Perfil de pacientes diagnosticados com câncer de vesícula biliar / Profile of patients diagnosed with gallbladder cancer

Objetivo: Descrever o perfil clínico-epidemiológico de pacientes diagnosticados com câncer de vesícula e identificar o estadiamento do tumor estabelecido no momento do diagnóstico, bem como o padrão histopatológico no momento da biópsia. Métodos: Trata-se de estudo transversal e descritivo realizado em um serviço de referência em oncologia clínica, baseado em análise secundária de dados correspondentes aos prontuários de indivíduos com diagnóstico de câncer de vesícula biliar atendidos entre janeiro de 2007 e janeiro de 2017. Resultados: A distribuição por sexo foi de cinco mulheres (62,5%) e três homens (37,5%). A idade variou de 47 a 74 anos, com média de 61,1 anos e desvio padrão de ±9,03. Nenhum indivíduo era assintomático ao diagnóstico; seis (75%) apresentaram dor em hipocôndrio direito, dois (25%) perda de peso e dois outros (25%) massa palpável. Dos oito indivíduos, seis (75%) apresentavam estadiamento clínico (EC) IV ao diagnóstico. O perfil histopatológico apresentou 100% de adenocarcinoma, sendo uma amostra com áreas papilíferas, três moderadamente diferenciadas, três metastáticas e uma bem diferenciada. Conclusão: O perfil clínico-epidemiológico estabelecido foi maior prevalência de câncer de vesícula biliar em mulheres, com média de idade na sétima década. Predominou a cólica biliar como sintoma. O padrão de adenocarcinoma foi identificado em todos os indivíduos. Três quartos dos indivíduos apresentavam estágio avançado de doença. (AU)

Objective: to describe the clinical-epidemiological profile of patients diagnosed with gallbladder cancer, and to identify tumor staging established at the time of diagnosis, as well as the histopathological pattern at the biopsy. Methods: This is a cross-sectional and descriptive study, carried out in a reference service of clinical oncology, based on secondary analysis of data corresponding to the medical records of patients diagnosed with Gallbladder cancer seen between January-2007 and January-2017. Results: Gender distribution was of five women (62.5%), and three men (37.5%). Patients' ages ranged from 47-74 years, mean age of 61.1 years and standard deviation of ±9.03). No patient was asymptomatic at diagnosis, six (75%) had right hypochondrium pain, two (25%) showed weight loss, and two others (25%), palpable mass. Of the eight patients, six (75%) had EC IV staging at diagnosis. The histopathological profile showed 100% of adenocarcinoma, with one sample having papilliferous areas, three being moderately differentiated, three metastatic, and one well differentiated. Conclusion: The clinical-epidemiological profile established in this study had a higher prevalence of gallbladder cancer in women, with a mean age of the individual around the 7th decade. The most frequent symptom was biliary colic. The adenocarcinoma pattern was identified in all individuals. Three-quarters of them had advanced disease. (AU)

Características clínicas y manejo de lactantes menores de 1 año con sospecha de alergia a proteína de leche de vaca / Clinical characteristics and management of infants less than 1-year-old suspected with allergy to cow's milk protein

Introducción: La alergia a proteína de leche de vaca (APLV) es frecuente en lactantes (2-5% en < 1 año). Tiene múltiples formas de presentación y un amplio diagnóstico diferencial, por lo que es relevante confirmar el diagnóstico. El estándar de oro del diagnóstico es el test de provocación oral (TPO), que en la práctica no siempre se realiza. En Chile hay escasa literatura respecto a esta entidad. Objetivo: Describir características demográficas, clínicas y manejo de lactantes < 1 año con sospecha de APLV. Pacientes y Método: Estudio retrospectivo en menores de 1 año atendidos por sospecha de APLV entre 2009-2011. Se registraron datos demográficos, historia perinatal, antecedentes de atopia, alimentación al momento del diagnóstico, síntomas de sospecha de APLV, estudios realizados para su confirmación, y respuesta a tratamiento. Se consideró como estándar de diagnóstico la respuesta a la dieta y la contraprueba. Se definió como respuesta a la dieta la ausencia de los síntomas atribuidos a la APLV al menos 4 semanas desde el cambio de leche. Se realizó estadística descriptiva mediante programa Epiinfo™. Resultados: Se incluyeron 106 lactantes, 51% varones, 80% recién nacidos de término, 74% con al menos un progenitor atópico, 34% con alguno de los padres o algún hermano con alergia alimentaria. La mediana de edad al inicio fue 1,5 meses (rango: 1,5-2 m). El 15% recibió fórmula desde el período neonatal y el 50% antes del tercer mes. Los síntomas más frecuentes fueron: vómitos (63%), cólicos (50%) y rectorragia (40%); el 61% presentó ≥ 2 síntomas al comienzo. Solo en el 34% se hizo TPO, en el resto se evaluó la respuesta a la dieta de exclusión y se realizaron exámenes. La realización de exámenes no cambió la conducta. Tratamiento: 43% lactancia materna con dieta de exclusión, 24% solo fórmula extensamente hidrolizada, 26% solo fórmula aminoacídica y 7% otros. Conclusión: Las características demográficas y antecedentes de los pacientes concuerdan con lo descrito en la literatura extranjera. El inicio clínico fue precoz, predominando los síntomas digestivos. Se realizaron exámenes en una proporción alta de pacientes, sin contribuir a un cambio de conducta; el TPO fue subutilizado como herramienta diagnóstica.

Introduction: Cow's milk protein allergy (CMPA) is highly prevalent in infants (2-5%). It has a wide clinical spectrum, and confirmation through an oral food challenge (OFC) is relevant for its differential diagnosis. Information on this topic is scarce in Chile. Objective: To describe the demographic and clinical features of infants with suspected CMPA. Patients and Method: A retrospective study of patients < 1 year-old, treated for suspected CMPA between 2009 and 2011. Demographic data, symptoms of atopy, nutrition at the time of diagnosis, CMPA symptoms, diagnostic studies, and response to treatment were recorded. Diet response at least 4 weeks after milk modification, and clinical behavior when suspected foods were added back to the diet were considered standard diagnostic criteria. Descriptive statistics were performed using Epiinfo ™ software. Results: The study included 106 infants, of whom, 51% male, 80% term newborns, 74% with ≥ 1 atopic parent, and 34% with ≥ 1 parent/sibling with food allergy. The median age at onset of symptoms was 1.5 months (range 1.5-2 m). Almost half (46%) were breast-feeding ≥ 6 m, with 15% receiving formula milk since the neonatal period, and 49% before the third month. Common symptoms were: vomiting (63%), colic (49%), and bleeding on passing stools (41%). No anaphylaxis was identified, and 61% had ≥ 2 symptoms at debut. Only 34% were subjected to OFC. The most frequently requested tests were, test patch (43%), prick test (40%), and blood in stools (37%). Treatment: 43% breast feeding with exclusion diet, 24% extensively hydrolysed formula, 26% amino acid formula, and 7% others. Conclusion: Demographic characteristics and risk factors were similar to those previously described in international literature. Clinical presentation was early in life, and digestive symptoms predominated. OFC was underused for diagnosis, and most of the tests requested did not change management.

[Assessment the relationship between anal stenosis and neonatal colic]

Due to abundance of neonatal colic in neonates, there is a need to discover the etiology of this problem by performing etiologic studies. There are some reports that show the anal stenosis has a probable etiologic role in these colics. This study aimed to determine the relationship between neonatal colic and anal stenosis in the neonates presenting to Mofid children hospital during the spring to autumn of 2009 to determine. This is a case-control study. The case group was the neonates at the age of 3 months or less with a documented diagnosis of neonatal colic. The control group was age and sex matched group of neonates with case group, without any neonatal colic. A total of 192 cases were studied and there were 96 cases in each group. Diagnosis of neonatal colic was confirmed by Wessel criteria and that of anal stenosis by bougie. The data were analyzed using Chi-square test, and OR was calculated. With respect to age and sex, the cases in two groups were matched. In case group, 23 patients [24%], and in control group 1 patient [1%] had anal stenosis [OR=23; p<0.000]. It appears that neonatal colic and anal stenosis have statistical relationship. Therefore, we recommend clinical trial to assess the etiologic relationship between neonatal colic and anal stenosis

Acute abdominal pain in Iraqi children: causes and management

Acute abdominal pain is the most frequent gastrointestinal complaint that brings children and adolescent to physicians and the one that frequently requires urgent evaluation in the office or emergency department. The challenge for the clinician is to identify those patients with abdominal pain who have either serious, potentially life-threatening conditions, such as appendicitis or bowel obstruction. The difficulty in this problem resides in the great diversity of underlying pathologies and poor localization of pain. To study different etiologies' of acute abdominal pain in children and their incidence in our locality to offer a clinical issue helping relevant doctors in management of their child patients. In this study, we enrolled children with age ranged from 4 months to 12 years, from April 2007 to April 2009 during which every child visit outpatient clinic or emergency unit complaining of acute abdominal pain was included; full clinical evaluation and necessary laboratory tests was obtained. Follow up data of these children in the emergency room, pediatric and surgical ward and after discharge were obtained. The study include 566 child with age range from 4 month to 12 years with overall mean age was 5.8+2.4 years, female children were 58% while male were 42%. 36% of children sustained emergency surgical operation [surgical group], the other 64% were treated conservatively [conservative group]. The commonest pathologies in surgical group were acute appendicitis 73%, intussusceptions 13%, primary peritonitis 5% and incarcerated hernias 2%. While that in conservative group, they were non-specific abdominal pain 44%, gastroenteritis 23%, UTI16% and ML 8%. The incidence of acute abdominal pain in relation to the age group was as following: Group l [age of 1 year and below] was 45 cases [8%], Group2 [2-5 years] was 294 cases [52%], Group 3[6 - 12 years] were 227 cases [40%].The commonest medical cause of acute abdominal pain is nonspecific abdominal pain followed by gastroenteritis while the surgical cause is acute appendicitis followed by intussusceptions. The age is fundamental clinical factor in assessing any child with acute abdominal pain and the underlying pathologies are closely related to the child's age. The repetitive gentle clinical examination is superior to most sophisticated investigations and it is considered a cornerstone in pediatrics' clinical practice

Diagnóstico e tratamento de litíase ureteral / Diagnosis and treatment of ureteral calculi

Pacientes com cálculo ureteral tipicamente apresentam cólica renal consequente à obstrução do trato urinário. Uma vez controlada a crise dolorosa, um plano terapêutico deve ser estabelecido. A tomografia computadorizada (TC) helicoidal de abdômen e pelve sem contraste endovenoso é o exame de imagem de eleição. O tratamento da litíase ureteral pode ser conservador ou interventivo.Bloqueadores alfa-adrenérgicos são as drogas mais utilizadas para o tratamento clínico expulsivo. Para cálculos com pequena probabilidade de eliminação espontânea devido ao seu tamanho e/ou localização, indica-se tratamento interventivo, realizado através de litotripsia extracorpórea por ondas de choque, endourologia ou excepcionalmente através de cirurgia, aberta ou laparoscópica. A urgência da intervenção é maior em casos de obstrução e infecção do trato urinário superior, impondo deterioração da função renal, dor ou vômitos, anúria ou severo grau de obstrução em rim único ou transplantado. A melhor modalidade terapêutica a ser empregada deve ser individualizada.

Patients with ureteral calculi typically present renal colic due to urinary tract obstruction. Once the acute pain is controlled a therapeutic plan should be established. The unenhanced CT is the best diagnostic test. Ureteral calculi treatment can be either clinical or interventive. Alpha-adrenergic blockers are the most frequently prescribed drugs for the so-called medical expulsion therapy. Stones with a low probability of spontaneous passage (on the basis of their size and location) should be treated using such interventions as extracorporeal shock wave lithotripsy, ureteroscopy, or open surgery, in selected cases. Urgent intervention is indicated for a patient with an obstructed, infected upper urinary tract, impending renal deterioration, intractable pain or vomiting, anuria, or high-grade obstruction in a solitary or transplanted kidney. The best therapeutic approach should be selected on an individual basis.

Cólica renal / Renal colic

Artigos de emergência em Medicina sugerem que 90 por cento dos cálculos menores do que 5mm e 15 por cento dos cálculos com 5mm a 8 mm são eliminados espontaneamente com quatro semanas, enquanto 95 por cento daqueles maiores de 8mm requerem intervenção urológica. Pesquisas recentes mostram que a terapia médico-expulsiva pode aumentar a taxa de eliminação para cálculos de 10mm, reduzir a perda de dias de trabalho, visitas médicas e evitar procedimentos para a sua remoção.

Text the emergency medicina suggests that 90 percent of stones less than 5mm and 15 percent of stones between 5mm and 8mm will pass spontaneously within 4 weeks. while 95 percent of those larger than 8mm will require urological intervention. Recent research shows that medical expulsive therapy can increase the expulsion rate for stones up to 10mm and decrease the expulsion time there by reducing lost workdays, medical visits and avoidable stone removal procedures.

Evaluation of emergency extracorporeal shock wave lithotripsy for obstructing ureteral stones

PURPOSE: To assess the efficacy of extracorporeal shockwave lithotripsy (ESWL) for ureteral calculi during acute renal colic. MATERIALS AND METHODS: From January 2002 to March 2007, 108 patients were treated by ESWL for obstructing ureteral stones causing acute renal colic. ESWL was performed within 24 hours of the onset of renal colic. RESULTS: The mean age of the patients was 39.5 years (11-72 years). Male/female ratio was 85/23. Mean stone size was 8.45 mm (4-20 mm). They were located in the pelvic (n = 53), iliac (n = 28) or lumbar (n = 27) region. Fragmentation after a single session was complete in 56 patients (52 percent), incomplete in 28 (26 percent), and absent in 24 (22 percent). Patients presenting incomplete fragmentation underwent a second (n = 28) or even a third session (n = 11). Of the 24 patients in whom ESWL had no impact on the stone, 21 underwent ureteroscopy, and in one case open ureterolithotomy for a patient with a hard 17 mm stone, while spontaneous passage occurred in two patients with small stones. CONCLUSION: Emergency ESWL for obstructing ureteral stones has a satisfactory success rate and very low morbidity. The stone-free rate of retreating ureteral calculi with ESWL decreases significantly after failed initial treatment. Stone size may be the main predictive factor for retreatment. We suggest that no more than 3 treatments should be given for a particular stone due to minimal improvement in the subsequent cumulative treatment success rate.

Tumoración inguinal Endometriosis: a propósito de un caso / Inguinal tumour: endometriosis: a purpose of a case

Endometriosis es una enfermedad que se caracteriza por la presencia fuera de la cavidad uterina de tejido idéntico al endometrio, es decir, que contiene glándulas y estroma endometrial. Este endometrio suele ser funcionante. La endometriosis suele darse a muy diferentes edades pero con mayor frecuencia entre los 30 y 40 años, en relación a los factores étnicos es mas frecuente en las mujeres Asiáticas que en las blancas. Las localizaciones mas frecuentes son las de la pelvis, esta patología es causa de infertilidad y dolor pélvico crónico. El diagnóstico se realiza en función de los factores de riesgo y de la sintomatología. Con la ayuda de pruebas especiales. Para el diagnóstico definitivo.

Una mirada evolutiva del cólico infantil / An evolutionaty look to infantile colic

El cólico infantil se define como episodios de llanto e irritabilidad paroxísticos en lactantes sin otra patología, de tres o mas horas de duración, por mas de tres días a la semana, que se presenta por a lo menos tres semanas. Esta patología afecta a mas del 25 por ciento de los lactantes, pero pese a su alta frecuencia no existe consenso sobre sus causas. Para entender sobre la etiología del cólico infantil, es útil observar este problema a la luz de la Medicina Evolucionaria, e intentar comprender cual es la mal adaptación que determina la expresión del cólico. El llanto puede ser interpretado como un efectivo mecanismo de defensa adaptado a una forma de vida de cazadores-recolectores distinta a la realidad occidental actual. Por factores sociales como la entrada de las mujeres al mundo laboral y la costumbre de dejar los niños a cargo de terceros, se produce un fenómeno en el que la díada madre-hijo esta más separada, lo que repercute de mala manera en la habilidad del lactante para desarrollar habilidades sociales en la infancia y aumenta su stress al no tener respuesta a sus necesidades de manera inmediata, lo que determina el desarrollo de un llanto más prolongado, característica del cólico infantil.

effect of tamsulosin in facilitating of juxtavesical stones' passage

We evaluated the effectiveness of tamsulosin and nifedipine during watchful waiting in patients with juxtavesical ureteral stone. Between Oct 2003 and Feb 2004, 382 patients with renal colic referred to our center which 64 patients suffered from juxtavesical stone less than 1 cm where enrolled in the study and were randomly divided into 3 groups. The average sizes of the stones were 6.7 mm, 6.4 mm, 6.8 nun in Groups 1, 2, 3. Group 1 [20 Patients] received daily oral treatment of 0.4 rag tamsulosin and group 2 [20 Patients] received 20 mg nifedipine daily oral therapy, group 3 [24 Patients] were used as controls The patients were treated about 4 weeks and the patients were every 1 week and sonography was done for 4 weeks and whenever the stone was expulsed, we discounted the drug. Information about stones passage and time and complication was noted. Statistical analyses were performed with using the K 2 test We had 35 males and 29 females patients mean age of38 years. According to patients age, sex and stone size there was no significant difference between 3 groups. The stone passage rate was 90% [8 Patients], 75% [14 Patients] and 45% [11 Patients] in groups 1, 2, 3 respectively. The difference in group 1 and 2 with respect to group 3 was significant Average expulsion time was 16 days, 20 days and 18 days in 3 groups respectively. A statistically significant difference was noted between group 1 and 3. Two patients from group 1, five patients from group 2 and thirteen patients from group 3 underwent transureteral lithotripsy. Tamsulosin and nifedipine administration in renal colic due to juxtavesical calsuli increased the stone expulsion rate, reduced expulsion time and decreased need for hospitalization and endoscopic procedures

Incidence of cow milk allergy in colicky baby

There is a strong relation between infantile colic and the early introduction of cow milk [raw or artificial] to the infants in the first few months of life. Cow milk proteins are responsible for the pathological changes which precipitate the different symptoms of allergy including colic. This study aimed to estimate the prevalence of cow milk allergy [CMA] in the infants suffering from repeated attacks of colic and to determine the adverse effects of CMA. 30 infants suffering from repeated attacks of colic were included in this study. They subjected to full history taking especially the dietary history, also were subjected to clinical examination with special attention to growth development and other signs of allergy. Blood sample was taken to test for CMA including, blood eosinophilic count, total IgE and S-IgE levels to cow milk proteins in the serum. In addition, patients were subjected to an open challenge test to cow milk, which is the gold standard for diagnosis of CMA. 13 children out of the 30 were CMA +ve i-e 43.3% of the studied patients had CMA diagnosed by challenge test. Study of the dietary history revealed that the total and mean duration of exclusive breastfeeding were significantly shorter in CMA+ve than in CMA-ve patients[p < 0.05 for both].in addition the age of first introduction of CM was significantly earlier in CMA+ve compared to CMA-ve patients[p < 0.05]. However, type of milk [raw or artificial or diary product as yogurt], showed no significant difference to the diagnosis of CMA in our study group. Other allergic manifestations were recorded in CMA+ve patients especially infantile eczyma. None of our patients had peripheral eosinophilia. High levels of total IgE and specific IgE were detected in 46.2% and 36.6% respectively. Specific IgE showed a higher specificity than total IgE [100% vs 52.9%].High levels of both total and Specific IgE were significantly more common in CMA+ve patients compared to CMA-ve patients. In addition, IgE - mediated reactions accounted for 46.2% of CMA+ve patients. CMA is a common finding in infants suffering from colic in the first months of life. Early introduction of cow's milk in the first year of life is frequently associated with increase risk of CMA. Testing total and specific IgE for cow milk is a useful tool for the diagnosis of suspicious cases. Challenge test is still the gold standard for the diagnosis of CMA. Although Exclusive breastfeeding in the first 6 months of age is not absolutely protective against all causes of colic, it is still obligatory for the prevention of the development of food allergy

Cólica em recém-nascido e lactente: revisão da literatura / Colic in newborn and infant: a literature review

Trata-se de uma revisão de literatura sobre a manifestação clínica da cólica que comumente afeta os bebês na fase inicial de vida. O texto aborda a definição do quadro clínico, fatores etiológicos e associados, condutas mais adotadas e estudadas para o alívio e tratamento da cólica do lactente. Analisaram-se publicações de periódicos nacionais e internacionais cadastradas nas bases de dados informatizadas MEDLINE e LILACS, com acesso disponível na BIREME, Bibliotecas da USP e pelo Portal da CAPES

Litotripsia extracorpórea en litiasis ureteral distal / Extracorporeal shock ware litotripsy in distal ureteral lithiasis

La litotripsia extracorpórea por ondas de choque (LEC), ha ganado su espacio en el tratamiento de los cálculos de la vía urinaria. Una de las indicaciones más ccontrovertidas para la LEC son los grandes cálculos renales y los de uréter distal. El objetivo de nuestro trabajo es evaluar la efectividad de la litotripsia extracorpórea (LEC) en cálculos de uréter distal. Se realizó una revisión retrospectiva de 70 pacientes sometidos a LEC por cálculo de uréter distal en nuestro hospital, durante el período diciembre 1996 a mayo del 2002. Se utilizó el litotriptor electrohidráulico Direx Tripter Compact. De nuestros 70 pacientes, el 68,6 porciento era de sexo masculino y el 31,4 porciento femenino, con un promedio de edad de 41,9 años. Tres de estos pacientes presentaban cálculos dobles, lo que da un total de 73 unidades de litiasis. El 53,4 porciento son derechos y 46,6 porciento izquierdos. El tamaño promedio de los cálculos fue de 8,5 mm y el promedio de ondas de choque aplicadas fue de 3211. El 19,2 porciento de los cálculos no se fragmentó o lo hizo en sólo 2 fragmentos, produciéndose fragmentación y posterior eliminación en el 80,8 porciento. En 14 pacientes (20 porciento) se requirió tratamiento complementario (9 ureterolitectomías : 8 endoscópicas yuna vía abierta, y 5 LEC adicionales).

Ureteroscopia en litiasis uréter bajo: 10 años de experiencia / Ureteroscopy in lower ureteral stones: 10 years of experience

Se podría decir que al comenzar el nuevo siglo, a lo menos existen dudas razonables sobre qué método es el ideal para resolver el difícil problema de litiasis ureteral baja. Este trabajo pretende contribuir con esta discusión. Se presenta experiencia personal de 11 años de ureteroscopía en el manejo de litiasis del uréter bajo. Se incluyeron en este trabajo prospectivo a todos los pacientes portadores de litiasis ureteral baja, sin ningún tipo de selección y con indicación quirúrgica, desde enero de 1990 hasta junio del 2001. La población estudiada comprendió a 186 pacientes con rangos de edad de 18-62 años. Todos los pacientes fueron tratados con anestesia regional y profilaxis antibiótica pre operatoria. El tamaño promedio de los cálculosfue de 5,6 mm, con rangos entre 3 y 18 mm. En 8 pacientes (4 porciento), el procedimiento fracasó por incapacidad de traspasar el uréter intramural, incluyendo una desinserción del uréter y tres laceraciones de la mucosa ureteral. En los otros cuatro pacientes de este grupo, no fue posible traspasar el fenómeno inflamatorio que se antepone al cálculo. Los 8 pacientes fueron operados de inmediato. El porcentaje de éxito global fue de un 96 porciento. El tiempo promedio de la cirugía fue de 24 minutos, con rangos de 15 a 120 minutos. No se utilizó radioscopía. El 95 porciento de los pacientes permaneció un día hospitalizado. La principal complicación post operatoria fue el cólico renal, en un 12 porciento de los pacientes. Un 20 porciento de los pacientes requirió fragmentación ultrasónica o neumática. No existió sepsis, pérdida de unidades renales, ni mortalidad quirúrgica. La ureteroscopía es un eficiente método de tratamiento en el manejo de la litiasis del uréter bajo, y es una técnica segura, luego de una adecuada curva de aprendizaje.

Valor de la tomografía computada en los pacientes con posible sospecha clínica de urolitiasis / Diagnostic value of unenhanced helical CT in patients with urolithiasis

El objetivo del presente trabajo es evaluar la efectividad de la tomografía computada helicoidal (TC) sin contraste oral ni endovenoso para la detección y el manejo de los pacientes con sospecha clínica de urolitiasis. Se estudiaron 60 pacientes con presunción diagnóstica de cólico renoureteral. A todos se les efectuó tomografía computada helicoidal sin contraste oral ni endovenoso. La tomografía computada fue leída para la presencia o ausencia de litiasis. El diagnóstico definitivo fue efectuado mediante seguimiento en todos los casos. Con los resultados obtenidos el valor predictivo positivo de una tomografía computada es del 98 por ciento y la certeza global un 93 por ciento. En los pacientes con sospecha de litiasis, debido a que la TC de árbol urinario es sencilla, eficaz y sin contraindicaciones, debe formar parte del protocolo de estudio de éstos pacientes

Aneurisma ilíaco aislado bilateral / Bilateral isolated iliac aneurysm

Se presenta un caso clínico de aneurisma ilíaco común a hipogástrico aislado bilateral, de 6,5 cm de diámetro a cada lado, sin compromiso aórtico, en una paciente de 69 años que debutó con dolor cólico abdominal difuso de un mes de evolución. Se confirma el diagnóstico con tomografía axial computarizada de abdomen y pelvis y arteriografía. Se interviene por laparotomía media, se excluyen los aneurismas en ambos cabos y se implanta una prótesis aortobifemoral. La evolución postoperatoria fue sin complicaciones