Disección espontánea de arteria ilíaca asociada a ejercicio y uso de ergotamina / Spontaneous dissection of iliac artery related with excercise and ergotamine. A case report

Introduction: Spontaneous dissection of the iliac artery (SDIA) is an extremely rare clinical manifestation, associated to different etiologies, and it usually shows an ischemia of the involved lower extremity. Clinical case: We report a case of a 48-year-old man, with past medical history of chronicle consumption of ergotamine, which presented left lower limb ischemia, while practicing physical exercise. An emergent contrast-enhanced computed tomography scan showed a spontaneous dissection of the common and the external left iliac artery. An endovascular therapy of the lesion was performed with self-expanding stents, achieving the reconstruction of the lesion, the recovery of the blood flow and of the lower limb ischemia. Conclusions: There are no previous descriptions of the association between ergotamine consumption, sport and this very rare pathology. Endovascular treatment represents a less invasive and, such as in our case report, successful management of the SDIA, and it should be considered among the alternative therapies.

Introducción: La disección espontánea de la arteria ilíaca es un cuadro muy poco frecuente asociado a diferentes etiologías que habitualmente se presenta como isquemia de la extremidad comprometida. Caso clínico: Se reporta el caso de un paciente masculino de 48 años con antecedente de consumo crónico de ergotamina, quien mientras practicaba deporte presenta cuadro de isquemia aguda de la extremidad inferior izquierda. Angio tomografía computada demostró disección espontánea de la arteria ilíaca común y externa izquierda. Se realizó terapia endovascular de la lesión con stents auto expandibles, logrando la reparación de la lesión, el restablecimiento del flujo y la recuperación de la isquemia de la extremidad. Discusión y conclusiones: No existen reportes previos de esta patología poco frecuente, en que se asocie en forma conjunta la práctica de deporte y el uso de ergotamina. Dentro de las alternativas terapéuticas, la reparación endovascular representa una opción menos invasiva y, como en este caso, con óptimos resultados.

Retroperitoneal drainage in the management of the septic phase of severe acute pancreatitis.

Eighteen consecutive patients with sepsis due to surgically confirmed peripancreatic necrosis extending diffusely into the retroperitoneal fat were treated in our hospital from 1980 to 1987. Management consisted of early retroperitoneal debridement of necrotic tissue and drainage through lumbar incisions. Enteral nutrition was implemented in all patients 3-8 days after their first surgery. A total of 40 reoperations were required--an average of 2.6 per patient. Complications included respiratory failure (17), renal failure (4), gastrointestinal bleeding (4), retroperitoneal bleeding (1), and gastrointestinal fistulas (6). Four (22%) of the 18 patients died; the major cause of death was multiple organ failure secondary to sepsis. Before 1980, all patients with severe pancreatitis treated in our hospital died, despite the use of different management techniques. The use of the extraperitoneal route for early debridement of necrotic tissue and to avoid contamination of the peritoneal cavity has substantially reduced the mortality associated with peripancreatic necrosis in our hospital. The mortality in this series of patients (22%) compares very favorably with that reported in studies of similar patients.

[Trial of experimental induction of cerebral metastasis in the rabbit carrying a VX2 tumor]. / Essais d'induction expérimentale de métastases cérébrales chez le lapin porteur de tumeur VX2

Numerous factors remain unknown as far as the mechanism of induction of cerebral metastases is concerned. Where as of cancer give metastases more readily than others, especially cerebral metastases, the neoplastic embolus can be either eliminated or remain in place in a state of quiescence. What is the role played by the blood brain barrier from a pathophysiological point of view? Is there a mechanism which prevents central nervous system metastases? What is the importance of individual variation? We attempted to induce cerebral metastases in VX2 carcinoma carrying rabbits to look for an approach to these problems and to create an experimental model of cerebral metastase. The VX2 carcinoma is easily transplantable and its biological characteristics are well known. The VX2 tumor is implanted in the thigh of the rabbits and is used in the experimentation starting two weeks following the take of the graft; the tumor is surgically resected and a solution containing approximatively 50,000 tumor cells for 0,1 ml is prepared. This solution is inoculated via the carotid artery to the same rabbit or to another rabbit of the same breed either or intrathecal way into the brain. Death occurred 6 to 20 days later and was followed by a complete pathological survey. The results were the following: --The inoculation via the carotid artery, even with very highly concentrated solution was never followed by any recognizable brain metastasis. --The inoculation intrathecaly produced only extraparenchymatous metastases where as the direct intracerebral inoculation was followed by the occurence of intracerebral metastases.