Quiste hidatídico hepático complicado con invasión a vena cava inferior y embolización de membranas hidatídicas a aurícula derecha: caso clínico / Hepatic hydatid cyst invading inferior vena cava with embolic membranes to right atrium: report of one case

We report a 30 year old female admitted with a story of right upper quadrant pain and previous hepatic surgery for hydatid disease. A thoracoabdominal angio CAT sean and transesophageal echocardiogram revealed a mass located in the right atrium. The patient was operated and the right atrial mass was excised. Pathological study of the surgical piece confirmed a hydatid cyst. Post operative recovery was uneventful.

La hidatidosis es una zoonosis parasitaria, de mayor incidencia en el sur de Chile. Su localización más frecuente es hepática y pulmonar. Sus complicaciones derivan de su crecimiento y afección de estructuras adyacentes o de su ruptura a cavidades. Presentamos un caso de quiste hidatídico hepático complicado, en una paciente que debutó con cuadro de dolor abdominal localizado en hipocondrio derecho producto de una lesión quística hepática con comunicación a vena cava inferior, siendo intervenida en su hospital de origen. Posteriormente AngioTAC y ecocardiografía transesofágica confirmaron masa intra auricular. Se realizó extracción de la masa bajo paro circulatorio con hipotermia profunda, correspondía a membranas hidatídicas y trombos adheridos a ella. La paciente evolucionó satisfactoriamente.

Cáncer de la vesícula biliar: manejo de pacientes con invasión de la túnica muscular / Management of gallbladder cancer with invasion of the muscular layer

Background: Gallbladder cancer is the leading cause of death of cancer among women in Chile. Detection of early forms of the disease during the pathological study of the cholecystectomy specimen is common. The management of these cases, specially those with invasion of the muscular layer is under discussion. Aim: To analyze the clinical features of patients with gallbladder cancer and muscular layer invasion and their prognosis after a simple cholecystectomy. Patients and methods: We studied a series of 46 patients with gallbladder cancer and invasion of the muscular layer. In the majority of cases diagnosis was performed at the moment of specimen study. Eleven patients underwent reoperation. Of these, ten underwent lymphadenectomy and liver resection while one patient underwent resection of the cystic duct stump. Results: During follow up, five patients died as a consequence of gallbladder cancer. Overall survival was 78 percent, with no differences between patients subjected or not a new operation. Conclusions: Gallbladder cancer with muscular infiltration has a good prognosis, independent of the type of therapy.

Quimiorradioterapia de neoadyuvancia en cáncer de vesícula biliar / Neoadjuvant chemoradiotherapy in gallbladder cancer

Background: Gallbladder cancer is generally associated with a poor prognosis, being local recurrence the main pattern of failure. Aim: To evaluate neoadjuvant chemoradiation as a means to improve the prognosis in gallbladder cancer. Patients and methods: Twenty three gallbladder cancer patients were prospectively treated between June 1993 and September 1999 in the Temuco Regional Hospital. Eighteen (82 percent) patients had subserosal infiltration, while three (13 percent) had serosal and two (9 percent) adipose tissue infiltration. Chemotherapy was done with 5-fluorouracil in continuous infusion during 5 days at day 1 and 28 of treatment. Radiotherapy consisted in a total dose of 4500 cGy, divided in 25 sessions. Patients' survival was compared with a series of 19 patients not subjected to chemoradiation, formerly treated at the institution. Results: Twenty patients had hematological problems secondary to the therapy. Leucopenia and thrombocytopenia were the most common toxic effects and eight had leucopenia under 2.0 x 10 during the treatment course. Chemoradiation delayed surgical treatment in eight patients. After the chemoradiation protocol, seven patients were excluded from surgical treatment and 14 patients underwent resection. Three of the latter (11 percent) had liver involvement and four (14 percent) had lymph node involvement. Among the patients who underwent resection, five are still alive with a follow up of 43.8 months. Treated patients had a worst actuarial survival than subjects not treated with chemoradiation. Conclusions: In this series of patients chemoradiation had no positive effect and a potentially detrimental effect in patients with gallbladder cancer (Rev Méd Chile 2004; 132: 51-7).

Coledocorrafia primaria y drenaje biliar interno vs coledocostomía con sonda de Kehr en pacientes con coledocolitiasis / Primary choledochorrhaphy and internal biliary drainage versus choledochostomy with T-tube in patients with Choledocholithiasis

La coledocostomía con sonda de Kehr ha sido el método quirúrgico clásico para el tratamiento de la coledocolitiasis. La coledocorrafia primaria y drenaje biliar interno es otro método terapéutico que evita el uso de sonda de Kehr. El objetivo es comparar ambas técnicas. Estudio de cohorte prospectivo, en el Hospital Regional de Temuco. El análisis se realizó mediante estadística descriptiva y analítica. La cohorte está compuesta por 18 pacientes por grupo. En el grupo de expuestos (coledocorrafia primaria), 100 por ciento son mujeres con promedio de 48,6 años; mientras que en el grupo de no expuestos (sonda Kehr) el 94 por ciento son mujeres con promedio de 52,7 años. La calidad de vida postoperatoria fue significativamente mejor en el grupo de expuestos. El promedio de hospitalización fue de 3 y 4 días en el grupo de expuestos y no expuestos, respectivamente; mientras que las complicaciones se presentaron en el 16,7 por ciento y 38,9 por ciento respectivamente. La serie no tiene mortalidad. Se concluye que la coledocorrafia primaria con drenaje biliar interno es una técnica alternativa con mejor calidad de vida y menor morbilidad postoperatoria que los métodos clásicos.