Nicolás Jarufe C

Alternativas terapéuticas actuales de las metástasis hepáticas

The liver is a common site of hematogenous metastasis, especially from gastrointestinal malignancies. Liver metastasis are generally classified as stage IV disease. Previously treatment in such patients was met with great skeptiscism. However, advances in surgical and medical therapies during the last two decades have provided effective therapeutic options for selected patients. Since major hepatic resections are now performed with acceptable morbidity and a mortality rate <3%, colorectal cancer metastasis to the liver are associated with 5-year survival rates of 30% or more. Meanwhile, a variety of new therapies have been developed, including hepatic artery infusion of chemotherapy; alcoholic, crio and radiofrequency ablation and novel strategies of systemic chemotherapy with the development of molecular targeted new products. These new therapeutic armamentarium have been used mostly in liver metastasis from colorectal cancer patients. However, liver metastasis of neuroendocrine tumors and selected cases of non colorectal cancer liver metastasis are benefited from the same strategies. This report summarizes the different therapeutic tools, their advantages and results mainly on colorectal cancer liver metastasis. These results are expected to improve even further with multimodality approaches

Hipotermia intravascular inducida en el manejo de la hipertensión intracraneana en insuficiencia hepática aguda: Caso clínico

Acute liver failure has a mortality rate in excess of 80%. Most deaths are attributed to brain edema with intracranial hypertension and herniation of structures, where ammonium plays a major role in its generation. We report an 18 year-old female with a fulminant hepatic failure caused by virus A infection. The patient developed a profound sopor and required mechanical ventilation. A CT scan showed the presence of brain edema and intracranial hypertension. A Raudemic® catheter was inserted to measure intracranial pressure and brain temperature. Intracranial hypertension became refractory and intravascular hypothermia was started, reducing brain temperature to 33°C. Seventy two hours later, a liver transplantation was performed. After testing graft perfusion, rewarming was started, completing 122 hours of hypothermia at 33°C. The patient was discharged in good conditions after 69 days of hospitalization.

Pancreatoduodenectomía totalmente laparoscópica: Técnica quirúrgica y experiencia inicial*

Abstract Totally laparoscopic pancreaticoduodenectomy: Surgical technique and initialexperience Introduction: Nowadays the utility of laparoscopic pancreatic surgery is accepted for a wide varietyof indications. However pancreaticoduodenectomy has been considered beyond the possibilities oflaparoscopy by the majority of surgeons. The objective of this report is to show our surgical techniqueand initial experience with totally laparoscopic pancreaticoduodenectomy. Material and Methods: Betweennovember of 2007 and june of 2008, a laparoscopic technique was offered to patients with indication ofpancreaticoduodenectomy for different pathologies. We describe the surgical technique, perioperativecare, intraoperative complications, need for conversion to open technique, mortality, and early postoperativecomplications. Results: A total of three patients were subjected to laparoscopic pancreaticoduodenectomy.The surgical indication was an ampullar adenocarcinoma in a 52 years old woman, a pseudopapilar tumor ofthe pancreatic head in a 17 years old woman, and a duodenal gastrointestinal stromal tumor in a 63 yearsold man. There was no need for conversion to open technique. There was no mortality. The operative timeranged from 300 to 360 min. The first patient presented an upper gastrointestinal bleeding, from pancreaticanastomoses requiring surgical hemostasis. The last patient developed a self-limited biliary fistula, managedsuccessfully with drains. The hospital stay varied from 8 to 25 days.

Factores pronósticos de pacientes con metástasis hepáticas de cáncer de colon y recto

Introduccion: Las metastasis hepaticas (MH) son causa frecuente de muerte en el cancer colo-rectal (CaCR). El objetivo del trabajo es evaluar los factores que determinan la sobrevida de pacientes con MH de CaCR. Material y Metodo: Analisis retrospectivo a partir de los registros de biopsias, ficha clinica y base de datos especialmente disenada de 122 pacientes con MH de CaCR evaluados entre 1978 y 2002. Se analizo demografia, caracteristicas del tumor primario, de las MH y del tratamiento utilizado. Se evaluo factores pronosticos y sobrevida a 5 anos segun Kaplan-Meier con el test de log-rank. Resultados: De los 122 pacientes, [71 (58,2%) hombres; edad: 65 ± 13 anos], en 73 (59,8%) la MH fue sincronica con el tumor primario; en 46 (37,7%) bilobar; en 70 (57,4 %) multiple con > 4 nodulos metastasicos y en 34 (27,9%) la MH fue unica. En 65 (53,3%) pacientes, el tratamiento quirurgico del primario se considero curativo. Las MH de CaCR fueron resecadas en 42 de estos pacientes (64,6%). Hubo recurrencia del canceren 18 pacientes a los 18 meses promedio. La sobrevida a 5 anos de todos los pacientes fue de 14,6 %. Los enfermos con mas de una metastasis, con compromiso bilobar y que no fueron resecadas, tuvieron un peor pronostico (p<0,0001). En los enfermos resecados R0 se obtuvo una sobrevida de 46,2%. Conclusiones: A un tercio de los pacientes con MH de CaCR de esta serie se le reseco la MH. La mejor sobrevida se obtuvo cuando la reseccion fue curativa (R0)

Tumor sólido pseudopapilar del páncreas: estudio descriptivo de una serie de casos

Resumen en: Rare neoplasm that occurs most often in young women, neoplasm with low degree of malignancy. Aim: to describe the clinical characteristics and postoperat...

Necrosectomía laparoscópica en pancreatitis aguda

Laparoscopic necrosectomy in severe pancreatitis. Retrospective analysis of 11 patients Background: Laparoscopic surgery can be used in the treatment of severe acute pancreatitis. Aim: To report the experience with laparoscopic necrosectomy and abscess drainage in severe acute pancreatitis. Material and Methods: Retrospective analysis of medical records of 11 patients aged 13 to 78 years (10 males), with severe pancreatitis, subjected to laparoscopic necrosectomy or abscess drainage between 2006 and 2009. Results: Operative time ranged from 110 to 205 min. In all cases, a satisfactory necrosectomy and collection drainage were performed. No complications were recorded and no patient required to be converted to open surgery. Five patients were reoperated. In three of these, the laparoscopic approach was used again. Conclusions: Laparoscopic necrosectomy is safe and useful for patients with severe pancreatitis.

Definiciones y conceptos en hepatolitiasis

Resumen es: La hepatolitiasis o litiasis intrahepatica, se define como la presencia de calculos en los conductos bi - liares proximales al confluente biliar. La etio...

TRATAMIENTO LAPAROSCÓPICO DE LA OBSTRUCCIÓN INTESTINAL POR BRIDAS

Laparoscopic treatment of adhesive small bowel obstruction Background: Treatment options for adhesive small bowel obstruction (ASBO) involve conservative and surgical management, traditionally through open adhesiolysis. Laparoscopic approach has been performed in recent years; however, limited data exist on its safety and results vary considerably. Our aim is to report our experience of laparoscopic treatment for ASBO. Methods: Retrospective study including patients admitted with the diagnosis of adhesive small bowel obstruction and that were submitted to laparoscopic exploration, between June 2003 and April 2013. We analyzed demographic, surgical variables and outcomes in terms of conversion rate, operative time, re-feeding time and length of stay. Non-parametric tests were used for statistical analysis. Results: Series of 38 patients submitted to laparoscopic exploration, mean age: 51 ± 16 years, 47% male. 53% had prior intra-abdominal surgeries. Laparoscopic resolution of bowel obstruction was possible in 31 patients (82%), with 7 conversions to open surgery. Median operative time was 60 (25-180) minutes, median re-feeding time was 24 (24-192) hours and median length of stay was 4 (2-52) days. Two patients required re-intervention during their hospital stay, one due to persistent bowel obstruction and one due to ischemic colitis. There were no other complications or mortality. Conclusions: Laparoscopy in adhesive small bowel obstruction was a feasible approach in this series, with good results when laparoscopic resolution is achieved. Patients with no prior surgeries seem to be good candidates for this approach.

Tratamiento quirúrgico en hepatocarcinoma: Experiencia preliminar

Resumen es: Introduccion: El carcinoma hepatocelular (HCC) es el principal tumor hepatico primario y es una importante causa de muerte a nivel mundial y nacional, ya...

Ameloblastoma mandibular maligno con metástasis hepática y pulmonar: Caso clínico

Malignant mandibular ameloblastoma with hepatic and lung metastases: a case report Ameloblastoma is a benign rare tumor, originated in the odontogenic epithelium, is locally invasive and with high tendency to local recurrence, a variety less common is the malignant or metastasizing ameloblastoma, where more frequent sites of deployment are the lung and cervical lymph nodes, being much less frequent sites the liver and skull among others. The surgical treatment is mainly the aggressive surgery of the primary tumor and metastases. We present a case of a patient with malignant mandibular ameloblastoma with metastases in liver and lung, which was subjected to a subtotal mandibulectomy, local radiotherapy and lung and liver metastasectomy in a second time, with late recurrence of the lesion.