Miguel Ruiz Marín

Laparoscopic adrenalectomy for nonfamilial adrenal medullary hyperplasia.

BACKGROUND AND OBJECTIVES Sporadic adrenomedullary hyperplasia (AMH) is characterized by a medical history of hypertension, excessive catecholamine excretion, and histomorphometric evidence of increased adrenomedullary tissue relative to the cortex in the absence of multiple endocrine neoplasia. The aim of this study was to perform a retrospective analysis of patients after laparoscopic adrenalectomy for AMH, an early form of sporadic adrenal medulla-related endocrine hypertension, as well as to update our understanding of the clinical features and management of this clinicomorphologic entity. METHODS We performed a retrospective review of the medical records of patients operated on between 2007 and 2011 at Reina Sofia University General Hospital, Murcia, Spain, with a diagnosis of AMH. Patient characteristics, diagnostic studies, surgical procedures, and histologic findings were analyzed. RESULTS Seven hypertensive patients with intermittent adrenergic crises were found to have AMH (3 men and 4 women; mean age, 44 years). Catecholamine levels were increased. Radiologic studies included 1 or more of the following: magnetic resonance imaging, computed tomography, positron emission tomography imaging with fluorodeoxyglucose, dihydroxyphenylalanine-positron emission tomography-computed tomography, Octreoscan (Mallinckrodt Pharmaceuticals, St. Louis, MO, USA) and (123)I-metaiodobenzylguanidine scintigraphy. Laparoscopic adrenalectomy was performed in all cases. One patient underwent bilateral adrenalectomy because of persistent symptomatology after unilateral adrenalectomy. Surgery was associated with normalization of catecholamine hypersecretion and complete disappearance of symptoms, as well as the reduction or abstention of antihypertensive therapy. CONCLUSIONS Sporadic AMH is a clinicomorphologic entity that may mimic pheochromocytoma clinically. Recent advances in diagnostic and surgical methods have changed the management and outcome of this unusual disease. Laparoscopic adrenalectomy may be recommended as the gold standard in the treatment of this entity. Definitive diagnosis is provided by histologic study.

Acute Mediastinitis Due to Extravasation of Parenteral Nutritional Formula via a Central Venous Catheter

Mediastinitis is a complication generally associated with thoracic surgery. Its occurrence after placement of a central venous catheter is uncommon, and only a few cases have been reported. An 83-year-old man who had mediastinitis due to extravasation of parenteral nutritional formula via a central venous catheter is presented. The signs and symptoms, diagnosis, and treatment of this unusual complication are described. This complication should be included in the differential diagnosis of mediastinitis in patients with a central venous catheter in place who have not had thoracic surgery.

Frequency and causes of conversion from laparoscopic to open Roux-en-Y gastric bypass for morbid obesity: the experience in our service.

Dear Editor Roux-en-Y gastric bypass (RYGBP) is a highly successful approach to morbid obesity. The majority of patients undergoing bypass surgery can expect to lose 60–70 % of excess body weight and maintain that weight loss. Serious complications after this operation are not unusual, however. The laparoscopic approach may decrease the incidence of some complications that are associated with the traditional open approach and may offer benefits, including a reduction in postoperative pain and complications, a shorter hospital stay, and faster recovery, but without decreasing the ultimate weight loss effect of the bypass. Not all patients, however, can have the operation completed totally laparoscopically [1]. Conversion from laparoscopic to open RYGBP is expensive and time-consuming [1] so we analyzed the factors determining this modification in the technique.

Enterolitiasis no obstructiva, presentación de 2 casos

Enterolithiasis, or coprolithiasis, stones formed mainly in the intestine, is uncommon in humans and is generally associated with intestinal stasis. This entity is highly common in some animals, such as horses. Enterolithiasis is usually asymptomatic but may lead to intestinal occlusion and should be considered as a possible cause of this event. We report two cases of enterolithiasis, in which the diagnosis was established by simple abdominal radiography and computed tomography. Although both patients had factors favoring the development of enterolithiasis, a genetic substrate predisposing them to this uncommon clinical entity cannot be excluded.

Fístula quistocólica secundaria a hidatidosis peritoneal

Varón de 26 años de origen magreb ı́, con antecedente de intervención en 2006 por )quiste hepático* (no aporta informes), que consulta por dolor abdominal en fosa ilı́aca y flanco izquierdos, de 48 h de evolución, acompañado de náuseas, vómitos y sensación distérmica. A la exploración destacan: temperatura de 37 1C y dolor a la palpación en hemiabdomen izquierdo con discreta defensa y signos de irritación peritoneal. En la analı́tica presenta leucocitosis de 17.900 con el 79% de neutrófilos y serologı́a positiva para hidatidosis. La tomografı́a abdominal evidenció abundantes quistes en el hı́gado, el retroperitoneo derecho y el espacio de Retzius y uno de 6 cm de diámetro en el retroperitoneo izquierdo fistulizado a colon descendente que lo comprime y desplaza hacia la lı́nea media (fig. 1). El enema opaco confirmó el paso de contraste desde el colon hacia la cavidad quı́stica (fig. 2). Fue tratado preoperatoriamente con albendazol y posteriormente se realizó la intervención quirúrgica, en que se halló siembra peritoneal con abundantes quistes hidatı́dicos en el epiplón, el mesenterio, la pelvis y uno en el retroperitoneo izquierdo fistulizado al colon sigmoide. Se realizó resección de los quistes y cierre del orificio fistuloso sigmoideo. El postoperatorio transcurrió sin incidencias, y se continuó el tratamiento con albendazol durante 6 semanas.