Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID)

Background: Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. Methods: Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. Results: The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). Conclusions: Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival

Repeated pancreatic resection for pancreatic metastases from renal cell Carcinoma: A Spanish multicenter study (PANMEKID)

Background and objectives: Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease -free survival. Methods: Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected. Results: The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2-56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895). Conclusion: Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection

Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID)

Background: Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. Methods: Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. Results: The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). Conclusions: Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival. (C) 2021 The Authors. Published by Elsevier Ltd

Aneurisma de la Arteria Pulmonar complicado con trombo.Presentación de dos casos

RESUMENEl aneurisma de la arteria pulmonar es la dilatación anómala del tronco de dicha arteria o de sus ramas principales, la presencia de hipertensión arterial pulmonar y procesos que afecten la pared vascular son las premisas fisiopatológicas para su desarrollo. Es una enfermedad poco frecuente, de etiología variada que puede cursar sin síntomas o ser estos inespecíficos o debutar con complicaciones; fisura o ruptura del aneurisma, compresión de estructuras vecinas o formación de trombos. Su historia natural no es conocida y esta relacionada con las causas que le dan origen. Presentamos dos pacientes con aneurisma de la arteria pulmonar secundario a hipertensión pulmonar severa en el curso de una comunicación interauricular complicados con trombos adheridos a las paredes. El diagnostico se realizo por ecocardiografía.Palabras claves: Aneurisma arteria pulmonar, ecocardiografía, trombo en arteria pulmonar.

Caracterización tisular miocárdica por ultrasonidos y detección de disfunción diastólica por Doppler pulsado: ¿índices precoces de miocardiopatía diabética?

Introduction: There is an intrinsec myocardiopaty related with the diabetes and probably produced for the increment of collagen in the myocardium. Objective: To value the paper of the tissular myocardial characterization by ultrasound and the detection of diastolic dysfunction by pulsated Doppler as precocious indexes of diabetic miocardiopaty. Methods: Transverse, prospective,and controlled study that analyzed the diastolic function with pulsated Doppler in 60 diabetic patients and a control group of 15 healthy individuals; all with a normal pressure, with a negative ergometric test and normal systolic function; 40 presented microvascular complications. The securities of magnitude of recurrent variation were determined at the level of the septum and the posterior wall. The echocardiograms were carried out with the equipment ALOKA 5500 with a multiband transducer of 2.5 MHZ using the beta digital handling program (DMS) and the power Doppler in ecocardiografic views . Results: Reduction of the recurrent variation was obtained in diabetics with respect to the control group at the level of the septum 2D (3.4 ±1.3 vs. 4.4 ± 0.4 dB; p <0.003) and the posterior wall PP2D (3.4 ± 1.3 vs. 6.2 ± 0.4 dB; p <0.000001). Was found a correlation between the presence of diastolic dysfunction and the low magnitudes of ciclic variation (p <0.001). The tissular characterization was more sensitive to detect precocious changes of the myocardium in diabetic patients (p <0.001). Conclusions: The diabetes mellitus is cause of myocardiopaties that originate very precocious alterations in the myocardium of these patients; these changes can be discovered in very early phases by the pulsated Doppler detecting diastolic dysfunction and the tissular characterization by ultrasounds. This last one is more sensitive for the diagnosis of this entity.Fundamento: Existe una miocardiopatía relacionada intrínsecamente con la diabetes y probablemente producida por el incremento de colágeno en el miocardio. Objetivo: Valorar el papel de la caracterización tisular miocárdica por ultrasonido y la detección de disfunción diastólica por Doppler pulsado como índices precoces de miocardiopatía diabética. Métodos: Estudio transversal, prospectivo, controlado que analizó la función diastólica con Doppler pulsado en 60 pacientes diabéticos y un grupo control de 15 personas sanas; todos normotensos, con prueba ergométrica negativa y función sistólica normal; 40 presentaban complicaciones microvasculares. Los valores de magnitud de variación cíclica fueron determinados a nivel del septum y la pared posterior. Los ecocardiogramas se realizaron con el equipo ALOKA 5500 con un transductor multibanda de 2.5 MHZ utilizando el programa beta de manejo digital (DMS) y el Power Doppler en vistas ecocardiográficas Resultados: Se obtuvo reducción de la variación cíclica en diabéticos respecto al grupo control a nivel del septum 2D (3.4 ±1.3 vs. 4.4 ± 0.4 dB; p<0.003) y pared posterior PP2D (3.4 ± 1.3 vs. 6.2 ± 0.4 dB; p< 0.000001). Se encontró correlación entre presencia de disfunción diastólica y magnitudes bajas de variación cíclica (p<0.001). La caracterización tisular fue más sensible para detectar cambios precoces del miocardio en pacientes diabéticos (p<0.001).Conclusiones: La diabetes mellitus es causa de miocardiopatías que originan alteraciones muy precoces en el miocardio de estos pacientes; estos cambios pueden ser descubiertos en fases muy tempranas por el Doppler pulsado detectando disfunción diastólica y la caracterización tisular por ultrasonidos. Esta última es más sensible para el diagnóstico de dicha entidad

Cardiac Tissue Characterization with Ultrasound and : a very early index of diabetic cardiomyopathy?

Introduction: There is an intrinsec myocardiopaty related with the diabetes and probably produced for the increment of collagen in the myocardium. Objective: To value the paper of the tissular myocardial characterization by ultrasound and the detection of diastolic dysfunction by pulsated Doppler as precocious indexes of diabetic miocardiopaty. Methods: Transverse, prospective,and controlled study that analyzed the diastolic function with pulsated Doppler in 60 diabetic patients and a control group of 15 healthy individuals; all with a normal pressure, with a negative ergometric test and normal systolic function; 40 presented microvascular complications. The securities of magnitude of recurrent variation were determined at the level of the septum and the posterior wall. The echocardiograms were carried out with the equipment ALOKA 5500 with a multiband transducer of 2.5 MHZ using the beta digital handling program (DMS) and the power Doppler in ecocardiografic views. Results: Reduction of the recurrent variation was obtained in diabetics with respect to the control group at the level of the septum 2D (3.4 ±1.3 vs. 4.4 ± 0.4 dB; p &lt; 0.003) and the posterior wall PP2D (3.4 ± 1.3 vs. 6.2 ± 0.4 dB; p &lt; 0.000001). Was found a correlation between the presence of diastolic dysfunction and the low magnitudes of ciclic variation (p &lt; 0.001). The tissular characterization was more sensitive to detect precocious changes of the myocardium in diabetic patients (p &lt; 0.001). Conclusions: The diabetes mellitus is cause of myocardiopaties that originate very precocious alterations in the myocardium of these patients; these changes can be discovered in very early phases by the pulsated Doppler detecting diastolic dysfunction and the tissular characterization by ultrasounds. This last one is more sensitive for the diagnosis of this entity.</p

Signo de McConnell en el diagnóstico ecocardiográfico del tromboembolismo pulmonar. A propósito de un caso.

Se presenta el caso de un paciente de 38 años de edad con disnea de súbita aparición. Sediagnostica tromboembolismo pulmonar sobre la base de los hallazgos ecocardiográficos, enparticular, por la presencia delsigno de Mc Connell. El diagnóstico se confirmó posteriormentemediante la tomografía multicortes

Sarcoma de vena cava inferior Sarcoma of the vena cava inferior

Se presentó un caso infrecuente de una paciente con tumor abdominal y gran circulación colateral superficial tipo cava-cava, el ultrasonido abdominal, el ecocardiograma trans-torácico y transesofágico y la tomografía axial computarizada identificaron un tumor de la vena cava inferior. La citología aspirativa con aguja fina de la lesión confirmó que se trataba de un sarcoma fusopleomórfico de alto grado de malignidad primario de la vena cava inferior.Authors present an infrequent case of a female patient with abdominal tumor a great superficial collateral circulation type cava-cava, the abdominal ultrasound, the transthoracic and transesophageal echocardiogram and the computerized axial tomography (CAT) identified a tumor of the vena cava inferior. The fine-needle aspiration cytology of lesion confirmed the presence of primary fusopleomorphous sarcoma of high degree of malignancy of vena cava inferior

Signo de Mc Connell en el diagnóstico ecocardiográfico del Tromboembolismo Pulmonar. A propósito de un caso. McConnell sign in the echocardiography diagnosis of the pulmonary embolism. Regarding a case.

The case of a 38 years old patient with sudden shortness of breath is presented. The diagnosisof Pulmonary Embolism was suggested by the echocardiogram, especially by Mc Connell’ssign. Shortly thereafter the condition was confirmed by computed tomography

Factores de riesgo, manifestaciones clínicas y tratamiento de la insuficiencia cardiaca en mayores de 65 años Risk factors, clinical manifestations and treatment of heart failure in over 65 years-old patients

Se realizó un estudio poblacional en 10 consultorios de médicos de familia seleccionados al azar para conocer la etiología, los síntomas, signos y el tratamiento de la insuficiencia cardiaca en pacientes mayores de 65 años. Se entrevistaron y examinaron 805 casos, se recogieron enfermedades previas, síntomas y signos, y tratamientos utilizados en ese momento. A los que tenían 2 síntomas y signos o más, se les realizó ecocardiograma y si existía disfunción sistólica y/o diastólica se consideraron casos positivos de insuficiencia cardiaca. Los principales factores etiológicos (solos o asociados) fueron hipertensión arterial 75,7 % y cardiopatía isquémica 61,3 %; la combinación de disnea de esfuerzo y edemas de miembros inferiores fue la más frecuente (54 %). Usaban diuréticos 55,1 %, inhibidores de la enzima convertidora de angiotensina 42,5 %, betabloqueadores 18,3 % y digoxina 43,6 %. La hipertensión arterial fue el principal factor etiológico. Hubo casos con insuficiencia cardiaca que estando ambulatorios, presentaron pocos síntomas. La mayoría no estaba recibiendo tratamiento adecuado.A population-based study was carried out in ten randomly selected family physician` offices in order to find out the etiology, symptoms, signs and treatment of heart failure in over 65 years-old patients. Eight hundred and five cases were surveyed and examined, data on previous diseases, symptoms, signs and therapies at that moment were collected. Those patients with two or more symptoms and signs underwent echocardiogram and in case of systolic and/or diastolic dysfunction, they were classified as heart failure cases. The main etiological factors (single or associated) were blood hypertension in 75,7 % of cases and ischemic cardiopathy in 61,3 %; the combination of effort dyspnea and swollen low limbers was the most common (54 %). Of the total number of patients, 55,1 % used diuretics; 42,5 % took angiotensin- converting enzyme inhibitors; 18,3 % used beta blockers whereas 43,6 % was prescribed Digoxin. Hypertension was the main etiological factor. There were cases of heart failure seen at outpatient service, but with few symptoms. Most of patients were not being properly treated