. En 4 pacientes se empleó la técnica de la gasa y en otros 2 (por presencia de estenosis) enema de formaldehído al 4%. En 2 pacientes apareció dolor como complicación principal (33,3). La mediana de seguimiento ha sido de 60 meses (rango intercuartílico 26 a 67 meses). Conclusiones El formaldehído al 4% en la hemorragia por proctitis actínica es una técnica eficaz, fácilmente reproducible y con poca morbilidad (AU)

Introduction: Bleeding is a common complication of proctitis secondary to radiotherapy of pelvic tumours. Between 5 and 10% may become severe and refractory to topical and endoscopic treatment. Experience with the application of 4% formaldehyde is presented. Patients and method: A retrospective and descriptive study was performed on a patient cohort with severe radiation proctitis admitted to the Hospital Universitario Donostia between January 2003 and September 2009. All patients were diagnosed by colonoscopy and admitted due to the severity of their treatment. Both 4% formaldehyde and the gauze technique were used, as well as using enemas, in cases refractory to topical and endoscopic treatment with argon. The technique was performed in theatre with regional anaesthetic. Clinical and endoscopic follow up was carried out. Results: The study included 25 males (73.5%) and 9 women (26.5%), with a mean age of69 years (32–80) who had rectal bleeding due to radiation proctitis and required admission. All treatments failed in 6 (28.5%) patients, and 4% formaldehyde was used, with a complete response to the bleeding in all 6 patients, with 3 cases requiring one session, and the 3 others2 sessions. The gauze technique was used in 4 patients and another 2 were given a formaldehyde enema due to the presence of stenosis. Pain appeared as the main complication in 2 (33.3%) patients. The median follow up was 60 months (interquartile range 26 to67 months).Conclusions: The use of 4% formaldehyde in bleeding due to radiation proctitis is an effective, easy to reproduce technique, with a low morbidity (AU)

[Pancreatic metastases due to renal carcinoma. Our cases and a literature review]. / Metástasis pancreáticas por carcinoma renal. Nuestra casuística y revisión de la literatura.

OBJECTIVE: To analyse the cases of pancreatic metastases due to renal carcinoma operated on in our hospital between the years 2000 and 2011. MATERIAL AND METHODS: A retrospective study using the variables of 8 patients who were subjected to surgery of pancreatic metastases due to renal carcinoma, and a comparison of our data with those from the literature. RESULTS: The incidence of metastatic disease of the pancreas due to renal carcinoma in our series was 1.2%. All the metastases were metachronous, with both sexes being affected equally. The mean time between resection of the renal tumour and the diagnosis of the metastasis was 12.42 years (range: 1.62-30.13 years). The therapeutic approach to the pancreatic lesions was surgical in all cases. Seven patients are currently still alive. CONCLUSION: Metastatic disease of the pancreas due to renal carcinoma is uncommon (1%-2.8%). The interval between the primary resection and the metastasis can be quite long. Pancreatic metastasis must always be suspected in patients who present with a pancreatic mass and a history of renal carcinoma. Aggressive surgical treatment is recommended in selected cases. The surgery in these cases improves survival and the quality of life.

[Radiation proctitis and chronic and refractory bleeding. Experience with 4% formaldehyde]. / Proctitis actínica, hemorrágica crónica y refractaria. Experiencia con formaldehído al 4%

INTRODUCTION: Bleeding is a common complication of proctitis secondary to radiotherapy of pelvic tumours. Between 5 and 10% may become severe and refractory to topical and endoscopic treatment. Experience with the application of 4% formaldehyde is presented. PATIENTS AND METHOD: A retrospective and descriptive study was performed on a patient cohort with severe radiation proctitis admitted to the Hospital Universitario Donostia between January 2003 and September 2009. All patients were diagnosed by colonoscopy and admitted due to the severity of their treatment. Both 4% formaldehyde and the gauze technique were used, as well as using enemas, in cases refractory to topical and endoscopic treatment with argon. The technique was performed in theatre with regional anaesthetic. Clinical and endoscopic follow up was carried out. RESULTS: The study included 25 males (73.5%) and 9 women (26.5%), with a mean age of 69 years (32-80) who had rectal bleeding due to radiation proctitis and required admission. All treatments failed in 6 (28.5%) patients, and 4% formaldehyde was used, with a complete response to the bleeding in all 6 patients, with 3 cases requiring one session, and the 3 others 2 sessions. The gauze technique was used in 4 patients and another 2 were given a formaldehyde enema due to the presence of stenosis. Pain appeared as the main complication in 2 (33.3%) patients. The median follow up was 60 months (interquartile range 26 to 67 months). CONCLUSIONS: The use of 4% formaldehyde in bleeding due to radiation proctitis is an effective, easy to reproduce technique, with a low morbidity.

Ligaduras múltiples verticales: un nuevo enfoque en el tratamiento de la enfermedad hemorroidal grado III. Estudio de seguridad y eficacia / Multiple vertical ligatures: A new approach to the treatment of haemorrhoidal disease grade III. Safety and efficacy study

Introducción: La ligadura elástica es el método ambulatorio más empleado en la enfermedad hemorroidal, con excelentes resultados en el control de la hemorragia. Sin embargo, las recurrencias en el prolapso oscilan del 15 al 40%. Proponemos un nuevo método de aplicación de ligaduras elásticas. Pacientes Diecisiete pacientes con hemorroides iii fueron elegidos para las ligaduras verticales (LV). La primera banda se colocó de 3 a 4cm a de la línea pectínea y 1 o 2 más en la raíz del grupo hemorroidal. Treinta y cuatro pacientes seleccionados aleatoriamente fueron empleados como grupo control. Se recogieron los datos demográficos, número de bandas y sesiones, escala de dolor, complicaciones y resultados. Los controles se realizaron a la semana, a la 3a semana, a los 3 meses y al año. Resultados Doce varones y 5 mujeres, con una mediana de edad de 46 años fueron tratados con LV. La mediana de seguimiento fue de 10 meses (de 8 a 19). Una mediana de 3 sesiones y 7 bandas fueron empleadas. Seis pacientes presentaron dolor moderado que requirió tratamiento analgésico. Ningún paciente precisó tratamiento urgente por dolor o hemorragia. Hubo respuesta completa al sangrado en 15 pacientes (88,2%) y al prolapso en 14 (82,2%). Dos pacientes requirieron hemorroidectomía por fracaso del tratamiento. Al final del año las medidas del efecto terapéutico fueron: NNT de 4 (IC 95%, de 2 a 22), para el prolapso y NNT de 4 (IC 95%, 2 a 15) para el sangrado. Conclusiones Las ligaduras elásticas verticales pueden representar una nueva alternativa para el tratamiento de hemorroides grado iii, mejorando los controles de sangrado y prolapso (AU)

Introduction: The elastic ligature is the most used method for the out-patient treatment of haemorrhoids, with excellent results in control of bleeding. However, the recurrences in prolapse vary between 15 and 40%. We propose a new method for applying the elasticligatures. Patients: A total of 17 patients with grade III haemorrhoids were chosen for the vertical ligatures (..) (AU)

[Multiple vertical ligatures: A new approach to the treatment of haemorrhoidal disease grade III. Safety and efficacy study]. / Ligaduras múltiples verticales: un nuevo enfoque en el tratamiento de la enfermedad hemorroidal grado III. Estudio de seguridad y eficacia.

INTRODUCTION: The elastic ligature is the most used method for the out-patient treatment of haemorrhoids, with excellent results in control of bleeding. However, the recurrences in prolapse vary between 15 and 40%. We propose a new method for applying the elastic ligatures. PATIENTS: A total of 17 patients with grade iii haemorrhoids were chosen for the vertical ligatures (VL). The first elastic band was placed 3 to 4 cm from the pectineal line and 1 or 2 more in the root of the haemorrhoid group. Another 34 randomly selected patients were used as a control group. Data collected included, demographic details, number of bands and sessions, pain scale, complications and results. The patients were followed up at week one, week 3, and 3 months and one year after the intervention. RESULTS: A total of 12 males and 5 females, with a median age of 46 years, were treated with VL. The median follow-up was 10 (from 8 to 19) months. A median of 3 sessions and 7 elastic bands were used, with 6 patients having moderate pain that required analgesic treatment. None of the patients needed urgent treatment for pain or bleeding. There was a complete response to bleeding in 15 patients (88.2%) and to prolapse in 14 (82.2%). Two patients required haemorrhoidectomy due to treatment failure. The measurements of therapeutic effect after one year were: number needed to treat (NNT) of 4 (95% CI, 2 to 22), for prolapse, and NNT of 4 (95% CI, 2 a 15), for bleeding. CONCLUSIONS: Elastic ligatures could become a new treatment option for Grade iii haemorrhoids, improving control of bleeding and prolapse.

Abordaje quirúrgico de la recidiva locorregional del cáncer de recto / Surgical approach to the locoregional recurrence of cancer of the rectum

Se ha realizado una revisión literaria relativa a la cirugía de la recurrencia pélvica del cáncer de recto utilizando las bases de datos MedLine, Ovid, EMBASE, Cochrane y Cinahl. La evaluación por pruebas de imagen de la recidiva locorregional debe realizarse tanto para descartar la presencia de metástasis como con el objetivo de localizar el sitio preciso (subsitio) de la misma dentro de la pelvis. Como el único tratamiento curativo será la resección completa de la recidiva con márgenes negativos, se deben realizar preoperatoriamente TC, RMN, ecografía endorrectal y PET-TC para determinar la resecabilidad. Para una potencial curación, se deben realizar resecciones radicales, variando la técnica según la localización de la recurrencia sea central (axial), posterior (presacra) o lateral, así como el tratamiento efectuado del tumor primario. Los tratamientos neoadyuvantes, la braquiterapia y la RTIO mejoran los resultados de control local y la supervivencia en estos pacientes (AU)

A literature review has been made on the pelvic recurrence of rectal cancer using the MedLine, Ovid, EMBASE, Cochrane and Cinahl data bases. Assessment of the locoregional recurrence must be made using imaging tests in order to rule out the presence of metastasis, as well as for locating its exact location within the pelvis. As the only curative treatment should be complete resection of the recurrence with negative margins, a pre-operative CT,NMR, endorectal ultrasound and PET-CT must be performed to determine its resectability. For a potential cure, radical resections must be made, with the technique varying according to whether the location is central (axial), posterior (presacral) or lateral, as well as treatment directed at the primary tumour. Neoadjuvant treatments, brachiterapy and intra-operative radiotherapy improve the local control results and survival in these patients (AU)

[Surgical approach to the locoregional recurrence of cancer of the rectum]. / Abordaje quirúrgico de la recidiva locorregional del cáncer de recto.

A literature review has been made on the pelvic recurrence of rectal cancer using the MedLine, Ovid, EMBASE, Cochrane and Cinahl data bases. Assessment of the locoregional recurrence must be made using imaging tests in order to rule out the presence of metastasis, as well as for locating its exact location within the pelvis. As the only curative treatment should be complete resection of the recurrence with negative margins, a pre-operative CT, NMR, endorectal ultrasound and PET-CT must be performed to determine its resectability. For a potential cure, radical resections must be made, with the technique varying according to whether the location is central (axial), posterior (presacral) or lateral, as well as treatment directed at the primary tumour. Neoadjuvant treatments, brachiterapy and intra-operative radiotherapy improve the local control results and survival in these patients.

Ileítis tras colectomía por colitis ulcerosa / Ileitis after colectomy due to ulcerative colitis

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El caso de la paciente que no podía ponerse el bikini: una forma inaudita de presentación clínica del cordoma sacro / The patient who could not wear her bikini. An amazing clinical presentation of sacral chordoma

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