Pancreatitis aguda secundaria a síndrome de asa aferente / Acute pancreatitis secondary to afferent loop syndrome: report of one case

We report a case of a 59 years old male patient, operated in our service for an Acute Pancreatitis secondary to an Afferent Loop Syndrome. According to the literature we evaluated the low incidence of this entity, the difficulty on the clinical diagnosis, supported by the imagenologic fmdings and the different surgical options.

Se presenta el caso de un paciente de 59 años operado en nuestro servicio por un cuadro de pancreatitis aguda secundario a un síndrome de asa aferente agudo. Se comenta en base a la literatura la baja frecuencia en que se presenta esta entidad actualmente, su presentación clínica inespecífica, haciendo énfasis en el apoyo radiológico para llegar al diagnóstico, y las diferentes alternativas de manejo quirúrgico.

Costo comparativo entre abordaje abierto y laparoscópico en cirugía resectiva de colon / Comparative costs of laparoscopic and open colorectal surgery

Background: In Chile, laparoscopic surgery is not universally used for colorectal diseases due to its learning curve and high costs. However this last drawback may not be trae if all hospitalization costs are considered. Aim: To compare the costs of open and laparoscopic colonic excisión surgery. Material and Methods: Data for all elective colectomies performed during 2005 and 2006 were retrieved from hospital records. Procedures were classified as open or laparoscopic and the total costs associated to the hospital stay of each group of procedures was obtained from the accounting office of the hospital. Results: Twenty nine patients aged 31 to 88 years (16 males), were subjected to laparoscopic surgery and 39, aged 38 to 87 years (20 females), to open surgery. Seventy six percent of patients in the group of laparoscopic surgery were subjected to a left hemicolectomy and 54 percent of those in the group of open surgery, to a right hemicolectomy. Operative times were 188 +/- 14 and 174 +/- 44 min for open and laparoscopic surgery, respectively (NS). The item with higher costs for both groups was consumables, followed by hospitalization days. No differences in the total hospitalization costs were observed between the two groups of patients. Conclusions: Laparoscopic colorectal surgery does not have a higher economical cost than traditional open surgery.

Introducción: La cirugía laparoscópica ha tenido gran auge en los últimos años. Disminuye el trauma quirúrgico, minimizando la activación inmunológica y el catabolismo. Sin embargo, en Chile no es utilizada universalmente en patología colorectal por dos motivos: la curva de aprendizaje y el costo elevado que representa para el centro hospitalario o el paciente. Nuestra hipótesis es que la cirugía laparoscópica colorectal no es un evento más caro que la cirugía abierta, si se toma en cuenta toda la hospitalización. El objetivo de este trabajo es comparar el costo de la cirugía resectiva de colon laparoscópica y abierta, durante los años 2005-2006 en nuestro hospital. Métodos: De los registros del hospital y de la base de datos de cirugía colorectal se obtuvieron los datos de todas las colectomías electivas realizadas desde enero del 2005 hasta diciembre del 2006. Se constituyeron dos grupos; pacientes sometidos a cirugía laparoscópica y pacientes sometidos a cirugía tradicional abierta. Los datos económicos con respecto a cada evento, definido como colectomía electiva y su respectiva hospitalización, fueron obtenidos del registro de finanzas del hospital. Se analizó el costo comparativo con el software EPI-INFO. Resultados: Se estudiaron 68 casos operados. El procedimiento más frecuente en el grupo de cirugía laparoscópica fue la hemicolectomía izq (76 por ciento), mientras que en el grupo de cirugía abierta fue la hemicolectomía derecha (54 por ciento). No se encontró diferencia en los tiempos operatorios (188 +/- 41 minutos en cirugía abierta y 174 +/- 44 minutos en cirugía laparoscópica). Para ambos grupos, el ítem más caro es el de insumos, seguido por los días-cama. No se encontró diferencias en las cuentas totales de ambos grupos. Discusión: Los resultados presentados muestran que la cirugía laparoscópica no tiene mayor costo que la cirugía tradicional abierta. La cirugía laparoscópica es el gold-estándar en la cirugía colónica. Este ...

Fenestración laparoscópica de quistes hepáticos sintomáticos: reporte de tres casos / Laparoscopic fenestration of symptomatic cysts of the liver: report of three cases

Los quistes hepáticos son una entidad frecuente y, en general, no dan manifestaciones clínicas. Sin embargo, algunos pacientes desarrollan síntomas derivados de la compresión de estructuras vecinas, distensión hepática o complicación de los quistes. Este grupo de enfermos requerirá tratamiento. Existen diversas opciones terapéuticas, siendo la alternativa quirúrgica la que presenta mejores resultados. Con el avance de las técnicas de cirugía mínimamente invasiva, la vía laparoscópica es de elección. Presentamos tres casos clínicos, el primero de un quiste hepático simple y los dos siguientes de enfermedad poliquística hepática, todos sintomáticos, en que la técnica de fenestración por vía laparoscópica se llevó a cabo con éxito.

Hepatic cysts are common and generally asymptomatic. However, some patients become highly symptomatic because of hepatomegaly, compression or a complicated presentation. There are several treatment options for this group of patients, but surgery has the highest long-term outcomes. With the increased utilization of minimal-access surgery, laparoscopy is the technique of choice. The aim of this study is to report three clinical cases, one of a simple hepatic cyst, and two of adult polycystic liver disease, al I of them treated successfully by laparoscopic fenestration.

Fibrosis retroperitoneal: caso clínico y revisión de la literatura / Retroperitoneal fibrosis: clinical case and literature review

La fibrosis retroperitoneal constituye una afección infrecuente y de causa generalmente no identificable, sin embargo, se ha descrito su asociación con algunas drogas, enfermedades del tejido conectivo y patología neoplásica. Se caracteriza por el depósito de tejido fibroso en el retroperitoneo y manifestaciones secundarias a la compresión ureteral o de estructuras vasculares. Las técnicas de imágenes (principalmente la tomografía axial computarizada) resultan importantes en su sospecha y diagnóstico diferencial, con utilidad en la exclusión de una enfermedad tumoral subyacente. La biopsia abierta se considera el gold standar para establecer el diagnóstico, cobrando especial relevancia en los casos sin una causa evidente. El enfrentamiento terapéutico tradicional se basa en la cirugía (ureterolisis) y suspensión de drogas potencialmente injuriantes, pero diferentes terapias médicas han sido planteadas, incluyendo el uso de corticoides, inmunosupresores y tamoxifeno, ya sea en forma exclusiva o asociados a técnicas intervencionistas o quirúrgicas propiamente tales.

Peripheral neuropathies in Waldenström's macroglobulinaemia.

OBJECTIVE: We sought to determine the prevalence, clinical features, and laboratory characteristics of polyneuropathies in Waldenström's macroglobulinaemia (WM), a malignant bone marrow disorder with lymphocytes that produce monoclonal IgM. METHODS: We prospectively studied 119 patients with WM and 58 controls. Medical history was taken, and neurological examinations, electrodiagnostic tests, and serum studies were performed by different examiners who were blinded to results except the diagnosis of WM. RESULTS: Polyneuropathy symptoms, including discomfort and sensory loss in the legs, occurred more frequently (p<0.001) in patients with WM (47%) than in controls (9%). Patients with WM had 35% lower quantitative vibration scores, and more frequent pin loss (3.4 times) and gait disorders (5.5 times) than controls (all p<0.001). Patients with IgM binding to sulphatide (5% of WM) had sensory axon loss; those with IgM binding to myelin associated glycoprotein (MAG) (4% of WM) had sensorimotor axon loss and demyelination. Patients with WM with IgM binding to sulphatide (p<0.005) or MAG (p<0.001) had more severe sensory axon loss than other patients with WM. Demyelination occurred in 4% of patients with WM with no IgM binding to MAG. Age related reductions in vibration sense and sural SNAP amplitudes were similar ( approximately 30%) in WM and controls. CONCLUSIONS: Peripheral nerve symptoms and signs occur more frequently in patients with WM than controls, involve sensory modalities, and are often associated with gait disorders. IgM binding to MAG or sulphatide is associated with a further increase in the frequency and severity of peripheral nerve involvement. Age related changes, similar to those in controls, add to the degree of reduced nerve function in patients with WM.

Enfermedad de Hodgkin extranodal primaria gástrica: presentación de un caso clínico / Primary extranodal gastric tumor: case presentation

La enfermedad de Hodgkin extranodal primaria es una entidad poco frecuente, siendo el compromiso más frecuente el tracto digestivo y en especial el estómago, seguido del intestino delgado, intestino grueso y esófago (2). Se presenta un caso de Enfermedad de Hodgkin extranodal primaria gástrica en una mujer de 74 años de edad, no inmunodeprimida.

Sensory exam with a quantitative tuning fork: rapid, sensitive and predictive of SNAP amplitude.

BACKGROUND: In the standard neurologic examination, outcome measures of sensation testing are typically qualitative and subjective. The authors compared the outcome of vibratory sense evaluation using a quantitative Rydel-Seiffer 64 Hz tuning fork with qualitative vibration testing, and two other features of the neurologic evaluation, deep tendon reflexes and sensory nerve conduction studies. METHODS: The authors studied 184 subjects, including 126 with Waldenström's macroglobulinemia and 58 controls, over the course of a weekend. Standard neurologic examinations and quantitative vibratory testing were performed. Sensory nerve action potentials (SNAP) were tested as a measure of sensory nerve function. Tests were carried out by different examiners who were blinded to the results of other testing and to clinical information other than the diagnosis of Waldenström's macroglobulinemia. RESULTS: Quantitative vibration measurements in all body regions correlated with sural SNAP amplitudes. Quantitative vibration outcomes were more strongly related to sural SNAP results than qualitative evaluations of vibration. Quantitative vibration testing also detected a loss of sensation with increased age in all body regions tested. CONCLUSIONS: Quantitative vibratory evaluation with Rydel-Seiffer tuning fork is rapid, has high inter- and intrarater reliability, and provides measures for evaluating changes in sensory function over time. Examinations with the quantitative tuning fork are also more sensitive and specific than qualitative vibration testing for detecting changes in sensory nerve function. Use of the quantitative tuning fork takes no more time, provides more objective information, and should replace the qualitative vibratory testing method that is now commonly used in the standard neurologic examination.

Reconstrucción combinada con injerto libre de yeyuno y ascenso gástrico en faringolaringoesofagectomía total / Combined reconstruction with free jejunal graft and gastric upflow in total pharingolaryngoesophagectomy

Se presentan dos casos clínicos de compromiso simultáneo de faringe y esófago cervical por carcinoma epidermoide en los que se realizó faringolaringoesofagectomía. Ambos se repararon con ascenso gástrico y autotrasplante de yeyuno. No hubo complicaciones postoeratorias atribuibles a la reparación. Sólo hubo hipocalcemia por la necesaria extensión de la cirugía resectiva en una paciente

Altered thalamic response to levodopa in Parkinson's patients with dopa-induced dyskinesias.

Parkinson's disease (PD) is a progressive neurologic condition characterized by tremor, slowness, stiffness, and unstable posture. Degeneration of dopamine-producing neurons in the substantia nigra causes PD. Treatment with levodopa, a precursor of dopamine, initially ameliorates the clinical manifestations of PD. However, chronic levodopa treatment can produce severe involuntary movements (so-called dopa-induced dyskinesias or DID), limiting treatment. Pallidotomy, placement of a surgical lesion in the internal segment of the globus pallidus, reduces DID. Because this result is inconsistent with current theories of both basal ganglia function and DID, it prompted us to investigate the brain's response to levodopa. We measured regional cerebral blood flow response to levodopa with positron-emission tomography in 6 PD patients with DID, 10 chronically treated PD patients without DID, 17 dopa-naïve PD patients, and 11 normals. The dose of levodopa was chosen to produce clinical benefit without inducing DID. This strategy allowed us to examine the brain response to levodopa across groups without the confounding effect of differences in motor behavior. We found that the DID group had a significantly greater response in ventrolateral thalamus than the other groups. This was associated with decreased activity in primary motor cortex. These findings are consistent with increased inhibitory output from the internal segment of the globus pallidus to thalamus after levodopa administration. They provide a physiological explanation for the clinical efficacy of pallidotomy and new insights into the physiology of the basal ganglia.

Cirugía abdominal del urgencia durante el embarazo / Emergency abdominal surgery during pregnancy

Se estudia el problema planteado por los cuadros de abdomen agudo quirúrgico en pacientes embarazadas. Para ello se revisan retrospectivamente las fichas clínicas de 44 enfermas embarazadas intervenidas entre 1990 y 1996, período durante el cual se atendieron 50.388 partos. Las causas más frecuentes de operaciones intra-embarazo fueron: apendicitis agudas (50 por ciento); patología biliar litiásica (27 por ciento); obstrucciones intestinales (5 por ciento); pancreatitis agudas (4 por ciento); quistes ováricos complicados (4 por ciento); hipertensión portal con ruptura de várices esofágicas (2 por ciento); cáncer de vía biliar (2 por ciento)

Decreased [18F]spiperone binding in putamen in idiopathic focal dystonia.

In this study we have investigated the pathophysiology of two idiopathic focal dystonias: hand cramp with excessive cocontractions of agonist and antagonist hand or forearm muscles during specific tasks, such as writing, and facial dystonia manifested by involuntary eyelid spasms (blepharospasm) and lower facial and jaw spasms (oromandibular dystonia). We used positron emission tomography (PET) to measure the in vivo binding of the dopaminergic radioligand [18F]spiperone in putamen in 21 patients with these two focal dystonias and compared the findings with those from 13 normals. We measured regional cerebral blood flow and blood volume in each subject as well as the radiolabeled metabolites of [18F]spiperone in arterial blood. A stereotactic method of localization, independent of the appearance of the images, was used to identify the putamen in all of the PET images. We analyzed the PET and arterial blood data with a validated nonsteady-state tracer kinetic model representing the in vivo behavior of the radioligand. An index of binding called the combined forward rate constant was decreased by 29% in dystonics, as compared with normals (p < 0.05). There were no significant differences between dystonics and normals in regional blood flow, blood volume, nonspecific binding, permeability-surface area product of [18F]spiperone or the dissociation rate constant. These findings are consistent with a decrease of dopamine D2-like binding in putamen and are the first demonstration of a receptor abnormality in idiopathic dystonia. These results have important implications for the pathophysiology of dystonia as well as for function of the basal ganglia.

La cirugía oncológica: una nueva subespecialidad? / Oncological surgery: a new subspecialty?

El cáncer constituye actualmente una de las principales causas de muerte. En los países desarrollados la cirugía oncológica es una subespecialidad a la que se accede después de un período formal de entrenamiento en diversas unidades especializadas. La complejidad de las decisiones, el costo de los tratamientos y la interacción estrecha con otras especialidades relacionadas con el tratamiento del cáncer, aconsejan que el cirujano de cáncer tenga una formación dirigida y programada

Diurnal rhythm of plasma delta-sleep-inducing peptide in humans: evidence for positive correlation with body temperature and negative correlation with rapid eye movement and slow wave sleep.

Since delta-sleep-inducing peptide (DSIP) was isolated in 1977, numerous reports have suggested that this nonapeptide stimulates delta-sleep [slow wave sleep (SWS)]. Although DSIP-like immunoreactivity (DSIP-LI) has been found in the serum of many animals and man, its diurnal rhythm and relation to sleep stages have not been well defined. We hypothesized that circulating levels of this putative sleep hormone would be highest at night and would probably be elevated before or during episodes of SWS. We, therefore, measured plasma DSIP-LI levels every 30 min for 24 h in 12 normal volunteers in whom we obtained simultaneous polygraphic recordings. We found a distinct diurnal rhythm for plasma DSIP-LI levels, with the maximum at 1500 h and the minimum at 0100 h. DSIP-LI levels were substantially lower in rapid eye movement sleep (P < 0.005) and somewhat lower in SWS (P < 0.05) compared to awake values. DSIP-LI levels did not rise before, during, or after a significant percentage of episodes of SWS. We found, however, that the diurnal rhythm of DSIP-LI closely followed that of body temperature with a high degree of correlation (r2 = 0.66; P < 0.0001). We conclude that endogenous elevations of circulating DSIP may be associated with suppression of slow wave and rapid eye movement sleep, and that the circadian rhythm of this peptide is coupled directly or indirectly to that of body temperature.

Obesidad mórbida: tratamiento quirúrgico: gastroplastía / Morbid obesity: surgical treatment: gastroplasty

La obesidad mórbida constituye un problema estético, social y sicológico, con morbilidad y mortalidad propias. El tratamiento médico de la obesidad morbida tiene un alto porcentaje de fracaso, mas del 80 por ciento a 5 años. La gastroplastía representa una técnica mas fisiológica y con menor morbilidad alejada que el puente. Se presentan 30 pacientes operados con sobrepeso entre 52 y 204 por ciento , con su estudio clínico, metabólico y endocrinológico, evaluando la técnica quirúrgica, patologías agregadas y resultados. De los 30 pacientes 9 recuperaron su peso por dilatación de la boca de comunicación digestiva entre 8 y 16 meses de operados. A los restantes se les efectuó refuerzo con malla, con resultados francamente mejores, mas permanentes y muy superiores al tratamiento médico, con comunicación en la curvatura mayor. La gastroplastía con bolsillo gástrico de 70 a 100 ml con aporte calórico de 500 calorías y una comunicación gástrica en curvatura menor con refuerzo de malla, ha demostrado ser una buena técnica, con baja morbilidad y sin mortalidad en el manejo de estos pacientes

Quilotórax postoperatorio en resección esofágica: tratamiento conservador / Post-surgery chylothorax in esophageal resection: conservative treatment

Se presenta el caso de un quilotórax en una enferma de 56 años, luego de una esofagectomía de Lewis-Tanner realizada debido a un tumor del tercio medio del cuerpo esofágico. Al séptimo día del postoperatorio se detecta la existencia de un quilotórax (líquido opalescente con alto contenido de triglicéridos). Se instituye tratamiento médico conservador suprimiendo la alimentación oral, iniciando la alimentación parenteral total central y manteniendo los drenajes pleurales. A los 10 días del postoperatorio se reinicia la alimentación oral, manteniéndose la parenteral hasta el vigésimo tercer día, momento en que se retiran los drenajes. En suma, el tratamiento médico descrito es una buena alternativa terapéutica para los quilotórax postoperatorios con fístulas que drenan menos de 1.000 ml diarios. Sus éxitos oscilan entre 25 y 50%

Fístula colohepática secundaria a enfermedad hidatídica: caso clínico / Colo-hepatic fistula secondary to hydatid disease: clinical case

The fistulization of a hepatic hydatid cyst to the colon is a very rare complication and only two cases have been described in the medical literature. We report 49 year-old male in whom this complication was suspected in the preoperative period. He was submitted to a cystotomy and colonic exteriorization. Recovery was uneventful

Agricultural depopulation in Croatia.

PIP: Trends in urban depopulation since 1945 in Yugoslavia and specifically in Croatia are analyzed. Two phases are identified: the first involved the eradication of the peasant farm under the Communist system, which resulted in a large-scale exodus from agricultural to urban-based activities. The second phase, which has lasted until the present, has two features: one is the tendency of those staying on family farms to have other employment off the farm; the other involves the likelihood of seeking employment abroad. (SUMMARY IN FRE AND GER)^ieng