Síndrome de Mirizzi, complicación inusual de la colelitiasis / Mirizzi Syndrome, a Rare Complication of Cholelithiasis

Introducción: El síndrome de Mirizzi es una entidad clínica rara y difícil de tratar; sin embargo, los avances tecnológicos recientes han brindado a los cirujanos nuevas opciones para un diagnóstico y tratamiento más efectivos de esta afección. Objetivo: Presentar el caso de síndrome de Mirizzi, complicación inusual de la colelitiasis. Presentación del caso: Se presenta una paciente femenina, de 56 años de edad, que acude a nuestra institución por presentar ictericia intermitente, dolor en el hipocondrio derecho, coluria y acolia. Conclusiones: El síndrome de Mirizzi, complicación de la colelitiasis, es una entidad poco frecuente, de difícil diagnóstico preoperatorio, por lo que en un gran porcentaje de los casos se diagnostica intraoperatoriamente. Su tratamiento es quirúrgico(AU)

Introduction: Mirizzi syndrome is a rare condition, difficult to treat; however, recent technological advances have provided surgeons with new options for diagnosing and treating this condition more effectively. Objective: To present a case of Mirizzi syndrome, an unusual complication of cholelithiasis. Case presentation: The case is presented of a 56-year-old female patient, who comes to our institution with intermittent jaundice, right hypochondrium pain, choluria and acholia. Conclusions: Mirizzi syndrome, a complication of cholelithiasis, is a rare entity, difficult to diagnose preoperatively; therefore, a large percentage of it's cases are diagnosed intraoperatively. Its treatment is surgical(AU)

Associations of cholecystectomy with the risk of colorectal cancer: a Mendelian randomization study / 中华医学杂志(英文版)

BACKGROUND@#Cholecystectomy is a standard surgery for patients suffering from gallbladder diseases, while the causal effects of cholecystectomy on colorectal cancer (CRC) and other complications are still unknown.@*METHODS@#We obtained genetic variants associated with cholecystectomy at a genome-wide significant level ( P value <5 × 10 -8 ) as instrumental variables (IVs) and performed Mendelian randomization (MR) to identify the complications of cholecystectomy. Furthermore, the cholelithiasis was also treated as the exposure to compare its causal effects to those of cholecystectomy, and multivariable MR analysis was carried out to judge whether the effect of cholecystectomy was independent of cholelithiasis. The study was reported based on Strengthening the Reporting of Observational Studies in Epidemiology Using Mendelian Randomization guidelines.@*RESULTS@#The selected IVs explained 1.76% variance of cholecystectomy. Our MR analysis suggested that cholecystectomy cannot elevate the risk of CRC (odds ratio [OR] =1.543, 95% confidence interval [CI]: 0.607-3.924). Also, it was not significant in either colon or rectum cancer. Intriguingly, cholecystectomy might decrease the risk of Crohn's disease (OR = 0.078, 95% CI: 0.016-0.368) and coronary heart disease (OR = 0.352, 95% CI: 0.164-0.756). However, it might increase the risk of irritable bowel syndrome (IBS) (OR = 7.573, 95% CI: 1.096-52.318). Cholelithiasis could increase the risk of CRC in the largest population (OR = 1.041, 95% CI: 1.010-1.073). The multivariable MR analysis suggested that genetic liability to cholelithiasis could increase the risk of CRC in the largest population (OR = 1.061, 95% CI: 1.002-1.125) after adjustment of cholecystectomy.@*CONCLUSIONS@#The study indicated that cholecystectomy might not increase the risk of CRC, but such a conclusion needs further proving by clinical equivalence. Additionally, it might increase the risk of IBS, which should be paid attention to in clinical practice.

Incidencia de factores de riesgo para desarrollo de litiasis vesicular en pacientes menores de 40 años colecistectomizados en el hospital Dr. Ricardo Baquero González. Periodo enero 2019- diciembre 2021. Estudio retrospectivo / Risk factors for the development of vesicular lithiasis in patients under 40 years old cholecystectomy at Hospital Dr. Ricardo Baquero González. Period january 2019-december 2021. Retrospective study

El objetivo de la investigación es analizar la incidencia de los factores de riesgo para el desarrollo de colelitiasis en pacientes menores de 40 años colecistectomizados en el Hospital Ricardo Baquero González. Periodo enero 2019 ­ diciembre 2021.Método: Se realizó un estudio retrospectivo; se analizaron los datos de los de los pacientes diagnosticados e intervenidos por litiasis vesicular. Resultados: Arrojaron que la muestra fue de 151 pacientes; 70% es de sexo femenino y el 30% masculino. El 41% de los pacientes tiene menos de 40 años. En los factores de riesgo se destaca que el 42% son del tipo familiar, el 40% de las mujeres utiliza anticonceptivos orales y el 40% de los pacientes presenta sobrepeso. Conclusión: Se concluye que los casos de litiasis vesicular se encuentran asociados de forma mayoritaria al sexo femenino y a factores de riesgos familiares y al sobrepeso; en cuanto a las mujeres, hubo alta incidencia de casos de litiasis vesicular en aquellas que emplean anticonceptivos orales. Además, en la investigación se observó un aumento en los casos de litiasis vesicular en pacientes que no se encuentran dentro de los grupos de riesgo, como son mujeres menores de 40 años, con peso normal y con pocas gestas(AU)

he objective of the research is to analyze the incidence of risk factors for the development of cholelithiasis in patients under 40 years of age who underwent cholecystectomy at the Ricardo Baquero González Hospital. Period January 2019 - December 2021.Methodi: retrospective study was carried out; Data from patients diagnosed and operated on for gallstones were analyzed. Results: showed that the sample was 151 patients; 70% are female and 30% male. 41% of patients have an age under 40 years old. In the risk factors, it is highlighted that 42% are of the family type, 40% of the women in the sample use oral contraceptives and 40% of the patients are overweight. Concluded: From the investigation it is concluded that the cases of vesicular lithiasis are mostly associated with the female sex and family risk factors and overweight; As for women, there was a high incidence of cases of gallstones in those who use oral contraceptives. In addition, the investigation observed an increase in cases of gallstones in patients who are not within the risk(AU)

Colelitíase sintomática como apresentação de colangite esclerosante primária na infância - série de casos e revisão de literatura / Symptomatic cholelithiasis as the presentation of pediatric primary sclerosing cholangitis - case series and literature review

ABSTRACT BACKGROUND: Primary sclerosing cholangitis (PSC) is a rare hepatobiliary disorder, whose etiology remains not fully elucidated. Given how rare PSC is in childhood, until the recent publication of a multicenter international collaboration, even data on its characteristics and natural history were scarce. Symptomatic cholelithiasis has not been previously reported as the presentation of PSC. OBJECTIVE: The aim of this study was the diagnosis of PSC following the initial unusual presentation with symptomatic cholelithiasis, that followed an atypical clinical course that could not be explained by cholelithiasis alone. A literature review was also conducted. METHODS: We conducted a retrospective chart review of three patients, who were diagnosed and/or followed at the Clinics Hospital, University of Campinas - Sao Paulo/ Brazil, between 2014 and 2020. Data analyzed included gender, age of presentation, past medical history, imaging findings, laboratory results, endoscopic evaluation, response to medical therapy and follow-up. RESULTS: Age at time of presentation with cholelithiasis varied from 10 to 12 years. In two of the cases reported, a more subacute onset of symptoms preceded the episode of cholelithiasis. Two patients were managed with cholecystectomy, not followed by any surgical complications, one patient was managed conservatively. Percutaneous liver biopsy was performed in all three cases, showing histological findings compatible with PSC. Associated inflammatory bowel disease (IBD) was not seen in any of the patients. The patients have been followed for a mean time of 3.4 years. CONCLUSION: PSC and cholelithiasis are both rare in the pediatric population. This study reports on symptomatic cholelithiasis as a presentation of PSC and raises the importance of suspecting an underlying hepatobiliary disorder in children with cholelithiasis without any known predisposing factors and/or that follow an atypical clinical course for cholelithiasis alone.

RESUMO CONTEXTO: A colangite esclerosante primária (CEP) é uma doença hepatobiliar rara, cuja etiologia ainda não está totalmente elucidada. Dada a raridade do CEP na infância, até a recente publicação de uma colaboração multicêntrica internacional, mesmo dados sobre suas características e história natural eram escassos. A colelitíase sintomática não foi relatada anteriormente como a apresentação inicial de CEP na infância. OBJETIVO: O objetivo deste estudo foi o diagnóstico de CEP após a apresentação inicial incomum com colelitíase sintomática, que seguiu um curso clínico atípico que não poderia ser explicado apenas pela colelitíase. Também foi realizada uma revisão da literatura. MÉTODOS: Foi realizada uma revisão retrospectiva dos prontuários de três pacientes, que foram diagnosticados e/ou acompanhados no Hospital das Clínicas da Universidade Estadual de Campinas - São Paulo / Brasil, entre 2014 e 2020. Os dados analisados incluíram sexo, idade de apresentação, história médica pregressa, achados de imagem, resultados laboratoriais, avaliação endoscópica, resposta à terapia médica e acompanhamento. RESULTADOS: A idade no momento da apresentação da colelitíase variou de 10 a 12 anos. Em dois dos casos relatados, um início mais subagudo dos sintomas precedeu o episódio de colelitíase. Dois pacientes foram tratados com colecistectomia, não seguida de qualquer complicação cirúrgica, e um paciente foi tratado de forma conservadora. Biópsia hepática percutânea foi realizada em todos os três casos, mostrando achados histológicos compatíveis com CEP. Doença inflamatória intestinal associada não foi observada em nenhum dos pacientes. Os pacientes foram acompanhados por um tempo médio de 3,4 anos. CONCLUSÃO: CEP e colelitíase são raras na população pediátrica. Este estudo relata a colelitíase sintomática como uma apresentação de CEP e levanta a importância da suspeita de doença hepatobiliar subjacente em crianças com colelitíase sem quaisquer fatores predisponentes conhecidos e/ou que seguem um curso clínico atípico.

Obstruccion intestinal por Íleo biliar: reporte de un caso / Biliary Ileus intestinal obstruction. a case report

El ileo biliar es una rara complicación de la colelitiasis no tratada. Presentamos el cuadro clínico y el manejo de un paciente masculino de 72 años (AU)

The biliary or Gallstone ileus is a rare complication of the non-treated Cholelithiasis. We present the clinical features and the treatment of a 72 years old patient

Íleo biliar, una causa poco frecuente de oclusión intestinal / Gallstone Ileus, A Rare Cause of Intestinal Occlusion

RESUMEN Introducción: El íleo biliar representa el 4 por ciento de las causas de obstrucción intestinal en la población general. Objetivo: Mostrar un paciente con cuadro de oclusión intestinal por íleo biliar que fue diagnosticado y tratado en el transoperatorio. Caso clínico: Paciente de 78 años de edad con un cuadro oclusivo por un íleo biliar, al cual se le realizó enterolitotomía como tratamiento definitivo. Conclusiones: El íleo biliar es una causa de oclusión intestinal que todo cirujano general debe tener presente ante un anciano con elementos clínicos e imaginológicos de oclusión y sin intervenciones quirúrgicas previas o hernias de la pared abdominal(AU)

ABSTRACT Introduction: Gallstone ileus represents 4 percent of the causes of intestinal obstruction in the general population. Objective: To present a patient with intestinal obstruction due to gallstone ileus and who was diagnosed and treated during the intraoperative period. Clinical case: The is presented of a 78-year-old patient with an occlusive condition due to gallstone ileus, who underwent enterolithotomy as definitive management procedure. Conclusions: Gallstone ileus is a cause of intestinal occlusion that every general surgeon should be aware of in the presence of an elderly with clinical and imaging elements of occlusion and without previous surgical interventions or hernias of the abdominal wall(AU)

Alterações histológicas da vesícula biliar de doentes submetidos à colecistectomia por colelitíase / Gallbladder histological alterations in patients undergoing cholecystectomy for cholelithiasis

RESUMO Objetivo: descrever os achados histológicos das vesículas biliares de pacientes submetidos à colecistectomia e avaliar a presença de fatores associados ao câncer incidental da vesícula. Métodos: estudo descritivo, transversal e observacional de 1.278 exames anatomopatológicos de vesículas biliares oriundas de colecistectomias por colelitíase e de seus respectivos laudos, realizadas no período de janeiro de 2008 a dezembro de 2017. Resultados: o achado anatomopatológico mais frequente foi a colecistite crônica, presente em 1.251 pacientes (97,8%), seguido pela colesterolose em 131 (10,2%). O câncer de vesícula foi identificado em seis pacientes, com prevalência de 0,5% nesta amostra. Houve associação significativa entre a presença de câncer e idade ≥60 anos e com a espessura da parede ≥0,3cm. Conclusão: houve baixa prevalência de câncer de vesícula na população avaliada, maior ocorrência na população idosa e associação de tumor com espessamento da parede vesicular.

ABSTRACT Objective: to describe the histological findings of the gallbladders of patients undergoing cholecystectomy and to evaluate the presence of factors associated with gallbladder incidental cancer. Methods: we conducted a descriptive, cross-sectional, observational study with 1,278 histopathological exams of gallbladders coming from cholecystectomy for cholelithiasis and of their reports, held from January 2008 to December 2017. Results: the most common pathological finding was chronic cholecystitis, present in 1,251 patients (97.8%), followed by gallbladder cholesterolosis, in 131 (10.2%). Gallbladder cancer was identified in six patients, with a prevalence of 0.5% in this sample. There was a significant association between the presence of cancer and age ≥60 years and wall thickness ≥0.3cm. Conclusion: there was low prevalence of gallbladder cancer in this population, higher occurrence in the elderly and association of the tumor with gallbladder wall thickness.

An elderly man with gastric cancer, Saint's triad and Heyde's syndrome / Un anciano con cáncer gástrico, tríada de Saint y síndrome de Heyde

This case study describes a 71-year-old man with signet-ring cell gastric adenocarcinoma and malignant sigmoidal polyp; and typical features of Saint's triad and Heyde syndrome. He had digestive bleeding, two types of hernia, diverticulosis, arterial hypertension, malignant polyp, and antecedent of smoking, lung tuberculosis, and surgical correction of aortic valve stenosis. There is a hypothetical inverse relationship between herniosis and development of malignancy; however, the patient herein described presented gastric and sigmoidal cancers. Gastrointestinal malignancies are sometimes associated with paraneoplastic entities, isolated or manifested as syndromes, but neither Saint's triad or Heyde syndrome have been included. This patient persisted clinically stable during the preoperative period, but suddenly died; Trousseau's syndrome would be the most probable mechanism of sudden death in this setting. Case reports can stimulate further studies to get additional knowledge about unusual entities.

Este estudio de caso describe un hombre de 71 años de edad, con adenocarcinoma gástrico con células en anillo de sello y un pólipo maligno sigmoideo; y características típicas de la tríada de Saint y del síndrome de Heyde. Tuvo una hemorragia digestiva, dos tipos de hernias, divertículos, hipertensión arterial, y pólipo maligno; con antecedente de tabaquismo, tuberculosis pulmonar, y corrección quirúrgica de estenosis de la válvula aórtica. Hay una hipotética relación inversa entre hernioses y el desarrollo de malignidades; sin embargo, el paciente que se describe en el presente documento presentó cánceres gástrico y sigmoideo. Neoplasias gastrointestinales se asocian a veces con entidades para neoplásicas aisladas o manifiestan síndromes, pero ni la tríada de Saint ni el síndrome de Heyde se ha incluido. Este paciente persistió clínicamente estable durante el período preoperatorio, pero de repente murió; síndrome de Trousseau sería el mecanismo más probable de muerte súbita en esta situación. Los informes de casos pueden estimular más estudios para obtener un conocimiento adicional sobre esas entidades inusuales.

Colelitiasis en pacientes obesos sometidos a cirugía bariátrica: estudio y seguimiento postoperatorio a 12 meses / Cholelithiasis in obese patients undergoing bariatric surgery: 12-month postoperatively study and monitoring

Introducción: Chile se caracteriza por ser uno de los países con mayor prevalencia de patología biliar en el mundo. Dentro de los factores de riesgo de la patología biliar se encuentran el sexo femenino, la edad, el sobrepeso y la obesidad. Estos factores asociados a la disminución rápida de peso son característicos de los pacientes obesos sometidos a cirugía bariátrica. Se ha reportado que los pacientes sometidos a esta cirugía tienen una alta incidencia de colelitiasis a 12 meses postoperatorio. Objetivos: Determinar la prevalencia de patología biliar en pacientes obesos sometidos a cirugía bariátrica, y analizar la aparición de esta patología durante el seguimiento postoperatorio a un año. Material y método: Serie de casos retrospectiva, incluyendo 221 pacientes sometidos a cirugía bariátrica, con seguimiento a 12 meses. Se realizó revisión de registros clínicos, consignando peso y ecografía abdominal en el control al año. Resultados: Un 18,09% de los pacientes tenía antecedentes de colecistectomía previa. Un 13,57% de los pacientes presentaba colelitiasis en el preoperatorio y se realizó colecistectomía de forma concomitante en todos ellos. Se realizó seguimiento a un año en 151 pacientes. En las ecografías al año, un 3,54% presentaba colelitiasis. Conclusiones: Existe una elevada prevalencia de colelitiasis en la población sometida a cirugía bariátrica. La aparición de esta patología en el primer año fue menor a la reportada en la literatura. Se debe considerar un seguimiento cercano para la detección de esta patología durante el primer año postoperatorio.

Introduction: Chile is known for being one of the countries with higher prevalence of gallstone disease in the world. Among the risk factors for biliary pathology are female gender, age, overweight and obesity. These factors associated with rapid weight loss are characteristic of obese patients undergoing bariatric surgery. It has been reported that patients undergoing these surgeries have a high incidence of cholelithiasis to 12 months postoperatively. Objectives: To determine the prevalence of gallstone disease in obese patients undergoing bariatric surgery, and analyze the occurrence of this disease during the postoperative follow-up up to 12 months. Material and methods: Retrospective case series including 221 patients undergoing bariatric surgery, with follow-up up to 12 months. Review of clinical records and abdominal ultrasound was conducted. Results: A 18.09% of patients had a history of previous cholecystectomy. A 13.57% of patients had preoperative cholelithiasis and a concomitant cholecystectomy was performed in all of them. Follow up was conducted in 151 patients. In ultrasound examinations at one year, 3.54% had cholelithiasis. Conclusions: There is a high prevalence of cholelithiasis in the population undergoing bariatric surgery. The emergence of this disease in the first year was lower than that reported in the literature. Patients should be closely monitored for the detection of this disease during the first postoperative year.

Íleo biliar: reporte de un caso de fístula colecistoduodenal asociada a hernia inguinal izquierda / Gallstone ileus: a case report of cholecystoduodenal fistula associated with leftinguinal hernia

Biliary ileus, first described byThomas Bartholin in the year1654, is a rare cause of mechanical ileus (small bowel obstruction) (1-3% in patients younger than 65 years), increasing significantly from that age (25%). The necessarycondition forthis pathologyis the presence ofa fistula between the gallbladderandthe gastrointestinaltract. Simple abdominal X-ray and ultrasonography are widely available and of relatively low cost, together presenting a sensitivity of 74% when they show the classic signs of Rigler’s triad (pneumobilia, ectopic gallstone and dilated loops of small intestine), but computed tomography of the abdomen is considered the gold standard, with a sensitivity and specificity higher than 90%. The aim of this article is to present a case of radiological diagnosis of biliary ileus in a patient with vesicular lithiasis + cholecystoduodenal fistula, associated with inguinal hernia on the left.

El íleo biliar, descrito por primera vez por Thomas Bartholin en el año 1654, constituye una causa poco frecuente de íleo mecánico (1-3% en menores de 65 años) aumentando significativamente a partir de esa edad (25%). La condición necesaria para esta patología es la presencia de una fístula entre la vesícula biliar y el tracto gastrointestinal. La radiografía simple de abdomen y la ecografía son de amplia disponibilidad y coste relativamente bajo, presentando en conjunto una sensibilidad del 74% cuando manifiestan los signos clásicos de la tríada de Rigler (neumobilia, lito biliar ectópico y dilatación de asas de intestino delgado), pero se considera que la tomografía computada de abdomen es el gold standard, con una sensibilidad y especificidad superiores al 90%. El objetivo de este artículo es presentar un caso de diagnóstico radiológico de íleo biliar en un paciente con litiasis vesicular + fístula colecistoduodenal asociadas a hernia inguinal izquierda.

Agenesia de vesícula biliar: presentación de caso y revisión de la literatura / Gallbladder agenesis: case report and a literature review

La agenesia de vesícula biliar es una enfermedad rara cuya sintomatología emula patología biliar. Está presente entre el 0,007 al 0,027% de aquellos en quienes se practica una colecistectomía. Luego de la misma, su evolución es asintomática. Se presenta el caso de una paciente femenina de 19 años con cuadro clínico compatible con colelitiasis. La ecografía revela vesícula escleroatrófica. Se realizó colecistectomía electiva, sin hallarse vesícula biliar. Tanto en el posoperatorio, como en el seguimiento anual, el curso fue asintomático. Además, se realizó una revisión de casos a partir de publicaciones de casos clínicos obtenidos de Medline. Catorce pacientes fueron incluidos en la revisión de casos, comparándose con otros cinco estudiados en una serie de casos. No existió diferencia significativa entre ambos grupos. La agenesia de vesícula biliar se presenta comúnmente entre los 40 y 64 años, con dolor en cuadrante superior derecho y diagnóstico ecográfico de colelitiasis. Es poco probable llegar a un diagnóstico preoperatorio. De intervenirse, es preferible limitarse a la exploración laparoscópica. La evolución ulterior será asintomática, sin estar claro aún el por qué.

Gallbladder agenesis is a rare disease, which its symptomatology emulates biliary pathology. It is presented between 0.007 to 0.027% of those patients in whom a cholecystectomy is performed. After it, its evolution is asymptomatic. We present the case of a 19 years old female patient with clinical presentationof cholelithiasis. Ultrasound reveals scleroatrophic vesicle. Elective cholecystectomy was performed,but the gallbladder was not found. The patient presented an asymptomatic evolution in the postoperative period and in the annual follow-up. In addition, we performed a case review from clinical case reports obtained from Medline. Fourteen patients were included in the review of cases, compared to another five studied in a series of cases. There was no significant difference between the two groups. Gallbladder agenesis usually happens between 40 and 64 years, with pain in the upper right quadrant and ultrasound diagnosis of cholelithiasis. It is unlikely to reach a preoperative diagnosis. If it is intervened, it is preferable to limit to laparoscopic examination. The following evolution will be asymptomatic, althoughthe cause of it is not known yet.

Complicaciones tardías en cirugía bariátrica / Late complications in bariatric surgery

La cirugía bariátrica denota complejidad y no está libre de complicaciones. Estas son de causa multfactorial y dependen de factores intrínsecos delpaciente o bien de habilidades técnicas y experiencia del cirujano. En general cualquier complicación puede catalogarse como temprana (< 30 días) otardía (> 30 días) según el tempo de aparición luego de la cirugía.La banda gástrica es uno de los procedimientos bariátricos mas realizados pero con un alto índice de complicaciones, entre las tardías destacan deslizamiento,migración y problemas del reservorio. El Bypass gástrico contnua teniendo mucha fabilidad en cuanto a control de la obesidad pero presentacomplicaciones como las hernias internas, estenosis y úlceras de anastomosis, y fstulas gastro gástricas entre otras, cuyo diagnóstco y manejo precozes importante.La gastrectomía vertcal en manga ha ganado terreno en los últmos años por sus buenos resultados pero también por su baja tasa de complicaciones amediano y largo plazo, dentro de sus problemas tardíos descritos están estenosis, dilatación gástrica y cierta relación con aparición o exacerbación derefujo gastroesofágico. Otro procedimiento bariátrico poco utlizado en la actualidad es la derivación biliopancreátca por su múltples complicacionestardías.La colelitasis es un problema comúnmente documentado luego de cirugía bariátrica en tasas de 30 a 52%, cuya resolución quirúrgica es importantepara evitar complicaciones mayores.

Bariatric surgery denotes complexity and is not free of complicatons. These are multfactorial and depend on intrinsic patent factors or technical skillsand experience of the surgeon. In general any complicatons can be classifed as early (<30 days) or late (> 30 days) as the tme of onset afer surgery.Gastric banding is one of the most performed bariatric procedures but with a high rate of complicatons; late complicatons as slipping, migraton andreservoir problems have been documented. Gastric bypass contnues to have much reliability as to control obesity but has complicatons such as internalhernias, anastomotc strictures and ulcers and gastro gastric fstulas among others, whose diagnosis and early management is important.Sleeve gastrectomy gained ground in recent years for its good results but also for its low complicaton rate in the medium and long term. The lateproblems described are stenosis, gastric dilataton and some relaton to onset or exacerbaton of gastro esophageal refux. Another bariatric procedureused actually is the biliopancreatc diversion but for his multple late complicatons it is less performed.Cholelithiasis is a problem commonly documented afer bariatric surgery rates from 30 to 52%, the surgical resoluton is important to prevent furthercomplicatons.

Idosos em situação de rua ou vulnerabilidade social: facilidades e dificuldades no uso de ferramentas computacionais / Elderlies in street situation or social vulnerability: facilities and difficulties in the use of computational tools / Ancianos en situación de calle o vulnerabilidad social: facilidades y dificultades en el uso de herramientas computacionales

Este estudo teve por objetivo identificar as facilidades e dificuldades encontradas por idosos em situação de rua ou vulnerabilidade social, no uso do computador ou internet. É uma pesquisa qualitativa do tipo exploratório, de que participaram cinco idosos assistidos em uma Organização não Governamental situada na cidade de São Paulo. Os discursos foram analisados pela Técnica de Análise de Conteúdo e evidenciaram como facilidades, dentre outras, esclarecer dúvidas com os monitores, o estímulo para novas descobertas aliada a proatividade e curiosidade, desenvolvimento de novas habilidades. As dificuldades estavam relacionadas a questões físicas ou cognitivas, à falta de instrutor e de conhecimento para interagir com a máquina. Os estudos voltados para a população idosa em situação de rua ou vulnerabilidade social podem contribuir com evidências que direcionem a formulação de políticas públicas voltadas para essa parcela da população.

This study aimed to identify the advantages and difficulties encountered by older people living on the streets or social vulnerability, to use the computer or internet. It is an exploratory qualitative research, in which five elderlies, attended on a non-governmental organization located in the city of São Paulo, have participated. The discourses were analyzed by content analysis technique and showed, as facilities, among others, to clarify doubts with the monitors, the stimulus for new discoveries coupled with proactivity and curiosity, and develop new skills. The mentioned difficulties were related to physical or cognitive issues, lack of instructor, and lack of knowledge to interact with the machine. The studies focusing on the elderly population living on the streets or in social vulnerability may contribute with evidence to guide the formulation of public policies to this population.

Este estudio tuvo como objetivo identificar las facilidades y dificultades encontradas por las personas mayores en situación de calle o vulnerabilidad social, en el uso de computadores o internet. Se trata de una investigación cualitativa exploratoria, a la que asistieron cinco personas mayores, asistidos en una Organización no Gubernamental ubicada en la ciudad de São Paulo. Los discursos fueron analizados por la técnica de análisis de contenido y evidencian como facilidades, entre otras cosas, aclarar dudas con los monitores, el estímulo para nuevas descubiertas asociadas a la pro actividad y curiosidad y al desarrollo de nuevas habilidades. Las dificultades se relacionaban con cuestiones físicas o cognitivas, a la falta de instructor y falta de conocimiento para interactuar con la máquina. Los estudios direccionados para la población anciana en situación de calle o vulnerabilidad social pueden contribuir con evidencias que direccionen la formulación de políticas públicas en beneficio de esa parcela de la población.

Acute Biliary Pancreatitis: A Case Report.

Acute biliary pancreatitis (ABP) a condition caused by gallstones; can be a life-threatening condition if not treated early (mortality ~2-7%). Complications and symptoms of ABP can be ranging from mild (nausea, vomiting, and fever) to severe (necrosis, infections, hemorrhage, abscesses, renal failure, and adult respiratory distress syndrome). Th is paper presents a specifi c case of a middle-aged male diagnosed with ABP to illustrate the disease in a clinical setting, mainly looking at its presentation, diagnosis and focusing more on treatment and management. Clinical examinations and radiological investigations are crucial to recognize the diagnosis and foresee the prognosis of this condition. Th e medications that are administered to patients suff ering from this condition include analgesics (like morphine), intravenous fl uids, and antibiotics (e.g. ciprofl oxacin). Th e limitations and lack of knowledge described above are immense concerns. It is highly encouraged that future research opportunities will compensate for the present gap in knowledge, contributing to current literature, as well as having practical implications for treatment and management of ABP.

Cholelithiasis in obese adolescents treated at an outpatient clinic / Litíase biliar em adolescentes obesos atendidos em ambulatório

OBJECTIVE: to describe the frequency and the factors associated with cholelithiasis in obese adolescents. METHODS: this was a cross-sectional descriptive study performed with the adolescents between 10 and 19 years of age treated at the Child and Adolescent Obesity Outpatient Clinic from May to December of 2011. Obesity was defined as body mass index (BMI) > P97, and overweight as BMI > P85, for age and gender, according to the 2007 World Health Organization reference. A questionnaire concerning the presence of signs and symptoms, such as abdominal pain, nausea, vomiting, and intolerance to fat, was administered. Patients were asked about how many kilograms they had lost and in how much time. Laboratory parameters were: triglycerides, total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels. Cholelithiasis and hepatic steatosis were diagnosed by ultrasonography. RESULTS: cholelithiasis was diagnosed in 6.1% (4/66) of the obese adolescents, most of whom were female (3/4); hepatic steatosis was identified in 21.2% (14/66). Intolerance to dietary fat was reported by all patients with cholelithiasis (4/4) and by 17.7% (11/62) of the group without cholelithiasis (p = 0.001). The average weight loss was 6.0 ± 2.9 kg in the patients with cholelithiasis and 3.2 ± 4.8 kg in the group without cholelithiasis (p = 0.04). However, there was no difference between the two groups regarding the time of weight loss (p = 0.11). CONCLUSIONS: cholelithiasis and hepatic steatosis are frequent among obese adolescents and should be investigated systematically in the presence or absence of symptoms. .

OBJETIVO: descrever a frequência e os fatores associados à litíase biliar em adolescentes obesos. MÉTODOS: estudo descritivo tipo corte transversal com adolescentes entre 10 e 19 anos atendidos em ambulatório de obesidade infanto-juvenil, no período de maio a dezembro de 2011. A obesidade foi definida como índice de massa corporal > P97 e o sobrepeso > P85, para idade e sexo, segundo o referencial OMS 2007. Foi aplicado um questionário com dados relacionados à presença de sinais e sintomas, como: dor abdominal, náusea, vômito e intolerância à gordura. Os pacientes foram questionados sobre quantos quilos perderam e em quanto tempo. As variáveis laboratoriais foram: triglicerídeos, colesterol total, lipoproteína de alta densidade (HDL) e lipoproteína de baixa densidade (LDL), aspartato aminotransferase (AST) e alanina aminotransferase (ALT). A litíase biliar e a esteatose hepática foram diagnosticadas por ultrassonografia. RESULTADOS: a litíase biliar foi diagnosticada em 6,1% (4/66) dos adolescentes obesos, a maioria do sexo feminino (3/4); a esteatose hepática foi identificada em 21,2% (14/66). Intolerância à gordura da dieta foi referida por todos os portadores de litíase biliar (4/4) e por 17,7% (11/62) do grupo sem litíase biliar (0,001). A média de perda de peso foi de 6,0 ± 2,9 kg nos pacientes com litíase biliar e 3,2 ± 4,8 kg no grupo sem litíase biliar (p = 0,04). Porém, em relação ao tempo de perda não houve diferença entre os dois grupos (p = 0,11). CONCLUSÕES: a litíase biliar e a esteatose hepática são frequentes entre adolescentes obesos e devem ser investigadas sistematicamente na presença ou ausência de sintomas. .

Intervenciones de enfermería en la atención del adulto con colelitiasis y colecistitis crónica agudizada / Interventions Nursing Care Adult Chronic cholecystitis with cholelithiasis erxacerbated

Introducción. Los trastornos de la vía biliar afectan una proporción importante de la población mundial; más del 95% son atribuibles a la colecistitis aguda. La principal manifestación es el dolor agudo abdominal por lo que el 50% de los pacientes han tenido este síntoma al menos 48 horas antes de su ingreso.Método. Se realizaron cuatro búsquedas sistematizadas de información donde arrojo meta análisis, ensayos clínicos aleatorizados y/o estudios de cohorte publicados que dieron respuesta a las preguntas planteadas, de los cuales se seleccionaran las fuentes con mayor puntaje obtenido, en la evaluación de su metodología, las de mayor nivel en cuanto a gradación de evidencias y recomendaciones.Resultado. El signo de Murphy positivo en la colecistitis presenta una sensibilidad del 97%; el 95% de la colecistitis se asocia con la colelitiasis y aumenta riesgo de complicaciones, la Escala Visual Análoga (EVA) permite establecer una base de control y alivio del dolor y del 1 al 3% de las mujeres embarazadas presentan litios vesiculares.Conclusión. La colecistitis aguda ocurre entre los 30 y 80 años, siendo más frecuente en mujeres, es de importancia la valoración de los signos y síntomas, además de identificar complicaciones secundarias con la finalidad que el personal de enfermería elabore un plan de cuidados especifico ante los problemas reales del paciente, contemplando intervenciones en la ministración de medicamentos, preparación quirúrgica garantizando la seguridad del paciente y cuidados postquirúrgicos para minimizar factores de riesgo de infección y las recomendaciones del autocuidado para su egreso.

Introduction. The biliary disorders affect a significant proportion of the world population; more than 95% are attributable to acute cholecystitis. The main manifestation is abdominal pain so sharp 50% of patients have this symptom at least 48 hours before admission.Method. Four systematized information searches were performed which threw meta-analysis, randomized clinical trials and / or studies published cohort that provided answers to the questions, of which the sources were selected with the highest score obtained in the evaluation methodology ,the highest level as to grading evidence and recommendations.Result. The positive sign of cholecystitis Murphy has a sensitivity of 97%; 95% of cholecystitis and cholelithiasis associated with increased risk of complications, the Visual Analogue Scale (VAS) allows us to set a base control and pain relief and 1 to 3% of pregnant women have vesicular lithiums.Conclusion. Acute cholecystitis occurs between 30 and 80 years, being more common in women, it is important the assessment of signs and symptoms, and identify secondary complications in order that nurses develop a specific plan of care to actual problems of the patient, contemplating interventions in the ministration of medicines, surgical preparation ensuring patient safety and postoperative care to minimize infection risk factors and recommendations for self discharge.

Introdução. Os distúrbios biliares afetar uma proporção significativa da população mundial; mais de 95% são atribuíveis a colecistite aguda. A principal manifestação é a dor abdominal tão acentuada de 50% dos pacientes apresentam este síntoma pelo menos 48 horas antes da admissão.Método. quatro informações sistematizadas pesquisas onde eu jogo meta-análise, ensaios clínicos randomizados e / ou estudos publicados coorte que forneceram respostas para as perguntas, das quais as fontes foram selecionados com a maior pontuação obtida na metodologia de avaliação foram feitas, maior nível de evidências e recomendações de classificação.Resultado. O sinal positivo de colecistite Murphy tem uma sensibilidade de 97%; 95% de colecistite e colelitíase associada ao aumento do risco de complicações, a Escala Analógica Visual (VAS) permite que você defina um controle base e alívio da dor e 1 a 3% das mulheres grávidas têm lithiums vesiculares.Conclusão. colecistite aguda ocorre entre 30 e 80 anos, sendo mais comum em mulheres, é importante a avaliação de sinais e sintomas, e identificar complicações secundárias com as enfermeiras objectivo q desenvolver um plano específico de atendimento a problemas paciente real, contemplando intervenções no ministério de medicamentos, preparo cirúrgico, garantindo a segurança do paciente e cuidados pós-operatórios para minimizar os fatores de risco de infecção e recomendações para a auto descarga.

[Comparison of specificity and sensitivity of ultrasonography and computed tomography with endoscopic retrograde cholangio pancreatography in diagnosis of biliary tract stones]

Cholelithiasis have concomitant with biliary tract stones [BTS] in about 10-15% of the affected patients. This study was carried out to compare the specificity and the sensitivity of ultrasonography and computed tomography [CT scan] with the endoscopic retrograde cholangio pancreatography [ERCP] for detecting of the biliary tract stones and to evaluate the efficacy of the ERCP therapy. In this descriptive study, 135 patients suspected of BTS whom were candidate for the ERCP were gone under investigation. Ultrasonography of the gallbladder, liver, biliary tract, oral and IV contrast of abdominal CT scan and the ERCP were conducted for each patient. ERCP was considered as key critria to define BTS. The specificity and sensitivity of the ultrasonography and CT scan and the success rate of the therapeutic ERCP was estimated. BTS were observed in 112 patients by ERCP method. The specificity and sensitivity of the ultrasonography was 72.3% and 73.9%, respectively. The specificity and sensitivity of the CT scan was 50.8% and 91.3%, respectively. The success rate of the therapeutic ERCP was estimated as 76.9%. Ultrasonography as a non-invasive, non-expensive and well sensitivity method which is recommended in patient screening of biliary tract stones in compare to ERCP and CT scan

Endoscopic Retrograde Cholangiopancreatography in Patients with Previous Acute Coronary Syndrome

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is considered a high-risk procedure in patients with previous acute coronary syndrome (ACS); however, clinical studies are rare in the literature. The aim of this study was to investigate the safety and efficacy of ERCP in patients with previous ACS. METHODS: We retrospectively reviewed the medical records of patients with previous ACS who underwent ERCP between January 2007 and August 2012. The clinical characteristics, ERCP diagnoses, treatment results, and complications were analyzed. RESULTS: Fifty patients underwent ERCP an average of 41.6 months after ACS. The most common indication for ERCP was calculous cholangitis. After deep biliary cannulation, endoscopic sphincterotomy, biliary stone removal and endoscopic biliary drainage were successfully performed. Immediate postsphincterotomy bleeding occurred in seven patients, which was successfully controlled using endoscopic therapy. Elevation of cardiac troponin I levels were observed in three patients (6%) before ERCP, and all of these patients were diagnosed with pancreatobiliary disease combined with recurrent ACS, which was treated with coronary artery stent insertion (n=2) and balloon angioplasty (n=1). CONCLUSIONS: Therapeutic ERCP is effective and safe in patients with previous ACS. Cardiac troponin I elevation should be considered a warning sign for recurrent ACS in patients who undergo ERCP.

Evaluation of leptin and insulin resistance in patients with cholelithiasis.

The association between insulin resistance, lipoproteins and leptin was evaluated in cholelithiasis. The study group included 55 women (68.8%) and 25 men (31.3%) with a mean age and SD of 50.56 ± 14.28 yrs. The control group included 25 women (62.5%) and 15 men (37.5%) with a mean age of 50.93 ± 11.73 yrs. Serum leptin levels were measured by the enzyme immunoassay method. HOMA-IR was determined by using fasting glucose and insulin levels. Insulin, total cholesterol (TC), LDL-C, HOMA-IR (p<0.01) and leptin (p<0.001) were significantly higher in the cholelithiasis group, compared to the controls. In patients with a HOMA-IR >2.2, age, body mass index (BMI), glucose, insulin, triglycerides (TG), TC and leptin levels were higher than in patients with a HOMA-IR <2.2. In patients with glucose levels >100 mg/dl, mean BMI, HOMA-IR, insulin, TG, TC and leptin levels were significantly higher than in patients with glucose levels <100 mg/dl. In patients with TG levels >150 mg/dl, mean age, BMI, glucose, insulin, TC, leptin and HOMA-IR were significantly higher than in patients with TG levels <150 mg/dl. In patients with BMI >25 kg/m2, mean age, glucose, insulin, TG, TC, leptin, HOMA-IR were significantly higher than in patients with BMI <25. In cholelithiasis group, there was a positive correlation between leptin and age, BMI, glucose, insulin, TG, TC, LDL-C or HOMA-IR. In conclusion, we found a positive association between increased leptin levels and abnormal lipoprotein metabolism in cholelithiasis. Cholelithiasis subjects with insulin resistance showed higher cardiometabolic risk factors than those without it.