Onyx®, A New Tool for Intraoperative Localization of Liver Lesions.

BACKGROUND: Precise preoperative localization of liver tumors facilitates successful surgical procedures, Intraoperative ultrasonography is a sensitive imaging modality. However, the presence of small non-palpable isoechoic intraparenchymal lesions may be challenging intraoperatively. METHODOLOGY AND MATERIAL DESCRIPTION: Onyx® is a non-adhesive liquid agent comprised of ethylene-vinyl alcohol usually used dissolved in dimethyl-sulfoxide and suspended micronized tantalum powder to provide contrast for visualization under fluoroscopy and ultrasonography and a macroscopic black shape. This embolization material has been increasingly used for the embolization of intracranial arteriovenous malformations. We present the novel application of Onyx® on liver surgery. CURRENT STATUS: We present the case of a female, 55 years-old, whose medical history revealed an elective sigmoidectomy (pT3N1a). After 17 months of follow up, by PET-CT scan, the patient was diagnosed of a small intraparenchymal hypo-attenuated 13 mm tumor located at segment V consistent with metachronous colorectal liver metastasis. Open metastasectomy was performed, ultrasonography-guided Onyx® infusion was delivered the day after, intraoperative ultrasonography showed a palpable hyperechoic material with a posterior acoustic shadowing artifact around the lesion. Onyx® is a promising new tool, without any previous application on liver surgery, feasible with advantages in small not palpable intraparenchymal liver lesions.

Perfiles hormonales de gastrina y secretina en pacientes sometidos a cirugía biliar / Gastrin and secretin hormone profiles in patients undergoing biliary surgery

Introducción. La pancreatitis postoperatoria es una complicación temida tras la intervención quirúrgica sobre la región biliopancreática. Entre los mecanismos patogénicos de la pancreatitis sigue especulándose alrededor de los secretagogos y, en concreto, sobre el papel de las hormonas estimuladoras de la secreción pancreática. Pacientes y método. Se realizó un estudio prospectivo en pacientes que iban a ser sometidos a cirugía biliar electiva por procesos benignos, determinándose la gastrina y secretina en el preoperatorio, a las 24 y 48 h del postoperatorio por técnicas de radioinmunoanálisis. Resultados. Quedaron incluidos 98 pacientes, 72 mujeres y 26 varones, con una edad media de 59 años. El perfil de la gastrinemia fue de 177 pg/ml en el preoperatorio, 186 pg/ml a las 24 h del postoperatorio y 172 pg/ml a las 48 h de éste; el perfil de la secretinemia proporcionó esta secuencia: 87, 86 y 84 pg/ml. Conclusiones. La cirugía sobre la vía biliar no modifica significativamente los valores hormonales de gastrina y secretina; aunque su liberación se sigue produciendo en concentraciones similares a las preoperatorias (AU)

[Gastric collision tumor with osseous metaplasia]. / Tumor de colisión gástrico con metaplasia osea.

Neuroendocrine cells are frequently found in gastric tumours, although they rarely make up more than one third of the total number of tumour cells. When juxtapositioning of the two kinds of tumour cells occurs a "collision tumour" is formed. These have been described to occur with varying frequency throughout the digestive tract. They are uncommon in the stomach. We describe a case, of a gastric collision tumour in which an adenocarcinoma coexisted with a carcinoide tumour and there were zones of bony metaplasia in the transition area between the two tumors. Positive CEA, VIP, beta-HCG and TSH on inmunohistochemical analysis was found.