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ABSTRACT: INTRODUCTION: Up to 45% anatomical variations are found in hepatic arterial system. Identifying these anatomical anomalies before or during surgery would prevent additional morbidity in performing a duodenopancreatectomy. They are routinely identified before surgery using CT imaging, but on certain occasions they are not reported and are only discovered during the surgical operation. The initial retroperitoneal access by the superior mesenteric artery (SMA) will avoid a fairly useless intervention if there is superior mesenteric artery invasion, and will identify the anatomical variations originating in the superior mesenteric artery. These anomalies acquire importance in that their unnoticed injury could lead to severe vascular compromise and/or perioperative bleeding. OBJECTIVES: To analyse celiac-mesenteric anomalies of the hepatic artery before duodenopancreatectomy using the information from multidetector computed tomography (MDCT) using a non-standardised method, a standardised method with multidimensional reconstruction, and maximum intensity projection (MIP), after initial surgical access to the SMA. PATIENTS AND METHODS: A retrospective study of the clinical, histopathological and surgical variables was conducted on patients with an indication for duodenopancreatectomy in our Department from 2008 until April 2010. A study was performed on the reports made after image acquisition by MDCT. A blind, three-dimensional, MIP reconstruction was performed on all the patients to identify arterial anomalies. A description is given of hepatic artery anomalies after initial access to the SMA. RESULTS: A total of 61 patients were included in the study. The mean age was 65±11 years, with 33 (54%) males and 28 (46%) females. Vascular anomalies, right hepatic artery (RHA) (SMA) substitute (subst), 5 (8%); RHA (SMA) accessory (acc), 4 (7%); left hepatic artery (LHA) (left gastric artery) (LGA) acc 3 (5%); common hepatic artery (CHA) (SMA) subst 3 (5%); RHA (SMA) acc+LHA (LGA) acc2 (3%); CHA (aorta) subst, 1 (2%); RHA+RGA+2 LHA (celiac trunk), 1 (2%); and CHA (SMA)+LHA (LGA) acc. CONCLUSION: On being able to identify arterial anomalies with a mixture of preoperative radiological and methodological criteria, with three-dimensional reconstruction, MIP, and initially performing a dissection of the superior mesenteric artery could avoid duodenopancreatectomies that may not benefit the patient and compromise bleeding.
Cirugía Española 12/2012; · 0.87 Impact Factor
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Esther P García-Santos,
Pablo Menéndez Sánchez,
Virginia Muñoz-Atienza,
Susana Sánchez-García,
Francisco Javier Ruescas-García,
Ricardo Valle-García,
Jose Luis Bertelli-Puche, David Padilla-Valverde,
Pedro Villarejo-Campos,
Aurora Gil-Rendo,
Alberto Jara-Sánchez,
David Reina Escobar,
Jesús Martín-Fernández
Gastroenterología y Hepatología 10/2012; · 0.73 Impact Factor
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ABSTRACT: INTRODUCTION: Angiogenesis and lymphangiogenesis are essential processes for the formation of blood and lymphatic vessels that allow tumour growth and spread. The binding of VEGF and VEGF-C factors with their receptors (VEGFR2, VEGFR3) in endothelial cells triggers signals that regulate these processes. We compared preoperative serum VEGF and VEGF-C levels with samples obtained after completion of surgery and adjuvant treatment in patients with gastric cancer. In addition, we determined the prognostic value and relationship to survival of serum VEGF and VEGF-C levels. METHODS: We used a prospective cohort study of 59 gastric cancer patients who underwent surgery. Serum VEGF and VEGF-C were measured by enzyme-linked immunosorbent assay (ELISA) the day before surgery and 6 months later, after completion of adjuvant treatment. RESULTS: Serum VEGF values decreased after treatment in patients with resectable tumours (mean ± SD) (405.42 ± 298.38 vs. 306.38 ± 212.47 pg/ml; p < 0.01), poorly differentiated and undifferentiated tumours (G3, G4) (438 ± 339.71 vs. 322.47 ± 210.71 pg/ml; p = 0.01), locally advanced gastric tumours (T4 stage) (424.27 ± 323.08 vs. 333.62 ± 221.72 pg/ml; p = 0.03) and tumours with a greater number of involved regional lymph nodes (N3) (442.38 ± 311.52 vs. 337.4 ± 203.64 pg/ml; p = 0.04). Serum preoperative VEGF values over 761 pg/ml were associated with shorter patient survival. The mean overall survival time for patients with serum VEGF levels higher than 761 pg/ml was 7 ± 2.99 months (95 % CI 1.14-12.86) while for patients with serum VEGF levels of less than 761 pg/ml was 21.18 ± 2.88 (95 % CI 15.54-26.83) The mean disease-specific survival time for patients with serum VEGF levels higher than 761 pg/ml was 6.25 ± 2.53 months (95 % CI 1.29-11.21) while for patients with serum VEGF levels of less than 761 pg/ml was 27.57 ± 3.45 (95 % CI 20.80-34.35). Multivariate analysis identified preoperative serum VEGF levels as an independent prognostic factor (HR = 0.144; p = 0.03). CONCLUSIONS: Serum VEGF levels decreased after the completion of treatment in patients with resected tumours, suggesting VEGF tracking may be useful in monitoring progression. Preoperative measurement of serum VEGF may help us identify patients with a poor prognosis.
Clinical and Translational Oncology 07/2012; · 1.33 Impact Factor
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ABSTRACT: Diaphragmatic rupture can be missed during trauma diagnosis. Different pressures between the thorax and the abdomen allow the abdominal viscera to herniate into the chest cavity. Cardiorespiratory and abdominal symptoms may appear later due to passive compression and incarceration, respectively.
We report the case of a 52-year-old female with abdominal pain and vomiting. Chest x-ray demonstrated an elevation of the right hemidiaphragm, and computed tomography showed herniation of small bowel and colon into the chest cavity with dilated small bowel due to a diaphragmatic hernia.
History of traumatic events should be considered with high suspicion in the diagnostic process to avoid delayed diagnosis of this condition. The nonspecific symptoms of this condition often lead the patient to consult different specialists. A multidisciplinary approach is required and aimed at preventing an unnecessary increase of morbidity and mortality.
Cirugia y cirujanos 01/2012; 80(1):72-5. · 0.14 Impact Factor
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ABSTRACT: Gliomatosis peritonei is the metastatic implantation of mature glial tissue within the peritoneal cavity of patients with ovarian teratomas. There is no clear guidance for how long these patients should be followed up.
We report the follow-up imaging findings of a 33-year-old female with abdominal distension and abdominal pain and who was postoperatively diagnosed with immature ovarian teratoma with gliomatosis peritonei.
Differentiation of peritoneal implants seems to be important for prognosis. Malignant transformations after several years cannot be excluded. Therefore, new studies will determine if it is necessary to create guidelines for the postsurgical monitoring of these patients.
Cirugia y cirujanos 05/2011; 79(3):256-9, 278-81. · 0.14 Impact Factor
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Jesús Martín Fernández,
Alberto Jara Sánchez,
M Carmen Manzanares Campillo,
Pablo Menéndez Sánchez,
Virginia Muñoz Atienza, David Padilla Valverde,
Pedro Villarejo Campos,
M Angeles Gil-Olarte,
Irene Arjona Medina,
Fernándo Martínez De Paz,
Bruno Menchen Trujillo
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ABSTRACT: Natural orifice endoscopic surgery is a new surgical procedure still in the development phase. The most natural entry for surgeons is to use an already existing scar, such as the navel. The recent introduction of trocars designed for this purpose has made it possible to put this into practice.
We present our preliminary experience in single trans-umbilical incision laparoscopic cholecystectomy, by means of a prospective study which included 26 patients operated on between January 2009 and January 2010. We also attempt to find out whether it can be performed in a MAS programme.
All patients had uncomplicated cholelithiasis, although in 5 of them cholecystitis was identified during the surgery. The mean surgical time was 51.2 min. The mean hospital stay was 25.7h, and 76.92% of patients were admitted for less than 24h. There were no re-admissions or significant intra-operative or post-operative complications.
On looking at our results, single port laparoscopic cholecystectomy could be included in a major ambulatory surgery programme.
Cirugía Española 10/2010; 88(5):328-31. · 0.87 Impact Factor
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ABSTRACT: resumen introducción: La pileflebitis es una complicación infre-cuente de los procesos infecciosos intraabdominales. La presentación clínica puede ser muy variada, por lo que son necesarias pruebas de imagen para su diagnóstico. El tratamiento de elección consiste en la administración de antibióticos de amplio espectro y el abordaje quirúrgico del foco infeccioso. Caso clínico: Mujer con abdomen agudo en quien se diag-nosticó colecistitis aguda y trombosis portal derecha. Fue intervenida quirúrgicamente y se le administró tratamiento antibiótico. Una tomografía computarizada mostró infarto hepático secundario a la trombosis portal. Conclusiones: La pileflebitis requiere un diagnóstico pre-coz para iniciar el tratamiento médico-quirúrgico adecua-do, de lo contrario presenta altas tasas de mortalidad. Palabras clave: Colecistitis aguda, pileflebitis, trombosis séptica. abstract Background: Pylephlebitis is a rare complication of in-traabdominal infections. Clinical presentation can be var-ied; therefore, it is necessary to carry out imaging tests for diagnosis. The treatment of choice is wide-spectrum antibi-otic therapy and surgery for the source of infection. Clinical case: We report the case of a female with acute abdomen who was diagnosed with acute cholecystitis and right portal vein thrombosis. The patient underwent surgery and antibiotic treatment was necessary. CT scan showed hepatic infarction secondary to portal thrombosis. Conclusions: Pylephlebitis presents high mortality rates without treatment; therefore, early diagnosis is necessary in order to initiate appropriate medical and surgical treat-ment.
Cir Cir. 01/2010; 7878:439-441.
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Bruno Juan Menchén-Trujillo,
Juan Manuel Molina-Martín de la Sierra,
Carmen Manzanares-Campillo,
Fernando Martínez de Paz,
Pedro Villarejo-Campos,
Roberto de la Plaza-Llamas,
Alberto Jara-Sánchez,
Antonio Lopez-Useros, David Padilla-Valverde,
Ricardo Pardo-García,
Teofilo Cubo-Cintas,
Jesús Martín-Fernández
Cirugía Española 05/2006; 79(4):259-60. · 0.87 Impact Factor
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ABSTRACT: Focal nodular hyperplasia is a benign liver tumor that usually follows an asymptomatic course. Hemorrhage of hepatic focal nodular hyperplasia is exceptional and occurs in tumors such as hepatocellular carcinoma and hepatic adenoma. We report the case of a woman with spontaneous rupture and hemorrhage of focal nodular hyperplasia. Hemodynamic stabilization was achieved by selective hepatic arterial embolization. Elective hepatic resection was subsequently performed. This clinical course is extremely rare. We describe the therapeutic management of these complications using hepatic transarterial embolization, which could avoid potentially harmful aggressive treatments.
Gastroenterología y Hepatología 30(7):387-90. · 0.73 Impact Factor
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ABSTRACT: resumen introducción: El angiomiofibroblastoma es una lesión de los tejidos blandos que se presenta casi exclusivamente en mujeres de mediana edad. Se caracteriza por ser una lesión subcutánea bien delimitada, localizada en la vulva y zona perineal, de crecimiento lento y doloroso. Frecuente-mente la primera impresión diagnóstica es la de un quiste de Bartolino. El tratamiento de elección es la exéresis qui-rúrgica. Caso clínico: Mujer de 49 años de edad con una tumo-ración en el lado derecho de la vulva, en crecimiento du-rante dos años. La ecografía, tomografía computarizada y la resonancia magnética mostraron una lesión en la fosa isquiorrectal derecha. El diagnóstico tras la exéresis qui-rúrgica fue angiomiofibroblastoma. Conclusiones: El angiomiofibroblastoma debe incluirse en el diagnóstico diferencial de los tumores vulvovaginales porque su tratamiento difiere del requerido en otras lesio-nes en esa región. Palabras clave: Angiomiofibroblastoma, tumores vulva-res, tumores de tejidos blandos, tumores vulvovaginales. abstract Background: Angiomyofibroblastoma is a soft-tissue le-sion. The vulvovaginal region of middle-aged females is the most frequent localization. Angiomyofibroblastoma is a well-circumscribed subcutaneous tumor at the vulva and perineum region. It is a painful and slow-growing tumor. It is often thought to represent a Bartholin's gland cyst. Treat-ment of choice is surgical excision. Clinical case: We describe the case of a 49-year-old fe-male with a right vulvar tumor that had been growing for 2 years. Ultrasonography, computed tomography and mag-netic resonance revealed a tumor at the right ischiorectal fossa. Diagnosis after surgical excision was angiomyofi-broblastoma. Conclusions: Angiomyofibroblastoma must be considered in the differential diagnosis of vulvovaginal tumors because its treatment differs from others lesions of that region.
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ABSTRACT: pylephlebitis is a rare complication of intraabdominal infections. Clinical presentation can be varied; therefore, it is necessary to carry out imaging tests for diagnosis. The treatment of choice is wide-spectrum antibiotic therapy and surgery for the source of infection.
we report the case of a female with acute abdomen who was diagnosed with acute cholecystitis and right portal vein thrombosis. The patient underwent surgery and antibiotic treatment was necessary. CT scan showed hepatic infarction secondary to portal thrombosis.
pylephlebitis presents high mortality rates without treatment; therefore, early diagnosis is necessary in order to initiate appropriate medical and surgical treatment.
Cirugia y cirujanos 78(5):439-41. · 0.14 Impact Factor
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ABSTRACT: angiomyofibroblastoma is a soft-tissue lesion. The vulvovaginal region of middle-aged females is the most frequent localization. Angiomyofibroblastoma is a well-circumscribed subcutaneous tumor at the vulva and perineum region. It is a painful and slow-growing tumor. It is often thought to represent a Bartholin's gland cyst. Treatment of choice is surgical excision.
We describe the case of a 49-year-old female with a right vulvar tumor that had been growing for 2 years. Ultrasonography, computed tomography and magnetic resonance revealed a tumor at the right ischiorectal fossa. Diagnosis after surgical excision was angiomyofibroblastoma.
angiomyofibroblastoma must be considered in the differential diagnosis of vulvovaginal tumors because its treatment differs from others lesions of that region.
Cirugia y cirujanos 78(5):448-50. · 0.14 Impact Factor
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ABSTRACT: Small bowel tumors comprise 25% of gastrointestinal (GI) neoplasms, of which only between 0.2 and 1% correspond to gastrointestinal stromal tumors (GIST). GI bleeding is the most common presentation of GIST, being responsible in 1% of the cases. This type of neoplasm can also be the origin of an intussusception, which is an infrequent process during adult age, representing only 5% of all intestinal obstructions.
We report a case of a patient who arrived at the emergency department due to abdominal pain and lower GI bleeding. The diagnostic process was not conclusive. After an exploratory laparotomy, the diagnosis was GI bleeding and intussusception due to GIST.
Surgery must be the last diagnostic and therapeutic resource, but it is sometimes necessary to localize bleeding and intestinal obstruction site.
Cirugia y cirujanos 77(6):451-3. · 0.14 Impact Factor
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ABSTRACT: Introduction: In 2008, colorectal cancer represented the third most commonly diagnosed tumor in Spain, and the second tumor with more deaths. Despite the new potential biomarkers in colorectal cancer, there are many challenges that need to be overcome, resulting in a need for the standardization of its determinations. Discussion: The continuous advance in tumor disease knowledge makes this review a summary of the current accepted, recommended and studied tumor markers for the diagnosis and monitoring of colorectal cancer, such as fecal markers, tissue markers and serological markers, and various prognostic markers on which there are different lines of treatment in colorectal cancer. Conclusions: Oncological guidelines recommend only a minority of tumor markers for routine use, such as the study of fecal occult blood, CEA determination in the postoperative followup, microsatellite instability to identify people susceptible to hereditary nonpolyposis colorectal cáncer, and mutation of APC in the diagnosis of familial adenomatous polyposis.
Cirugia y cirujanos 81(2):169-75. · 0.14 Impact Factor
