ABSTRACT
No disponible
Subject(s)
Female , Humans , Middle Aged , Obesity, Morbid/diagnosis , Bariatric Surgery/adverse effects , Gastric Bypass/adverse effects , Foreign-Body Migration/surgery , Intestinal Perforation/etiologySubject(s)
Intestinal Diseases , Stomach Diseases , Gastroplasty , Humans , Intestinal Perforation , Intestine, SmallABSTRACT
No disponible
Subject(s)
Humans , Female , Adolescent , Splenic Neoplasms/complications , Splenic Neoplasms/surgery , Immunocompetence , Immunocompetence/physiology , Liver Abscess/complications , Abdominal Abscess/complications , Abdominal Abscess/surgery , Ceftriaxone/therapeutic use , Ciprofloxacin/therapeutic use , Splenectomy/methods , Calcinosis/complications , Calcinosis/diagnosis , Salmonella Infections/complications , Salmonella Infections/surgery , Salmonella/pathogenicityABSTRACT
Retroperitoneal cystic tumors are uncommon. More than two thirds are malignant. Benign lesions include lipomas and leiomyomas, among others. Bronchogenic cysts are congenital anomalies that result from an abnormal budding of the primitive foregut, and are most commonly found in the mediastinum. Occasionally they can be seen in the skin, subcutaneous tissue, in the pre-sternal and pericardial areas, but those located under the diaphragm are extremely rare. We report a 24 year-old female who consulted for abdominal pain. An abdominal ultrasound disclosed a retroperitoneal cystic lesion, that was confirmed with a CAT scan. The patient was operated, finding a cyst that was adhered to the pancreas. A distal pancreatectomy and cyst excision were done. The pathological examination of the lesion showed a bronchogenic cyst. The patient was discharged ten days after surgery.
Subject(s)
Bronchogenic Cyst/pathology , Retroperitoneal Space/pathology , Adult , Bronchogenic Cyst/surgery , Diagnosis, Differential , Female , Humans , Laparoscopy , Pancreatectomy/methods , Retroperitoneal Space/surgeryABSTRACT
Retroperitoneal cystic tumors are uncommon. More than two thirds are malignant. Benign lesions include lipomas and íeiomyomas, among others. Bronchogenic cysts are congenital anomalies that result from an abnormal budding of the primitive foregut, and are most commonly found in the mediastinum. Occasionally they can be seen in the skin, subcutaneous tissue, in the pre-sternal andpericardial areas, but those located under the diaphragm are extremely rare. We report a 24 year-old female who consulted for abdominal pain. An abdominal ultrasound disclosed a retroperitoneal cystic lesion, that was confirmed with a CAT scan. The patient was operated, finding a cyst that was adhered to the pancreas. A distal pancreatectomy and cyst excision were done. The pathological examination of the lesion showed a bronchogenic cyst. The patient was discharged ten days after surgery.
Subject(s)
Adult , Female , Humans , Bronchogenic Cyst/pathology , Retroperitoneal Space/pathology , Bronchogenic Cyst/surgery , Diagnosis, Differential , Laparoscopy , Pancreatectomy/methods , Retroperitoneal Space/surgeryABSTRACT
Sirolimus (SRL) is a new immunosuppressive drug approved for renal transplantation, but is being used increasingly in orthotopic liver transplantation (OLT). Compared with the calcineurin inhibitors, SRL has different mechanisms of action and side effects profile. Thus, this drug offers significant potential advantages over other immunosuppressive agents. SRL does not cause glucose intolerance, hypertension or renal failure, but it may cause dyslipidemia, hepatic artery thrombosis, thrombocytopenia, anemia, leukopenia, oral mucosa ulcers, edema, arthralgias and wound complications. SRL inhibits the signal of interleukin 2 at a post-receptor level, inhibiting lymphocyte proliferation and fibroblast proliferation. It also has antineoplastic and antifungal effects. We report a 10 years old girl who underwent OLT, experiencing a biopsy-proven recurrent acute rejection (AR) in spite of using three immunosuppressive agents (tacrolimus, mofetil micofenolate and steroids). She developed diabetes mellitus as a consequence of the immunosuppressive therapy. She was rescued with SRL, not experiencing AR again. Mofetil micofenolate, steroids and insulin could be discontinued and tacrolimus doses were reduced, without experiencing severe complications. SRL is a new and safe immunosuppressive agent for rescue in patients with OLT and recurrent AR.
Subject(s)
Diabetes Mellitus/chemically induced , Graft Rejection/prevention & control , Immunosuppressive Agents/therapeutic use , Liver Transplantation , Sirolimus/therapeutic use , Child , Female , Humans , Immunosuppressive Agents/adverse effectsABSTRACT
End stage renal disease is not an absolute contraindication for liver transplantation (LT) in patients with end stage liver disease. Actuarial patient and graft survival are comparable for children and adults who undergo LT alone and liver-kidney transplantation (LKT). The most common indications for LKT are the primary hyperoxaluria type I (PH1) and the liver and renal polycystic disease. We report a 12 years old boy with congenital hepatic fibrosis with severe portal hypertension, encephalopathy and polycystic kidney disease with end stage renal disease on dialysis that underwent LKT. During the second postoperative week, he had a biopsy-proven acute liver and renal rejection, that had a good response to corticosteroids. Thirty days after surgery, the liver biopsy was without rejection. No other complications were observed.
Subject(s)
Kidney Failure, Chronic/surgery , Kidney Transplantation , Liver Cirrhosis/surgery , Liver Transplantation , Child , Graft Survival , Humans , Kidney Failure, Chronic/complications , Liver Cirrhosis/complications , Liver Cirrhosis/congenital , MaleABSTRACT
BACKGROUND: The success of orthotopic liver transplantation (OLT) has resulted in its widespread use for different liver diseases. AIM: To report our 8 years experience with adult OLT at Clinica Alemana de Santiago. PATIENTS AND METHODS: In all transplantations done at the center, we recorded patient's overall data and survival, postoperative medical and surgical complications and causes of death. RESULTS: Between November 1993 and September 2001, 51 consecutive OLT were performed in 44 patients (22 females, median age 45 years old). Thirty eight patients presented with chronic and 6 with acute or sub-acute liver failure. Cryptogenic cirrhosis and hepatitis C infection were the most common causes for OLT. Postoperative bleeding and extrahepatic biliary complications were seen in 17.6 and 21.5% of cases respectively. Acute rejection, bacterial infections, CMV infection or disease and post OLT hemodialysis were the most common medical complications (51, 31, 19.6 and 19.6% of cases respectively). The overall 1 and 5 years survival rates were 80% and 73% respectively. Considering exclusively the last 22 OLT performed since January 1999, the 1 year survival rate has improved to 91%. CONCLUSIONS: Liver transplantation in Chile provides a good long term survival with acceptable morbidity, due to a multidisciplinary approach management. The survival rates have improved over the last few years probably due to better surgical techniques, ICU care and immunosuppression. These overall results are comparable with those from other Centers in developed countries.
Subject(s)
Liver Diseases/surgery , Liver Transplantation/mortality , Adolescent , Adult , Aged , Female , Graft Rejection , Humans , Liver Failure/surgery , Liver Transplantation/adverse effects , Liver Transplantation/statistics & numerical data , Male , Middle Aged , Postoperative Complications/mortality , Reoperation , Survival RateABSTRACT
Se presenta la casuística de la colecistectomía laparoscópica (CL) del Hospital Militar en la patología vesicular, revisando los resultados obtenidos en 1.102 pacientes en un lapso de 23 meses. El 22 por ciento de los pacientes son portadores de un cuadro vesicular agudo. El 10 por ciento de las CL recibieron una colangiografía endoscópica retrógrada (CER) preoperatoria en búsqueda de coledocolitiasis, encontrándola en un tercio de ellos. Durante la intervención se detecta un 1,8 por ciento de coledocolitiasis, llegando a un 5,3 por ciento de cálculos coledocianos en toda la serie. En el 1,6 por ciento de la serie se realizó exploración coledociana trancística, lo que permite resolver el 40 por ciento de los hallazgos de coledocolitiasis intraopereratoria. Se convirtió la técnica en el 6 por ciento de las CL, existiendo 3,8 por ciento de complicaciones médicas, 3,5 por ciento de complicaciones quirúrgicas, con 0,7 por ciento de reoperaciones, 06 por ciento rehospitalizaciones 0,18 por ciento de sección del colédoco y 0,09 por ciento de mortalidad. Las cifras refuerzan sólidamente el concepto de que la CL es la técnica quirúrgica para tratar la patología vesicular no neoplásica, con un adecuado margen de seguridad, buena recuperación postoperatoria y rápida rehabilitación
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Cholecystectomy , Cholelithiasis/surgery , Gallstones/surgery , Laparoscopy , Cholangiography , Common Bile Duct , Diagnostic Techniques, Surgical , Intraoperative Complications , Postoperative Care , Postoperative Complications , Reoperation/statistics & numerical dataABSTRACT
Se describe la técnica clásica de extracción múltiple de corazón, hígado y riñones para trasplantes, la cual permite un mejor aprovechamiento de los donantes frente a la creciente necesidad de órganos. También se presenta la técnica rápida que ha permitido que la intervención de extracción de órganos se realice en un tiempo más breve, no demorando al equipo que realiza la cardiectomía, con esta técnica se puede además utilizar donantes homodinámicamente inestable que antiguamente se perdían
Subject(s)
Middle Aged , Humans , Heart Transplantation , Kidney Transplantation , Liver Transplantation , Surgical Procedures, Operative , Tissue Donors , Transplantation/instrumentationABSTRACT
Se realiza una somera reseña con referencia a la literatura sobre el tema. Se informa un caso de coma hipoglucémico y convulsiones en una niña de 4 años de edad, secundario a ingestiíon de bebida alcohólica, quien se recobra totalmente luego de una inyección intravenosa de solución glucosada hipertónica. Se hacen algunas reflexiones sobre el planteo diagnóstico. Se menciona el posible mecanismo fisiopatológico de la hipoglucemia en esta intoxicación. Se pone énfasis en la omisión de la intoxicación por alcohol como posible causa de convulsiones en los tratados de Pediatría. Se efectúan consideraciones con referencia al tratamiento, llamando la atención sobre la necesidad de determinar inmediatamente la glucemia, aconsejando la inyección intravenosa de solución glucosada hipertónica al 50 por ciento, aún antes de conocer el resultado de la misma.
