Simultaneous presentation of oesophageal and renal cancer.

Oesophageal cancer has been documented to be often associated with other primary tumours. However, concurrent oesophageal and renal cell carcinoma is extremely uncommon. We report a case of synchronous oesophageal and kidney cancer that was successfully treated at our hospital by a one-stage surgical procedure. The patient is doing well and without recurrence 54 months after the operation.

Simultaneous presentation of oesophageal and renal cancer

Oesophageal cancer has been documented to be often associated with other primary tumours. However, concurrent oesophageal and renal cell carcinoma is extremely uncommon. We report a case of synchronous oesophageal and kidney cancer that was successfully treated at our hospital by a one-stage surgical procedure. The patient is doing well and without recurrence 54 months after the operation (AU)

Cáncer de muñón gástrico: resultados del tratamiento quirúrgico / Gastric stump cancer: results of surgical treatment

Introducción. El pronóstico de cáncer de muñón gástrico, en general, es peor que el de cáncer gástrico primario. Métodos. Un total de 33 pacientes con cáncer de muñón tratados en nuestro servicio desde 1984 a 1999, 31 varones y 2 mujeres, con una edad media de 69,6 años. La primera intervención fue por úlcera gástrica en 14 casos, y duodenal o pilórica en 19. Presentaban gastrectomía Billroth II 22 pacientes y Billroth I 11 pacientes. El intervalo medio entre la primera operación y el diagnóstico del tumor fue de 30,6 años. Resultados. Fueron operados 27 pacientes; el índice de resecabilidad fue del 66,6 por ciento. Se realizaron 16 gastrectomías totales, 6 de ellas ampliadas y 2 casi totales. Predominó el adenocarcinoma tipo intestinal (22 casos); 4 pacientes presentaban tumores precoces (early) y en 13 (72,2 por ciento) existía afección de la serosa (pT3-pT4). La supervivencia actuarial global a los 5 años es del 22 por ciento, un 41,4 por ciento en los pacientes resecados (p < 0,001). Fue significativa la supervivencia de los casos resecados según el tamaño del tumor (p < 0,05).Conclusiones. En los pacientes gastrectomizados parece aconsejable el control endoscópico a partir de los 15 años para mejorar la resecabilidad y la supervivencia mediante un diagnóstico más precoz. La supervivencia obtenida en los casos tratados con gastrectomía total justifica este tratamiento quirúrgico agresivo. Hubo diferencias significativas en la supervivencia según el tamaño del tumor (AU)

Influence of donor cardiopulmonary arrest in human liver transplantation: possible role of ischemic preconditioning.

Hepatic allografts from donors who have suffered a brief cardiopulmonary arrest may sustain ischemic damage before organ procurement. However, there is no reported correlation between donor cardiopulmonary arrest and hepatic allograft dysfunction. On the other hand, brief ischemia-reperfusion injury has been shown experimentally to result in protection in several organ models. Induction of ischemic tolerance has been called ischemic preconditioning. Our objective was to study the influence of brief donor cardiopulmonary arrest on hepatic allograft outcome in human liver transplantation. Between May 1997 and July 1998, 181 consecutive orthotopic liver transplant (OLT) cases were divided into 2 groups based on the occurrence of donor cardiopulmonary arrest. Group A consisted of 37 donors who suffered a cardiopulmonary arrest. Group B consisted of the remaining 144 patients. Liver graft survival within 90 days of OLT and early postoperative graft function were analyzed. Although there was significant liver damage resulting from circulatory failure during cardiopulmonary arrest before organ procurement in group A, graft survival was not affected. After OLT, the mean peak aspartate transaminase and alanine transaminase concentrations in group A (1, 444.1 and 718.2 U/L) were significantly lower than those in group B (2,382.8 and 1,507.3 U/L) (P <.05). Experiences of brief cardiopulmonary arrest in organ donors did not affect post-OLT hepatic allograft survival and function. Although the liver function tests are elevated in an organ donor, the hepatic allograft is suitable for OLT if the liver damage is induced by brief donor cardiopulmonary arrest.

Carcinoma verrucoso sobre hidrosadenitis supurativa perianal. Presentación de un caso y revisión bibliográfica / Verrucous carcinoma complicating perianal hidradenitis suppurativa. Case report and literature review

La hidrosadenitis supurativa es una enfermedad inflamatoria crónica que afecta a las glándulas apocrinas. Al igual que en otras enfermedades inflamatorias crónicas de la piel pueden producirse cambios degenerativos. El carcinoma escamoso es la neoplasia maligna descrita con más frecuencia siendo excepcional el hallazgo de su variedad bien diferenciada denominado carcinoma verrucoso. Desde 1988, en nuestro hospital se han intervenido 44 pacientes diagnosticados de hidrosadenitis supurativa, de los cuales 15 presentaban una forma masiva de la enfermedad. Durante este periodo tan solo un paciente atendido en nuestra unidad de coloproctología por afectación perianal presentó degeneración maligna hacia un carcinoma verrucoso. Presentamos este caso y comentamos las peculiaridades clínicas y terapeúticas de esta situación tan poco frecuente (AU)

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Influence of high donor serum sodium levels on early postoperative graft function in human liver transplantation: effect of correction of donor hypernatremia.

Donor hypernatremia was reported to cause postoperative graft dysfunction in human orthotopic liver transplantation (OLT). However, the effects of the correction of donor hypernatremia before organ procurement have not been confirmed. The aim of this study is to determine whether donor hypernatremia is associated with early graft dysfunction after OLT and to determine the effect of the correction of donor hypernatremia. One hundred eighty-one consecutive OLTs performed between May 1997 and July 1998 were entered onto this study. The cases were divided into three groups according to the donor serum sodium concentration: group A, serum sodium of 155 mEq/L or less before organ procurement (n = 118); group B, peak sodium greater than 155 mEq/L and final sodium 155 mEq/L or less (n = 36); and group C, final sodium greater than 155 mEq/L (n = 27). Graft survival within 90 days after OLT and early postoperative graft function were analyzed. There were no significant differences in donor and recipient variables among the three groups. The frequencies of graft loss were 15 of 118 grafts (12.7%) in group A, 4 of 36 grafts (11.1%) in group B, and 9 of 27 grafts (33.3%; P <.05 v groups A and B) in group C. The liver enzyme values in groups B and C were significantly greater than those in group A postoperatively. The prothrombin times of group C were significantly longer than those of group A for the first 4 postoperative days. Recipients of hepatic allografts from donors with uncorrected hypernatremia had a significantly greater incidence of graft loss compared with recipients of hepatic allografts from normonatremic donors. However, the differences in graft survival were abrogated by the correction of donor hypernatremia before procurement.