A large spontaneous splenorenal shunt in a patient with liver cirrhosis and uncomplicated portal hypertension.

The aim of this paper is to describe and discuss, on the basis of a thorough review of the literature, the case of a 70-year-old woman with probable cirrhosis secondary to chronic hepatitis B and C, uncomplicated portal hypertension (without ascites, encephalopathy or bleeding varices), splenomegaly and hypersplenism, and an unusual, spontaneous, large splenorenal shunt and recanalization of the umbilical vein. The tortuous and varicose splenorenal shunt was diagnosed by abdominal ultrasound and CT investigations. A duplex Doppler ultrasonography evaluation was performed to study shunt flow direction and velocity. No gastroesophageal varices were identified on endoscopic examination. The clinical relevance of spontaneous splenorenal shunt, often associated with fundic gastric varices, is discussed.

Hypomagnesemia and smooth muscle contractility: diffuse esophageal spasm in an old female patient.

The aim of this paper is to describe and discuss, on the basis of the available literature, the case of an old female patient, admitted to our university hospital because of a severe dysphagia for solid foods, in whom laboratory data showed a marked hypomagnesemia. She reported a long history (20 years) of allergic bronchial asthma treated with theophylline. Esophagography evidenced a disorder of esophagus motility with diffuse multiple spasm, reminiscent of the 'corkscrew esophagus'. A link with the severe hypomagnesemia (Mg 1.1 mEq/l, normal range 1.6-2.1) was suspected, and a therapy with oral pidolate of Mg (1.5 g/twice a day) was started and continued for 4 months. This was associated with a slow progressive normalization of the Mg plasma level and reverted radiographic esophageal findings with disappearance of dysphagia. Mg is an important element for health and disease, and today Mg deficiency in man has become an accepted medical problem which might complicate many diseases. Neuromuscular disorders, as laryngeal spasm, are recognized complications of hypomagnesemia, but until now only 1 case of motor esophageal disorder associated with a low Mg plasma level was briefly reported in the literature, even if dysphagia is generally included in the symptomatological pattern of hypomagnesemia. Our observation of a severe form of esophageal spasm, associated with hypomagnesemia, in an aged female patient underlines the pathophysiological meaning of the plasma Mg level and suggests the need for routine Mg determination in the clinical setting.

[Diffuse symptomatic polypoid lipomatosis of the colon with hyperplasia of epiploic appendices: a case report]. / Diffusa e sintomatica lipomatosi polipoide del colon con iperplasia delle appendici epiploiche: descrizione di un caso clinico.

Diffuse and symptomatic lipomatosis of the colon, particularly when associated with hyperplasia of the appendices epiploicae, is a rare disease. We report here the case of a lean, 26-year-old woman who had polypoid lipomatosis of the colon with submucosal and subserous expression (involving the mesentery and peritoneum) associated with extreme hyperplasia of the appendices epiploicae. Her disease led to a recurrent subocclusive syndrome which required total colectomy. We discuss the case and review the literature on this subject. The particular characteristics of this case and early onset of disease would suggest that our patient was affected by a congenital lipomatous syndrome linked to mesenchymal dysplasia. Long-term monitoring will enable prompt intervention in the case of reformation of lipomatous tissue.

Angioplastia transluminal percutanea (ATP). Comienzo de un estudio y perspectivas. / Percutaneous transluminal angioplasty (PTA). The beginning of a study and perspectives

La angioplastia transluminal percutanea (ATP), permite la dilatacion de una estenosis o la desobstruccion vascular por medio del cateterismo. Tecnica introducida por Dotter en 1964, en los ultimos anos ha experimentado gran difusion mundial a raiz del uso del cateter de Gruntzig. Practicamente en todos los territorios vasculares se han efectuado angioplastias, siendo sus indicaciones y resultados a largo plazo, todavia no totalmente definidos. Sin embargo el metodo ha sido aceptado y sus buenos resultados comprobados, cuando la cirugia no permite realizar procedimientos de revascularizacion o estos involucran un importante riesgo para el enfermo.Nuestro interes es que el primer caso exitoso de ATP realizado en nuestro pais, sea el comienzo de un trabajo a largo plazo para valorar las posibilidades de dicho metodo terapeutico

Tecnica quirurgica en la tiroidectomia para reducir la agresion recurrencial. / Surgical technic in thyroidectomy to reduce recurrent nerve injury

Proponemos una tecnica de tiroidectomia que no pretende ser original. Esta destinada fundamentalmente a mantener la indemnidad anatomica y funcional del nervio recurrente. La misma debe cumplir en forma ordenada y sistematica con los siguientes tiempos operatorios 1) Abordaje y seccion primaria del istmo tiroideo; 2) Abordaje del polo inferior del lobulo tiroideo y ligadura escalonada de las ramas de la tiroidea inferior contra la glandula; 3) busqueda sistematica del nervio recurrente; 4) ligadura del pediculo tiroideo medio, bien pegado a la capsula glandular; 5) ligadura por separado de las tres ramas del pediculo tiroideo superior

Lipoma muscular gigante. Una excepcion a las normas de tratamiento oncologico de los tumores de partes blandas. / Giant muscular lipoma. An exception to the standards for oncologic treatment of soft tissue tumors

Frente a lipomas que cumplen con los criterios clinico y anatomopatologico preestablecidos se puede prescindir del tratamiento oncologico, si el mismo implica la perdida del miembro o el severo compromiso funcional. Teniendo en cuenta que el lipoma muscular gigante es una lesion histologicamente benigna y que aunque con gran tendencia a la recidiva local, no da metastasis ni mata el enfermo

Neumopatia recidivante por reflujo gastro-esofagico. Procedimientos diagnosticos. / Recurrent pneumopathy by gastroesophageal reflux.Diagnostic procedures

A proposito de un caso de bronquitis y neumopatia recidivante por reflujo gastro-esofagico, se analiza la fisiopatologia del mismo haciendose enfasis en la competencia del esfinter esofagico inferior. Se utilizan en el diagnostico nuevos metodos de exploracion: manometria gastro-esofagica, endoscopia y biopsia esofagica y laringea. Se hacen consideraciones sobre la terapeutica medica y quirurgica