[Intraoperative echography of hepatic metastases]. / Ecografía intraoperatoria de las metástasis hepáticas.

In order to evaluate the usefulness of intraoperative echography in the study of liver metastases, two groups of patients were submitted to study: A consecutive series of 25 patients operated on for digestive tumours. Before operation, echography was performed to all of them. Four patients operated on for liver metastases. In the patients who were operated for digestive tumors, the authors found 8.6% of metastasis which neither the preoperative echography nor liver palpation had detected. The usefulness of the examination in the patients to whom resective hepatic surgery was going to be performed was based on: The finding of a portal thrombosis which had not been detected in the preoperative study. The possibility of connecting the intrahepatic vascularity with the lesions, in order to decide which technique to choose. The demonstration of the non-existence of other metastases.

[Intraoperative echography in the diagnosis of obstructive jaundice of undetermined cause]. / Aportación de la ecografía intraoperatoria en el diagnóstico de las ictericias obstructivas de causa no filiada.

Intraoperative ultrasonography was performed in a consecutive series of 11 patients with obstructive jaundice. On two occasions, the examination modified the preoperative diagnosis, diagnosing liver metastasis in a patient with hydatid cysts and in another by detecting gallstones in the main biliary duct in which ERCP was suggestive of an ampullary tumor. Ultrasound made a definitive diagnosis of choledocholithiasis in one case, and pancreatic carcinoma in three cases all of which had a preoperative diagnosis of biliary obstruction of undetermined cause. The examination defined accurately the level of obstruction and the extent of a carcinoma of the bile ducts in two patients and it helped in obtaining cytological samples from a pancreatic tumor mass. Its use is recommended when the cause of biliary obstruction cannot be accurately diagnosed preoperatively.

[Intraoperative echography during surgery for biliary lithiasis]. / Ecografía intraoperatoria en la cirugía de la litiasis biliar.

We present the experience with the use of intraoperative ultrasonography in detecting biliary calculi on 55 patients, 19 of which had lithiasis of the common bile duct. Operative ultrasonics imaging of the biliary tree and operative cholangiography had a similar accuracy when both explorations were performed. In this series, accuracy indexes of ultrasonography in diagnosing choledocholithiasis were: sensitivity, 84.21%; specificity, 100%; efficiency, 94%; predictability of a positive test, 100%; predictability of a negative test, 92%. We think ultrasonography is a better exploration in two conditions: when intrahepatic duct lithiasis exists and if calculi are at the end of choledochus, because differentiation with neoplastic changes is easier.

[Focal steatosis of the liver]. / Esteatosis focal del hígado.

We present a case of focal hepatic steatosis, presenting with longstanding and poorly defined discomfort. The exploratory methods could not exclude the presence of a tumor mass in the liver; for this reason the patient was submitted to surgery, which allowed the histological diagnosis. We call attention to the existence of this lesion and the convenience of using all the available diagnostic methods to obtain the diagnosis in order to avoid the risks of an unnecessary major surgical procedure.

Colonic perforation by amyloidosis. Report of a case.

One patient with a colonic perforation associated with secondary amyloidosis and ankylosing rheumatoid spondylitis was treated successfully. To our knowledge, this is the first case described of colonic perforation in amyloidosis.