[Surgery for choledocholithiasis following extracorporeal lithotripsy in 3 patients]. / Cirugía por litiasis coledociana después de litotripsia extracorpórea en tres pacientes.

Extracorporeal lithotripsy has been used as a therapeutic modality for gallbladder and common duct stones. When duct stones are fragmented and do not pass to the duodenum or endoscopic extraction is not possible, a surgical intervention seems justified. At operation under these circumstances we have appreciated an unusual increment of vascularity and inflammation that makes the operation somewhat difficult. In the last year we have operated three patients that had common duct stones and received lithotripsy. In two cases the procedure failed. Even when postlithotripsy cholangiogram showed fragmentation of stone, in one patient those fragments could not be evacuated transendoscopically and patient was operated few days later. During operation small fragments were found and probably they could have been eliminated through the sphincterotomy. Thus, we suggest to obtain a new cholangiogram before operating such cases.

Deteccion gammagrafica de lesiones venosas secundarias a cateterismo para nutricion parenteral total. Estudio prospectivo. / Gammagraphic detection of venous lesions secondary to total parenteral nutritional catheterism. A prospective study

Se efectuo un estudio prospectivo en 25 pacientes que recibieron nutricion parenteral total por via subclavia con el fin de detectar lesion venosa temprana. Se empleo tecnecio 99 con estudios dinamicos de la circulacion venosa a nivel subclavio, con tomas secuenciales en la camara de centelleo. El metodo permitio descubrir tempranamente las lesiones venosas que se observaron en 20 por ciento de los casos y son problablemente secundarias a la presencia del cateter en la luz vascular y reversibles en forma espontanea tras retirar el mismo