Escisión laparoscópica de quiste mesotelial hepático / Laparoscopic excision of a hepatic mesothelial cyst

Los quistes mesoteliales son lesiones congénitas extremadamente raras que tienen origen en restos celómicos. Los autores describen el caso de un niño de tres años de edad. Presenta como hallazgo casual imagen quística hepática en ecografía abdominal, en el contexto de estudio de dolor abdominal. El examen objetivo y el estudio analítico no demostraron ninguna alteración. La RMN confirmó la presencia de lesión quística, sugiriendo como hipótesis diagnóstica tratarse de un cistadenoma quístico. El enfermo fue sometido a quistectomía por laparoscopia, con alta al 2º día. El estudio de anatomía patológica concluye que se trata de un quiste mesotelial hepático. Los quistes mesoteliales hepáticos son lesiones muy raras, de difícil diagnóstico preoperatorio. Su escisión laparoscópica es un procedimiento exequible y seguro (AU)

Over the past few years there has been an increase in application of minimally invasive techniques in pediatric surgery, especially in the approach of liver lesions. The mesothelial cysts are extremely rare congenital lesions that arise from celomic remnants. The authors present the clinical case of a three year old child, referred to our institution after an incidental finding of a liver cystic lesion in abdominal ultrasound. The physical examination and blood study were irrelevant. The MRI confirmed the presence of the cystic lesion and pointed, as a possible etiology, a cystic cyst adenoma of the liver. The child was submitted to laparoscopic cyst resection. There peri and postoperative periods were uneventful. He was discharged 48h after surgery. The anatomo-pathological and immunohistochemical studies concluded it was a mesotelial cyst of the liver. The mesothelial cysts of the liver are very rare lesions, with difficult preoperative diagnosis. The laparoscopic excision is a feasible and safe (AU)

[Experimental free muscle transplantation. Is autologous graft on the distal esophagus viable?]. / Trasplante muscular libre experimental. Es viable el implante autólogo en esófago distal?

UNLABELLED: Experimental free muscle transplantation has resulted in some successful clinical applications. AIM: The possibility that this type of transplantation could act as a sphincteric mechanism motivated us to start by assessing the viability of autologous skeletal grafts on the distal esophagus of laboratory animals. MATERIAL AND METHODS: Twenty transplants of previously denervated free plantaris muscle grafted on the distal esophagus of Sprague-Dawley rats were evaluated at the 1st, 2nd, 4th, 8th and 16th posttransplant week. Histological and histochemical studies were performed to evaluate general features of the grafts and the muscle fibers condition. RESULTS: One and two weeks after transplant the grafts show large areas of necrosis with inflammatory infiltrate. Between the 2nd and the 4th week, as revascularization and motor endplates become significant, the areas of necrosis begin to regress and they almost disappear by the 8th week. Since the 4th week after transplant, regenerated muscle fibers demonstrate morphological and biochemical features similar to normal. CONCLUSIONS: Experimental free plantaris muscle transplantation on the distal esophagus is viable and shows revascularized and reinnervated muscle fibers from the 8th week after transplant on, and at least until the 16th. These fibers have the structural and metabolic properties enabling contractile function. This original model may allow further investigation of some features related to pathophysiology and therapy of gastroesophageal reflux.

[Experimental alkaline reflux esophagitis. Role of the refluxed material]. / Esofagitis por reflujo alcalino experimental. Papel del material refluyente.

Alkaline reflux is new recognised to play an important place in gastroesophageal reflux disease. In order to investigate the role of refluxate in the development of esophagitis we have performed an experimental study in laboratory animals submitted to alkaline reflux inducing operations. We produced esophagitis in two experimental groups of Sprague-Dawley rats: group I, end-to-side esophagojejunostomy (EY) and group II, esophagojejunostomy with partial derivation of afferent loop by an omega-like conduit (EO) designed to attain lesser reflux. Group III consisted of sham laparotomized animals (L). RESULTS. At day 14, all the animals of experimental groups have developed esophagitis, but the macroscopic extent and histological grade in group EO (med: 27 mm; grade 2) were significantly lower than in group EY (med: 35 mm; grade 3). Biochemical measurements (med) in esophageal washout revealed: a) pH were alkaline in all groups with a decrease in experimental groups that was only significant in group EY; b) Amylase, lipase and bile acids in groups EY (8090; 498; 32) and EO (12840; 449; 50) were similar, but significantly more higher than in group L (920; 24; 0). The analysis of correlation between esophagitis parameters and biochemical measurements revealed no significant ones except for pH (r = -.437 and -.417). CONCLUSIONS. 1- The alternative model (EO) presents lesser grade and extent of esophagitis. 2) The refluxate was rich in bile acids and pancreatic enzymes what is proof of the actual occurrence of reflux and supports its determinant contribute to the development of esophagitis. 3) Esophagitis has developed at alkaline pH but with no alkalinity increase in the experimental groups what indicate that "alkaline reflux esophagitis" is not an appropriate denomination. 4) The discrepancy between the biochemical analysis in esophageal washout and the extent and grade of esophagitis suggests that others than the nature and amount of refluxate (e.g. mucosal resistance) could play a role in reflux esophagitis.