Resección laparoscópica de dilatación quística congénita del conducto cístico en un paciente pediátrico / Laparoscopic Resection of Congenital Cystic Dilatation of the Cystic Duct in a Pediatric Patient

Introducción: La dilatación quística congénita del conducto cístico o dilatación tipo VI de la clasificación de Todani, es una variante rara de dilatación congénita de la vía biliar. Objetivo: Explicar la metodología diagnóstica y terapéutica empleada en un caso pediátrico con esta entidad, y destacar la ventaja de su tratamiento oportuno por vía mínimamente invasiva. Presentación del caso: Paciente masculino de 6 años con sintomatología sugestiva de enfermedad vesicular, referido desde la atención secundaria por sospecha de quiste de colédoco. En el ultrasonido se detectaba una lesión ecolúcida adyacente a la vesícula biliar, sin dilatación de las vías biliares intrahepáticas. Se realizó colangiografía laparoscópica y se confirmó una dilatación quística aislada del conducto cístico, la cual se resecó por vía laparoscópica, igualmente. Conclusiones: La incidencia de la dilatación quística del conducto cístico es muy baja y se puede presentar en niños con sintomatología variable. El diagnóstico generalmente es tardío, puede sospecharse mediante la ecografía abdominal y confirmarse con la colangiografía laparoscópica, aun en ausencia de otros medios diagnósticos más modernos. Su reconocimiento y correcta clasificación permiten realizar el tratamiento quirúrgico definitivo exitosamente, de preferencia por vía laparoscópica(AU)

Introduction: Congenital cystic duct dilatation, or Todani classification type VI dilatation, is a rare variant of congenital bile duct dilatation. Objective: To explain the diagnostic and therapeutic methodology used in a pediatric case with this entity, and to highlight the advantage of its timely minimally invasive treatment. Case presentation: Six-year-old male patient with symptoms suggestive of gallbladder disease, referred from secondary care for suspicion of a common bile duct cyst. Ultrasound showed an echolucent lesion adjacent to the gallbladder, without dilatation of the intrahepatic bile ducts. Laparoscopic cholangiography was performed and confirmed an isolated cystic dilatation of the cystic duct, which was resected laparoscopically, likewise. Conclusions: The incidence of cystic dilatation of the cystic duct is very low and may present in children with variable symptomatology. Diagnosis is usually late, can be suspected by abdominal ultrasound and confirmed by laparoscopic cholangiography, even in the absence of other more modern diagnostic tools. Its recognition and correct classification permit a successful definitive surgical treatment, preferably laparoscopically(AU)

The new classifications of biliary tract diseases based on actual anatomy / 中华外科杂志

In order to facilitate the treatment strategies for biliary tract injury, hilar cholangiocarcinoma, bile duct tumor thrombus, cholangiocellular carcinoma and bile duct cystic dilatation, many classifications have been made, even more than 10 types for one disease. Each type is represented by numbers or English alphabet, which are not only confusing but also difficult to remember. The Academician Mengchao Wu divided the liver into five sections and four segments base on its anatomy, this classification is very direct and visual, thus had been using till now. In order to overcome those complicated problems, it is considered to develop a new classification based on actual anatomic location similar to that for liver cancer, which is easy to remember and to directly determine the treatment strategy. All kinds of classifications have their own characteristics and advantages and disadvantages. This practical classifications avoid the complexity and may be useful for clinicians.

Cistomatose de glândula apócrina em onça-pintada (Panthera onca) / Apocrine cystomatosis in a jaguar (Panthera onca)

A cistomatose de glândula apócrina é uma condição rara e não-neoplásica, que tem sido relatada em cães e gatos, e caracterizada por vários grupos de glândulas sudoríparas dilatadas, cuja distribuição generalizada raramente é observada. Uma fêmea de onça-pintada melânica (Panthera onca), com idade estimada de 16 anos e mantida em cativeiro, apresentou aumento de volume abdominal. Ao exame físico foram observados vários nódulos de consistência macia e flutuante, não aderidos, com tamanho de 2 a 15cm de diâmetro, na região ventral abdominal. Outras massas de menor diâmetro (0,5-1,0cm) estavam presentes na região cervical e no dorso do animal. Estas massas foram removidas em um procedimento cirúrgico. Dentro deste cisto havia conteúdo líquido, inodoro e translúcido. Microscopicamente, observou-se entre a derme média e profunda a formação de múltiplos cistos de tamanho variável. Esses cistos eram revestidos por uma única camada de células predominantemente cubóides. Em alguns focos eram observadas raras projeções papiliformes de epitélio glandular. O citoplasma estava levemente eosinofílico e com raras imagens de decapitação do ápice. O diagnóstico de cistomatose de glândulas apócrinas foi realizado através dos achados macroscópicos e microscópicos.(AU)

Cystomatosis of the apocrine gland is a rare condition reported in dogs and cats. It is a non-neoplastic condition, characterized by several groups of dilated cystic sweat glands. Rarely a more widespread distribution can be observed. A captive female about 16 year-old melanic jaguar (Panthera onca) presented increased abdominal volume. Physical examination showed multiple floating nodular masses ranging from to 2 to 15cm in diameter located in the ventral abdomen. Other masses of smaller diameter (0.5-1.0cm) were present in the cervical region and in the back of the jaguar. These masses were surgically removed. Within this cyst had a odorless translucent content. Microscopically, between the mid and deep dermis there existed multiple cysts of different sizes, coated with a single layer of cuboidal cells. In some foci, there were rare papilliform projections of glandular epithelium. The cytoplasm was slightly eosinophilic with rare images of decapitation of the apex. The diagnostic of apocrine cystomatosis was performed through macroscopic and microscopic findings.(AU)

Planned hepatectomy for the "central type" intrahepatic and extrahepatic choledochal cysts / 中华肝胆外科杂志

Objective To retrospectively study the clinical value and the advantages in " planned hepatectomy" for the "central type" intrahepatic and extrahepatic choledochal cysts.Methods The clinical data of 7 patients with the "central type" of intrahepatic and extrahepatic choledochal cysts which were treated with "planned hepatectomy" from January 2014 through April 2017 at the Department of Biliary Tract Surgery of the Eastern Hepatobiliary Surgery Hospital,Second Military Medical University were retrospectively analyzed.Results All the patients completed radical resection of the intrahepatic and extrahepatic choledochal cysts in accordance with the " planned hepatectomy".The operations included 6 patients who were treated with percutaneous transhepatic cholangial drainage (PTCD) and 5 patients with portal vein embolization (PVE) prior to the surgical excision.Combined right liver resection was performed in 6 patients,and combined left liver resection in one patient.All the 7 patients had a history of chronic cholangitis.Liver volume tests demonstrated that the hemiliver volume to be removed (the embolized hemiliver) significantly decreased after PVE,whereas the hemilivers to be persevered were remarkably enlarged.No complication associated with PTCD and PVE occurred.The mean postoperative hospitalization was 12 days.Liver function tests suggested all the patients recovered well.No postoperative complication of bleeding,infection or liver function failure was observed,except in one patient who experienced pleural and abdominal effusion.Conclusions Combined subtotal hepatectomy may increase the risk of complications associated with the "central type" intrahepatic and extrahepatic choledochal cysts.The surgical strategy in planned hepatectomy can be used effectively to treat the "central type" of intrahepatic and extrahepatic choledochal cysts,with improved surgical safety,decrease in incidences of postoperative liver function failure and residual choledochal cysts.

Gran galactocele / Big Galactocele

El galactocele es la dilatación quística de un conducto durante la lactancia. Se considera la lesión mamaria más común encontrada durante esta etapa, aunque ocurre más frecuentemente después del cese de esta cuando la leche es retenida y comienza a acumularse en la mama. Se reporta el caso de un gran galactocele presentado durante la lactancia en una paciente angolana de 28 años de edad, cuya resolución se logró con tratamiento quirúrgico. El objetivo del artículo es presentar, con fines docentes, algunos aspectos de esta lesión benigna frecuente, pero que no alcanza generalmente la magnitud y dimensiones del caso presentado.

The galactocele is cystic dilatation of a duct during lactation. It is considered the most common breast lesion found during this stage; although it occurs most frequently after its cessation is when milk is retained and accumulates in the breast. A case of a large galactocele during lactation in an Angolan patient aged 28 is reported in this paper. Her solution was achieved with surgical treatment. The aim of this paper is to present, for teaching purposes, some aspects of this common benign lesion, but the size and dimensions do not usually reach thoswe of the case presented here.

Dilatação cística do úraco e uroperitônio em touros: relato de cinco casos / Cystic dilatation of the urachus and uroperitoneum in bulls: report of five cases

Descrevem-se os aspectos clínicos da dilatação cística do úraco e uroperitônio em cinco touros. Os animais apresentaram, em datas distintas, distensão abdominal e diminuição da ingestão de alimentos e água, até culminar com inapetência, cerca de duas semanas após o aparecimento dos primeiros sintomas. Ocorreu distensão abdominal bilateral progressiva, que, no início do processo, era discreta e restrita ao quadrante inferior do abdômen; com cerca de duas semanas de evolução, o abdômen assumiu forma arredondada semelhante à pera. Observou-se bruxismo, atonia ruminal e desidratação. A abdominocentese revelou a presença de líquido amarelado com concentração de ureia superior a 200mg/dL. A concentração de ureia no soro sanguíneo variou de 220 a 280mg/dL e a creatinina de 65 a 82mg/dL. A ligadura do divertículo do úraco próximo ao vértex da bexiga foi eficaz nos quatro touros operados.

The clinical findings and outcomes in five bulls with a perforation or rupture of the urachal diverticulum are described. All the bulls had a dilated round or pear-shaped abdomen, bruxism, ruminal atony, and dehidration. In all the bulls, abdominocentesis yielded a stream fluid and the serum concentrations of urea and creatinine were 220 to 280mg/dL and 65 to 82mg/dL, respectively. Peritoneal fluid concentration of urea was higher than 200mg/dL. In fours bulls, urachal diverticulums were closed next to the cranial pole of the bladders. After the surgery, the recovery was effective.

A case of infantile nephrotic syndrome / 영남의대학술지

We have experienced a case of infantile nephritic syndrome confirmed by renal biopsy in a 13-month-old female patient who showed and develop mental retardation and persistent proteinuria. She revealed mild eyelid edema, joint laxity, delayed speech development and adrenal cortical calcification on the radiologic study. Renal biopsy showed microcystic tubular change, micro-glomeruli and marked mesangial proliferation.