[Liver resection for non tumoral liver disease. Multicentric experience in Argentina]. / Hepatectomía en patología hepática no tumoral. experiencia multicéntrica en Argentina.

BACKGROUND: The role of liver resection (LR) in patients with non-tumoral hepatic disease (NTHD) remains controversial. OBJECTIVE: To analyze the indications and outcomes of liver resections in patients with NTHD. METHODS: A retrospective analysis in a multicentric data base was performed. Outcome measures were incidence of postoperative cholangitis, infectious and non-infectious complications, hospital stay and overall mortality. RESULTS: One hundred and fourteen patients underwent LR due to NTHD from January 2001 to November 2011. Fourteen patients presented complex bile duct injuries (CBDI), 18 intra-hepatic lithiasis (IL), 32 liver hydatid cysts (LHC), 10 polycystic liver disease (PLD), 19 Caroli's disease (CD) and 21 other NTHD. Forty seven patients underwent a major hepatectomy and 67 a liver segmentectomy or an atypical liver resection. Thirty four patients (29%) presented surgical related complications. There was not intra or post-operative mortality. In long term outcomes, 98 patients (85%) were asymptomatic, 10 presented episodes of intermittent cholangitis that were treated with antibiotics, and 7 underwent another surgical procedure. CONCLUSIONS: LR is a radical and effective procedure to treat benign NTHD instead of other surgical or percutaneous procedures, avoiding multiple sessions of treatment and high post procedure complications rates.

Cirugía radical en el cáncer de vesícula incidental: valor del hallazgo de enfermedad residual en el estudio histopatológico diferido / Radical surgery for incidental gallbladder cancer: The value of a deferred pathological finding of residual disease

ANTECEDENTES: El tratamiento quirúrgico del cáncer de vesícula continúa siendo controvertido. La extensión de la cirugía radical y su eficacia terapéutica todavía están en debate. OBJETIVO: Valorar la efectividad de la resección radical en el cáncer de vesícula incidental, evaluando la presencia de enfermedad residual en la pieza de resección, los factores asociados y su impacto en la supervivencia alejada. MÉTODO: Se analizó en forma retrospectiva a 43 pacientes adultos con diagnóstico de cáncer incidental de vesícula entre junio de 1999 y junio de 2011. Se incluyeron tumores incidentales con resección R0. Las variables analizadas fueron datos demográficos, características clínicas, estudio histopatológico de la colecistectomía previa, indicación de resección, tipo de resección, morbilidad, mortalidad, estudio histopatológico, presencia de enfermedad residual y supervivencia. Se consideró significativa una p < 0,05. RESULTADOS: Se identificó a 43 pacientes con cáncer incidental de vesícula: 28 pacientes fueron tratados mediante resección, el 78,6% era de sexo femenino, la edad mediana fue de 56 años (rango: 38-78). En todos los pacientes se realizaron resecciones 4b/5, más linfadenectomía, en 6 de 8 casos se realizó la resección de los puertos de laparoscopia. No hubo mortalidad perioperatoria, 25% de morbilidad (71% tipo I). Se identificó enfermedad residual en el estudio histopatológico en el 42% (37% en el hígado), la cual se relacionó con el estadio tumoral (T) (p 0,001) Los pacientes con enfermedad residual presentaron una SG y SLE de 6,5 y 10 meses respectivamente vs 56 meses en aquellos sin enfermedad residual (p 0,001). Los factores independientes relacionados con la supervivencia fueron la presencia de enfermedad residual, el estadio T y el TNM. CONCLUSIÓN: La cirugía radical del cáncer incidental de vesícula es el único procedimiento con intención curativa pero su eficacia depende de la extensión de la enfermedad tumoral hallada durante la resección y en el estudio patológico diferido

BACKGROUND: Surgical treatment of gallbladder cancer is still controversial. The extent of the radical surgery and its therapeutic efficacy continue to be debated. OBJECTIVE: Analyze the efficacy of radical resection in patients with incidental gallbladder cancer evaluating the presence of residual disease in the resection specimen and analyzing the associated factors of survival. METHODS: A retrospective analysis of patients with incidental GC between June 1999 and June 2010 was performed. Incidental (I) tumors were included. Data covering demographic features, clinical characteristics, local pathological stage, histological features and factors for long term survival were analyzed. P < 0.05 were considered significant. RESULTS: A total of 28 patients: 78,6% females. Median age 56 years. All treated by resection of segments 4b/5 and lymphadenectomy. Histological examination revealed residual disease in 42% (37% liver), residual disease was related to tumoral (T) stage (p 0,001). Patients with residual disease presented a DSS and DFS of 10 and 6.5 months respectively vs 56 months in those without residual disease (p 0,001). Variables associated with survival were T stage (P .006), TNM stage (P < .001), and residual disease in the resected specimen (P < .001). CONCLUSIONS: Aggressive re-resection of incidental GC offers the only chance for cure but its efficacy depends on the extent of the disease found at the time of repeated surgery and in the deferred pathological study

[Radical surgery for incidental gallbladder cancer: the value of a deferred pathological finding of residual disease]. / Cirugía radical en el cáncer de vesícula incidental: valor del hallazgo de enfermedad residual en el estudio histopatológico diferido.

BACKGROUND: Surgical treatment of gallbladder cancer is still controversial. The extent of the radical surgery and its therapeutic efficacy continue to be debated. OBJECTIVE: Analyze the efficacy of radical resection in patients with incidental gallbladder cancer evaluating the presence of residual disease in the resection specimen and analyzing the associated factors of survival. METHODS: A retrospective analysis of patients with incidental GC between June 1999 and June 2010 was performed. Incidental (I) tumors were included. Data covering demographic features, clinical characteristics, local pathological stage, histological features and factors for long term survival were analyzed. p< 0.05 were considered significant. RESULTS: A total of 28 patients: 78,6% females. Median age 56 years. All treated by resection of segments 4b/5 and lymphadenectomy. Histological examination revealed residual disease in 42% (37% liver), residual disease was related to tumoral (T) stage (p 0,001). Patients with residual disease presented a DSS and DFS of 10 and 6.5 months respectively vs 56 months in those without residual disease (p 0,001). Variables associated with survival were T stage (P .006), TNM stage (P<.001), and residual disease in the resected specimen (P<.001). CONCLUSIONS: Aggressive re-resection of incidental GC offers the only chance for cure but its efficacy depends on the extent of the disease found at the time of repeated surgery and in the deferred pathological study.

Hepatectomía en patología hepática no tumoral. experiencia multicéntrica en Argentina / [Liver resection for non tumoral liver disease. Multicentric experience in Argentina].

BACKGROUND: The role of liver resection (LR) in patients with non-tumoral hepatic disease (NTHD) remains controversial. OBJECTIVE: To analyze the indications and outcomes of liver resections in patients with NTHD. METHODS: A retrospective analysis in a multicentric data base was performed. Outcome measures were incidence of postoperative cholangitis, infectious and non-infectious complications, hospital stay and overall mortality. RESULTS: One hundred and fourteen patients underwent LR due to NTHD from January 2001 to November 2011. Fourteen patients presented complex bile duct injuries (CBDI), 18 intra-hepatic lithiasis (IL), 32 liver hydatid cysts (LHC), 10 polycystic liver disease (PLD), 19 Caroli’s disease (CD) and 21 other NTHD. Forty seven patients underwent a major hepatectomy and 67 a liver segmentectomy or an atypical liver resection. Thirty four patients (29

) presented surgical related complications. There was not intra or post-operative mortality. In long term outcomes, 98 patients (85

) were asymptomatic, 10 presented episodes of intermittent cholangitis that were treated with antibiotics, and 7 underwent another surgical procedure. CONCLUSIONS: LR is a radical and effective procedure to treat benign NTHD instead of other surgical or percutaneous procedures, avoiding multiple sessions of treatment and high post procedure complications rates.

Hepatectomía en patología hepática no tumoral. experiencia multicéntrica en Argentina. / [Liver resection for non tumoral liver disease. Multicentric experience in Argentina].

BACKGROUND: The role of liver resection (LR) in patients with non-tumoral hepatic disease (NTHD) remains controversial. OBJECTIVE: To analyze the indications and outcomes of liver resections in patients with NTHD. METHODS: A retrospective analysis in a multicentric data base was performed. Outcome measures were incidence of postoperative cholangitis, infectious and non-infectious complications, hospital stay and overall mortality. RESULTS: One hundred and fourteen patients underwent LR due to NTHD from January 2001 to November 2011. Fourteen patients presented complex bile duct injuries (CBDI), 18 intra-hepatic lithiasis (IL), 32 liver hydatid cysts (LHC), 10 polycystic liver disease (PLD), 19 Carolis disease (CD) and 21 other NTHD. Forty seven patients underwent a major hepatectomy and 67 a liver segmentectomy or an atypical liver resection. Thirty four patients (29

) presented surgical related complications. There was not intra or post-operative mortality. In long term outcomes, 98 patients (85

) were asymptomatic, 10 presented episodes of intermittent cholangitis that were treated with antibiotics, and 7 underwent another surgical procedure. CONCLUSIONS: LR is a radical and effective procedure to treat benign NTHD instead of other surgical or percutaneous procedures, avoiding multiple sessions of treatment and high post procedure complications rates.

Relevance of residual disease after liver resection for incidental gallbladder cancer.

OBJECTIVES: In patients diagnosed with incidental gallbladder cancer (GC), the benefit and optimal extent of further surgery remain unclear. The aims of this study were to analyse outcomes in patients who underwent liver resection following a diagnosis of incidental GC and to determine factors associated with longterm survival. METHODS: A retrospective analysis of patients diagnosed with incidental GC between June 1999 and June 2010 was performed. Data covering demographics, clinical and surgical characteristics and local pathological stage were analysed. RESULTS: A total of 24 patients were identified. All patients underwent a resection of segments IVb and V and lymphadenectomy. Histological examination revealed residual disease in 10 patients, all of whom presented with recurrent disease at 3-12 months. Overall 5-year survival was 53%. Increasing T-stage (P < 0.001), tumour-node-metastasis (TNM) stage (P= 0.003), and the presence of residual tumour in the resected liver (P < 0.001) were all associated with worse survival. CONCLUSIONS: Aggressive re-resection of incidental GC offers the only chance for cure, but its efficacy depends on the extent of disease found at the time of repeat surgery. The presence of residual disease correlated strongly with T-stage and was the most relevant prognostic factor for survival in patients treated with curative resection.

[Study of prognostic factors in the hepatectomy for metastases of colorectal carcinoma--analysis of two scores]. / Estudio de factores pronóstico en resecciones hepáticas por metástasis de carcinoma colorrectal--análisis de dos scores.

BACKGROUND: Resection is the treatment of choice for colorectal cancer liver metastases. OBJECTIVE: This is a retrospective, longitudinal, retrospective analysis of different prognostic factors for survival in a consecutive series of liver resection for metastatic colorectal carcinoma. PATIENTS AND METHODS: Between October 1998 and November 2007, we performed 89 liver resections for colorectal metastases. A retrospective analysis from the liver resection database was performed and the variables analyzed were related to demography, primary tumor and surgical procedure. Survival analysis was performed according to the Fong and Basingstoke scores. RESULTS: The mean age of patients was 60.5 years and 67.4% were men. The primary tumor was localized in the colon in 73% of cases. In 68.5% the metastases were metachronous. The right hemiliver was involved in 46 patients (52%). Major hepatectomy was performed in 36 (40.2%), minor in 55 (59.8%) and combined procedures in 14 (15.7%). Seventy-seven (86.5%) R0 resections were achieved. Morbidity was 32.6%, with no perioperative mortality. Average follow-up was 32.5 months (range 1 to 158 months), with a median of 25.5 months. Median overall survival was 69.7 months and mean disease-free survival 58.7 months. Multivariate analysis found statistical significance for blood product requirement and margin of resection. Thirty-four patients are alive at the end of this study (45.9%). The Basingstoke predictive index for postoperative variables showed significant differences that were not demonstrated by the Fong clinical score on prognostic factors. CONCLUSIONS: The application of Basingstoke predictive index and Fong score with biomarkers may indicate the most appropriate therapeutic strategy in each patient with colorectal liver metastases.

Caroli's disease: report of surgical options and long-term outcome of patients treated in Argentina. Multicenter study.

BACKGROUND: Caroli's disease (CD) management is still controversial. AIM: The purpose of this study is to report the most frequent clinical features, treatment options, and outcome obtained after surgical management of CD. METHODS: A voluntary survey was conducted. Demographic, clinical, surgical, and pathological variables were analyzed. RESULTS: Six centers included 24 patients having received surgical treatment from 1991 to 2009. Seventeen (70.8%) patients were female, with average age of 48.7 years old (20-71), and 95.5% were symptomatic. There was left hemiliver involvement in 75% of the patients. Surgical procedures included nine left lateral sectionectomies, eight left hepatectomies, and four right hepatectomies for those with hemiliver disease, while for patients with bilateral disease, one right hepatectomy and two Roux-en-Y hepaticojejunostomies were performed. The average length of hospitalization was 7 days. For perioperative complications (25%), three patients presented minor complications (types 1-2), while major complications occurred in three patients (type 3a). No mortality was reported. After a median follow-up of 166 months, all patients are alive and free of symptoms. CD diagnosis was confirmed by histology. Congenital hepatic fibrosis was present in two patients (8.3%) and cholangiocarcinoma in one (4.2%). CONCLUSIONS: CD in Argentina is more common in females with left hemiliver involvement. Surgical resection is the best curative option in unilateral disease, providing long-term survival free of symptoms and complications. In selected cases of bilateral disease without parenchymal involvement, hepaticojejunostomy should be proposed. However, a close follow-up is mandatory because patients might progress and a transplant should be indicated.

Heridas penetrantes de cuello / Neck penetrating wounds

Antecedentes: Los mayores desafíos que enfrentan los cirujanos de emergencia en el manejo de esta patología radica en la metodología diagnóstica a emplear y en la conducta a seguir. Objetivo: Ofrecer una propuesta unificadora de criterios, basada en una clasificación propia dividida en grados de las heridas penetrantes del cuello con el fin de obtener criterios selectivos de tratamientos y disminuir las tasas de morbimortalidad. Diseño: Retrospectivo. Lugar de aplicación: Hospital General de Agudos. Población: 210 pacientes asistidos entre enero de 1989 y diciembre de 2003, 83,81 por ciento masculinos, con relación 5.1:1 y una edad media de 32.3 años. Métodos: 99/210 recibieron tratamiento quirúrgico. 20 correspondían al grado II, 68 al grado III y 11 al grado IV. En 25/99 las lesiones del complejo laringotraqueal, 53/99 fueron lesiones venosas, 19/99 arteriales, 21/99 del complejo faringoesofágico y 8/99 correspondieron a la glándula tiroides, parótida y conducto torácico. Resultados: La clasificación propuesta tiende a disminuir considerablemente la tasa de exploraciones negativas. Los tratamientos de urgencia se aplicarán sólo a pacientes inestables y en situación de emergencia. En aquellos pacientes que presentan lesiones sin peligro de muerte, se emplearán métodos complementarios de estudios, que aseguren el diagnóstico de los órganos dañados. La morbilidad específica fue del 18,6 por ciento siendo las más frecuentes las infecciones y los hematomas, mientras la mortalidad fue de 13,3 por ciento

Heridas penetrantes de cuello / Neck penetrating wounds

Antecedentes: Los mayores desafíos que enfrentan los cirujanos de emergencia en el manejo de esta patología radica en la metodología diagnóstica a emplear y en la conducta a seguir. Objetivo: Ofrecer una propuesta unificadora de criterios, basada en una clasificación propia dividida en grados de las heridas penetrantes del cuello con el fin de obtener criterios selectivos de tratamientos y disminuir las tasas de morbimortalidad. Diseño: Retrospectivo. Lugar de aplicación: Hospital General de Agudos. Población: 210 pacientes asistidos entre enero de 1989 y diciembre de 2003, 83,81 por ciento masculinos, con relación 5.1:1 y una edad media de 32.3 años. Métodos: 99/210 recibieron tratamiento quirúrgico. 20 correspondían al grado II, 68 al grado III y 11 al grado IV. En 25/99 las lesiones del complejo laringotraqueal, 53/99 fueron lesiones venosas, 19/99 arteriales, 21/99 del complejo faringoesofágico y 8/99 correspondieron a la glándula tiroides, parótida y conducto torácico. Resultados: La clasificación propuesta tiende a disminuir considerablemente la tasa de exploraciones negativas. Los tratamientos de urgencia se aplicarán sólo a pacientes inestables y en situación de emergencia. En aquellos pacientes que presentan lesiones sin peligro de muerte, se emplearán métodos complementarios de estudios, que aseguren el diagnóstico de los órganos dañados. La morbilidad específica fue del 18,6 por ciento siendo las más frecuentes las infecciones y los hematomas, mientras la mortalidad fue de 13,3 por ciento (AU)

[Diminution of antifungal activity of fluconazole associated with ibuprofen and piroxicam in experimental histoplasmosis of hamsters (Mesocricetus auratus)] / Disminución de la actividad antifúngica del fluconazol asociada a ibuprofeno y piroxicam en la histoplasmosis experimental del hámster (Mesocricetus auratus).

The aim of this study was to determine if tha association of non-steroid antiinflammatory drugs (piroxicam and ibuprofen) with fluconazole, affects the antifungal activity of the azole compound, in an experimental model histoplasmosis in hamsters (Mesocricetus auratus). Sixty hamsters were intracardially inoculated with 4x10(6) yeasts of Histoplasma capsulatum var. capsulatum. Treatments began one week after the challenge and continued for three weeks. The hamsters were divided in six groups of ten animals each and received the following treatment: 1- fluconazole 8 mg/kg/day; 2- ibuprofen 20 mg/kg/day; 3- piroxicam 20 mg/kg/day; 4- fluconazole+ibuprofen; 5- fluconazole+piroxicam and 6- only received the solvent of these drugs. One week after ending the treatment, all the animals were sacrified and the evaluation of the treatments was based on the results of blood cultures, on the determination of colony forming units per gram of spleen, and the histopathologic studies of the same organ. The animals treated with fluconazole plus ibuprofen or piroxicam showed more colony colony forming units per gram (3.9x10(7) and 3.3x10(7)) when compared with the animals treated with fluconazole alone (0.9x10(7)). The histopathologic results of the hamsters that received fluconazole showed well-organized granulomas with few yeast-like elements inside the macrophages. In contrast, those which received fluconazole associated with antiinflammatory drugs presented lax granulomas containing numerous yeast-like elements. These findings let us to conclude that non-steroids antiinflammatory drugs diminish the antifungal efficacy of fluconazole in this animal model.