Minimally invasive repair of pectus carinatum and how to deal with complications.

While less common than pectus excavatum, pectus carinatum is also a chest wall deformity affecting males in higher proportion than women. Patient requests for a solution of this disease occur especially during the growth spurt of puberty when this malformation becomes more obvious and difficult to conceal. Those people suffering from pectus carinatum are very likely subject to behavioral changes and negative personality impacts. By compressing the protruding anterior region of the chest wall we achieve correction of the chest contour and simultaneous lateral expansion of the depressed costochondral arches. This original technique and the procedure to apply it fit within the category of minimally invasive surgery. The compression system acts in a way similar to that of orthodontic braces. Two rectangular fixation plates are fixed to the compression strut with screws. The plates have threaded holes along a groove in the central portion, and two holes at both ends used to attach them to the ribs by means of steel wire suture. The compression strut has to be modified into a convex shape to adapt it to the particular characteristics of the patient's malformation. This molding is done using benders designed as part of the procedure.

Total gastrectomy due to ferric chloride intoxication.

INTRODUCTION: The ferric chloride intoxication is frequently caused by accident. Its toxicity is generally underrated, which can lead to fatal evolution or irreversible consequences. In this case, the caustic condition of the substance is related to the toxic properties of iron. CASE PRESENTATION: A 36-year-old male patient arrives by ambulance indicating sensory deterioration. He presents erosive injuries in the buccal cavity and in the oropharynx, brownish teeth and metabolic acidosis. Toxicology tests and ferritin blood dosage are requested, which show a result from 1400 mg/dl. The symptoms are interpreted as acute iron intoxication. Due to the unfavorable evolution of his condition, an abdominal and pelvic CT scan are performed, which show extensive pneumoperitoneum and free fluid in the abdominal cavity. An exploratory laparotomy, a total gastrectomy with esophagostomy and feeding jejunostomy, washing and drainage due to perforated gastric necrosis caused by caustic ingestion are performed. DISCUSSION: In our country, there is a high rate of intoxication caused by iron compounds, although it is not statistically measured. Nevertheless, the ferric chloride intoxication is extremely infrequent. The ingestion of this product leads to complications, which are associated with the iron concentration and its condition as a caustic agent. CONCLUSIONS: The surgical indications in the presence of intoxication caused by iron compounds are: stomach evacuation of iron, gastric necrosis, perforation or peritonitis and stenosis. Early or prophylactic gastrectomy is contraindicated. However, if complications that require immediate surgical intervention arise, there should be no hesitation and the corresponding procedure should be performed.

The pancreatic ductal system and biliaropancreatic union: a study of 50 cases

Since its discovery in the 17th century, the anatomy of the pancreatic ductal system and its variations has been studied by numerous authors around the world, and Argentina is not an exception. Nevertheless, most of these researches were carried out upon non representative or insufficient population samples in order to determine a reliable amount of evidence. Therefore, the purpose of this study was to detail the course and distribution of pancreatic ducts and their convergence with the bile duct in adult corpses in the Medicine Faculty of Buenos Aires University. This scientific research has been developed under a non-experimental cross section descriptive design. Gross macroscopic classic dissection was performed in (n=50) adult human cadaveric pancreas-duodenum with no criteria of exclusion. The dissections were made using microsurgical tools and optical magnification devices. The measurements were obtained by means of a vernier caliper and a protractor. In addition, a digital photo camera was used in order to achieve the necessary photographic documentation of the results. The variables under study were recorded for statistic analysis. The exocrine pancreas ducts and their union with the bile duct were dissected and exhibited in all anatomical pieces. The morphological patrons were established in terms of length and gauge of the principal and accessory ducts, number of tributaries, distribution and course within the gland. Finally, we registered the angle between principal pancreas duct and bile duct, and between principal and accessory pancreatic ducts. We evaluated the degree of duct suppression, and the features of the biliaropancreatic ampulla, and major and minor duodenal papillae. According to the results, there were patterns of distribution of pancreatic ducts and biliaropancreatic union that provide anatomical basis for an etiopathogenic analysis of acute biliary pancreatitis (AU)

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