Biopsia endobiliar con pinza por acceso percutáneo: primera experiencia en Uruguay / Biopsy of biliary ducts via percutaneous catheterization: first experience in Uruguay / Biópsia endobiliária com pinça de acesso percutâneo: primeira experiência no Uruguai

Resumen: Presentamos la primera experiencia en Uruguay de una biopsia endobiliar con pinza por acceso percutáneo que realizáramos en una paciente con estenosis biliar hiliar de probable causa neoplásica. Hasta nuestro conocimiento, no existen reportes de esta técnica en Uruguay. La difusión de la disponibilidad de esta técnica en nuestro medio es de gran importancia, ya que permite al equipo médico tratante disponer de una nueva herramienta para el manejo diagnóstico de las estenosis biliares.

Abstract: The study presents the first experience in Uruguay of a forceps biopsy of biliary ducts via percutaneous catheterization performed in a patient with hilar biliary strictures probably caused by a tumor. As far as we know, no reports on this technique have been published in our country. It is important to spread the availability of this technique in our country since it provides the medical team with a new tool for the diagnostic handling of biliary strictures.

Resumo: Apresentamos a primeira experiência no Uruguai de uma biópsia endobiliária com pinça de acesso percutânea realizada em um paciente com estenose biliar hilar de provável causa neoplásica. Para nosso conhecimento, não há relatos dessa técnica no Uruguai. A difusão da disponibilidade dessa técnica em nosso ambiente é de grande importância, pois permite à equipe médica responsável o tratamento ter uma nova ferramenta para o manejo diagnóstico da estenose biliar.

Estenosis de la apertura piriforme y síndrome de incisivo central único: casos clínicos / Piriform aperture stenosis and solitary median maxillary central incisor: clinical cases

El síndrome incisivo central único es un trastorno que involucra anomalías de la línea media. Se puede presentar con dificultad respiratoria poniendo en peligro la vida del recién nacido, debido a malformaciones nasales. Estas malformaciones incluyen atresia de coanas y la estenosis de la apertura del orificio piriforme. Debe pensarse en esta última en todo recién nacido con estridor y dificultad respiratoria de grado variable, asociado a la dificultad de pasar una sonda a través de la región anterior de las fosas nasales. El diagnóstico se confirma por tomografía computarizada del macizo craneofacial y el examen nasofibroscópico. La conducta terapéutica dependerá de la gravedad de los síntomas, pero en general si es que no hay compromiso respiratorio severo, se prefiere una conducta expectante, y esperar el crecimiento craneofacial del niño, para aumentar permeabilidad nasal. Presentamos dos casos clínicos.

Solitary median maxillary central incisor syndrome is a rare disorder involving midline abnormalities. It may present with life threatening respiratory distress in the neonate secondary to nasal malformations. These include choanal atresia and pyriform aperture stenosis. The last to be thought in any newborn with stridor and respiratory distress associated with the difficulty of passing a tube through the anterior region of the nostrils. The diagnosis is confirmed by craniofacial CT scan and nasolaryngoscope evaluation. The therapeutic approach depends on the severity of symptoms.

Sclerosing Cholangitis: Clinicopathologic Features, Imaging Spectrum, and Systemic Approach to Differential Diagnosis

Sclerosing cholangitis is a spectrum of chronic progressive cholestatic liver disease characterized by inflammation, fibrosis, and stricture of the bile ducts, which can be classified as primary and secondary sclerosing cholangitis. Primary sclerosing cholangitis is a chronic progressive liver disease of unknown cause. On the other hand, secondary sclerosing cholangitis has identifiable causes that include immunoglobulin G4-related sclerosing disease, recurrent pyogenic cholangitis, ischemic cholangitis, acquired immunodeficiency syndrome-related cholangitis, and eosinophilic cholangitis. In this review, we suggest a systemic approach to the differential diagnosis of sclerosing cholangitis based on the clinical and laboratory findings, as well as the typical imaging features on computed tomography and magnetic resonance (MR) imaging with MR cholangiography. Familiarity with various etiologies of sclerosing cholangitis and awareness of their typical clinical and imaging findings are essential for an accurate diagnosis and appropriate management.

Stents farmacológicos de segunda geração para tratamento de lesões proximais isoladas da artéria descendente anterior. dados do registro Safira / Second-generation drug-eluting stent treatment for isolated proximal left anterior descending artery stenoses. the Safira registry data

Introdução: A estenose grave do terço proximal da artéria descendente anterior (ADA) é classificada como lesão de alto risco, visto que pode comprometer grande parte do miocárdio ventricular esquerdo. Os stents farmacológicos (SF) de segunda geração têm demonstrado maior eficácia e segurança quando comparados aos não farmacológicos ou aos de primeira geração. São escassos os relatos na literatura do emprego desses dispositivos para o tratamento de lesões isoladas do terço proximal da ADA. Métodos: Estudo observacional e prospectivo, que incluiu pacientes uniarteriais, portadores de lesão de novo no terço proximal da ADA, tratados eletivamente com SF de segunda geração. Avaliamos os desfechos clínicos hospitalares e tardios. Resultados: Foram incluídos 70 pacientes, sendo a maioria do sexo masculino (70%), com média de idades de 65,4 ± 11,2 anos e com alta prevalência de diabetes (37%). O quadro clínico mais frequente foi angina estável (57,1%) e metade das lesões era do tipo B2 ou C. Foram tratadas 70 lesões com 71 stents, com sucesso angiográfico de 100%. O desfecho primário composto por óbito cardíaco, infarto não fatal ou revascularização do vaso alvo no seguimento clínico de 2,5 anos ocorreu em 3% dos pacientes. A mortalidade cardíaca foi de 1,5%, e a revascularização da lesão alvo foi necessária em apenas 1,5% dos pacientes. Conclusões: Em pacientes uniarteriais com lesões de novo da ADA proximal, o tratamento eletivo com SF de segunda geração parece ser uma opção segura, com baixas taxas de eventos cardíacos adversos ou necessidade de nova revascularização

Background: Severe stenosis of the proximal left anterior descending artery (LAD) is classified as a high-risk lesion, as it may affect a large part of the left ventricular myocardium. Second-generation drug-eluting stents (DES) have been shown to be more effective and safer when compared to bare-metal or first-generation ones. There are few reports in the literature on the use of these devices for the treatment of isolated lesions in the proximal LAD. Methods: Observational and prospective study, which included single-vessel patients with de novo lesions in the proximal LAD, electively treated with second-generation DES. In-hospital and late clinical outcomes were evaluated. Results: Seventy patients were included, most of them males (70%), with a mean age of 65.4 ± 11.2 years and a high prevalence of diabetes (37%). The most common clinical presentation was stable angina (57.1%) and half of the lesions were type B2 or C. A total of 70 lesions were treated with 71 stents, with 100% angiographic success. The primary endpoint, consisting of cardiac death, nonfatal infarction, or target-vessel revascularization during the 2.5-year clinical follow-up, occurred in 3% of the patients. Cardiac death was 1.5%, and target-lesion revascularization was required in only 1.5% of the patients. Conclusions: Elective treatment with second-generation DES seems to be a safe option in single-vessel patients with de novo lesions in the proximal LAD, with low rates of adverse cardiac events or need for additional revascularization procedure

Síndrome de compresión del tronco celíaco por el ligamento arcuato mediano: Tratamiento laparoscópico

El síndrome del ligamento arcuato medio (SLAM), o síndrome de compresión del tronco celíaco, es causado por la compresión extrínseca del ligamento arcuato medio, bandas fibrosas prominentes y tejido ganglionar periaórtico. En muchas ocasiones es asintomático, pero puede manifestarse con síntomas como dolor abdominal postprandial o durante el ejercicio, náuseas, vómitos y pérdida de peso. Mediante técnicas poco invasivas, como la ecografía doppler color y la angiotomografía preoperatoria, es posible obtener resultados diagnósticos comparables a los de la arteriografía. La cirugía constituye el tratamiento de elección, siendo la vía laparoscópica una técnica segura y eficaz Se presenta un caso sintomático atípico que requirió tratamiento quirúrgico laparoscópico, con mejoría clínica e imagenológica luego del procedimiento.

Median arcuate ligament syndrome (MALS), or celiac trunk compression syndrome, is caused by extrinsic compression of median arcuate ligament, prominent fibrous bands and periaortic nodal tissue. In many cases is asymptomatic, but it may manifests with symptoms such as postprandial abdominal pain or during exercise, nauseas, vomiting and weight loss. Trough less invasive diagnostic techniques, such as doppler ultrasound for screening and preoperative angiotomograhpy, it is possible to obtain good results, comparable to those with arteriography. Surgical treatment by laparoscopic approach is a safe and effective technique. A symptomatic case that required surgical treatment, a laparoscopic approach, with clinical and imaging improvement after the procedure, is presented.

Lung Infarction due to Pulmonary Vein Stenosis after Ablation Therapy for Atrial Fibrillation Misdiagnosed as Organizing Pneumonia: Sequential Changes on CT in Two Cases

Pulmonary vein (PV) stenosis is a complication of ablation therapy for arrhythmias. We report two cases with chronic lung parenchymal abnormalities showing no improvement and waxing and waning features, which were initially diagnosed as nonspecific pneumonias, and finally confirmed as PV stenosis. When a patient presents for nonspecific respiratory symptoms without evidence of infection after ablation therapy and image findings show chronic and repetitive parenchymal abnormalities confined in localized portion, the possibility of PV stenosis should be considered.

Ureteral stricture formation after ureteroscope treatment of impacted calculi: A prospective study

PURPOSE: Urinary calculi is a familiar disease. A well-known complication of endourological treatment for impacted ureteral stones is the formation of ureteral strictures, which has been reported to occur in 14.2% to 24% of cases. MATERIALS AND METHODS: This was a prospective study. Ureterotripsy treatment was used on patients with impacted ureteral stones. Then, after 3 months and 6 months, the condition of these patients was assessed by means of a kidney-ureter-bladder (KUB) ultrasound. If the KUB ultrasound indicated moderate to serious hydronephrosis, the patient was further assessed by means of a computed tomography intravenous urogram or retrograde pyelogram to confirm the occurrence of ureteral strictures. RESULTS: Of the 77 patients who participated in the study, 5 developed ureteral strictures. Thus, the stricture rate was 7.8%. An analysis of the intraoperative risk factors including perforation of the ureter, damage to the mucous membrane, and residual stone impacted within the ureter mucosa revealed that none of these factors contributed significantly to the formation of the ureteric strictures. The stone-related risk factors that were taken into consideration were stone size, stone impaction site, and duration of impaction. These stone factors also did not contribute significantly to the formation of the ureteral strictures. CONCLUSIONS: This prospective study failed to identify any predictable factors for ureteral stricture formation. It is proposed that all patients undergo a simple postoperative KUB ultrasound screening 3 months after undergoing endoscopic treatment for impacted ureteral stones.

Estenosis crítica de conducto hepático común por anillo vascular: reporte de un caso / Common bile duct stricture caused by vascular ring: A case report

Introduction: The most common congenital malformations of the bile duct are biliary atresia and choledochal cyst. In addition, the most common liver anatomical variation is the right hepatic artery aberration. The goal of this study is to characterize a patient with this disease and propose the hepatoduodenal anastomosis as surgical treatment. Case report: One-month-old patient with suspected congenital biliary atresia due to progressive jaundice and acholia since birth. Liver tests consistent with a cholestatic pattern and brain MRI scan consistent with biliary atresia. Periods of decreased bilirubin and sporadic slight pigmentation of depositions were described. The surgical finding was a bile duct stricture due to a vascular ring caused by aberrant right hepatic artery. Resection of bile duct and hepatic-duodenal bypass were performed. The patient evolved satisfactorily from this condition. Conclusion: There are few reports of biliary obstruction due to vascular malformations. It is important to keep in mind that not all neonatal jaundice episodes are caused by biliary atresia or choledo-chal cyst. The clinical course, laboratory tests and imaging should be considered and in the case of suspicion, further exploration should take place.

Introducción: Las malformaciones congénitas de la vía biliar más frecuentes son la atresia de vías biliares y quiste de colédoco. Por otro lado, la variante anatómica hepática más común es la aberración de la arteria hepática derecha. El objetivo es caracterizar un paciente portador de esta patología y plantear la hepato-duodeno anastomosis como tratamiento quirúrgico. Caso clínico: Paciente de 1 mes de edad, con sospecha de Atresia de Vía Biliar congénita por ictericia progresiva y acolia desde recién nacido. Pruebas hepáticas concordantes con un patrón colestásico y resonancia magnética compatible con atresia de vías biliares. Evolucionó con períodos de descenso de bilirrubina y leve pigmentación, esporádica, de deposiciones. El hallazgo quirúrgico fue una estenosis crítica de vía biliar a nivel del conducto hepático común debido a un anillo vascular por una arteria hepática derecha aberrante. Se realizó una sección de vía biliar y una derivación hepato-duodenal. Evolucionó con una resolución completa de su patología. Conclusión: Existen pocos reportes de obstrucción de vía biliar por malformaciones vasculares. Es importante tener presente que no todas las ictericias neonatales son por atresia de vías biliares o quiste de colédoco. Se debe considerar la evolución clínica, laboratorio e imágenes, y si existen sospechas, explorar.

Estenosis actínica de colon 22 años después / Actinic colon stenosis after 22 years

La estenosis actínica del intestino se produce en ocasiones después del tratamiento con radioterapia de distintos tumores del abdomen o de zonas vecinas, afecta la mucosa del colon y es más frecuente la que aparece en algunos pacientes que han recibido radioterapia para el tratamiento de tumores de la región pélvica durante muchos meses, o incluso años después. Presentamos a un paciente masculino de 34 años de edad, que desarrolló una estenosis colónica 22 años después de tratamiento radiante y quimioterapia por un tumor de Wilms, que requirió resección quirúrgica(AU)

Actinic stenosis of the intestine sometimes occurs after the radiotherapy applied to different tumors in the abdominal area or surrounding areas, it affects the colon mucosa and is more frequent in some patients who have been treated with radiotherapy to manage tumors of the pelvic region after many months or even years. Here is a male patient aged 34 years, who developed colon stenosis after 22 years of having been treated with radiation and chemotherapy since he had a Wilms' tumor that required surgical excision(AU)

Renal artery stenosis in association with congenital anomalies of the kidney and urinary tract

To describe 8 cases of renal artery stenosis [RAS] in children with congenital anomalies of the renal tract. We conducted a retrospective chart review of 78 children with RAS who were followed up at Great Ormond Street Hospital, London, United Kingdom between 2003 and 2012. We used an interventional radiology database to identify all patients who had RAS confirmed by digital subtraction angiography and examined all cases of congenital anomaly of the renal tract that had been diagnosed during childhood. We documented the following renal anomalies: multicystic dysplastic kidney [n=2], renal hypoplasia [n=1], congenital solitary kidney with hydronephrosis [n=1], and unilateral vesicoureteric reflux with poorly functioning kidneys [n=2]. The anomaly was unknown in 2 cases. Seven children had unilateral nephrectomy at a median age of 2.5 years [range, 0.4-10 years] for various urological abnormalities. All children were confirmed to have RAS after presentation with hypertension at a median age of 10 [3.5-16.2] years. Angioplasty was performed in 7 children, of which 6 achieved control of their blood pressure on reduced medications. We highlight the association between RAS and other renal anomalies, which indicates that they could share a common genetic background

Estenosis antrales en niños: manejo endoscópico / Antral stenosis in children: endoscopic management

La obstrucción del tracto de salida gástrico es poco frecuente en la infancia; su etiología es diversa e incluye causas congénitas y adquiridas. Las manifestaciones clínicas son variadas e inespecíficas como dolor y/o distensión abdominal, vómitos y pérdida de peso. El diagnóstico se realiza por la anamnesis apoyada en estudios de imágenes como radiología simple y contrastada y, en ocasiones, ecografía y TAC abdominal. La endoscopia digestiva superior confirma el diagnóstico y proporciona valor pronóstico y terapéutico. El tratamiento, desde hace muchos años ha sido la cirugía, con espectro variable de técnicas quirúrgicas y morbilidad y mortalidad asociada. Desde el advenimiento de las técnicas endoscópicas y la aparición del balón "through-the-scope", la terapia endoscópica constituye la primera línea de tratamiento. Se presentan dos pacientes de 2 y 5 años de edad que consultaron a nuestro Servicio por presentar vómitos, distensión abdominal y pérdida de peso de un mes de evolución, recibiendo tratamientos adecuados sin mejoría, en quienes se diagnosticó inicialmente obstrucción del tracto de salida gástrico asociado a úlcera prepilórica cicatrizada. En uno de ellos se reportó el antecedente de ingestión de golosina ácida y en el segundo no se encontró causa aparente. La resolución fue satisfactoria en ambos por dilatación endoscópica antropilórica con balón neumático, sin complicaciones

The tractus gastric obstruction of exit is frequent in infancy; its etiology is diverse and includes congenital causes and adquired. the clinical manifestations are varied and specific like pain And or abdominal distension, vomiting, and weight loss the diagnosis is carry out through anamnesis backed up in studies of images like simple radiology, and contrasted and at times, echography and abdominal TAC. The digestive superior endoscopy confirms the diagnosis and provides value forecast and therapeutic. The treatment, has been surgery eversince with variable specter of surgical technologists and morbidity and mortality associated however, since the arrival of the endoscopic techniques and the appearing of the baron "through-the-scope", the endoscopic treatment constitutes the front line of treatment. Two patients of 2 and 5 years old that consulted our service for presenting vomiting, abdominal distension and weight loss of a month of evolution, receiving appropriate treatment without improvement, whose obstruction of exit was diagnosed initially gastric prepyloric ulcer healedwas associated. In one of them the antecedent of ingestion of acid sweet was yielded and in the second one there was not anhy cause. Resolution was satisfactory in both for dilatation endoscopic antropyloric with pneumatic ball, without complications

Diagnóstico y tratamiento de las complicaciones biliares asociadas al trasplante hepático / Diagnosis and treatment of biliary complications associated with liver transplantation

Las complicaciones biliares se presentan en 10 - 25% de los pacientes que reciben un trasplante hepático y pueden causar una importante morbilidad e incluso la pérdida del injerto. Las complicaciones más comunes son la estenosis biliar (anastomótica y no anastomótica), fuga biliar y litiasis biliar. La gran mayoría de estas complicaciones puede tratarse con éxito mediante colangiopancreatografía retrógrada endoscópica. Esta revisión se centra en el diagnóstico, factores de riego y tratamiento endoscópico de las complicaciones biliares asociadas al trasplante hepático

Biliary complications ocurr in 10 - 25% of liver transplant recipients and are associated to a significant morbidity and the possibility of graft failure. The most common biliary complications are strictures (both anastomotic and non-anastomotic), bile leaks and stones. Most of these complications can be appropriately managed with endoscopic retrograde cholangiopancreatography. This article will review the diagnosis, risk factors, and endoscopic management of biliary complications related to liver transplantation

Estenosis acueductal en acondroplasia: a propósito de un caso / Aqueductal stenosis in achondroplasia: report of a case

Achondroplasia is the most frequent cause of disproportionate short stature. Characterized by abnormal growth of long bones, it renders a short-limbed individual of normal intelligence. A serious potential complication is spinal compression, which can happen at any level but is particularly common at the craniocervical junction. It can cause important morbility during the first few years of life, including sudden death. We present a 22-month-old patient diagnosed with achondroplasia, who developed aqueductal stenosis with symptomatic spinal cord compression, diagnosed during a routine consultation, requiring decompressive surgery with excellent results.

La acondroplasia es la condición asociada a talla baja desproporcionada más frecuente, caracterizada por un crecimiento óseo anormal, que resulta en talla baja con extremidades cortas e inteligencia normal. Una de las complicaciones más habituales es la compresión medular, que puede ocurrir a cualquier nivel, siendo más frecuente en la unión cráneo cervical, generando alta morbimortalidad en los primeros años de vida, principalmente por muerte súbita. Presentamos una paciente de 1 año 10 meses con diagnóstico precoz de acondroplasia, que presentó en su evolución estenosis acueductal con compresión medular, sintomática, pesquisada en control rutinario, que requirió cirugía descompresiva con buena evolución posterior.

Ingestión de cáusticos: revisión de la casuística en el Hospital de Niños “J. M. de los Ríos” durante los años 1998 a 2008: un problema de salud pública / Ingestion of caustics: review of caseloads at Hospital de Niños J. M. de los Ríos between 1998 and 2008: a public health issue

La ingestión de sustancias cáusticas es uno de los accidentes más importantes en la infancia debido a su incidencia, gravedad y difícil tratamiento. Determinar la incidencia de la ingestión de cáusticos y sus complicaciones en pacientes pediátricos, en un período de 10 años en el Hospital de Niños J. M. de los Ríos, Caracas Venezuela. Estudio descriptivo, transversal, retrospectivo en el Hospital de Niños J. M. de los Ríos, desde 1998 a 2008. Variables: edad, sexo, hallazgos endoscópicos y complicaciones. De 142 niños con ingestión de cáusticos, 89/142 (62,6%) corresponden al sexo masculino y el grupo predominante fueron los preescolares 74/142 (52,1%) seguido por lactantes en 44/142 (31%). La edad media 2.8 años (10 m a 10 años). El 84,5% reportarón esofagítis (Grado IIIB 7%, IIIA 10,5%, IIB 13%, IIA 21,1%, I 33%). El 77,4% desarrollaron estenosis, y 7% se perforaron. La ingesta de cáusticos es un accidente común en países subdesarrollados. Los niños son susceptibles debido a la curiosidad natural, y la costumbre de trasegar agentes limpiadores en recipientes atractivos. Se plantea la necesidad de legislar sobre la seguridad de estos productos...

The ingestion of caustic substances is one of the most relevant accidents in childhood because of its incidence, seriousness and diffi culty to treat. Determining the incidence of caustics ingestion and its complication in pediatric patients during a 10-year term at Hospital de Niños J. M. de los Ríos, Caracas Venezuela. Retrospective cross-sectioned descriptive study performed at Hospital de Niños J. M. de los Ríos between 1998 and 2008. Variables: age, sex, endoscopic fi ndings and complications. Out of 142 children who had ingested caustics, 89/142 (62.6%) are male, and preschool children was the prevailing group, 74/142 (52.1%), followed by nursing children, 44/142 (31%). 2.8 years was the mean age (ranging from 10 months through 10 years). 84.5% was reported with esophagitis (7% with Grade IIIB, 10.5% with IIIA, 13% with IIB, 21.1% with IIA, 33% staged as I). 77.4% developed stenosis and 7% showed perforation. Caustics ingestion is a common accident in underdeveloped countries. Children are susceptible to suffer such because of their natural curiosity and the usage of transferring household cleaners in attractive recipients. The necessity of law-making on the safety of such products is proposed...

La enteroscopia asistida por balón es útil para diagnosticar las estenosis del intestino delgado / Balloon-assisted enteroscopy for small-bowel strictures

Describimos el caso de una mujer de 47 años tratada repetidamente en nuestra unidad de endoscopia por estenosis del intestino delgado por enfermedad de Crohn. El caso ejemplifica la combinación de distintas estrategias para el tratamiento de las estenosis del intestino delgado.

Tratamento endoscópico das lesões biliares / Endoscopic treatment of the biliary injuries

As técnicas cirúrgicas convencionais ofertam uma apropriada condição de cura na maioria dos pacientes com estreitamento biliar benigno. Nesta condição, no entanto, o reparo cirúrgico está associado com recorrência tardia da re-estenose em 10 por cento a 30 por cento dos pacientes. Neste contexto, os avanços tecnológicos na endoscopia terapêutica promoveram a possibilidade alternativa do tratamento efetivo destas obstruções benignas. Considerações em relação ao tempo de reospitalização e de procedimentos devem ser averiguados em detalhes e ponderados em relação á cirurgia. Estenoses malignas estão relacionadas á colangite, icterícia e dor e, consequentemente, com as alterações sistêmicas relacionadas com a sepsis biliar. A conduta endoscópica cria uma derivação do suco biliar para o duodeno, sendo uma verdadeira derivação biliodigestiva endoscópica e utilizando-se próteses plásticas ou metálicas. O propósito desta revisão é ofertar aos leitores a eficácia do tratamento endoscópico na estenose benigna e maligna biliopancreática.

Standard surgical techniques offer a good chance of cure forthe majority of patients affected by extrahepatic benign biliarystricture. Nevertheless, operative repair has a long-termrecurrence rate of stricture in 10 percent to 30 percent of patients. Advancesin endoscopic procedures have provided alternative options ofrelieving biliary obstructions, but prolonged length of treatmentand rehospitalization have to be considered if endoscopy isperformed. Malignant stenoses are an important factor determining cholangitis, jaundice and pain and it's each systemic consequences. The endoscopic approach intends to create a deviation of bile juice to duodenum by means of metal or plastic stents aiming a safe palliation. The purpose of this review is to show to the readerseffectiveness of endoscopic treatments of benign and malignat stenosis of the bile duct and pancreatic.

Cáncer del ángulo esplénico del colon: presentación de un caso / Cancer of the colon spleen angle: presentation of a case

El cáncer de colon es actualmente un importante problema de salud pública en los países desarrollados. Es el cuarto cáncer más frecuente en el mundo. Reportamos un caso de una paciente femenina, de 65 años de edad, raza negra, que acude a la consulta por presentar trastornos dispépticos como único síntoma, sin factores de riesgo conocido. Se le indicó un colon por enema, en el que se observó un estrechamiento distal al ángulo esplénico del colon en la misma zona de la estrechez fisiológica a ese nivel. Se le realizó colonoscopia que diagnostica: tumor de colon izquierdo próximo al ángulo esplénico. Se operó y se le realizó la resección segmentaria de ángulo esplénico, así como biopsia. Anatomía patológica informa adenocarcinoma del colon bien diferenciado.

The colon cancer is currently an important public health problem in developed countries. It is the fourth most common cancer in the world. We report the case of a 65-years-old, black, female patient, assisting our consultation with dyspeptic disturbances as the unique symptom, without known risk factors. We indicated a colon by enema and a distal narrowing was observed at the colon spleen angle, at the same zone of the physiologic narrowing at that level. A colonoscopy was carried out diagnosing a left colon tumor near the spleen angle. It was operated with segmental resection of the spleen angle and a biopsy was made. Pathologic anatomy informed a well-differentiated colon adenocarcinoma.

Pinzamiento femoroacetabular: Conceptos básicos en una nueva causa de dolor inguinal: [revisión] / Femoroacetabular impingement as a cause of inguinal pain: [review]

Femoro-acetabular impingement is an anatomical disturbance of the hip, caused by a deformity of the acetabulum, femur or both that causes an abnormal contact between both structures during certain movements. Its prevalence is 10 to 15 percent and causes chronic inguinal pain. It can be confused with several other causes of inguinal pain such as hernias, facet syndromes, a renal colic, etc. Patients with this condition are usually young individuals with inguinal pain that may appear after a minor trauma. During examination, pain may be elicited by infernal rotation and abduction movements of hip, flexed in 90°. Plain hip X ray is the most commonly used diagnostic method. Non-steroidal anti-inflammatory drugs and physical therapy can be used to alleviate pain, but the definitive treatment is surgical.

Experiencia en el tratamiento quirúrgico de estenosis subglótica adquirida en pacientes del servicio de cirugía general del Hospital Militar Escuela Doutor Alejandro Dávila Bolaños, en el período comprendido entre enero 2000 y diciembre 2006 / Experience in the surgical treatment of acquired subglottic stenosis in patients of general surgery department of the Military Training Hospital Doctor Alejandro Dávila Bolaños in the period between January 2000 and December 2006

Se realizó un estudio retrospectivo, serie de casos, en el servicio de cirugía del Hospital Militar Escuela Alejandro Dávila Bolaños, teniendo como universo a 7 pacientes con diagnóstico de estenosis subglótica adquirida y una muestra de 6 casos al excluir un caso dado que no cumplió con los criterios de inclusión del estudio. Se encontró que el rango de edad que predominó fue el de 18 a 30 años, seguido del de 31 a 40 años; sin haber predilección de género; todos los pacientes presentaron estenosis grado III según la clasificación de Cotton, empleándose en todos los casos la resección crico-traqueal con anastomosis crico-tiro-traqueal termino terminal, teniendo neumotórax como complicación en un solo caso. Se logró decanulación de todos los casos en el transquirúrgico, obteniéndose un resultado satisfactorio en el 100% de los casos, con un seguimiento mínimo de 2 años y máximo de 7 años. Dado los resultados obtenidos en nuestro estudio, establecemos las siguientes recomendaciones: 1. Realizar estudios para determinar la incidencia de estenosis subglótica adquirida post intubación en el servicio de U.C.I.2. Realizar seguimiento endoscópico a todos los pacientes que presenten más de 7 días de intubación en U.C.I., con el fin de realizar traqueostomías tempranas para evitar estenosis subglótica. 3. Establecer en conjunto con los servicios de ORL y ENDOSCOPIA un protocolo de manejo de los pacientes con estenosis subglótica...

Experiencia en el tratamiento quirúrgico de estenosis subglótica adquirida en pacientes del servicio de cirugía general del Hospital Militar Escuela Doctor Alejandro Dávila Bolaños, en el período comprendido entre enero 2000 y diciembre 2006

Se realizó un estudio retrospectivo, serie de casos, en el servicio de cirugía del Hospital Militar Escuela Alejandro Dávila Bolaños, teniendo como universo a 7 pacientes con diagnóstico de estenosis subglótica adquirida y una muestra de 6 casos al excluir un caso dado que no cumplió con los criterios de inclusión del estudio. Se encontró que el rango de edad que predominó fue el de 18 a 30 años, seguido del de 31 a 40 años; sin haber predilección de género; todos los pacientes presentaron estenosis grado III según la clasificación de Cotton, empleándose en todos los casos la resección crico-traqueal con anastomosis crico-tiro-traqueal termino terminal, teniendo neumotórax como complicación en un solo caso. Se logró decanulación de todos los casos en el transquirúrgico, obteniéndose un resultado satisfactorio en el 100% de los casos, con un seguimiento mínimo de 2 años y máximo de 7 años. Dado los resultados obtenidos en nuestro estudio, establecemos las siguientes recomendaciones: 1. Realizar estudios para determinar la incidencia de estenosis subglótica adquirida post intubación en el servicio de U.C.I.2. Realizar seguimiento endoscópico a todos los pacientes que presenten más de 7 días de intubación en U.C.I., con el fin de realizar traqueostomías tempranas para evitar estenosis subglótica. 3. Establecer en conjunto con los servicios de ORL y ENDOSCOPIA un protocolo de manejo de los pacientes con estenosis subglótica...