Choledochus angulation by T-tube. / Angulación de colédoco por sonda en T.

BACKGROUND: The presence of bile stasis is a frequent mechanism for presenting choledocholithiasis and recurrence of this one. The bile duct angulation, also known as "elbow sign," could be a risk factor for reducing the flow of bile and forming stones and it has been reported as a consequence secondary to the use of T-tube. The recurrence of choledocholithiasis without the use of T-tube in the bile duct is minimal, whereas in those with T-tube is four times higher in bile duct exploration surgeries. We present a case report of a patient who underwent T-tube laparoscopic bile duct exploration surgery, who had a bile duct angulation and residual choledocholithiasis as a complication. CASE REPORT: 34-yeard-old female, who presented acute cholecystitis and underwent cholecystectomy. In this operation it was detected choledocholithiasis, which is why it was carried out a T-tube bile duct exploration surgery for acute cholecystitis, without solving the choledocholithiasis condition. Afterwards, she had three endoscopic retrograde cholangiopancreatography procedures, requiring endoscopic hemoclip. Four months later, she was referred to a third-level hospital for definitive treatment with unsolved choledocholithiasis. CONCLUSIONS: The bile duct angulation by T-tube is unusual and it favors bile duct dilatation, stasis of bile pigments and new stones formation. We consider that the best surgical option is the biliary bypass.

INTRODUCCIÓN: La presencia de estasis biliar es un mecanismo frecuente para presentar coledocolitiasis y su recurrencia. La angulación del conducto biliar, también llamada «signo del codo¼, puede ser un factor de riesgo para disminuir el flujo biliar y propiciar la formación de litos, y ha sido reportada como una complicación del uso de sonda en T. La posibilidad de recurrencia de la coledocolitiasis sin colocación de sonda en T en una exploración quirúrgica de vía biliar es mínima, y en aquellas con sonda es cuatro veces mayor. Se presenta el caso de una paciente operada de exploración de la vía biliar con colocación de sonda en T que presentó como complicación una angulación de la vía biliar y coledocolitiasis residual. CASO CLÍNICO: Mujer de 34 años con colecistitis crónica litiásica agudizada que fue sometida a colecistectomía. En la intervención se notó la presencia de coledocolitiasis, por lo que se hizo una exploración de vía biliar y se colocó una sonda en T, sin resolver el cuadro de coledocolitiasis. Posteriormente se hicieron tres colangiopancreatografías retrógradas endoscópicas que fueron fallidas, lo cual ameritó la colocación de hemoclip por sangrado. Cuatro meses después, la paciente fue referida a tercer nivel con diagnóstico de coledocolitiasis no resuelta para tratamiento definitivo. CONCLUSIONES: La angulación de la vía biliar por sonda en T es poco frecuente y favorece la dilatación del conducto biliar común, la estasis de pigmentos biliares y la formación de litos. Consideramos que la mejor opción quirúrgica es la derivación biliodigestiva.

[Esophageal bronchogenic cyst: an uncommon cause of dysphagia in adults. Case report and literature review]. / Quiste broncogénico esofágico: una causa poco común de disfagia en adultos. Reporte de caso y revisión de la literatura.

BACKGRONUND: Bronchogenic cysts result from abnormal budding of the primitive tracheobronchial tube and are rare congenital cystic lesions. The location of the cyst depends on the embryological stage of abnormal budding. Although periesophageal bronchogenic cysts have been frequently reported, a completely intramural cyst is very rare. CLINICAL CASE: A 42-year-old female patient, a three-month course with retrosternal pain associated with food intake, accompanied by intermittent dysphagia to solids. Esophagogram, high resolution thoracic tomography and endoscopic ultrasound are performed, concluding a probable esophageal bronchogenic cyst. Resection is performed by video-assisted thoracic surgery, without complications. Patient presents with adequate evolution and complete remission of the symptomatology. CONCLUSION: Bronchogenic cysts of the esophageal wall are extremely uncommon lesions. Its surgical treatment is indicated to be symptomatic; video-assisted thoracoscopic surgery resection is of choice, with excellent long-term results and minimal morbidity.

ANTECEDENTES: Los quistes broncogénicos son lesiones congénitas raras que resultan de brotes anormales del tubo traqueobronquial primitivo. La localización del quiste depende de la etapa embriológica del brote anormal. Aunque los quistes broncogénicos periesofágicos han sido frecuentemente reportados, un quiste completamente intramural es muy raro. CASO CLÍNICO: Mujer de 42 años con cuadro de 3 meses de evolución, con dolor retroesternal asociado a la ingestión de alimentos, acompañado de disfagia intermitente a sólidos. Se realiza esofagograma, tomografía de tórax de alta resolución y ultrasonido endoscópico, que concluyen probable quiste broncogénico esofágico. Se realiza resección por cirugía torácica videoasistida, sin complicaciones. La paciente cursa con adecuada evolución y remisión completa de la sintomatología. CONCLUSIÓN: Los quistes broncogénicos de la pared esofágica son lesiones extremadamente poco comunes. Está indicado su tratamiento quirúrgico al ser sintomáticos; es de elección la resección por cirugía torácica videoasistida, con excelentes resultados a largo plazo y mínima morbilidad.

High Serum Levels of High-Mobility Group Box 1 (HMGB1) and Low Levels of Heat Shock Protein 70 (Hsp70) are Associated with Poor Prognosis in Patients with Acute Pancreatitis.

INTRODUCTION: Cell damage in Acute Pancreatitis (AP) lead to release of cytokines and HMGB1 and Hsp70. While Hsp70 plays a role in cytoprotection, when released to extracellular milieu constitutes, as HMGB1, a danger signal and trigger pro-inflammatory responses. These molecules seem to be related to the clinical progression; but because no evidence exists about them as molecular network in AP development, we quantify HSP70, HMGB1, and cytokines in patients with AP and search for correlations with severity and prognosis. METHODS: Fifteen patients with AP were included. The average age was 52 years. Six patients had mild pancreatitis, 4 were moderately severe and 5 with a severe form. Blood samples were taken within the first 24 h, at 3d and 7d from the start. Serum HMGB1 and Hsp70 were determined using ELISA; TNF-α, IL-1ß, IL-6, IL-8, IL-10 and IL-12p70 were determined by bead based immuassay. RESULTS: Of all 15 patients recruited, 4 were women. Eight patients had APACHEII score higher than 8. Two patients died from AP related complications. Increase in serum HMGB1 and decrease of Hsp70 were associated with the severity and mortality. TNF-α, IL-6 and IL-8 were higher in patients that did not survive, in those with an APACHE II >8, and in those with severe AP. CONCLUSIONS: High HMGB1 and low Hsp70 were associated with poor prognosis. Hsp70 might play a protective role in AP. TNF-α, IL-6, IL-8, HMGB1 and Hsp70 during hospital admissions might serve to evaluate risk of death due to AP.

Effect of Oral ω3-Polyunsaturated Fatty Acids as a Complement Management to Control Fistula Output and Inflammation in Patients With Digestive Fistula.

BACKGROUND: The presence of digestive fistula involves chronic inflammation and fibrosis. It has been reported that ω3-polyunsaturated fatty acids stimulate the resolution of inflammation. AIM: Determine if the administration of oral ω3 reduces fistula output and the time required for fistula closure. METHODS: Forty-nine patients with postoperative fistula were randomly divided in two groups: 26 received conventional treatment and 23 received the conventional treatment supplemented with ω3 (540 mg eicosapentaenoic acid and 360 mg docosahexaenoic acid) for 35 days. Patients were monitored daily for fistula output and spontaneous closure. Additionally, serum pro-inflammatory cytokines and C-reactive protein were quantified in four patients with conventional and in seven patients with ω3 treatment. RESULTS: Patients with ω3 had significantly decreased fistula output from days 2 to 27, compared to control (p < 0.05). Spontaneous fistula closure was achieved in 15 patients (65%) in the ω3 group and in 14 (54%) in the control group. ω3-polyunsaturated fatty intake also decreased the serum concentrations of interleukin-6 and C-reactive protein (p < 0.05). CONCLUSIONS: Our results suggest that ω3 supplementation to conventional medical treatment decreases fistula output and reduces inflammation (interleukin-6 and C-reactive protein), and these effects may increase the efficiency of conventional medical treatment.

The Impact of a Good Season Start on Team Performance in Elite Handball.

The aim of the current study was (i) to identify how important was a good season start in relation to elite handball teams' performance, and (ii) to examine if this impact was related to the clubs' financial budget. The match performances and annual budgets of all teams were collected from the Spanish Professional Handball League during ten seasons. The dependent variable was the difference between the ranking of each team in accordance to the annual budget and the ranking of each team at the end of the season. A k-means cluster analysis classified the clubs according to their budget as High Range Budget Clubs (HRBC), Upper-Mid Range Budget Clubs (UMRBC), Lower-Mid Range Budget Clubs (LMRBC) and Low Range Budget Clubs (LRBC). Data were examined through linear regression models. Overall, the results suggested that the better the team performance at the beginning of the season, the better the ranking at the end of the season. Each position in the ranking above expected in accordance to the budget of the teams in Rounds 3, 4 or 5 improved by 0.47, 0.50 or 0.49, respectively, in the ranking at the end of the season (p<0.05). However, the impact of the effect depended on the clubs' annual budget. For UMRBC, LMRBC and LRBC a good start to the season had a positive effect on the final outcome (p<0.05). Nevertheless, for HRBC, a good or a bad start of the season did not explain their final position. These variables can be used to develop accurate models to estimate final rankings. UMRBC, LMRBC and LRBC can benefit from fine-tuning preseason planning in order to accelerate the acquisition of optimal performances.

Objetivos financieros y deportivos en la eficiencia del fútbol europeo / Financial and sport objectives in the efficiency of european football

El objetivo del presente estudio es medir la eficiencia de los principales equipos europeos considerando los objetivos financieros y deportivos, por lo que se utilizan el beneficio y el coeficiente UEFA como outputs. Un modelo alternativo es presentado bajo la premisa de la maximización de los resultados deportivos y la minimización de las pérdidas financieras. Los resultados muestran un amplio margen de mejora, especialmente en la gestión financiera

The goal of this study is to measure the efficiency of the major European football teams under financial and win objectives using profits and UEFA coefficient as outputs. An alternative model is presented maximizing wins and minimizing financial losses. Results show much room for improvement, especially in financial management

[Usefulness of hepatobiliary scintigraphy in the follow-up of patients with biliary reconstruction]. / Utilidad del colangiogamagrama en el seguimiento de pacientes con reconstrucción de vía biliar.

BACKGROUND: The relevance of biliary tract injury patients is not only related to diagnosis and treatment but also to follow-up for the possibility of late complications and medical and legal aspects. Hepatobiliary scintigraphy has played a principal roll in diagnosis of many hepatobiliary diseases. METHODS: We carried out a descriptive and retrospective study. Included were all patients with biliary tract injuries who underwent biliary reconstruction and liver biopsy. Clinical, laboratory exams and hepatobiliary scintigraphy follow-up was done. RESULTS: From January 2001 to december 2009 one hundred patients, sixty-five women and thirty-five men were registered. According to Strasberg's classification we had 13 % type E1, 17 % type E2, 38 % type E3 and 32 % type E4. All of them underwent biliary tract reconstruction, eighty-four Hepp-Couinaud type and sixteen conventional jejunum-hepatic anastomosis (Roux-Y). Liver biopsy demonstrated twelve patients with inflammation, forty-nine with cholestasis, nineteen with ductular proliferation and nineteen with fibrosis. When we compare pathologic results of liver biopsy with pre and postoperatively hepatobiliary scintigraphy we found significance in those patients with cholestasis and ductular proliferation in hepatobiliary scintigraphy elimination step, but none in those with inflammation and fibrosis. CONCLUSIONS: Hepatobiliary scintigraphy is an adequate study to the follow-up of patients who underwent hepatobiliary reconstruction been more significative in patients with cholestasis and ductular proliferation.

Introducción: la importancia de casos de lesión de vía biliar no solo involucra el diagnóstico y el tratamiento oportuno, sino también el seguimiento a largo plazo por la posibilidad de complicaciones tardías y los aspectos médico-legales. La medicina nuclear ha desempeñado un papel importante en el diagnóstico de múltiples enfermedades hepatobiliares. Métodos: estudio observacional, retrospectivo, transversal y analítico. Revisión de pacientes con lesión de vía biliar y sometidos a reconstrucción bilio-digestiva y biopsia hepática en la cirugía. Seguimiento clínico, con laboratorio y colangiogamagrama. Resultados: de enero de 2001 a diciembre de 2009 se evaluaron cien pacientes, treinta y cinco hombres y sesenta y cinco mujeres con edad promedio de 38.8 años. Los tipos de lesión de acuerdo con la Clasificación de Strasberg fueron: Tipo E1 (13 %); Tipo E2 (17 %); Tipo E3 (38 %), y Tipo E4 (32 %). Todos los pacientes fueron sometidos a cirugía reconstructiva de la vía biliar, 84 con técnica de Hepp-Couinaud y 16 pacientes con técnica convencional de hepático-yeyuno anastomosis en Y de Roux. Por biopsia hepática, doce pacientes con inflamación, cuarenta nueve colestasis, diecinueve ductopenias y diecinueve fibrosis. Conclusiones: la colangiogamagrafía, es un estudio adecuado en el seguimiento al valorar la captación y eliminación, su mejor utilidad es en pacientes con resultado histopatológico de colestasis y ductopenia.

[Experience of the surgical management of the esophageal achalasia in a tertiary care hospital]. / Experiencia del manejo quirúrgico de la acalasia esofágica en un hospital de alta especialidad.

INTRODUCTION: Achalasia is a primary esophageal motor disorder. The most common symptoms are: dysphagia, chest pain, reflux and weight loss. The esophageal manometry is the standard for diagnosis. The aim of this paper is to determine the effectiveness of the surgical management in patients with achalasia in a tertiary care hospital. METHODS: A case series consisting of achalasia patients, treated surgically between January and December of 2011. Clinical charts were reviewed to obtain data and registries of the type of surgical procedure, morbidity and mortality. RESULTS: Fourteen patients were identified, with an average age of 49.1 years. The most common symptoms were: dysphagia, vomiting, weight loss and pyrosis. Eight open approaches were performed and six by laparoscopy, with an average length of cardiomyotomy of 9.4 cm. Eleven patients received an antireflux procedure. The effectiveness of procedures performed was 85.7 %. CONCLUSIONS: Surgical management offered at this tertiary care hospital does not differ from that reported in other case series, giving effectiveness and safety for patients with achalasia.

Introducción: la acalasia es un trastorno motor primario del esófago. La sintomatología más frecuente es la disfagia, dolor torácico, reflujo y pérdida de peso. La manometría esofágica es el estándar para su diagnóstico. El objetivo de este trabajo fue determinar la eficacia del manejo quirúrgico de los pacientes con acalasia en nuestro centro hospitalario. Métodos: se realizó un estudio de serie de casos en el que se incluyeron pacientes con acalasia tratados de manera quirúrgica entre enero y diciembre de 2011. Se revisaron los expedientes para obtener los datos y registros del tipo de procedimiento quirúrgico realizado, morbilidad y mortalidad. Resultados: se incluyeron 14 pacientes con edad promedio de 49.1 años. Los síntomas predominantes fueron: disfagia, vómito, pérdida de peso y pirosis. Se realizaron ocho abordajes abiertos y seis laparoscópicos, con una longitud media de cardiomiotomía de 9.4 cm. Once pacientes recibieron un procedimiento antirreflujo concomitante. La efectividad de los procedimientos realizados fue del 85.7 %. Conclusiones: el manejo quirúrgico ofrecido en nuestro centro no difiere de lo reportado en otras series de caso, lo que otorga efectividad y seguridad a los pacientes tratados con acalasia.

Triggering receptor expressed on myeloid cells-1 expression on monocytes is associated with inflammation but not with infection in acute pancreatitis.

INTRODUCTION: Acute pancreatitis (AP) is usually a mild and self-limiting disease, but some patients develop a severe form that is associated with high mortality. In AP, local inflammation is followed first by the systemic inflammatory response syndrome and then by the compensatory anti-inflammatory response syndrome, which is defined by low human leukocyte antigen (HLA)-DR expression on monocytes, increased concentration of the anti-inflammatory cytokine IL-10, and decreased monocyte function. Our aim was to measure the expression of triggering receptor expressed on myeloid cells (TREM)-1 (a proposed marker of infection or inflammation) and HLA-DR on monocytes, and the serum concentrations of IL-6 (a proinflammatory cytokine) and IL-10 in patients with AP to determine whether these markers can identify patients at high risk of developing severe AP or infection. METHODS: Fifty healthy volunteers, 18 patients with mild AP, and 11 patients with severe AP were included in this study. Samples were taken at admission and one and three days later. TREM-1 and HLA-DR expression was evaluated by flow cytometry, and soluble TREM-1, IL-6 and IL-10 concentrations were measured by ELISA. RESULTS: TREM-1 expression was higher in patients with AP than in healthy volunteers, but there was no difference between patients with mild and severe AP. TREM-1 expression was not associated with mortality or with the presence of infection. Soluble TREM-1 concentration in serum was higher in non-survivors than in survivors. HLA-DR expression was lower and IL-6 concentration higher in patients with severe AP and in infected patients. CONCLUSIONS: Increased TREM-1 expression was associated with the presence of inflammation but not infection in AP. In patients with AP, low HLA-DR expression and high IL-6 concentration could predict severity and infection in samples taken shortly after admission.

The increased expression of TREM-1 on monocytes is associated with infectious and noninfectious inflammatory processes.

BACKGROUND: Inflammation is the response of an organism to tissue injury or infection. It is usually limited to the affected tissue, but sometimes the inflammatory mediators reach the bloodstream and act systemically. A compensatory anti-inflammatory response syndrome, in which expression of major histocompatibility complex class II (MHC-II) molecules are decreased, regulates the resulting systemic inflammatory response syndrome (SIRS). SIRS and compensatory anti-inflammatory response syndrome can lead to the development of sepsis. Triggering receptor expressed on myeloid cells (TREM)-1 has been proposed as a biomarker of the presence of sepsis. In this study, we investigated whether TREM-1 is increased only in septic patients, and not in patients with systemic inflammatory response but no infection. We also looked for a possible correlation between TREM-1 and MHC-II expression levels and the patients' progress. MATERIALS AND METHODS: Fifty-eight surgical patients, 14 septic patients and 50 healthy volunteers, were included in this study. TREM-1 and MHC-II expression on blood monocytes was determined by flow cytometry. RESULTS: TREM-1 expression was increased in all patients after surgery, and its expression was higher in patients with preexisting SIRS. No association was found with the presence of infection. In septic patients, the increase in TREM-1 expression was transitory. MHC-II expression was decreased in both surgical and septic patients, and this decrease was greater in patients with a worse outcome. CONCLUSIONS: Increased TREM-1 expression on monocytes is associated with both infectious and noninfectious inflammatory processes, and the levels of MHC-II expression is better correlated with the patient outcome.

[Open abdomen. Evolution in management]. / Abdomen abierto. Evolución en su manejo.

The open abdomen (OA) strategy is accepted in the treatment of extremely ill surgical patients. Its usage has increased in the last decade as the understanding of its functions, advantages and disadvantages increases. Unfortunately, it continues to be associated with very high morbidity and mortality, and the different techniques used to protect the intra-abdominal contents cannot be standardized for all surgical circumstances. The objective is to review the origins, actual indications and controversies of the staged abdominal repair (STAR) and to report on the latest and most used techniques to ensure an optimal temporary abdominal closure (TAC). A search was done in Medline and Ovid for articles with key words of open abdomen, temporary abdominal closure and staged abdominal repair. We found the use of the technique is justified in patients with trauma, abdominal compartment syndrome and patients with severe intra-abdominal sepsis. The technique used for TAC must always be individualized for each clinical circumstance. The best reported results have been obtained with the vacuum pack technique. In our own experience and as a general rule we discouraged the use of mesh to protect intra-abdominal contents. The strategy of OA is useful in complex surgical situations in extremely ill patients. Its use must be very carefully evaluated, knowing the potentially serious complications that the patient may develop with its use.

Abdomen abierto: evolución en su manejo / Open abdomen: evolution in management

The open abdomen (OA) strategy is accepted in the treatment of extremely ill surgical patients. Its usage has increased in the last decade as the understanding of its functions, advantages and disadvantages increases. Unfortunately, it continues to be associated with very high morbidity and mortality, and the different techniques used to protect the intra-abdominal contents cannot be standardized for all surgical circumstances. The objective is to review the origins, actual indications and controversies of the staged abdominal repair (STAR) and to report on the latest and most used techniques to ensure an optimal temporary abdominal closure (TAC). A search was done in Medline and Ovid for articles with key words of open abdomen, temporary abdominal closure and staged abdominal repair. We found the use of the technique is justified in patients with trauma, abdominal compartment syndrome and patients with severe intra-abdominal sepsis. The technique used for TAC must always be individualized for each clinical circumstance. The best reported results have been obtained with the vacuum pack technique. In our own experience and as a general rule we discouraged the use of mesh to protect intra-abdominal contents. The strategy of OA is useful in complex surgical situations in extremely ill patients. Its use must be very carefully evaluated, knowing the potentially serious complications that the patient may develop with its use.

[Use of vacuum-assisted closure in the treatment of surgical infection sites]. / Uso del sistema de cierre asistido al vacío VAC en el tratamiento de las heridas quirúrgicas infectadas. Experiencia clínica.

Surgical site infection is one of the most important health problems representing an increase in morbi-mortality and economical devastation for the patient. There have been a variety of procedures that surgeons have employed to control this situation, from very refined surgical procedures, advanced antimicrobial therapy to local therapy with alginates, hydrocolloid dressings and many others with active topical substances. One of the newest treatments is the VAC (Vacuum-Assisted Closure). This therapy has been proven to be useful in wound infection control and we used it to carry out this study in 38 patients with wound infections. We present the results with this therapy in our institution.

Expression of triggering receptor on myeloid cell 1 and histocompatibility complex molecules in sepsis and major abdominal surgery.

AIM: To evaluate the surface expression of triggering receptor on myeloid cell 1 (TREM-1), class II major histocompatibility complex molecules (HLA-DR), and the expression of the splicing variant (svTREM-1) of TREM-1 in septic patients and those subjected to major abdominal surgery. METHODS: Using flow cytometry, we examined the surface expression of TREM-1 and HLA-DR in peripheral blood monocytes from 11 septic patients, 7 elective gastrointestinal surgical patients, and 10 healthy volunteers. svTREM-1 levels were analyzed by RT-PCR. RESULTS: Basal expression of TREM-1 and HLA-DR in healthy volunteers was 35.91+/-14.75 MFI and 75.8+/-18.3%, respectively. In septic patients, TREM-1 expression was 59.9+/-23.9 MFI and HLA-DR expression was 44.39+/-20.25%, with a significant difference between healthy and septic groups (P<0.05) for both molecules. In the surgical patients, TREM-1 and HLA-DR expressions were 56.8+/-20.85 MFI and 71+/-13.8% before surgery and 72.65+/-29.92 MFI and 72.82+/-22.55% after surgery. TREM-1 expression was significantly different (P = 0.0087) between the samples before and after surgery and svTREM-1 expression was 0.8590+/-0.1451 MF1, 0.8820+/-0.1460 MF1, and 2.210+/-0.7873 MF1 in the healthy, surgical (after surgery) and septic groups, respectively. There was a significant difference (P = 0.048) in svTREM-1 expression between the healthy and surgical groups and the septic group. CONCLUSION: TREM-1 expression is increased during systemic inflammatory conditions such as sepsis and the postoperative phase. Simultaneous low expression of HLA-DR molecules correlates with the severity of illness and increases susceptibility to infection. Additionally, TREM-1 expression is distinctly different in surgical patients at different stages of the inflammatory response before and after surgery. Thus, surface TREM-1 appears to be an endogenous signal during the course of the inflammatory response. svTREM-1 expression is significantly increased during sepsis, appearing to be an indicator of severity of illness. Together, these data indicate that TREM-1 may play an important role in establishing and amplifying the systemic inflammatory response. TREM-1, HLA-DR, and svTREM-1 expression analysis can provide useful diagnostic and prognostic indicators during SIRS, CARS, and sepsis.

[Appendiceal tumors. Clinicopathologic review of 5,307 appendectomies]. / Tumores apendiculares. Revisión clínico-patológica de 5,307 apendicectomías.

INTRODUCTION: Appendix tumors are unusual, accounting for 0.4% of all gastrointestinal- tract malignancies. Although rare, the spectrum of malignant disease is complex and has led to confusion with regard to accurate description of the natural history of these tumors. Consequently, many errors in diagnosis and treatment have occurred. OBJECTIVE: Our aim was to analyze incidence and clinic-pathologic behavior of appendiceal tumors. METHODS: Our study type was retrospective, observational, longitudinal, and descriptive, and was conducted at a secondary-care-level hospital. From a single care center, a histopathologic database of 5,307 appendectomies, all appendiceal tumors, was identified and case notes were reviewed. Analysis of clinical presentation, histopathology, operation, and outcome is presented. RESULTS: During a 10-year period (5,307 appendectomies), 31 patients (0.58%) with appendiceal tumors were identified: 11 had carcinoid tumors, 18 benign, and two patients had malignant tumors. Acute appendicitis was the most common presentation (79.1%), and 20.3% were normal appendices. Patients with appendiceal tumor included 23 females and eight males with mean age of 48 years. Ninety seven percent of patients had preoperative diagnosis of acute appendicitis. CONCLUSIONS: Appendiceal tumors are uncommon and most commonly present as acute appendicitis. Macroscopic suspicion during surgery is the most important point to make the best decision.

Hamartoma de la vía biliar. Reporte de un caso / Bile duct hamartoma. Report of a case

Antecedentes: las obstrucciones de la vía biliar en general son provocadas por cálculos y neoplasias. Existen otras alteraciones mucho menos frecuentes que pueden provocar obstrucción, entre ellas se encuentran los hamartomas de la vía biliar. Se presenta el caso de una paciente de 34 años diabética, que inicia su padecimiento con dolor abdominal e ictericia. El estudio inicia con ultrasonido de vesícula y vías biliares, que reporta colelitiasis y dilatación de vías biliares. Se realiza CPRE y se descubre una lesión ocupativa del árbol biliar. Se somete a colecistectomía y exploración de la vía biliar. La evolución de la paciente fue satisfactoria. La revisión de patología reporta un hamartoma de la vía biliar extrahepática. Los hamartomas de la vía biliar son neoplasias benignas poco frecuentes, sin embargo, debemos de tenerlas en mente como parte del diagnóstico diferencial.

Factores de riesgo para dehiscencia de herida quirúrgica / Risk factors for wound dehiscence

Objetivo: determinar los factores de riesgo para dehiscencia de herida quirúrgica en pacientes sometidos a cirugía abdominal. Material y método: revisión de expedientes y distribución en dos grupos: pacientes con dehiscencia de herida y sin ella. Se registraron sexo, edad, antecedentes patológicos, tipo de cirugía, complicaciones de la cirugía, estado nutricional y tiempo entre la cirugía y la dehiscencia. Resultados: de enero de 1987 a enero de 1997 se registraron 9,897 cirugías de las cuales 72 presentaron dehiscencia de herida quirúrgica. Cuarenta y ocho hombres y 24 mujeres; 33 operados electivamente y 39 urgentes. Grupo control con 74 pacientes. El órgano más afectado fue el colon; los antecedentes más frecuentes diabetes mellitus y enfermedad pulmonar. Los factores de riesgo con significancia estadística fueron infección de herida, hipoalbuminemia, enfermedad pulmonar crónica y tos. Conclusiones: los pacientes con factores de riesgo para dehiscencia de herida deben ser identificados y tratados para evitar esta complicación.