Lymphoepithelial cyst of the pancreas.

Within pancreatic cysts, the lymphoepithelial variant is considered a highly atypical condition with few reported cases in the literature. Following a case managed in our hospital, we aim to shed more light on this entity as an incidental finding, providing a temporal description until its excision, along with radiological, surgical, and histological images.

Evaluation of Clinical Factors Predictive of Diabetes Remission Following Bariatric Surgery.

Bariatric surgery is an effective treatment for achieving significant weight loss and improving metabolic comorbidities such as type 2 diabetes mellitus (T2DM). The aim of our study was to investigate clinical factors related to T2DM remission in obese patients who had undergone bariatric surgery. METHODS: A cohort of patients with T2DM and a minimum of class II obesity undergoing bariatric surgery had their clinical and anthropometric variables assessed. The statistical evaluation included multivariate analyses of clinical factors predicting a T2DM remission two years post-surgery. RESULTS: 83 patients were included (mean age 44.13 ± 10.38 years). Two years post-surgery, the percentage of excess weight lost was 63.43 ± 18.59%, and T2DM was resolved in 79.5% of the patients. T2DM remission was directly related to a high body mass index (BMI) (OR: 1.886; p = 0.022) and the absence of macro-vascular complications (OR: 34.667; p = 0.002), while it was inversely associated with T2DM with a duration longer than 5 years (OR: 0.022; p = 0.040) and baseline insulin treatment (OR: 0.001; p = 0.009). 15.6% of the patients presented early complications and 20.5% developed late complications. CONCLUSION: In our study sample, bariatric surgery proved to be an effective and safe technique for sustained medium-term weight loss and the resolution of T2DM. A higher baseline BMI, a shorter T2DM duration, non-insulin treatment, and the absence of macro-vascular complications are factors predictive of T2DM remission.

Niveles de proteína C reactiva, bilirrubina y leucocitos como predictores de evolución anatomopatológica apendicular / Levels of C-reactive Protein, Bilirubin and Leucocytes as Predictors of Anotomopathological Appendicular Evolution

RESUMEN Introducción: La apendicitis aguda es la urgencia quirúrgica más frecuente en cualquier hospital del mundo. Aunque la mayoría de las veces se trata de un proceso intrabdominal banal, en ocasiones presenta una no desdeñable morbilidad y todavía en la época actual. Esta morbimortalidad se asocia, en la mayoría de los casos, a estados avanzados de afección apendicular. Objetivo: Predecir, con la cifra de bilirrubina, la proteína C reactiva y el recuento leucocitario, el estado del proceso apendicular agudo que presentaban los pacientes. Métodos: Se realizó un estudio observacional descriptivo en el que se han incluido aquellos pacientes intervenidos por sospecha de apendicitis aguda durante un periodo de 3 años (2017-2019) que cumplían los criterios de inclusión. Se analizó, como datos de laboratorio, la cifra de leucocitos, proteína C reactiva y bilirrubina. Resultados: Se observó un aumento de las cifras de proteína C reactiva y bilirrubina en los casos apendiculares avanzados, al igual que otros autores han evidenciado en la literatura. Así mismo, estos dos valores han resultado ser un factor de riesgo para presentar formas graves. El nivel de leucocitos sin embargo no ha demostrado relacionarse con la gravedad del proceso. Conclusiones: Vemos relevante el uso de los biomarcadores estudiados para predecir la gravedad apendicular con el objetivo de mejorar la asistencia en estos enfermos y disminuir las complicaciones derivadas del retraso terapéutico(AU)

ABSTRACT Introduction: Acute appendicitis is the most frequent surgical emergency in any hospital worldwide. Although most of the time it is a trivial intraabdominal process, sometimes it presents an unneglectable morbidity. This morbidity and the subsequent mortality are associated, in most cases, with advanced stages of an appendicular disease. Objective: To predict, using the value corresponding to bilirubin, C-reactive protein and leukocyte count, the state of acute appendicular process presented by patients. Methods: A descriptive observational study was carried out, including patients operated on for suspected acute appendicitis during a period of three years (2017-2019) and who met the inclusion criteria. The values for leukocyte count, C-reactive protein, and bilirubin were analyzed as laboratory data. Results: An increase in the values of C-reactive protein and bilirubin levels was observed in advanced appendicular cases, as other authors have shown in the medical literature. Likewise, these two values ​​have turned out to be a risk factor for presenting severe forms. However, the level of leukocytes has not been shown to be related to the severity of the process. Conclusions: We consider the use of the biomarkers studied as relevant to predict appendicular severity in view of improving care of these patients and reducing complications derived from therapeutic delay(AU)

Metástasis de carcinoma pulmonar pleomórfico como causa de abdomen agudo / Small Bowel Perforation Due to Metastatic Pleomorphic Lung Cancer

No disponible

Obstrucción intestinal secundaria a metástasis de cáncer de mama no diagnosticado / Intestinal obstruction secondary to metastases of undiagnosed breast cancer

No disponible

Pancreas is a preeminent source of ghrelin after sleeve gastrectomy in Wistar rats.

Many surgical techniques are employed in the treatment of severe obesity. A main consequence of these techniques is the improvement of type 2 Diabetes mellitus. Ghrelin is a gut hormone released in the gastric fundus and corpus, which has been related to diabetic improvement as mentioned in these papers. Sleeve gastrectomy and Roux-en Y Gastric Bypass are surgical techniques broadly employed in humans; both severely reduce the gastric surface. Paradoxically, the serum level of ghrelin in patients is preserved. We hypothesized about the role of embryonic pancreatic epsilon cells, which have the capacity to release ghrelin. We studied the changes in the epsilon cells and differentiation markers with immunostaining and ghrelin serum level and after surgery. We employed euglycemic male Wistar rats: two surgical groups (Sleeve gastrectomy and Roux-en Y Gastric Bypass) and two control groups. We reported a significant increase of ghrelin epsilon-cells in the pancreas and basal serum after Sleeve gastrectomy versus the control groups. The epsilon cellular increment was related to neogenesis, as the neurogenin-3 marker revealed. The Roux-en Y Gastric Bypass showed neither epsilon cell increase nor basal serum changes in ghrelin release. As a conclusion, we reported that the severe suppression of the fundus gastric produced the recovery of ghrelin released by the epsilon cells, which was indicative of an ontogenic embryonic pancreatic function.

Experiencia del empleo sistemático de la dieta de muy bajo valor calórico para la optimización en el preoperatorio de cirugía bariátrica / Experience of the systemic use of the very low caloric value diet for the optimization in the preoperatory of bariatric surgery

Resumen Introducción: La cirugía bariátrica no está exenta de complicaciones. Para minimizar dichas complicaciones es importante optimizar al paciente antes de la cirugía. Dicha optimización se basa fundamentalmente en la realización de dieta preoperatoria. Dentro de los múltiples tipos de dietas, la dieta de muy bajo valor calórico (DMBVC) es cada vez más utilizada. El objetivo de este estudio es analizar los resultados del empleo de la DMBVC en el preoperatorio de cirugía bariátrica. Método: Estudio observacional de una serie de 100 casos en los que se empleó la DMBVC como optimización preoperatoria. Se analizaron el grado de cumplimiento de la dieta, la opinión de los pacientes, la pérdida de peso preoperatoria y las complicaciones postoperatorias. Resultados: La pérdida de peso preoperatoria media fue de 10,2 kg y la disminución media del IMC fue de 4,8. En cuanto al grado de seguimiento, el 68% refirió que la cumplió estrictamente, el 22% manifestó un buen grado de seguimiento con alguna transgresión ocasional, el 8% reportó un mal seguimiento y el 1% la abandonó precozmente. No se presentaron efectos adversos significativos. En cuanto a la técnica quirúrgica, en ningún caso el volumen hepático dificultó la cirugía, con un 0% de conversiones y un tiempo medio operatorio de 60 min. En el postoperatorio inmediato se registraron un 4% de sangrado y un 1% de reintervención por hemoperitoneo. Conclusiones: Las DMBVC son sencillas de utilizar, con escasos efectos adversos, bien toleradas durante un periodo limitado de tiempo, obteniendo una adecuada pérdida ponderal preoperatoria.

Abstract Introduction: Bariatric surgery may have some complications. To minimize such complications is important to optimize the patient before surgery. Such optimization is based primarily on the performance of preoperative diet. Among the many types of diets, very low caloric diet (VLCD) is increasingly used. The aim of this study is to analyze the results of the use of VLCD preoperative bariatric surgery. Method: Observational study of a series of 100 cases in which the DMBVC was used as a preoperative optimization. The degree of compliance with the diet, the opinion of patients, preoperative weight loss and postoperative complications were analyzed. Results: The mean preoperative weight loss was 10.2 kg and the average BMI decrease of 4.8. As for the degree of compliance, 68% said that the strictly fulfilled, 22% follow up with a good degree occasional transgression, mistracking 8% and 1% abandoned early. No significant adverse effects occurred. Regarding the surgical technique, in any case difficult surgery liver volume, with 0% conversion and an average operating time of 60 min. In the immediate postoperative period 4% cases of reoperation for bleeding and 1% hemoperitoneum were reported. Conclusions: DMBVC are simple to use, with few adverse effects, well tolerated for a limited period of time, obtaining adequate preoperative weight loss.

[LONG-TERM FULMINANT HEPATIC FAILURE IN PATIENTS UNDERGOING GASTRIC BYPASS FOR MORBID OBESITY]. / FALLO HEPÁTICO FULMINANTE A LARGO PLAZO EN PACIENTES SOMETIDOS A BYPASS GÁSTRICO POR OBESIDAD MÓRBIDA.

UNLABELLED: Morbid obesity is a risk factor for numerous diseases including liver disease with an incidence of hepatic steatosis from 70 to 80%. Although surgical treatment is effective in reducing weight, its effects on the liver have not been established convincingly. We report 2 cases of patients with bariatric surgery and who had a fulminant hepatic failure resulting in death. METHODS: case N.º 1: a 36-year-obesity intervened in 1995 with VBG with BMI 52.5 to reganancia weight back after revision surgery is performed in 2009 performed distal gastric bypass. Case N.º 2: 42 Woman surgery for obesity in 2009 by distal gastric bypass with a BMI of 51 and placement of prophylactic Composix kugel midline mesh. After 3 years with good weight loss, presents abscess wall and enterocutaneous fistula he was surgically intervene. extracting mesh, identifying themselves two fistulas in alimentary and common intestinals loops that are removed and new anastomosis was performed. RESULTS: case N.º 1: at 2 months of revision surgery, tje patient starts vomiting secondary to stenosis of gastrojejunostomy anastomosis and symptoms of progressive jaundice, ascites and encephalopathy fulminant hepatic failure resulting in death. Case N.º 2: in the immediate postoperative period starts increased drainage of debit and rise of liver enzymes cytolysis and coagulopathy. It reinterviene on suspicion of anastomotic leak and abdominal Sepsis, developing fulminant hepatic failure with coagulopathy and encephalopathy is treated by MARS system, and died within 4 hours of the onset of therapy. CONCLUSIONS: although current surgical techniques of bariatric surgery are considered quite safe, there have been cases of hepatic failure, unclear whether this would relate to the progression of a preexisting steatohepatitis, or may have other predisposing factors related to surgery. Treatments available, the emergency orthotopic liver transplantation is one of the best interventions. For our patients the outcome was fatal triggering the death of both. In both cases presented a septic shock with positive ascitic fluid cultures to multiresistant microorganisms, and both had revision surgery. Unfortunately the factors that can influence that occur after bariatric surgery such complications, and probably will be grounds for future studies are unknown.

La obesidad mórbida es un factor de riesgo para numerosas enfermedades, incluidas las enfermedades hepáticas, siendo la incidencia de esteatosis hepática de un 70 a 80%. Aunque el tratamiento quirúrgico es eficaz en la reducción del peso, sus efectos sobre el hígado no se han establecido convincentemente. Presentamos dos casos de pacientes intervenidas de cirugía bariátrica y que presentaron un fallo hepático fulminante con resultado de muerte. Material y método: caso clínico n.º 1: mujer de 36 años intervenida de obesidad en 1995 con gastroplastia vertical anillada con IMC 52,5 que tras reganancia ponderal posterior se realiza cirugía de revisión en 2009, realizándose by-pass gástrico distal. Caso clínico n.º2: mujer de 42 años intervenida de obesidad en 2009 mediante by-pass gástrico distal con IMC de 51 y colocación de malla profiláctica de composix kugel midline. A los tres años con buena pérdida ponderal presenta absceso de pared por fístula enterocutánea y se interviene quirúrgicamente, extrayendo malla, identificándose dos fístulas en asa alimentaria y común que se extirpan y se realizá nueva anastomosis. Resultados: caso clínico n.º1: a los dos meses de la cirugía de revisión inicia cuadro de vómitos secundarios a estenosis de anastomosis gastroyeyunal que se trata mediante dilatación, y cuadro de ictericia progresiva, ascitis y encefalopatía por fallo hepático fulminante con resultado de muerte. Caso clínico n.º2: en el postoperatorio inmediato inicia incremento del debito del drenaje, así como ascenso de enzimas de citolisis hepática y coagulopatía. Se reinterviene por sospecha de fuga anastomótica y sepsis abdominal, desarrollando fallo hepático fulminante con coagulopatía y encefalopatía que se trata mediante sistema MARS, falleciendo a las cuatro horas de la instauración de la terapia. Conclusiones: si bien las técnicas quirúrgicas actuales de cirugía bariátrica se consideran bastante seguras, se han presentado casos de fallo hepático, sin estar claro si esto se relacionaría con la progresión de una esteatohepatitis preexistente, o bien pudiera haber otros factores favorecedores relacionados con la cirugía. De los tratamientos disponibles, el trasplante hepático ortotópico de emergencia es una de las mejores intervenciones. En el caso de nuestras pacientes la evolución fue fatal, desencadenando la muerte de ambas. Ambos casos presentan un shock séptico con cultivos de líquido ascítico positivo a microorganismos multirresistentes, y ambas presentaron cirugías de revisión. Lamentablemente se desconocen los factores que pueden influir en que tras la cirugía bariátrica ocurran este tipo de complicaciones, y probablemente será motivo de estudios futuros.

Fallo hepático fulminante a largo plazo en pacientes sometidos a bypass gástrico por obesidad mórbida / Long-term fulminant hepatic failure in patients undergoing gastric bypass for morbid obesity

La obesidad mórbida es un factor de riesgo para numerosas enfermedades, incluidas las enfermedades hepáticas, siendo la incidencia de esteatosis hepática de un 70 a 80%. Aunque el tratamiento quirúrgico es eficaz en la reducción del peso, sus efectos sobre el hígado no se han establecido convincentemente. Presentamos dos casos de pacientes intervenidas de cirugía bariátrica y que presentaron un fallo hepático fulminante con resultado de muerte. Material y método: caso clínico n.º 1: mujer de 36 años intervenida de obesidad en 1995 con gastroplastia vertical anillada con IMC 52,5 que tras reganancia ponderal posterior se realiza cirugía de revisión en 2009, realizándose by-pass gástrico distal. Caso clínico n.º2: mujer de 42 años intervenida de obesidad en 2009 mediante by-pass gástrico distal con IMC de 51 y colocación de malla profiláctica de composix kugel midline. A los tres años con buena pérdida ponderal presenta absceso de pared por fístula enterocutánea y se interviene quirúrgicamente, extrayendo malla, identificándose dos fístulas en asa alimentaria y común que se extirpan y se realizá nueva anastomosis. Resultados: caso clínico n.º1: a los dos meses de la cirugía de revisión inicia cuadro de vómitos secundarios a estenosis de anastomosis gastroyeyunal que se trata mediante dilatación, y cuadro de ictericia progresiva, ascitis y encefalopatía por fallo hepático fulminante con resultado de muerte. Caso clínico n.º2: en el postoperatorio inmediato inicia incremento del debito del drenaje, así como ascenso de enzimas de citolisis hepática y coagulopatía. Se reinterviene por sospecha de fuga anastomótica y sepsis abdominal, desarrollando fallo hepático fulminante con coagulopatía y encefalopatía que se trata mediante sistema MARS, falleciendo a las cuatro horas de la instauración de la terapia. Conclusiones: si bien las técnicas quirúrgicas actuales de cirugía bariátrica se consideran bastante seguras, se han presentado casos de fallo hepático, sin estar claro si esto se relacionaría con la progresión de una esteatohepatitis preexistente, o bien pudiera haber otros factores favorecedores relacionados con la cirugía. De los tratamientos disponibles, el trasplante hepático ortotópico de emergencia es una de las mejores intervenciones. En el caso de nuestras pacientes la evolución fue fatal, desencadenando la muerte de ambas. Ambos casos presentan un shock séptico con cultivos de líquido ascítico positivo a microorganismos multirresistentes, y ambas presentaron cirugías de revisión. Lamentablemente se desconocen los factores que pueden influir en que tras la cirugía bariátrica ocurran este tipo de complicaciones, y probablemente será motivo de estudios futuros (AU)

Morbid obesity is a risk factor for numerous diseases including liver disease with an incidence of hepatic steatosis from 70 to 80%. Although surgical treatment is effective in reducing weight, its effects on the liver have not been established convincingly. We report 2 cases of patients with bariatric surgery and who had a fulminant hepatic failure resulting in death. Methods: case N.º 1: a 36-year-obesity intervened in 1995 with VBG with BMI 52.5 to reganancia weight back after revision surgery is performed in 2009 performed distal gastric bypass. Case N.º 2: 42 Woman surgery for obesity in 2009 by distal gastric bypass with a BMI of 51 and placement of prophylactic Composix kugel midline mesh. After 3 years with good weight loss, presents abscess wall and enterocutaneous fistula he was surgically intervene. extracting mesh, identifying themselves two fistulas in alimentary and common intestinals loops that are removed and new anastomosis was performed. Results: case N.º 1: at 2 months of revision surgery, tje patient starts vomiting secondary to stenosis of gastrojejunostomy anastomosis and symptoms of progressive jaundice, ascites and encephalopathy fulminant hepatic failure resulting in death. Case N.º 2: in the immediate postoperative period starts increased drainage of debit and rise of liver enzymes cytolysis and coagulopathy. It reinterviene on suspicion of anastomotic leak and abdominal Sepsis, developing fulminant hepatic failure with coagulopathy and encephalopathy is treated by MARS system, and died within 4 hours of the onset of therapy. Conclusions: although current surgical techniques of bariatric surgery are considered quite safe, there have been cases of hepatic failure, unclear whether this would relate to the progression of a preexisting steatohepatitis, or may have other predisposing factors related to surgery. Treatments available, the emergency orthotopic liver transplantation is one of the best interventions. For our patients the outcome was fatal triggering the death of both. In both cases presented a septic shock with positive ascitic fluid cultures to multiresistant microorganisms, and both had revision surgery. Unfortunately the factors that can influence that occur after bariatric surgery such complications, and probably will be grounds for future studies are unknown (AU)