ABSTRACT
The duplication of the gallbladder is a rare malformation, seen in one every 3.000 necropsies. It is detected preoperatively by abdominal ultrasound. We report a 28 years old female consulting for abdominal pain. An abdominal ultrasound showed the presence of cholelithiasis and a complete septum in the gallbladder lumen. During surgery, a distended and inflamed gallbladder was found with a septum that divided it in two parts, and one biliary stone. There was also a double cystic duct. The pathological study confirmed the gallbladder duplication with inflammation.
La patología de la vesícula biliar (VB) ocupa un lugar importante en nuestro país. Las anomalías congénitas más frecuentes incluyen alteraciones en los conductos biliares, arteria cística e infrecuentemente duplicaciones de la VB, con una incidencia de 1 en 3.000-4.000 autopsias. Esta anomalía congénita puede ser detectada preoperatoriamente por estudios imagenológicos, principalmente ecotomografía, siendo en el pasado un hallazgo quirúrgico. El diagnóstico diferencial de la duplicación vesicular incluye la vesícula con fondo plegado o gorro frigio, divertículos vesiculares, quistes de las vías biliares extra-hepáticas y la vesícula bilobulada o septada. Comunicamos el caso de una duplicación vesicular de tipo Y, en una mujer con diagnóstico ecotomográfico, la cual fue operada de forma clásica.
Subject(s)
Humans , Adult , Female , Cholelithiasis/surgery , Cholelithiasis , Gallbladder/abnormalities , Gallbladder/surgery , Gallbladder , CholecystectomyABSTRACT
Background: Mechanical ventilation may contribute to lung injury and then enhance systemic inflammation. Optimal ventilatory parameters such as tidal volume (V T) and positive end expiratory pressure (PEEP) can be determined using different methods. Low flow pressure volume (P/V-LF) curve is a useful tool to assess the respiratory system mechanics and set ventilatory parameters. Aim: To set V T and PEEP according P/V-LF curve analysis and evaluate its effects on gas exchange and hemodynamic parameters. Materials and methods: Twenty seven patients underwent P/V-LF within the first 72 hours of acute lung injury/acute respiratory distress syndrome (ALI/ARDS). P/V-LF curves were obtained from the ventilator and both lower and upper inflexion points determined. Gas exchange and hemodynamic parameters were measured before and after modifying ventilator settings guided by P/V-LF curves. Results: Ventilatory parameters set according P/V-LF curve, led to a rise of PEEP and reduction of V T: 11.6±2.8 to 14.1±2.1 cm H2O, and 9.7±2.4 to 8.8±2.2 mL/kg (p <0.01). Arterial to inspired oxygen fraction ratio increased from 158.0±66 to 188.5±68.5 (p <0.01), and oxygenation index was reduced, 13.7±8.2 to 12.3±7.2 (p <0.05). Cardiac output and oxygen delivery index (IDO2) were not modified. Demographic data, gas exchange improvement and respiratory system mechanics showed no significant difference between patients with extra-pulmonary and pulmonary ALI/ARDS. There was no evidence of significant adverse events related with this technique. Conclusion: P/V-LF curves information allowed us to adjust ventilatory parameters and optimize gas exchange without detrimental effects on oxygen delivery in mechanically ventilated ALI/ARDS patients.