Trauma pancreático / Pancreatic trauma

El páncreas es un órgano intraabdominal en posición retroperitoneal, cuyo traumatismo es poco frecuente. La clasificación por grados ha ayudado a la práctica de tratamientos más eficaces y la disminución del número de complicaciones. Estas últimas aparecen como consecuencia del traumatismo o del tratamiento quirúrgico, el cual puede ser simple o implicar grandes resecciones. Se presenta el caso de un paciente sufrió un trauma abdominal cerrado de 3 días de evolución. Se realizaron exámenes diagnósticos y por la clínica y los complementarios se decidió realizar el tratamiento quirúrgico. El objetivo de este trabajo fue exponer los elementos clínicos, resultados de complementarios y hallazgos quirúrgicos en este paciente, así como incentivar la sospecha de esta afección en el traumatismo abdominal(AU)

Pancreas is an intra-abdominal organ in retroperitoneal location chow trauma is uncommon. Degree classification helps in more effective treatment practice and in decrease of complications appeared s consequence of traumas or the surgical treatment, which may be simple or involves large resections. The case of a patient with closed abdominal trauma of 3 days course. Diagnostic and clinic and complementary examinations were carried out being necessary surgical treatment. The aim of present paper was to expose the clinical elements, complementary results and surgical findings in this patient, as well as to motivate the suspicion of this affection in abdominal trauma(AU)

Correlación entre el protocolo preoperatorio y los hallazgos quirúrgicos en pacientes programados para colecistectomía por colelitiasis: estudio realizado en el hospital Luis Vernaza, de la ciudad de Guayaquil en el período entre mayo de 2005 a enero de 2006 / Correlation between preoperative protocol and surgical findings in patients programmed for cholecistectomy due to cholelithiasis: study carried out in the Luis Vernaza hospital, in Guayaquil from may/2005 to january/2006

Tipo de estudio: prospectivo y descriptivo con 82 pacientes elegidos al azar, período: mayo, 2005- enero, 2006. Objetivo: Comprobar la sensibilidad y especificidad del protocolo preoperatorio utilizado en pacientes sometidos a colecistectomía por colelitiasis. Criterios de inclusión: diagnóstico único colelitiasis con protocolo preoperatorio completo programadas para colecistectomía. Criterios de exclusión: colecistectomía previa, colelitiasis con otras alteraciones de vías biliares, pacientes sin diagnóstico de colelitiasis. Protocolo preoperatorio: historia clínica, enzimas hepáticas y ecografía. Resultados: 14.6 ictericia, 12.2 coluria y 2.4 acolia; paredes vesiculares finas (65.8), gruesas (30.5) y escleroatróficas (3.6); valores anormales de bilirrubina 20.6, GOT 31.6, GPT 39, FA 34.1 y GT 50; hallazgos quirúrgicos: paredes vesiculares finas, 57.3, gruesas 37.8 y escleroatróficas, 4.8; 29.26 presentaron PAC; Pacientes con PAC, el 38 tuvo manifestaciones clínicas y DUC, 9. Pacientes con manifestaciones clínicas detectamos PAC en 64, y sin manifestaciones 22 (p=0.00157). Pacientes con PAC alterada γ GT 66.7. Valores enzimáticos significativamente superiores en PAC. Ecografía: precisión 70 al observar pared vesicular y 81-82 al determinar tamaño y cantidad de cálculos.

Study type: prospective and descriptive with 82 patients randomly selected from May/2005 to January/2006. Objective: To verify the sensitivity and specificity of the preoperative protocol used in patients who has had a cholecistectomy due to cholelithiasis. Criteria to be included: Single diagnosis: cholelithiasis with preoperative protocol and programmed for cholecistectomy. Criteria to be excluded: Prior cholecistectomy, cholelithiasis with other abnormalities of the bile ducts, patients without a diagnosis of cholelithiasis. Preoperative protocol: medical record, hepatic enzymes, and echography. Results: 14.6 jaundice, 12.2 choluria, and 2.4 acholia; gallbladder walls: thin (65.8), thick (30.5), and scleroatrophic (3.6); abnormal levels: bilirubin, 20.6; GOT, 31.6; GPT, 39; AP, 34.1 y γGT, 50; surgical findings: gallbladder walls: thin 57.3, thick 37.8, and scleroatrophic 4.8; 29.26 presented PAC; Patients with PAC: 38 had clinical symptoms and DUC, 9. Patients with clinical symptoms: in 64 PAC was found and without symptoms 22 (p=0.00157). Patients with PAC, abnormal γGT: 66.7. Enzimes levels significantly higher in PAC. Echography: accuracy 70 watching the gallblader wall, and 81-82 setting size and amount of gallstones.

Multiplanar reconstruction computed tomography of lumbar spinal stenosis in correlation with surgical findings: Initial experience.

Lumbar spinal stenosis is a debilitating illness affecting middle-aged and elderly people. There are several imaging modalities available for use in affirming the diagnosis. The CT provides excellent osseous detail of osteophyte, fracture and location of bony abnormality and extension to adjacent soft tissue. New spiral CT technology allows multiplanar images to be obtained quickty and easily. Among these, multiplanar reconstruction computed tomography (MPR-CT) is the specific means to assess narrowed lumber spinal canal. This present work was done in order to evaluate the reliability of MPR-CT in diagnosing lumber spinal stenosis by correlation with operative finding. From July to December 2002, MPR-CT was done on 10 patients and evaluated by a well-known radiologist. Seven patients were approached surgically and the remaining three treated medically. Subsequently, the following variables were analyzed: central canal stenosis, lateral canal stenosis, fornminal stenosis, dise herniation, nerve root compression, ligamentum flavum hypertrophy and spondylolisthesis. The results of MPR-CT were in good correlation with finding from surgical exploration; the positive predictive values of central canal atenosis, lateral canal stenosis and foraminal stenosis were 77.7%, 75% and 50% respectively which were higher than those for disc herniation or nerve root compression. Typical claudication was found in 10% of the cases and the most common affected level was L4-L5. Therefore, MPR-CT which composed of axial, coronal and sagittal views was shown to be an application imaging modality because of its reliability.