Correction of anomalous systemic venous drainage in heterotaxy syndrome.

A 3-month-old patient with heterotaxy syndrome, complex intracardiac malformations, and severe heart failure underwent surgical correction. Anatomy included an interrupted inferior vena cava with hemiazygous continuation to a persistent left superior vena cava draining to the left atrium. The presence of partial anomalous pulmonary venous drainage precluded an intraatrial baffle. Systemic venous reconstruction was achieved using the left atrial appendage along with an intracardiac repair of the other defects.

Risk factors for operative morbidity in patients with systemic lupus erythematosus: an analysis of 63 surgical procedures.

The surgical morbidity rate of patients with Systemic Lupus Erythematosus is considered very high; however, the experience in the literature is small. This study will determine the rate of surgical morbidity and the existence of predictive factors in patients with such a disease. The medical records of 53 patients with Systemic Lupus Erythematosus who underwent 63 major operations were analyzed retrospectively. The rate and causes of operative morbidity were registered. Univariate and multivariate statistical analysis was performed to ascertain the existence of predictive factors for morbidity. The overall morbidity and mortality were 16% and 6% respectively. Lymphopenia, hypoalbuminemia, increased SGOT and SGPT, urgent indication of operation, the physical status of the American Society of Anesthesiology, as well as a shorter duration of Systemic Lupus Erythematosus showed a significant correlation with operative morbidity in the univariate analysis; high blood urea nitrogen showed marginal significance. Physical status, urgent indication, and blood urea nitrogen remained as significant variables with the multivariate logistic regression analysis. The surgical morbidity rate of these patients may be lower than previously estimated. The physical status, urgency of operation, and level of blood urea nitrogen seemed to be the most useful independent predictors for surgical morbidity risk in patients with Systemic Lupus Erythematosus.

[Endoscopy and laparoscopy in the treatment of lithiasic cholecystitis associated with benign bile duct obstruction]. / Endoscopía y laparoscopía en el tratamiento de la colecistitis litiásica asociada a obstrucción benigna de vía biliar.

OBJECTIVE: To analyze the efficacy of a combined approach using ERCP plus laparoscopic cholecystectomy in the treatment of gallstones associated to benign common bile duct obstruction. DESIGN: Prospective study. SETTING: Tertiary-care medical center. PATIENTS: From a total of 270 laparoscopic cholecystectomies performed between October 1991 and January 1994, a group of 25 patients in whom preoperative ERCP was performed to rule out bile duct obstruction was selected for analysis. RESULTS: Choledocholithiasis was documented in nine patients (36%). In eight of them, stones were retrieved by ERCP. The diagnosis of odditis was established in five patients and a papilotomy was performed. The entire bile duct was normal in 11 cases. All patients in whom the common bile duct was normal, or cleared endoscopically, underwent laparoscopic cholecystectomy uneventfully. There was one complication of papilotomy. Duodenal perforation occurred in one patient who ultimately died. CONCLUSION: The combined approach using ERCP followed by laparoscopic cholecystectomy seems to be adequate for the treatment of gallstones associated to bile duct obstruction.

[Traumatic rupture of the aorta. A report of a case operated on with success]. / Sección traumática de la aorta. Presentación de un caso operado con éxito.

The purpose of this paper is to present the case of a patient with traumatic rupture of the aorta, that was diagnosed and treated successfully. We describe the clinical data and diagnostic procedures of this case and we analyze the diagnostic and treatment aspects in accordance to the review of the literature. If, as in this case, the lesion does not extend through the adventitia and the entity is suspected based on the mechanism of the traumatism, a successful surgical treatment is feasible. This can be done by only clamping the aorta and doing the repair without an atrium to aorta by-pass, as was done in this case with no complications, or with the use of such a by-pass with a centrifugal pump with which it might be possible to prevent, in some cases, the paraplegia that can be associated with the clamping of the aorta. We conclude that a high degree of suspicion and a precise surgical technique are mandatory for a successful treatment of a traumatic rupture of the aorta.

[Intestinal endometriosis: a report of 3 cases]. / Endometriosis intestinal: reporte de tres casos.

Between 1978-1990 three patients were surgically treated with different kinds of intestinal endometriosis at the Instituto Nacional de la Nutrición Salvador Zubirán in Mexico City. The first patient had acute appendicitis without dysmenorrhea or pelvic endometriosis detected during laparotomy. The second patient had incomplete intestinal obstruction related to ileo-cecal involvement. She clinically had dysmenorrhea and were found multiple endometriosis implants during operation. After the ileocecal excision suppressive hormonal therapy was given, the patient developed side effects, then surgical resection of the uterus and ovaries were performed. The third patient was a 48-year-old woman who developed a progressive lower intestinal obstruction. She underwent a three-time operative procedure. Lower sigmoid resection was performed and no endometriosis implants or metastatic disease were found. Postoperative course was uneventful in all patients, no mucosal involvement or associated carcinoma was found. Surgical resection of the affected portions of the bowel was highly effective in each case.