Trombosis aguda carotídea en el traumatismo penetrante: es necesaria la revascularización en el paciente sin déficit neurológico central? / Acute carotid thrombosis in penetrating traumatism: is revascularization necessary in the patient without central neurological deficit?

INTRODUCTION: Carotid lesions require priority in both evaluation and treatment due to their high morbidity and mortality. Controversy about therapeutic behavior in these patients with or without central neurological deficit is still under in discussion. OBJECTIVES: To present a patient with acute carotid thrombosis due to a shotgun wound and discuss its therapeutic behavior. SETTING: Hospital de Urgencias in Córdoba city. MATERIAL AND METHODS: A 15-year-old male patient is presented with a point-blank shotgun wound in the soft parts of the left cervical region, and a left carotid thrombosis with no central neurological deficit. RESULTS: Wound toilette and carotid revascularization by means of resection and venous by-pass with external carotid ligature was performed. The procedure was finished by delaging for plastic reconstruction of the cervical injury. Carotid postoperative angiographic control showed good permeability with no carotid flow alteration. CONCLUSION: Penetrating carotid injuries should be resolved, if technically possible, with revascularization of the carotid sector. This procedure has to be aborted if the patient is in coma or the lesion is difficult to repair, in such a case ligature should be carried out.

The utility of percutaneous fine-needle aspiration biopsy in the diagnosis of peripheral pulmonary lesions

A pulmonary lesion usually poses a diagnostic problem requiring a swift solution. Percutaneous fine-needle aspiration biopsy (NAB) technique yields a high percentage of correct diagnosis. However, this procedure is often underestimated and its indication vaguely known. Experience with 185 NAB in 175 patients is reviewed. One hundred and ten procedures were performed in hospitalized patients and 75 in an outpatient setting. Forty-four percent of cases in the whole series have had a previous negative fiberoptic bronchoscopy examination (FOB). Sixty-five percent were peripheral solitary pulmonary nodules, 54 percent of which were less than 2 cm lesions. The majority of NAB were performed under imaging guidance utilizing 20-23 gauge Chiba needles. High resolution fluoroscopic guidance was employed in 86 percent of cases, Computed Tomography (CT) in 11 percent and Ultrasonography in 3 percent. Specific cytologic diagnosis were obtained in 87 percent of the procedures done in hospitalized patients and 86.3 percent in ambulatory cases. In both groups, a 69 percent of neoplastic lesions were obttained. Post-biopsy pneumothorax was detected in 15 percent in each series. Only 3 patients in the whole series required the placement of a chest tube. To date, no needle tract seeding has been observed. A 9.3 percent and 10 percent of false negative results were recorded in both series, respectively. In this report, the complication rate is low and showed no statistical significant differences between the hospitalized and the outpatient groups. The latter resulted in less operative costs. Besides, TC guidance increases about 80 percent the operative expenses without offering a significant diagnostic yield. We conclude that NAB under fluoroscopic guidance in an outpatient basis is a reliable, safe, expeditious and cost effective diagnostic tool in small peripheral pulmonary lesions.

Nuestra experiencia en 4 casos de linfoma colónico / Malignaut lymphoma of the colon and rectum: 4 cases

Recogemos, en nuestra experiencia de tres años en el CEDIG, cuatro linfomas colónicos; tres de ellos en su expresión de linfoma multinodular de colon y uno de linfoma con afectación rectal. Dos casos de linfoma multinodular de colon y el rectal, fueron primarios. Los hallazgos característicos del linfoma multinodular fueron: 1) Nódulos submucosos, sésiles, de suave angulación con la pared, superficie lisa, sin erosiones ni umbilicación, con moderada indentación de sus bases en la observación tangencial, de variado tamaño, con un promedio de 8mm; con afectación de la totalidad del colon en dos de los tres casos, y sin pérdida de la distensibilidad parietal. 2) Masa cecal vegetante, mayor de 4cm, única, de superficie lisa, lobulada, con base amplia, sin ulceración mucosa, y ubicada sobre el borde mesentérico. Los linfomas localizados en ampolla rectal presentaron una imagen vegetante, grande, lobulada, de afectación circunferencial y cercana al esfínter anal. En el diagnóstico diferencial se incluyó: poliposis colónica, enfermedades inflamatorias, hiperplasia linfoidea, colitis pseudo membranosa, adenocarcinoma y SIDA

Duplicacion intestinal: informe de dos casos / Intestinal duplication: report of 2 cases

Las duplicaciones intestinales son infrecuentes y resultan de fallos embriológicos en la canalización normal del tubo digestivo. Este trabajo presenta un caso de duplicación intestinal en el ileon y su diagnóstico diferencial con el Divertículo de Meckel. A continuación se presenta un caso de duplicación de recto en un paciente de edad asintomático