Incidencia de factores de riesgo para desarrollo de litiasis vesicular en pacientes menores de 40 años colecistectomizados en el hospital Dr. Ricardo Baquero González. Periodo enero 2019- diciembre 2021. Estudio retrospectivo / Risk factors for the development of vesicular lithiasis in patients under 40 years old cholecystectomy at Hospital Dr. Ricardo Baquero González. Period january 2019-december 2021. Retrospective study

El objetivo de la investigación es analizar la incidencia de los factores de riesgo para el desarrollo de colelitiasis en pacientes menores de 40 años colecistectomizados en el Hospital Ricardo Baquero González. Periodo enero 2019 ­ diciembre 2021.Método: Se realizó un estudio retrospectivo; se analizaron los datos de los de los pacientes diagnosticados e intervenidos por litiasis vesicular. Resultados: Arrojaron que la muestra fue de 151 pacientes; 70% es de sexo femenino y el 30% masculino. El 41% de los pacientes tiene menos de 40 años. En los factores de riesgo se destaca que el 42% son del tipo familiar, el 40% de las mujeres utiliza anticonceptivos orales y el 40% de los pacientes presenta sobrepeso. Conclusión: Se concluye que los casos de litiasis vesicular se encuentran asociados de forma mayoritaria al sexo femenino y a factores de riesgos familiares y al sobrepeso; en cuanto a las mujeres, hubo alta incidencia de casos de litiasis vesicular en aquellas que emplean anticonceptivos orales. Además, en la investigación se observó un aumento en los casos de litiasis vesicular en pacientes que no se encuentran dentro de los grupos de riesgo, como son mujeres menores de 40 años, con peso normal y con pocas gestas(AU)

he objective of the research is to analyze the incidence of risk factors for the development of cholelithiasis in patients under 40 years of age who underwent cholecystectomy at the Ricardo Baquero González Hospital. Period January 2019 - December 2021.Methodi: retrospective study was carried out; Data from patients diagnosed and operated on for gallstones were analyzed. Results: showed that the sample was 151 patients; 70% are female and 30% male. 41% of patients have an age under 40 years old. In the risk factors, it is highlighted that 42% are of the family type, 40% of the women in the sample use oral contraceptives and 40% of the patients are overweight. Concluded: From the investigation it is concluded that the cases of vesicular lithiasis are mostly associated with the female sex and family risk factors and overweight; As for women, there was a high incidence of cases of gallstones in those who use oral contraceptives. In addition, the investigation observed an increase in cases of gallstones in patients who are not within the risk(AU)

Lithopedion causing intestinal obstruction in a 71-year-old woman: A case report / Litopedia causando obstrução intestinal em idosa de 71 anos: relato de caso

Abstract Ectopic pregnancy is the leading cause of pregnancy-related death during the first trimester, and it occurs in 1 to 2% of pregnancies. Over 90% of ectopic pregnancies are located in the fallopian tube. Abdominal pregnancy refers to an ectopic pregnancy that has implanted in the peritoneal cavity, external to the uterine cavity and fallopian tubes. The estimated incidence is 1 per 10,000 births and 1.4%of ectopic pregnancies. Lithopedion is a rare type of ectopic pregnancy, and it occurs when the fetus from an unrecognized abdominal pregnancymay die and calcify. The resulting "stone baby" may not be detected for decades andmay cause a variety of complications. Lithopedion is a very rare event that occurs in 0.0054% of all gestations. About 1.5 to 1.8% of the abdominal babies develop into lithopedion. There are only ~ 330 known cases of lithopedion in the world. We describe a lithopedion that complicated as intestinal obstruction in a 71-year-old woman.

Resumo A gravidez ectópica é a principal causa de morte materna no primeiro trimestre, e ocorre em 1 a 2% das gestações. Mais de 90% ocorrem nas tubas uterinas. Gravidez abdominal refere-se à gravidez ectópica implantada na cavidade peritoneal, externamente ao útero e às tubas uterinas.Aincidência estimada éde 1 por 10mil nascimentos e 1,4%das gravidezes ectópicas. A litopedia é um tipo raro de gravidez ectópica, e ocorre quando o feto de uma gravidez abdominal não reconhecida morre e se calcifica. O "bebê de pedra" resultante pode não ser detectado por décadas, e pode causar complicações futuras. A litopedia é um evento muito raro que ocorre em 0,0054% de todas as gestações. Cerca de 1,5 a 1,8% dos bebês abdominais se tornam litopédios. Existem somente cerca de 330 casos conhecidos de litopedia no mundo. Descrevemos uma litopedia que se agravou, tornando-se uma obstrução intestinal, em uma idosa de 71 anos.

Microlitiasis alveolar pulmonar. A propósito de un caso / Pulmonary alveolar microlithiasis. A case report

La microlitiasis alveolar pulmonar es una enfermedad poco frecuente caracterizada por el depósito intraalveolar de concreciones de calcio y fósforo. Es muy poco habitual su presentación en niños, dada su característica progresión crónica a lo largo de varios años, con marcada disociación clínico-radiológica. En su etiopatogenia está implicado un gen, recientemente descrito, que codifica un cotransportador de sodio y fosfato expresado en tejido pulmonar. Típicamente evoluciona desde un estadio asintomático de duración variable, agregando tos y dificultad respiratoria, determinando insuficiencia respiratoria y corpulmonale en estadios avanzados. Se presenta un caso pediátrico que ilustra las características clínicas de la enfermedad y las dificultades que ofrece en el diagnóstico dada su baja frecuencia, particularmente en niños.

Logros y retos de la colecistectomía laparoscópica en Cuba / Achievements and challenges of the laparoscopic cholecystectomy in Cuba

Objetivo: conocer los resultados de la generalización de la colecistectomía laparoscópica en Cuba. Métodos: se realizó un estudio retrospectivo y descriptivo a través de una encuesta completada por 16 grupos de cirugía de mínimo acceso de hospitales universitarios en 9 provincias del país para definir carácter, conversiones, conducta ante litiasis de la vía biliar, morbilidad y mortalidad perioperatoria. Resultados: se obtuvieron datos relacionados con 56 878 intervenciones realizadas, desde los inicios de la actividad en esos servicios, hasta noviembre de 2007, y se definió carácter, conversiones, conducta ante litiasis de la vía biliar, morbilidad y mortalidad perioperatoria. El acceso laparoscópico se usó en 80,7 por ciento de los casos, electivo en 97,1 por ciento, con índices de conversión de 1,4 por ciento, morbilidad de 0,58 por ciento y mortalidad de 0,10 por ciento. Predominó, ante el hallazgo de litiasis coledociana, el convertir y explorar de forma convencional. Conclusiones: los resultados de la generalización de la colecistectomía laparoscópica en Cuba son excelentes, pero es necesario extender su uso como arsenal en el tratamiento de las complicaciones de la litiasis biliar(AU)

Objective: to know the results from the standardization of the laparoscopic cholecystectomy in Cuba. Methods: a descriptive and retrospective study was conducted be means of a survey completed by 16 groups of minimal access surgery from university hospital in 9 provinces of our country to define the character, conversions, behavior in face of biliary tract lithiasis, perioperative morbidity and mortality. Results: it was possible to obtain data related to 56 878 surgical interventions performed from the onset of activity in these centers up to November, 2007 defining the character, conversions, behavior in face of a biliary tract lithiasis and perioperative morbidity and mortality. The laparoscopic approach was used in the 80,7 percent of cases, elective in the 97,1 percent, with conversion rates of 1,4 percent, morbidity of 0,58 percent and mortality of 0,10 percent. There was predominance of conversion and exploration of conventional for in face of the choledochal lithiasis finding. Conclusions: results of standardization of laparoscopic cholecystectomy in Cuba are excellent, but it is necessary to extend its use as a tool in the treatment of the biliary lithiasis complications(AU)

Clinical importance and prevalence of testicular microlithiasis in pediatric patients / Importância clínica e prevalência de microlititíase testicular em pacientes pediátricos

PURPOSE: To evaluate the prevalence of testicular microlithiasis among pediatric patients with inguinoscrotal affections. METHODS: Between January 2005 and January 2010, we evaluated, prospectively 1504 children ranging from 1 to 15 years with inguinoscrotal affections with a high-frequency ultrasound system, which employs a 10-MHz transducer. RESULTS: Testicular microlithiasis was identified in 20 testes of eleven children (0.71 percent of 1504 patients evaluated), through an ultrasound scan. Testicular microlithiasis was found in 5 children with cryptorchidism (3.93 percent of 127 patients), 4 children with retractile testes (14.8 percent of 27 patients), 1 child with a hypotrophic testis (100 percent of 1 patient), and 1 child with inguinal hernia (0.07 percent of 1349 patients). The children with testicular microlithiasis were submitted to annual physical examinations and ultrasound evaluations. CONCLUSIONS: Testicular microlithiasis was a rare condition and occurred in 0.7 percent of the subjects studied. The association with cryptorchidism, retractile and hypotrophic testis was significant.

OBJETIVO: Avaliar a prevalência de microlitíase testicular entre pacientes pediátricos com afecções inguinoescrotais. MÉTODOS: Estudo prospectivo entre janeiro de 2005 a janeiro de 2010, utilizando ultrasonografia escrotal em 1504 crianças (de 1 a 15 anos) com afecções inguinoescrotais. RESULTADOS: Microlitíase testicular foi identificada em 20 testículos de 11 crianças (0,71 por cento dos 1504 pacientes). 5 crianças com criptorquidia (3,93 por cento de 127 pacientes), 4 com testículo retrátil (14,8 por cento de 27 pacientes), 1 com hipotrofia testicular e 1 com hérnia inguinal (0,07 por cento de 1349 crianças). As crianças foram avaliadas anualmente com exame físico e ultrassonografia inguinoescrotal. CONCLUSÕES: A microlitíase testicular é uma entidade rara, ocorrendo em 0,7 por cento dos pacientes pediátricos com afecções inguinoescrotais. A associação com a criptorquidia, testículo retrátil e a hipotrofia testicular foi significativa.

Íleo biliar:: complicación poco frecuente de la litiasis vesicular / Biliary ileum:: an uncommon complication of vesicular lithiasis

Se presenta el caso de una paciente de 80 años de edad, con antecedentes de diabetes mellitus de tipo II, cardiopatía isquémica y obesidad exógena, que ingresó de urgencia, por presentar un cuadro de dolor abdominal, varios vómitos y distensión abdominal de 3 días de evolución. De forma secundaria presentó una deshidratación moderada. En la radiografía simple de abdomen se constataron signos radiológicos de oclusión intestinal, que corroboraron una ecografía abdominal y una tomografía axial computadorizada de abdomen. Se corrigió el desequilibrio hidroelectrolítico y se realizó una laparotomía exploradora, en la que se encontró un cálculo grande enclavado en el íleon terminal. Se realizó una enterolitotomía con enterorrafia y resolvió el cuadro oclusivo. A los 16 días del alta, la paciente reingresa con un cuadro similar y al reintervenirla se constató la presencia de otro cálculo y de una fístula colecistogástrica, que involucraba la vesícula biliar y el antro gástrico. Se reparó mediante colecistectomía y gastrorrafia. Al final del transoperatorio la paciente presentó un episodio de fibrilación ventricular, con bradicardia extrema, y finalmente un paro en asistolia. Fue reanimada, pero la situación no se revirtió y la paciente falleció(AU)

This the case of a female patient aged 80 with a history of type 2 diabetes mellitus, ischemic heart failure and a exogenous obesity urgently admitted due to abdominal pain, vomiting and abdominal distention of 3 days course. In abdominal simple radiograph radiological signs of intestinal occlusion were confirmed corroborated by abdominal echography and CAT. Hydroelectrolytic imbalance was corrected performing an exploration laparotomy observing the presence of large calculus located in terminal ileum. An enterolithotomy with enterorrhaphy and occlusive picture was resolved. At 16 from discharge, patient is re-admitted with a similar situation and at re-intervention presence of another calculus and a cholecystogastric fistula was verified involving the gall bladder and the gastric antrum repairing by gastrorrhaphy. At the end of transoperative period, patient had an episode of ventricular fibrillation with extreme bradycardia and an asystolic arrest. She was reanimated but there wasn't reversion and patient died(AU)

Pancreatite aguda sem etiologia aparente: a microlitíase deve ser pesquisada? [revisão] / Unexplained acute pancreatitis: the microlithiasis must be searched? [review]

In a large number of patients, with episodes of acute pancreatitis the etiology is not identified, even after initial clinical history, detailed physical examination, laboratory tests and biochemical exams and an transabdominal ultrasound. This patient are considered with a unexplained acute pancreatitis. In this cases the treatment is restricted to improvement of symptoms. These patients after treated tend to have new episodes with the risk of raising the rates of morbidity and mortality. Therefore, the identification of a cause and its prompt treatment prevent at recurrent episodes of pancreatitis. This review aims to draw attention to how best diagnostic approach when the light of evidence-based medicine, to search for causes of difficult identification with microlithiasis, occult stones, the anatomical variations of biliary and pancreatic duct and in addition to sphincter of Oddi dysfunction.

Enterolithiasis: An uncommon finding in abdominal tuberculosis.

Enterolithiasis, the formation of intestinal calculi due to stasis, is known to occur with abdominal tuberculosis. It has uncommonly been reported from India and only rarely in older children.

Calculose intra-hepática: desafio diagnóstico como causa de colestase: relato de caso / Íntra-hepatic gallstones: a diagnostic challenge as etiology of cholestasis: a case report

A colestase pode resultar de diversas etiologias e pode se constituir em importante problema diagnóstico na prática médica. Os exames laboratoriais são inespecíficos e não determinam a causa da colestase. O quadro clínico pode ser amplamente variável, podendo não revelar qualquer sintoma em algumas ocasiões, e, em outras, apresentar quadro toxêmico compatível com a síndrome colangio-hepatite ou a colangite piogênica. Na avaliação diagnóstica realizada por exames radiológicos de imagem, vários métodos podem ser utilizados com essa finalidade: ultrassonografia (US) e tomografia computadorizada de abdômen (TC), ressonância nuclear magnética com colangiografia (CRMN), colangiopancreatografia por via endoscópica retrógrada (CPRE), colangiografia por via transparieto-hepática (CTPH) ou por dreno biliar e, ainda, métodos complementares, como a colangioscopia e ultrassonografia intraoperatórias. Relata-se caso de calculose intra-hepática (ClH), diagnosticada por CRMN de repetição, em paciente assintomática e anictérica, que, após realização de vários métodos de imagem não elucidativos da causa de colestase, evoluiu com presença persistente de elevação dos níveis de enzimas canaliculares, desde o pós-operatório imediato até dois anos após a realização de colecistectomia.

Fístula peritoneocutánea por cálculos biliares: una complicación tardía de la colecistectomía laparoscópica / Peritoneocutaneous fistula caused by abandoned biliary stones during laparoscopic cholecystectomy

Gallbladder perforation may occur during laparoscopic cholecystectomy. The leakage of bile and stones to the peritoneal cavity is less common and the real incidence of abandoned stones is hard to ascertain. The possible complications of these abandoned stones are not well known. We report five patients (four females) aged 49 to 78 years, with a peritoneo-cutaneous fistula caused by biliary stones abandoned in the peritoneal cavity during laparoscopic cholecystectomy performed between 1.5 and 10 years before. We conclude that abandoned stones in the peritoneal cavity can be associated to important complications and those that leak to the peritoneal cavity during laparoscopic cholecystectomy, should be removed during the surgical procedure and the gallbladder should be excised in a bag. The conversion to open surgery for an exhaustive peritoneal lavage is apparently not indicated.

La perforación de la vesícula biliar ocurre con alguna frecuencia durante la colecistectomía laparoscópica (CL). El derrame de bilis y cálculos en la cavidad peritoneal es menos frecuente y la verdadera incidencia de cálculos abandonados en ésta cavidad es difícil de determinar. Éstos no son considerados un peligro; sin embargo, la exacta biología natural de estos cálculos extraviados no está bien dilucidada y parece ser que no son tan inocuos como se creía, ya que con frecuencia se están reportando variadas complicaciones tardías de esta condición. Presentamos 5 pacientes atendidos en nuestro servicio por fístula peritoneocutánea secundaria a litiasis biliar abandonada en la cavidad abdominal durante la CL practicada entre 1,5 y 10 años atrás. Concluimos que, si bien es cierto que las complicaciones secundarias a cálculos biliares abandonados en la cavidad peritoneal son poco frecuentes (0,08 -0,3 por ciento), cuando ocurren se traducen en alta morbilidad, por lo que debe evitarse esta condición retirando todos los cálculos derramados al ocurrir una rotura vesicular, e idealmente exteriorizarla en una bolsa. La conversión a cirugía abierta para aseo peritoneal exhaustivo pareciera no estar indicada, pero si la necesidad de entregar clara información al paciente acerca de las potenciales complicaciones tardías que la situación puede conllevar, evitando así problemas médico legales futuros.

Utilización de la nefrostomía percutánea en la práctica urológica / Percutaneous nephrostomy in clinical practice

Objetivo: Presentar una serie de nefrostomías percutáneas realizadas únicamente por urólogos de un mismo servicio. Se describen las indicaciones y se detallan las complicaciones y los resultados obtenidos. Material y métodos: La serie esta constituida por 53 pacientes, 29 hombres y 24 mujeres, con una edad promedio de 64,2 años (rango 10 a 83 años). Se excluyen de este análisis las nefrostomías efectuadas para una nefrolitectomía percutánea. Resultados: La indicación primaria de la nefrostomía percutánea fue: obstrucción ureteral en 36 casos, pionefrosis en 13 e hidronefrosis secundaria a litiasis en 4 casos. La patología de base fue una obstrucción ureteral maligna en 31 pacientes, litiasis obstructiva en 13 casos, estenosis ureteral en derivación urinaria en 8 casos y 1 caso de estenosis pieloureteral. El procedimiento de nefrostomía fue unilateral en 26 casos (derecho en 27 e izquierdo en 17) y bilateral en 9 casos, para un total de 62 nefrostomías en 53 pacientes. La única complicación observada fue una obstrucción de la nefrostomía en un caso de derivación por obstrucción maligna, la cual requirió cambio sin inconvenientes. Conclusiones: La nefrostomía percutánea es un procedimiento de amplia difusión, de resultados satisfactorios, con baja morbilidad y con capacidad de poder ser realizada en forma ambulatoria. Recalcamos la importancia de que la colocación de la misma sea efectuada por el urólogo.

Objective: To report a series of percutaneous nephrostomies solely performed by urologist of a single institution. Indications, complications and results are presented. Material and methods: A total of 53 patiens, 29 male and 24 female with a mean age of 64.2 years (range 10 to 83 years) underwent percutaneous nephrostomy placement at our institution. Nephrostomies associated with lithotomy are excluded. Results: Primary indication for nephrostomy tube placement was: ureteral obstruction 36 cases, pyonephrosis 13 cases, hydronephrosis secondary to stone 4 cases. Malign ureteral obstruction was seen in 31 patients, obstructive calculi in 13 patients and ureteral malign stenosis in 8 patients. One patient presented with ureteropelvic junction obstruction. A total of 62 nephrostomies were placed, unilateral nephrostomy was performed in 26 cases and bilateral in 9 cases (27 right and 17 left). One patient with a ureteral obstruction secondary to malign pathology required nephrostomy tube replacement. Conclusions: Percutaneous nephrostomy is wide spread procedure with satisfactory results, low morbidity and it can be performed in an ambulatory basis. We emphasize the importance of the urologist being carried out by the urologist.

Microlithiasis of the epididymis: a case report and review of literature.

Microlithiasis of the epididymis, which is not associated with epididymal inflammation, is a rare entity that has been infrequently published in the literature. We report, one such case that was incidentally detected in association with prostatic adenocarcinoma.

Pulmonary alveolar microlithiasis in siblings.

We report two cases of pulmonary alveolar microlithiasis (PAM) in siblings. The male child was diagnosed initially and family screening led to the diagnosis of the asymptomatic sister. The diagnosis was confirmed by high resolution computed tomography (HRCT) and bone scintigraphy which demonstrated the calcific nature of the lesions. We emphasize the importance of family screening of PAM index cases to detect the disease in the early, asymptomatic stage.

Allergic Bronchopulmonary Aspergillosis Coupled with Broncholithiasis in a Non-asthmatic Patient

Allergic bronchopulmonary aspergillosis (ABPA), an asthmatic disease, is caused primarily by hypersensitivity to Aspergillus species. ABPA is rarely observed in the absence of asthma, which is, in fact, the principle criterion for its diagnosis. Here, we report the case of a 36-yr-old woman without a history of bronchial asthma, who manifested a localized pneumonic consolidation, coupled with broncholithiasis. Pathologic examinations of bronchoscopic biopsy specimens and resected surgical specimens revealed features typical of ABPA. This is a very rare case of ABPA coupled with broncholithiasis in a non-asthmatic individual.

Association between testicular microlithiasis, testicular cancer, cryptorchidism and history of ascending testis

OBJECTIVE: To prospectively determine the prevalence of testicular microlithiasis in symptomatic patients who were referred for scrotal ultrasound examination and to evaluate the possible association of testicular microlithiasis with testicular cancer and other conditions such as cryptorchidism or history of ascending testis. MATERIALS AND METHODS: 391 men who were referred to our institutions between July 2002 and May 2005 for any type of symptoms from the testicles, underwent physical and scrotal ultrasound examination. The presence of testicular microlithiasis, the number of lesions and the involvement of both testicles in relation to the symptoms as well as the coexistence of other lesions were studied. RESULTS: Eighteen (4.6 percent) of 391 men enrolled into the study had testicular microlithiasis. Two out of the eighteen patients (11 percent) had concomitant testicular cancer, which was confirmed by pathological evaluation of the orchidectomy specimen. One of the patients with testicular microlithiasis presented a rising in biochemical tumor markers (LDH, and HCG) and underwent orchidectomy one year later. Five of the remaining 373 (1.3 percent) patients without microlithiasis were diagnosed with testicular cancer. Thirty six men reported having a history of ascending testis, but none of them was found with testicular cancer. Two cases of testicular torsion in a cryptorchid position had testicular microlithiasis, but the orchidectomy specimen (after surgery) was negative for testicular cancer. The correlation between testicular cancer and testicular microlithiasis found in our study was statistically significant (p < 0.05). CONCLUSION: There seems to be an association between testicular microlithiasis and testicular cancer.

Técnica de resecciones hepáticas con disección suprahiliar del pedículo / Posterior intrahepatic approach for liver resections

Existen distintas formas de abordar el pedículo hepático para realizar resecciones anatómicas. La más utilizada es la extrahepática o clásica en la que los elementos de la tríada portal se disecan y seccionan por separado. En este trabajo, se describe la técnica suprahiliar o posterior que consiste en abordar la tríada portal dentro del hígado, previo a la sección del parénquima. Se realizaron 30 hepatectomías entre julio de 2003 a diciembre de 2004, 8 de las cuales fueron con abordaje suprahiliar. Respecto a la técnica quirúrgica, se realizaron 6 segmentectomías VI y VII, una hepatectomía derecha y una segmentectomía V y VIII. La mitad de los casos fueron metástasis colorectales. Sólo el tiempo de clampeo pedicular resultó ser significativo al comparar las variables de la técnica suprahiliar versus la clásica: 8,6 y 0 minutos respectivamente. Se concluye que la técnica suprahiliar es factible de realizar con morbimortalidad similar al abordaje clásico y que este estudio demostró menores tiempos de isquemia.

Íleo biliar resuelto por laparoscopia: reporte de un caso / Gallstone ileus corrected by laparoscopic enterolithotomy: report of one case

Se presenta el caso de un paciente de 65 años, con cuadro sospechoso de íleo biliar, que se resolvió en forma completa por laparoscopia. Se analiza aquí la técnica quirúrgica y los resultados postoperatorios.

Rinolitíase como causa de fístula oronasal / Rhinolithiasis as cause of oronasal fistula

A Rinolitíase é uma doenca na qual ocorre a deposicão de compostos orgânicos e inorgânicos em torno de um núcleo na cavidade nasal, causando rinorréia, obstrucão nasal unilateral, odor fétido, epistaxe, podendo haver complicacões. Os autores apresentam um caso de rinolitíase com fístula oronasal e revisão de literatura.