[Embolism caused by a bullet. Report of a case and review of the literature]. / Embolismo por proyectil de arma de fuego. Reporte de un caso y revisión de la literatura.

We describe the case of a 23 years old male, who suffered a 45 bullet wound in the arm and upper right hemithorax. He walked after his injury and 10 minutes later presented dizziness, cough and tachycardia. On admission a minor haemothorax was seen on a chest X ray, but the bullet was not seen. Even without symptoms, an X ray of abdomen showed the missile lying above the left sacroiliac joint. A chest tube was placed, the patient had an excellent recovery and was discharged a week later. After several months he presented hemoptysis and a moderate pain on his right chest and was treated as an acute bronchitis. Six months after his initial injury he developed a florid picture of acute pulmonary embolism (chest pain, dyspnea, hemoptysis, tachycardia, severe cough). A new chest X ray was done and the bullet was shown lying in the right chest. A pulmonary arteriography located it in a lower basal branch. Through a posterolateral thoracotomy the slug was obtained. The recovery was uneventful and he has remained well since. We discuss the possible mechanisms to explain the entrance of the bullet into the vascular system and conclude that in cases of gunshot wounds: a) An exit wound must be always searched for; if not found exploratory X ray are mandatory, b) If the bullet is not found, specially after thoracic injuries, bullet embolism should be contemplated, c) If there are signs of regional ischemia arteriography is mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)

[Blood transfusion from cadavers]. / Transfusión de sangre de cadáver.

Most of the transplant programs in our days are based on cadaveric donation; blood has been not recovered from dead bodies, except by some Soviet groups. We selected 16 subjects, eight with brain death and eight with "biological" death (heart arrest) that were considered as ideal donors. From them we obtained 23 units of whole blood, either by surgical dissection of the internal jugular vein, by puncture of the femoral artery or by puncture of a peripheral arm vein. Twelve were not used due to bacterial growth, HBsAg positivity or hemolysis. Of the remaining, we obtained 10 packed red cells and 10 units of plasma, one unit was transfused as whole blood. Three plasma units were discharged due to "turbidity". Sixteen patients for whom it was difficult to get a voluntary donor were transfused with some of the products and followed for as long as they remained in hospital. None showed adverse reactions due to the procedure. We conclude that the organization of any program related to the transplantation of organs is not a simple matter, but that blood is easily recovered and that this should be done always as part of the "total use" of a donating body; cadaveric blood transfusion is harmless provided donors are carefully selected and that the sterility of the product is confirmed by culture.

Colecistitis aguda. Tratamiento quirurgico temprano. / Acute cholecystitis. Early surgical treatment

Se presenta nuestra experiencia con 21 casos de colecistitis aguda, confirmada histologicamente, y que fueron intervenidos en cuanto se establecio el diagnostico. La colangiografia preoperatoria endovenosa permitio confirmar el diagnostico preoperatorio en 19 pacientes. En todos durante la intervencion se efectuo puncion evacuadora, y la evolucion postoperatoria fue excelente. Se concluye que en cuanto se establece el diagnostico de colecistitis aguda se debe resolver quirurgicamente el problema con lo que se evitan internamientos multiples y se disminuye de manera considerable los dias de hospitalizacion

Autotransfusion en cirugia electiva. / Autologous blood transfusion in elective surgery

La transfusion de sangre homologa tiene riesgos; entre otros la transmision de enfermedades y reacciones de tipo antigenico. Por ello consideramos que la mejor sangre para un paciente es la suya propia y que la sangria preoperatoria, el almacenamiento y su empleo durante o despues de la cirugia es un procedimiento que se puede efectuar en nuestro medio. Se comunica nuestra experiencia con 12 casos de autotransfusion sanguinea con tecnica de predeposito

Litofagia. Una causa poco comun de obstruccion colonica incompleta. / Lithophogia. An unusual case of incomplete colon obstruction

Se comunica el caso de una paciente demente de treinta anos de edad, con la obsesion de deglutir guijarros, los cuales se alojaron en el colon formando un molde solido del mismo que ocasiono suboclusion.En ambas fosas iliacas se encontro a la palpacion tumoraciones que semejaban "bolsas de canicas", modernamente dolorosas.El ampula rectal estaba impactada con pequenas piedras las cuales fueron extraidas con cierta dificultad. Se aplicaron enemas jabonosos durante varios dias; tratamiento conservador que dio excelentes resultados: se arrojaron mas de 2608 piedras. Los hallazgos radiologicos son impresionantes.No existe en la literatura otro caso semejante

Aire libre subdiafragmatico? Interposicion colonica hepatodiafragmatica?. / Subdiaphragmatic free air? Hepatodiaphragmatic interposition of colon

Se presenta el caso de un paciente masculino de 62 anos de edad, que ingreso al servicio de urgencias por presentar cuadro abdominal agudo de dos horas de evolucion. Al efectuarse una placa posteroanterior de torax se encontro una imagen sugestiva de aire libre subdiafragmatico. Dada la gran cantidad de aire y la separacion entre el higado y el diafragma, se repitieron los estudios radiograficos, demostrando que la imagen aerea obedecia a la interposicion de un segmento colonico entre el higado y el diafragma (Sindrome de Chilaiditi). En base al cuadro clinico y no al radiologico, se efectuo laparatomia exploradora de urgencia encontrando peritonitis biliar consecutiva a la perforacion de la vesicula biliar. Se efectua revision de las placas de torax cuando existe aire libre subdiafragmatico. En caso de duda las proyecciones laterales son de gran utilidad