Isthmectomy: a conservative operation for solitary nodule of the thyroid isthmus.

PURPOSE: To assess the results obtained in patients with nontoxic uninodular goiter confined to the isthmus undergoing isthmectomy. METHODS: Between April 1994 and June 2006, 330 consecutive patients with nontoxic uninodular goiter underwent thyroidectomy at our institution. In 31 patients, lesions were limited to the thyroid isthmus with evidence of benign or undetermined pathology on ultrasound-guided fine-needle aspiration biopsy. Total isthmectomy was performed. RESULTS: Preoperatively, thyroid nodules on ultrasonography were solid in 26 patients and mixed with cystic and solid components in 2. The mean size of nodules was 2.43 (+/- 0.88) cm. No intraoperative or postoperative complications occurred. Histological examination showed nodular hyperplasia in 29 cases, follicular adenoma in 1 and papillary thyroid carcinoma in 1. The patient with papillary carcinoma underwent bilateral lobectomy 7 days later. A total of 24 patients (77.4%) attended clinical visits at follow-up (mean 70,57 months). Ultrasonographic scanning revealed thyroid nodules in 17 patients, in 16 of which nodules range from one to five (0.5 to 2 cm in size) and further surgery was not indicated. One patient with a 4-cm nodule and tracheal displacement found at ultrasonography 2 years after isthmectomy had inconclusive results of FNAB. This patient was re-operated for completion thyroidectomy, which was successfully performed without technical difficulties. The detection of recurrent nodules was independent of the time elapsed since thyroid isthmectomy. CONCLUSIONS: These findings document the feasibility and efficacy of isthmectomy in solitary thyroid nodules confined to the isthmus.

The effects of successful parathyroidectomy on clinical and biological manifestations of primary hyperparathyroidism.

PURPOSE: To assess changes of clinical manifestations, laboratory data, and bone mineral density after parathyroidectomy for primary hyperparathyroidism. METHODS: In 39 patients with symptomatic primary hyperparathyroidism undergoing parathyroidectomy, data of preoperative symptoms and bone densitometry were collected from the medical records. A telephone survey was used to collect information on postoperative symptoms and the patient's degree of satisfaction with the operation. Results of biochemical parameters before surgery, at the immediate postoperative period, and at late follow-up were compared. Differences of proportions were assessed with the chi-square test and differences in means with the one-way ANOVA and the Student's t test. RESULTS: A significant decrease was observed in the occurrence of renal colic and bone pain after parathyroidectomy. Calcium and PTH levels decreased and phosphorus levels increased significantly after the operation. 24-hour renal calcium excretion showed a statistically significant decrease in the immediate postoperative control and at follow-up in patients without renal colic, whereas in those with nephrolithiasis, significant differences were only observed at follow-up. Alkaline phosphatase decreased significantly in the immediate postoperative period, and bone densitometry improved in a 90% of the patients. Ninety-six percent of patients were satisfied with parathyroidectomy. CONCLUSIONS: In this clinical series, successful parathyroidectomy resulted in improvement of clinical manifestations, normalization of biochemical parameters, and a decrease in osteoporosis. Patients reported a high degree of satisfaction with parathyroidectomy.

[Hypokaliemic nephropathy as a form of presentation of Conn syndrome]. / Nefropatía hipokaliémica como presentación de un síndrome de Conn.

Hypokalemia is generally associated to neuromuscular symtoms, acid-base disorders and even to rhabdomyolysis. However, chronic hypokalemia can induce chronic renal failure through a characteristic tubulointerstitial damage consisting on vacuolization of epithelial tubular cells and interstitial fibrosis. This entity is called hypokalemic nephropathy, quite unusual and probably little know in our speciality. We present a clinical report of a patient admitted to our hospital with a severe hypokalemia secondary to an aldosterone producing adrenal adenoma that was diagnosed during admission. Besides hypokalemia the patient presented renal failure. Renal biopsy proved characteristic tubulointerstitial damage as described in hypokaliemic nephropathy. In summary, we report a Conn syndrome presenting as a hypokalemic nephropathy.

Nefropatía hipokaliémica como presentación de un síndrome de Conn / Hypokaliemic nephropathy as a form of presentation of a Conn syndrome

Una hipopotasemia puede causar alteraciones a nivel neuromuscular, en elequilibrio ácido-base o incluso producir rabdomiólisis. Pero si se trata de unahipopotasemia crónica también puede ser causa de una insuficiencia renal cuyosustrato histológico reside en una característica lesión túbulo-intersticial consistenteen vacuolización de los túbulos renales y fibrosis intersticial. Es la entidaddenominada nefropatía hipokaliémica, realmente poco descrita en nuestra especialidad.Presentamos el caso clínico de un paciente que ingresó con una hipopotasemiasevera, secundaria a un hiperaldosteronismo primario producido por un adenomasuprarrenal que se diagnosticó durante ese mismo ingreso. Este paciente presentabaademás una insuficiencia renal crónica en cuya biopsia renal aparecían lastípicas lesiones histológicas a nivel túbulo-intersticial arriba descritas. Se tratabapor tanto de un síndrome de Conn que debutaba como una nefropatía hipokaliémica

Hypokalemia is generally associated to neuromuscular symtoms, acid-base disordersand even to rhabdomyolysis. However, chronic hypokalemia can inducechronic renal failure through a characteristic tubulointerstitial damage consistingon vacuolization of epithelial tubular cells and interstitial fibrosis. This entity is calledhypokalemic nephropathy, quite unusual and probably little know in our speciality.We present a clinical report of a patient admitted to our hospital with a severehypokalemia secondary to an aldosterone producing adrenal adenoma that wasdiagnosed during admission. Besides hypokalemia the patient presented renal failure. Renal biopsy proved characteristic tubulointerstitial damage as described inhypokaliemic nephropathy. In summary, we report a Conn syndrome presentingas a hypokalemic nephropathy

Nefropatía hipokaliémica como presentación de un síndrome de Conn / Hypokaliemic nephropathy as a form of presentation of a Conn syndrome

Una hipopotasemia puede causar alteraciones a nivel neuromuscular, en el equilibrio ácido-base o incluso producir rabdomiólisis. Pero si se trata de una hipopotasemia crónica también puede ser causa de una insuficiencia renal cuyo sustrato histológico reside en una característica lesión túbulo-intersticial consistente en vacuolización de los túbulos renales y fibrosis intersticial. Es la entidad denominada nefropatía hipokaliémica, realmente poco descrita en nuestra especialidad. Presentamos el caso clínico de un paciente que ingresó con una hipopotasemia severa, secundaria a un hiperaldosteronismo primario producido por un adenoma suprarrenal que se diagnosticó durante ese mismo ingreso. Este paciente presentaba además una insuficiencia renal crónica en cuya biopsia renal aparecían las típicas lesiones histológicas a nivel túbulo-intersticial arriba descritas. Se trataba por tanto de un síndrome de Conn que debutaba como una nefropatía hipokaliémica

Hypokalemia is generally associated to neuromuscular symtoms, acid-base disorders and even to rhabdomyolysis. However, chronic hypokalemia can induce chronic renal failure through a characteristic tubulointerstitial damage consisting on vacuolization of epithelial tubular cells and interstitial fibrosis. This entity is called hypokalemic nephropathy, quite unusual and probably little know in our speciality. We present a clinical report of a patient admitted to our hospital with a severe hypokalemia secondary to an aldosterone producing adrenal adenoma that was diagnosed during admission. Besides hypokalemia the patient presented renal failure. Renal biopsy proved characteristic tubulointerstitial damage as described in hypokaliemic nephropathy. In summary, we report a Conn syndrome presenting as a hypokalemic nephropathy

Strangulated small bowel evisceration after intraperitoneal drainage.

We report an exceptional case of strangulated small bowel evisceration through an intraperitoneal drainage after open cholecystectomy. It is a recognized but rare complication of surgical procedures. The drainage must be sited carefully and when necessary. If possible, drains of less than 10 mm external diameter should generally be used.

Actividad de las enzimas hepáticas en la colecistectomía laparoscópica / Liver enzymes levels after laparoscopic cholecistectomy

No disponible

[Modification of nephritic colic and 24-hour calcium excretion in urine in primary hyperthyroidism after parathyroidectomy]. / Modificación de los cólicos nefríticos y de la excreción de calcio en orina de 24 horas en el hiperparatiroidismo primario tras la paratiroidectomía.

We documented the frequency of nephritic colic in patients with primary hyperparathyroidism, and determined its modification after the parathyroidectomy; we also studied laboratory parameters such as calcium, phosphorus and parathyroid hormone in serum, and the excretion of Cao 24h, previous and later to the intervention. At sight of the results it is possible to be concluded that the parathyroidectomy is useful in the treatment of the kidney stone disease produced by the primary hyperparathyroidism.

Modificación de los cólicos nefríticos y de la excreción de calcio en orina de 24 horas en el hiperparatiroidismo primario tras la paratiroidectomía / Modification of nephritic colic and 24-hour calcium excretion in urine in primary hyperthyroidism after parathyroidectomy

Se documentó la frecuencia de cólicos nefríticos en pacientes con hiperparatiroidismo primario, y se determinó su modificación tras la paratiroidectomía; así mismo se estudiaron parámetros de laboratorio tales como calcio, fósforo y parathormona en suero, y excreción de calcio en orina de 24h previos y posteriores a la intervención. A la vista de los resultados se puede concluir que la paratiroidectomía es útil en el tratamiento de la enfermedad calculosa renal producida por el hiperparatiroidismo primario (AU)

We documented the frequency of nephritic colic in patients with primary hiperparathyroidism, and determined its modification after the parathyroidectomy; we also studied laboratory parameters such as calcium, phosphorus and parathyroid hormone in serum, and the excretion of Cao 24h, previous and later to the intervention. At sight of the results it is possible to be concluded that the parathyroidectomy is useful in the treatment of the kidney stone disease produced by the primary hyperparathyroidism (AU)

Microanastomosis venosas directas mediante cuff extraluminal / Direct venous microanastomoses with an extraluminal cuff

Introducción. Las microanastomosis venosas son más difíciles de realizar que las arteriales debido a las características de la pared venosa. La técnica habitual es la sutura con puntos sueltos, pero presenta los inconvenientes de una duración excesiva y la presencia de gran cantidad de material de sutura desde el punto de vista anastomótico. La técnica del cuff extraluminal para la realización de estas microanastomosis puede evitar estas complicaciones. Materiales y métodos. Se realizan 30 microanastomosis en la vena yugular interna de la rata Sprague-Dawley mediante la colocación de un cuff extraluminal de silicona, y se determina la duración, la permeabilidad inmediata (tanto en la primera hora como al mes) y sus posibles complicaciones. Se realiza además un estudio histológico a los quince días y al mes de su realización. Resultados. Duración media de las anastomosis: 6,77 minutos. Permeabilidad al mes del 83,3 por ciento. Destaca la presencia de tres trombosis y dos dehiscencias.El estudio histológico revela una escasa alteración parietal con una marcada hiperplasia subendotelial. Conclusiones. La técnica de microanastomosis venosas con un cuff extraluminal es una técnica rápida y fácil de realizar, y presenta unas tasas de permeabilidad altas (83,3 por ciento), a pesar de que se genera una tensión excesiva dentro de la línea de anastomosis debido al acortamiento vascular que se produce (AU)

Microanastomosis venosa yuguloyugular contralateral. Un nuevo modelo experimental / Contralateral jugular-jugular venous microanastomosis. A new experimental model

Introducción. Las microanastomosis venosas son de difícil realización, fundamentalmente por las características de la pared venosa. Objetivo. Ofrecer una técnica que evite las frecuentes complicaciones, y diseñar un nuevo modelo experimental. Materiales y métodos. Se utiliza la rata albina Sprague-Dowley. Tras cervicotomía en T invertida y disección de las dos venas yugulares externas, se mide la longitud de ambas desde sus extremos mandibular y clavicular. Se procede a la ligadura del extremo proximal de una yugular y el extremo distal de la contralateral, y se mide la longitud de las venas yugulares, así como la distancia entre las dos secciones vasculares. Se realiza una microanastomosis terminoterminal yuguloyugular contralateral en 10 animales, cinco mediante la técnica habitual de puntos sueltos y otros cinco con la utilización de un cuff extraluminal. Resultados. Longitud de cada vena yugular externa de 18 mm (ñ 1 mm). La distancia entre ambas secciones venosas fue de 25 mm. Se consiguió 5 mm de longitud añadida, útil para la microanastomosis.Todas las microanastomosis fueron permeables. Discusión. Con este nuevo modelo experimental se consigue una longitud venosa suficiente para realizar anastomosis directas fácilmente movilizables, permitiendo técnicas que obliguen a acortamiento de los segmentos venosos, y que se eviten los fallos anastomóticos secundarios a la tensión longitudinal y lesión de la pared vascular. Si se emplea un cuff extraluminal la anastomosis queda sin tensión, a pesar de la eversión y del telescopaje necesario (AU)

[Venous microanastomoses by extraluminal cuff versus standard technique]. / Microanastomosi venosa diretta con cuff extraluminale versus sutura standard.

AIM: Venous microanastomoses are more difficult to carry out in comparison with the arterial ones, because of the characteristics of the vascular wall. The suture with loose stitches is the usual surgical technique, but it has 2 disadvantages: a long time of execution and the presence of foreign material in the anastomosis. To avoid these complications, we an extraluminal silicone cuff has been used. METHODS: We performed 70 microanastomoses on the internal jugular vein of Sprague-Dawley rats with these 2 techniques, estimating the immediate and late permeability and postoperative complications. Moreover, a histological study of all the anastomoses was carried out on the 15th day and after 1 mo from the intervention. RESULTS: The mean time requested to perform the microanastomosis is significatively shorter when using the extraluminal cuff. The late permeability with standard suture is 97% and 77% with the cuff. The number of complications with standard suture is significatively lower than with cuff, where rates of 20% of dehiscence and 14% of trombosis were observed. The histological study showed a poor alteration of the vascular wall, with important subendothelial hypertrophy on cuff microanastomosis and a great permanent histopatologic alteration if the standard technique had been used. CONCLUSIONS: The suture with loose stiches is a very good technique to use for this type of microanastomosis, even if the extraluminal cuff can be used in microanastomosis of a free graft or when it is necessary to perform more than 1 microanastomosis.

Subtotal thyroidectomy with transposition of the remnant gland to the subcutaneous space. A new alternative technique in benign thyroid disease.

BACKGROUND: Thyroidectomy is the preferred surgical option for the treatment of benign disease of the thyroid in a wide rage of indications. Controversy exists concerning the extent of the primary excision for optimal results. A subtotal thyroidectomy with transposition of the thyroid remnant to the subcutaneous space prevents thyroid hormone supplementation for life and laryngeal nerve damage during a re-operation. METHODS: We present the case of a 42-year-old female with nontoxic multinodular goitre who underwent subtotal thyroidectomy in which a thyroid remnant of the left upper pole was placed subcutaneously through a buttonhole incision at the junction of the left sternocleidomastoid and the pre-thyroidal muscles. The remnant of thyroid nourished by the vascular pedicle of the superior pole vessels was sutured to the pre-thyroidal muscles. RESULTS: One month after operation, the remnant was palpated as a small well-limited mass without signs of inflammation and thyroid function tests were normal. A contrast-enhanced computed tomography (CT) scan confirmed the subcutaneous position of the thyroid tissue without pathological signs. The scintigraphy showed uptake radioactivity by the transported thyroid remnant. One year after operation the patient was clinically euthyroid with TSH and T4 levels within normal limits. CONCLUSIONS: This report documents the feasibility and efficacy of subtotal thyroidectomy with transposition of the thyroid remnant to the subcutaneous space in multinodular goitre.

[Interferon-alpha2b recombinant improved the cognitive dysfunction in patients with relapsing remitting multiple sclerosis]. / El interferón-alpha2b recombinante mejora la disfunción cognitiva en pacientes con esclerosis múltiple.

INTRODUCTION: Some experimental, Phase II clinical trials and the preliminary reports of the Cuban Phase III clinical trial indicate that alpha-IFN (IFN) may be useful in relapsing remitting (RR) multiple sclerosis (MS). The reports in Cuba showed that 70% of the MS patients have cognitive dysfunction. OBJECTIVE: To assess the efficacy of IFN-alpha2b recombinant in the cognitive dysfunction of RR MS. PATIENTS AND METHODS: 57 RR-MS clinical definite patients from the randomised, double blind, placebo controlled study of 225 patients with RR-MS and brain MRI confirmed. Patients were randomly assigned to receive intramuscular IFN-alpha2b (Heberon R) 10 million IU (high dose), 3 million IU (low dose) or placebo twice week for 2 years. Outcome results were blinding evaluated considering changes in the following tests: Luria, WAIS, Benton and PASAT-3. Adverse events and side effects were not evaluated to maintain physician blinding. RESULTS: The initial comparison of the groups did not show any differences among the placebo (n=20), low dose (n=18) and high dose (n=19) considering age (p=0.234), gender, ethnic group (p=0.012), years ill (p=0.787), EDSS (p=0.203) and rate of relapses (p=0.432). The Luria's Test showed an improved in the low dose group from 2.50 +/- 1.34 to 1.39 +/- 1.85 (p=0.029) and in the high dose group from 3.22 +/- 1.89 to 2.17 +/- 1.50 (p=0.006) vs placebo 2.85 +/- 1.66 to 2.90 +/- 1.97 (p=0.723). The results of the Benton's test demonstrated that the low dose group had an improved from 5.50 +/- 1.10 to 6.22 +/- 1.31 (p=0.047), in the high dose group from 4.87 +/- 1.85 to 5.78 +/- 1.35 (p=0.005) where as in the placebo group worse from 5.15 +/- 1.76 to 5.05 +/- 2.11 (p=0.893). The WAIS test showed the same results, the low dose group increased from 5.17 +/- 1.34 to 6.06 +/- 1.21 (p=0.022), the high dose group from 4.56 +/- 1.38 to 5.39 +/- 1.29 (p=0.007) and the placebo group worse from 5.25 +/- 1.25 to 5.05 +/- 1.57 (p=0.354). Finally, the PASAT-3 test increased in the IFNs groups: from 45.72 +/- 10.61 to 49.94 +/- 11.68 (p=0.015) in the low dose group, from 42.67 +/- 11.04 to 48.72 +/- 8.84 (p=0.03) in the high dose group, but in the placebo group worse from 44.55 +/- 10.86 to 41.95 +/- 13.74 (p=0.655). CONCLUSION: IFN-alpha improved the cognitive dysfunction in RR-MS patients. The higher dose is more beneficial.

El interferón alfa-2b recombinante mejora la disfunción cognitiva en pacientes con esclerosis múltiple / Interferon alpha-2b recombinant improved the cognitive dysfunction in patients with relapsing-remitting multiple sclerosis

Introducción. Ensayos clínicos recientes indican que el interferón (IFN)alfa-2b recombinante, parece ser útil en la forma exacerbación-remisión (ER) de la esclerosis múltiple (EM). Un 70 por ciento los pacientes con EM en Cuba tienen disfunción cognitiva. Objetivo. Evaluar la eficacia del IFNa2b en los trastornos cognitivos de la EM. Pacientes y métodos. 57 pacientes con EM-ER clínicamente definida y confirmada por RM, del ensayo clínico en Cuba, fase III, multicentro, aleatorizado, doblemente ciego y controlado con placebo. Los pacientes se distribuyeron en: grupo I, con 10 millones (MI) de UI de IFNalf-a2b (Heberon-R ®) intramuscular; el grupo II, con 3 MI IFNalfa-2b y grupo III,con placebo, dos veces a la semana, durante dos años. Las evaluaciones fueron a ciegas, al inicio y al final, mediante la escala neuropsicológica de Luria, Benton visual retention test, escala verbal WAISR ( Weschler adult intelligence-revised) y el PASAT-3 (paced auditory serial addition test). La detección de anticuerpos neutralizantes (ACN) al IFNalfa-2b, se realizó semestralmente. Resultados. Los resultados iniciales no demostraron diferencias significativas entre los grupos para las variables demográficas, clínicas y de discapacidad. Los resultados del Luria fueron: placebo [inicial (I)/final (F)] 2,85 ñ 1,66/2,90 ñ 1,97 (p = 0,723); IFNalfa-2b 3 MI (I/F): 2,50 ñ 1,34/1,39 ñ 1,85 (p = 0,029); IFNalfa-2b 10 MI (I/F): 3,22 ñ 1,69/2,17 ñ 1,50 (p = 0,006). Al fusionar los dos grupos IFNa2b frente a placebo se obtuvo p = 0,021 frente a 0,367. En el Benton, los resultados fueron: placebo (I/F): 5,15 ñ 1,76/5,05 ñ 2,11 (p = 0,893); IFNalfa-2b 3 MI (I/F): 5,50 ñ 1,10/6,22 ñ 1,31 ( p = 0,047); IFNalfa-2b 10 MI (I/F): 4,67 ñ 1,85/5,78 ñ 1,35 (p = 0,005). Al unir los grupos IFNalfa-2b frente a placebo, se obtuvo p = 0,181 frente a 0,440. En el test WAIS se encontró: placebo (I/F): 5,25 ñ 1,25/5,05 ñ 1,57 (p = 0,354); IFNalfa-2b 3 MI (I/F): 5,17 ñ 1,34/6,06 ñ 1,21 ( p = 0,022); IFNalfa-2b 10 MI (I/F): 4,56 ñ 1,38/5,39ñ1,29 (p = 0,007). Al comparar los grupos IFNalfa-2b frente a placebo (I/F) se obtuvo p = 0,026 frente a 0,216. Los resultados del PASAT-3 fueron: placebo (I/F): 44,55 ñ 10,86/41,95 ñ 13,74 (p = 0,655); IFNa2b 3 MI (I/F), 45,72 ñ 10,61/49,94 ñ 11,68 ( p = 0,015); IFNalfa-2b 10 MI (I/F), 42,67 ñ 11,04/48,72 ñ 8,84 (p = 0,003). Al comparar los grupos IFN frente a placebo, con el PASAT-3, se obtuvo p = 0,033 frente a 0,621. Los ACN contra el IFNalfa-2b se detectaron en un 3,5 por ciento de los casos. Conclusiones. El IFNa2b mejora las alteraciones cognitivas en la EM-ER. Esta mejoría es dependiente de la dosis y la frecuencia de ACN es muy baja (AU)

Introduction. Some experimental, Phase II clinical trials and the preliminary reports of the Cuban Phase III clinical trial indicate that alpha-IFN (IFN) may be useful in relapsing-remitting (RR) multiple sclerosis (MS). The reports in Cuba showed that 70% of the MS patients have cognitive dysfunction. Objective. To assess the efficacy of IFN-alpha 2b recombinant in the cognitive dysfunction of RR-MS. Patients and methods. 57 RR-MS clinical definite (Poser et al) patients from the randomised, double-blind, placebo-controlled study of 225 patients with RR-MS and brain MRI confirmed. Patients were randomly assigned to receive intramuscular IFN alpha-2b (Heberon-R ®) 10 million IU (high dose), 3 million IU (low dose) or placebo twice week for 2 years. Outcome results were blinding evaluated considering changes in the following tests: Luria, WAIS, Benton and PASAT-3. Adverse events and side effects were not evaluated to maintain physician blinding. Results. The initial comparison of the groups did not show any differences among the placebo (n= 20), low dose (n= 18) and high dose (n= 19) considering age (p= 0.234), gender, ethnic group (p= 0.012), years ill (p= 0.787), EDSS (p=0.203) and rate of relapses (p= 0.432).The Luria’s Test showed an improved in the low dose group from 2.50±1.34 to 1.39±1.85 (p= 0.029) and in the high dose group from 3.22±1.89 to 2.17±1.50 (p= 0.006) vs placebo 2.85±1.66 to 2.90±1.97 (p=0.723). The results of the Benton’s test demonstrated that the low dose group had an improved from 5.50±1.10 to 6.22±1.31 (p= 0.047), in the high dose group from 4.87±1.85 to 5.78±1.35 (p= 0.005) where as in the placebo group worse from 5.15±1.76 to 5.05±2.11 (p= 0.893). The WAIS test showed the same results, the low dose group increased from 5.17±1.34 to 6.06±1.21 (p= 0.022), the high dose group from 4.56±1.38 to 5.39±1.29 (p= 0.007) and the placebo group worse from 5.25±1.25 to 5.05±1.57 (p=0.354). Finally, the PASAT-3 test increased in the IFNs groups: from 45.72±10.61 to 49.94±11.68 (p= 0.015) in the low dose group, from 42.67±11.04 to 48.72±8.84 (p= 0.03) in the high dose group, but in the placebo group worse from 44.55±10.86 to 41.95±13.74 (p= 0.655). Conclusion. IFN alpha improved the cognitive dysfunction in RR-MS patients. The higher dose is more beneficial (AU)

Aneurismectomía con preservación del bazo en el tratamiento electivo del aneurisma de arteria esplénica / Aneurysmectomy with preservation of the spleen in the elective treatment of splenic artery aneurysm

Introducción. Los aneurismas de la arteria esplénica (AAE) son los más frecuentes del territorio esplácnico y ocupan el tercer lugar dentro de los aneurismas intraabdominales, después de los que asientan en la aorta abdominal y en las arterias ilíacas. Normalmente, estos aneurismas suelen ser únicos y no producen sintomatología; se detectan y diagnostican accidentalmente en exploraciones complementarias indicadas y realizadas por otras causas. Caso clínico. Se presenta el caso de una paciente con sintomatología inespecífica atribuible a la presencia de dos AAE, localizados ambos próximos entre sí, y uno de ellos de 3 cm de diámetro. Dichos aneurismas se diagnosticaron después de realizar una TAC y una arteriografía selectiva. Se intervino quirúrgicamente a la paciente y se practicó resección del aneurisma y preservación del bazo, sin reconstrucción de la arteria esplénica. Se obtuvieron excelentes resultados. Conclusiones. Consideramos la resección aneurismática con preservación esplénica como una de las opciones quirúrgicas a tener en cuenta ante un AAE. No obstante, se deben valorar las características anatómicas del aneurisma, las condiciones particulares de cada paciente y las posibilidades terapéuticas disponibles en cada centro (AU)

Introduction. Splenic artery aneurysms (SAA) are the most frequently occurring aneurysms in the splanchnic territory and are the third most common of all intra-abdominal aneurysms, behind those that affect the abdominal aorta and the iliac arteries. Normally, these aneurysms are usually single and do not produce any symptoms; they are detected and diagnosed accidentally in complementary explorations that are recommended and performed for other causes. Case report. We report the case of a patient with unspecified symptomatology attributed to the presence of two SAA located close to each other, one of which was 3 cm in diameter. These aneurysms were diagnosed following a CAT scan and a selective arteriography. The patient was submitted to a surgical intervention in which the aneurysm was removed and the spleen preserved without reconstruction of the splenic artery, and excellent results were obtained. Conclusions. We consider aneurysmatic resection with preservation of the spleen to be one of the surgical options to be taken into account when faced with SAA. Nevertheless, it is also important to evaluate the anatomical characteristics of the aneurysm, the particular conditions of each patient and the therapeutic possibilities available in each centre (AU)