Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia.

PURPOSE: Combination of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin type A (BT) has not been previously reported in the management of large incisional hernia (LIH). METHODS: Observational study of 45 consecutive patients with LIH between June 2010 and July 2014. The diameters of the hernia sac, the volumes of the incisional hernia (VIH) and the abdominal cavity (VAC), and the VIH/VAC ratio were measured before and after PPP and BT using abdominal CT scan data. We indicated the combination of both techniques when the volume of the incisional hernia (VIH)/volume of the abdominal cavity (VAC) ratio was >20%. RESULTS: The median insufflated volume of air for PPP was 8.600 ± 3.200 cc (4.500-13.250), over a period of 14.3 ± 1.3 days (13-16). BT administration time was 40.2 ± 3.3 days (37-44). We obtained an average value of reduction of 14% of the VIH/VAC ratio after PPP and BT (p < 0.05). Complications associated with PPP were 15.5%, and with surgical technique, 26.6%. No complications occurred during the BT administration. Reconstructive technique was anterior CST and primary fascial closure was achieved in all patients. Median follow-up was 40.5 ± 19 months (12-60) and we reported 2 cases of hernia recurrence (4.4%). CONCLUSIONS: Preoperative combination of PPP and BT is feasible and a useful tool in the surgical management of LIH, although at the cost of some specific complications.

Imagen en RM de encefalomielitis aguda diseminada, cerebelitis y mielitis en la infancia: probables variantes topográficas de un mismo proceso / MR imaging of acute disseminated encephalomyelitis, cerebellitis and myelitis in infancy: likely topographic variants of a single process

Describir los hallazgos en RM de la encefalomielitis aguda diseminada (EAD) en un grupo pediátrico, incidiendo en sus posibles variantes topográficas, cerebelitis y mielitis, en su evolución y en el diagnóstico diferencial con un brote inicial de esclerosis múltiple. Material y método: Se revisan de forma retrospectiva los hallazgos de RM craneal iniciales y evolutivos de 14 pacientes pediátricos diagnosticados de EAD, cerebelitis o mielitis. En nueve pacientes se incluyó estudio medular. Resultados: Se han considerado tres variantes topográficas: EAD (siete pacientes), cerebelitis aislada (cuatro pacientes) y mielitis aislada (tres pacientes). En la EAD se observó afectación de la sustancia blanca supratentorial en todos los casos, del tronco del encéfalo en cinco (71 por ciento) y del cerebelo en dos (28,5 por ciento). Se detectaron lesiones de ganglios basales en cinco pacientes (71 por ciento) y del córtex en uno (14 por ciento). Se asoció alteración medular en cinco de los seis casos en los que se incluyó su estudio (83 por ciento). Las lesiones en la EAD tendieron a ser nodulares y mal delimitadas, mientras que en las cerebelitis y mielitis el patrón predominante fue la afectación difusa. La tendencia evolutiva fue hacia la disminución-resolución de las lesiones. El seguimiento con RM a medio plazo en seis pacientes (cuatro EAD y dos cerebelitis) no detectó nuevas lesiones. El seguimiento clínico de los pacientes no mostró recurrencias neurológicas en ninguno de ellos. Conclusiones: La EAD, la cerebelitis y la mielitis pueden ser variantes topográficas del mismo proceso con una patogenia común. La frecuente participación medular en la EAD aconseja incluir su estudio, aún en ausencia de sintomatología referida. Esta alteración medular, que suele ser difusa, la afectación de la sustancia gris profunda, y el curso monofásico de la enfermedad, avalado por un seguimiento secuencial con RM, nos ayudan en el diagnóstico diferencial con la esclerosis múltiple. Aún así, el diagnóstico diferencial entre una forma recurrente de EAD y una EM es prácticamente imposible de realizar (AU)

Influence of electromagnetic fields on bone mass and growth in developing rats: a morphometric, densitometric, and histomorphometric study.

The effect of electromagnetic fields on bone is debated. In an experimental study of this effect, we compared two lots of growing female rates (both lots n = 15, age 3 weeks, average weight 23.2 +/- 3.3 g), one of which was exposed to a 3-mT, 100-Hz, Helmholtz-type electromagnetic field for 24 hours a day for 30 days, and the other of which served as the control. Bone development and bone mass were evaluated by morphometry, densitometry, and histomorphometry. The rats were killed at 30 days and weighed. The right femurs were dissected, measured, and weighed; bone densitometry was used to determine femoral bone mineral content (BMC) and density (BMD), and histomorphometry of the nondecalcified bone was used to determine trabecular bone volume (Cn-BV-TV%), number (Tb-N mm) and thickness (Tb-Th microm), intertrabecular space (Tb-Sp microm) and growth cartilage thickness (Gc-Th microm). In the rats exposed to the electromagnetic field, BMC and BMD (P = 0.019 and P = 0.002, respectively) and Cn-BV-TV, Tb-N, Tb-Th (P = 0.005, P = 0.036, and P = 0.027, respectively) all were decreased, whereas Tb-Sp was increased (P = 0.002). There were no significant differences in initial and final body weight, or in final femur weight, femur length, and GC-Th. These findings indicate that electromagnetic fields of the type used here reduced bone formation and increased bone resorption without affecting bone development in rats.

[Dermatomyositis and small cell tumor of the kidney]. / Dermatomiositis y tumor renal de células pequeñas.

Dermatomyositis is an inflammation of the striated muscle with an important leukocyte infiltrate which is accompanied by a characteristic cutaneous exanthema. In the international classification we find DM associated with neoplasm in 10% of cases. It is accepted that neoplasms are related to DM if it does not exceed it in two years (prior o after the onset of the disease. The most commonly associated are lung, ovary and breast cancers. In the pas ten years only two cases of DM associated to renal cancer (both in renal cell cancers) have been published. In this article we present a case history of a woman with a DM associated to a renal oat-cell carcinoma. Also, we will review the literature on this theme and will evaluate the predictive parameters of the presence of malignancies in this pathology.

[Cyst of the seminal vesicle associated with renal dysgenesis and ipsilateral ectopic ureter. Apropos of 3 clinical cases]. / Kyste de la vésicule séminale associée à une dysgénésie rénale et à un uretère ectopique ipsilatéral. Présentation de 3 cas cliniques.

We discuss the cystic pathology of seminal vesicles, and its relation with ureteral ectopy, as well as the therapeutic options for both entities. We present our experience in the resolution of three typical cases.

[The therapeutic management of the rupture of a kidney graft]. / Actitud terapéutica ante la rotura del injerto renal.

From a consecutive series of 106 renal transplants, we present our experience on spontaneous renal allograft rupture. This complication appeared in 6 patients, which accounts for 5.6% of the overall group: four patients (66.6%) had acute rejection, two (33.3%) developed thrombosis of the renal vein (one of which coincided with rejection), and rupture was attributed to trauma in one patient (16.6%). Rupture was diagnosed within the first two weeks after transplant in five patients and on day 27 in one patient. The therapeutic approach was determined according to the cause of the rupture. In our view, nephrectomy is warranted in those cases with venous thrombosis and in acute rejection correction of hypovolemia and adequate immunosuppression are essential. Drainage of perirenal hematoma is the first step when conservative surgical treatment is required. We use three-dimensional renal corsetage with polyglycolic acid mesh (PAM) for hemostasis and to prevent expansion and fragmentation of the parenchyma. PAM is easy to handle and covers the kidney completely and uniformly. Two nephrectomies were carried out and in both cases thrombosis of the renal vein was diagnosed. PAM was placed in two cases: one with rejection and the other with trauma. The remaining two patients were managed conservatively due to the good response of rejection to immunosuppressor therapy and the patients response to medical treatment. There were no deaths and complications were observed in only one patient (16.6%). All patients with preserved transplant (66.6%) had a good course and renal function was preserved.

[Chemoembolization in the treatment of hepatocarcinoma]. / La quimioembolización en el tratamiento del hepatocarcinoma.

Transcatheter arterial chemoembolization with lipiodol and adriamycin was performed in 46 patients with hepatocellular carcinoma (HCC). In 27, this procedure was followed by selective arterial embolization using gelatin sponge particles. Surgical resection was carried out in 5 cases and 13 patients were transplanted (OLT). The aim of the study was to analyze the survival and degree of tumor necrosis. In the nonsurgical group the overall survival was 67% after 24 months in the OKUDA I stage, 31% after 20 months in the OKUDA II stage and 25% after 6 months in the OKUDA III stage. For the patients who underwent surgery, survival was 38% after 20 months in 5 patients who were resected and 72% after 24 months in 13 patients who were transplanted. Transcatheter arterial chemoembolization improves survival in patients who are not operated on, and can be used as a complementary treatment for patients who undergo surgery. A full tumor necrosis was observed in well encapsulated tumors.