[Intraoperative choledochoscopy usefulness in the treatment of difficult biliary stones]. / Utilidad de la coledocoscopia transquirúrgica en el tratamiento de litos biliares difíciles.

BACKGROUND: Choledocholithiasis presents in 5-10% of the patients with biliary lithiasis. Numerous treatment algorithms have been considered for this disease, however, up to 10% of these therapeutic procedures may fail. Intraoperative choledochoscopy has become a useful tool in the treatment of patients with difficult-to-manage choledocholithiasis. OBJECTIVES: To determine the usefulness of intraoperative choledochoscopy in the laparoendoscopic treatment of difficult stones that was carried out in our service. PATIENTS AND METHODS: A cross-sectional study was conducted. The case records were reviewed of the patients that underwent intraoperative choledochoscopy during biliary tree exploration plus laparoscopic choledochoduodenal anastomosis within the time frame of March 1, 2011 and May 31, 2012, at the Hospital General Dr. Manuel Gea González. Transabdominal choledochoscopies were performed with active stone extraction when necessary, followed by peroral choledochoscopies through the recently formed bilioenteric anastomosis. The data were analyzed with descriptive statistics and measures of central tendency. RESULTS: The mean age was 71 years, 57% of the patients were women, and the ASA III score predominated. Active extraction of stones with 7 to 35mm diameters was carried out in 4 of the cases and the absence of stones in the biliary tract was corroborated in all the patients. The mean surgery duration was 18 minutes (range: 4 to 45min). CONCLUSIONS: Choledochoscopy is a safe and effective minimally invasive procedure for the definitive treatment of difficult stones.

Leiomiosarcoma primario sobre un aneurisma de aorta abdominal. Descripción de un caso y revisión de la bibliografía / Primary leiomyosarcoma over an abdominal aortic aneurysm. Presentation of a case and a review of the literature

La enfermedad neoplásica vascular es excepcional. Los leiomiosarcomas son los tumores aórticos malignos más frecuentes, y en el 60% de los casos se originan a nivel intimal. Nosotros describimos un caso muy poco frecuente de un leiomiosarcoma aórtico primario de origen adventicial sobre una aorta abdominal aneurismática (AU)

The vascular neoplasic pathology is exceptional. Leiomyosarcomas are the most common malignant aortic tumors, and 60% of them are from intimal origin. We describe a rare case of primary aortic leiomyosarcoma of adventitial origin on an abdominal aortic aneurysm (AU)

Hipertensión arterial resistente en adulto joven / Resistant arterial hypertension in a young adult

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[Anatomic variants of biliary ducts detected by endoscopio colangiography]. / Variantes anatómicas de la vía biliar por colangiografía endoscópica.

INTRODUCTION: The gallbladder and bile ducts originate through a complex process during the 4th gestational week; there is a wide variety in their anatomy. OBJECTIVE: To identify the type, frequency, and association with certain pathologies of anatomic variations of bile ducts in patients in which endoscopic retrograde colangiography (ERC) was performed. METHODS: Six hundred and six patients in whom ERCs were performed from 2005 to 2007 in the Endoscopio Unit at the Hospital General Dr. Manuel Gea González in Mexico City were included. Variations in bile duct anatomy seen in the X-ray taken during ERC were identified. Demographic characteristics of the patients, indications of the study, complications, treatments, and type of anatomic variant were registered. Descriptive statistics were used to analyze the information. X2 and Fisher´s exact test were also performed for the comparison between patients with and without anatomic variations. RESULTS: We identified biliary anatomic variations in 5.1% of patients in the study. Among them, seventy- seven per cent were women, with a mean age of 41 years. The anatomic variation most frequently found was a low union of the cystic duct with the common hepatic duct. The main diagnosis during ERC was choledocholithiasis in 71% of patients. Bile duct injuries were found in only 3.2% of patients with anatomic variations. CONCLUSIONS: Anatomic variations in bile ducts identified by ERC are frequent in Mexican population; nevertheless they were not associated with the occurrence of bile duct injuries.

Resultados de la cirugía de revascularización infragenicular mediante bypass con venas braquiales / Results of infragenicular revascularisation with arm vein bypass

IntroducciónSe presentan los resultados de nuestro grupo en cuanto a la utilización de las venas braquiales como conducto alternativo en la revascularización quirúrgica infragenicular.Pacientes y métodosEstudio retrospectivo de 30 pacientes portadores de bypass infragenicular con venas braquiales.ResultadosA 30 días la permeabilidad y la tasa de salvamento de la extremidad fue del 90±5,5%. La permeabilidad primaria fue del 51% (±9,6%) al año y del 45±9,7% a los dos años. La permeabilidad primaria asistida y la secundaria fueron del 54%±9,5% al año, y del 45±9,7% y del 49±9,7% respectivamente a los dos años. La tasa de salvamento de la extremidad fue del 54±9,5% al año y del 45±9,8% a los dos años. En un 70% de los pacientes no se detectaron complicaciones perioperatorias.ConclusionesEn la revascularización quirúrgica del territorio infragenicular sin posibilidad de uso de vena safena interna, el bypass con venas braquiales debe considerarse una buena opción terapéutica(AU)

IntroductionWe present our results on infragenicular surgical revascularisation with arm vein bypass.Patients and methodsA retrospective study of 30 patients with infragenicular arm vein bypass.ResultsThe 30 day patency and limb salvage rate was 90±5.5%. The 1 year patency rates were 54±9.5% (primary, primary assisted and secondary). The 2 year rates were 45±9.8% (primary and primary assisted) and 49±9.7% (secondary). The limb salvage rate was 54±9.5% (1 year) and 45±9.8% (2 years). Up to 70 per cent of the patients did not have any perioperative complications.ConclusionsIn infrapopliteal bypass surgery without an adequate great saphenous vein, the use of arm veins should be considered as a good therapeutic option(AU)

[Comparative study of the use of sennoside A and B vs polyethylene glycol and electrolytes in anterograde preparation of the colon]. / Estudio comparativo del uso de senósidos A y B vs solución de polietilenglicol y electrólitos en la preparación anterógrada de colon.

OBJECTIVE: Compare effectiveness of antegrade bowel preparation by liquid diet, polyethylenglycol (PEG) and electrolytes solution plus sennosides A and B, vs. liquid diet plus sennosides A and B only. BACKGROUND DATA: Preparation for colonoscopy with a balanced solution (PEG and electrolytes) has some physiological advantages. Nonetheless, drawbacks of such preparation include nasty flavor, large volumes and low availability in our country. METHOD: A randomized, comparative, prospective, transversal and blind trial that included 200 patients scheduled for colonoscopy were randomly assigned (one hundred each group) to receive: group 1: liquid diet, sennosides A and B and a two litter of solution with PEG and electrolytes; and group 2: liquid diet plus sennosides A and B. Compliance, tolerance and effectiveness of both preparations were evaluated blindly. The results were assessed by Student's T test. RESULTS: The effectiveness of group 2 preparation proved superior (p < 0.05) to group 1. Tolerance and side effects were similar for both groups with no related complications.

[HELLP syndrome. Severe consequence of hypertensive disease induced by pregnancy]. / Síndrome de HELLP. Consecuencia severa de enfermedad hipertensiva inducida por el embarazo.

A descriptive, transversal retrospective study was performed, to determine the prevalence of HELLP syndrome among patients with Pregnancy-Induced Hypertension (PIH), who were admitted into the Gynecology and Obstetrics Service the American British Cowdray Hospital in Mexico City, since July 1992 to June 1995. We detected a total or 11 patients who had the diagnostic parameters proposed by Sibaí, those were 11.8% of all the patients with PIH. The medial gestational age was 33 weeks (range from 30 to 39) The mean tensional levels were 170/ 107 mm Hg, in base of platelet count, nine patients were classified as Class I (82%) and two in Class II (18%), the medial peak levels of transaminases and bilirubins was reached 40 hours and that of lactic deshidrogenase 60 hours after the diagnosis was established, while the minimum levels of hematocrit and platelets were at 48 and 57 respectively. The mean weight of the neonates was 1,655 g, the maternal mortality rate was 9% and the perinatal 8.3%, the diagnosis of HELLP syndrome was established before delivery in 40% of the cases and after that in 60%, puerperal HELLP may occur more frequently that is believed. Point out the importance of early detection of this clinic entity in order to establish an opportune and efficient treatment which improves maternal and fetal prognosis.