Drainage of the hepatic cyst by laparoscopy - clinical case

Liver cysts are formations of serous content surrounded by normal liver parenchyma, without communication with the bile duct. The cyst wall is generally lined with cuboidal epithelium surrounded by layers of connective tissue. They are rare entities in adult patients, generally, they are asymptomatic in 3%, and between 10-15% of all patients will generate symptoms that lead them to consult. A 38-year-old man with an external abdominal tomography study that reported a giant hepatic cyst. Laboratory blood tests: hemoglobin 7.9 g/dl; leukocytosis 11,000/ul; serum electrolytes, liver transaminases, and bilirubin were normal, alkaline phosphatase, and gamma glutamyl-transpeptidase 94 U/l and 241 U/l, respectively. Non-reactive anti-human immuno-deficiency virus (HIV 1) and two antibodies, venereal disease research laboratory (VDRL), cancer antigen (CA) 19-9 antigen, hepatitis B-C surface antigen, and carcinoembryonic antigen were negative. He underwent surgery by laparoscopic drainage of the liver cyst, through a median infraumbilical incision with the Hasson technique and placement of three 12 mm trocars, hepatomegaly was observed without finding an exit site for purulent material, it was punctured through liver segment V, and 2000 ml of citrine fluid was extracted. The hepatic wound is addressed with a 1-0 caliber chromic catgut thread, placing a Penrose-type drain. At 48 hours postoperatively, it evolves favorably, so it is decided to discharge. Hepatic cysts are fluid-filled cavities lined by a single-layered cuboidal or columnar biliary epithelium in the liver. A majority of hepatic cysts are found incidentally on liver imaging, such as abdominal ultrasonography, computed tomography, or magnetic resonance imaging

Mesozooplankton distribution, production and respiration in the global ocean.

Mesozooplankton biomass, abundance and mass-specific physiological rates as well as community production and respiration in the upper 2000 m were assessed from samples collected during the Malaspina circumnavigation expedition (~35ºN-40ºS) using an image-based analysis system (IBS). Equations relating metabolic rates, temperature, and body weight, were developed according to temperature ranges found at the different ocean regions and depth layers. High abundance and biomass were observed in the epipelagic zone and decreasing with depth as expected. However, high biomass was also found beyond 1000 m related to the colder and productive waters of the eastern regions of the Indian and Pacific Oceans. Specific growth and respiration rates followed a similar pattern and were highly correlated with temperature (r2=0.835 and 0.806 , respectively). Therefore, higher values were observed in the tropical and subtropical zones as the effect of higher temperature. Community production and respiration were considerably higher in the epipelagic layer, matching the distribution of biomass, with high values below 1000 m in the eastern Pacific/Indian Oceans. Global metabolism assessed through the IBS was similar to previous results based on data review.MALASPINA (CSD2008-00077

Plastic debris in the open ocean

There is a rising concern regarding the accumulation of floating plastic debris in the open ocean. However, the magnitude and the fate of this pollution are still open questions. Using data from the Malaspina 2010 circumnavigation, regional surveys, and previously published reports, we show a worldwide distribution of plastic on the surface of the open ocean, mostly accumulating in the convergence zones of each of the five subtropical gyres with comparable density. However, the global load of plastic on the open ocean surface was estimated to be on the order of tens of thousands of tons, far less than expected. Our observations of the size distribution of floating plastic debris point at important size-selective sinks removing millimeter-sized fragments of floating plastic on a large scale. This sink may involve a combination of fast nano-fragmentation of the microplastic into particles of microns or smaller, their transference to the ocean interior by food webs and ballasting processes, and processes yet to be discovered. Resolving the fate of the missing plastic debris is of fundamental importance to determine the nature and significance of the impacts of plastic pollution in the ocean

Colangiografía transoperatoria en colecistectomía laparoscópica: ¿sistemática o selectiva?

Se realizó un estudio comparativo en pacientes operados de colecistectomía laparoscópica, con el empleo de la indicación de la colangiografía transoperatoria, en 151 pacientes por el método de selección y en 456 de forma sistemática. En los 2 grupos se utilizaron los mismos criterios de inclusión. El tiempo quirúrgico medio en ambos fue inferior de 1 hora. Se comprobó que con el entrenamiento se logran índices de factibilidad por encima del 90 %, lo cual es similar a la cirugía abierta. La realización de la colangiografía de forma sistemática detectó un mayor tanto por ciento de litiasis no sospechada en la vía biliar principal; diagnosticó afecciones del colédoco no litiásicas; identificó anomalías potencialmente peligrosas y detectó iatrogenias sobre la vía biliar principal durante el transoperatorio. Se concluye que en la colecistectomía laparoscópica la colangiografía transoperatoria debe realizarse de forma sistemátic

Resultados de 1 000 colangiografías transoperatorias laparoscópicas realizadas de forma sistemática

Se realizó un estudio en 1 097 pacientes con litiasis vesicular, a los cuales se les indicó colangiografía transoperatoria de forma sistemática por vía transcística, en el período comprendido entre el 1 de junio de 1996 y el 14 de junio de 1998. Se excluyeron de este estudio a los pacientes con indicación de colangiografía selectiva, según los criterios que tienen en cuenta los que defienden este último proceder. Se hizo factible realizarla a 1 000 pacientes (91,15 %). La principal causa de no-factibilidad correspondió a los conductos císticos extremadamente finos (5,65 %). La colangiografía se efectuó mediante el uso de catéter percutáneo a 173 enfermos y con la pinza de Olsen a 827. El tiempo promedio del proceder fue de 8,5 min. La colangiografía detectó en 55 pacientes (5,5 %) afecciones quirúrgicas no sospechadas, dentro de éstas a 41 pacientes con cálculos coledocianos. Se diagnosticaron además 72 anomalías congénitas potencialmente peligrosas (7,2 %). Se concluye que en la colecistectomía laparoscópica la colangiografía transoperatoria se debe realizar de forma liberalA study of 1 097 patients with vesicular lithiasis that systematically underwent transoperative cholangiography by transcistic route from June, 1996, to June, 1998, was conducted. Patients with indication of selective cholangiography were excluded from this study, according to the criteria of those who advocate this procedure. It was possible to perform it in 1000 patients (91.15%). The main cause of non-feasibility corresponded to the extremely fine cystic ducts (5.65%). Cholangiography was performed by using the percutaneous catheter in 173 patients and with Olsen's clamp in 827 individuals. The average time for carrying out this procedure was of 8.5 min. Non-suspected surgical affections were detected in 55 patients (5.5%) by cholangiography. 41 of them had choledocus calculi. 72 potentially dangerous congenital anomalies (7.2%) were diagnosed. It was concluded that in laparoscopic cholecystectomy the transoperative cholangiography should be carried out in a liberal wa

Zooplankton biomass during the Malaspina Cruise

Carbon export (from the epipelagic towards the mesopelagic zone) and sequestration (from the mesopelagic towards the bathypelagic zone) in the ocean are reviewed. Particulate organic carbon (POC) flux, and active flux due to migrant zooplankton and micronekton are shown from the epipelagic to the mesopelagic zone, and from the latter to the bathypelagic zone. Values towards the meso- and bathypelagic zones are compared in oligotrophic and productive systems. Zooplankton and prokaryote respiration in the meso- and bathypelagic zones of the ocean are also reviewed for oligotrophic and productive systems. Values were integrated over a depth layer and are given as the flux or respiration under one square meter (in g/m**2/a) between e.g. 100 m and 1000 m depth

Patterns in the size structure of phytoplankton in the deep fluorescence maximum of the Alborán sea (southwestern mediterranean)

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El ictioplancton y el medio marino en los sectores norte y sur del mar de Alborán, en julio de 1992. (Resultados de la campaña Ictio. Alborán 0792).

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A Colocolonic intussusception in an adult secondary to an inflammatory polyp of the transverse colon - clinical case

There are multiple causes of colocolonic intussusception in adults, such as tumors, autoimmune pathologies, previous abdominal surgeries, and gynecological conditions. Associated complications are small bowel obstruction, ischemia, necrosis, perforation with peritonitis, and sepsis that require urgent attention. A 78-year-old woman who started with colic in the mesogastrium of 5 months of evolution and changes in bowel habits. She went to the emergency room due to intense pain in the mesogastrium. On physical examination, she presented dehydration of the mucous membranes and pale integuments, pain on superficial and deep palpation in the mesogastrium. Admission laboratories: leukocytosis 17,110/ul, neutrophilia 67.9%, hydroelectrolyte imbalance: mild hyponatremia, mild hypochloremia, slightly prolonged coagulation times, normal blood chemistry. Abdominal ultrasound with "pseudokidney" image. Computed tomography reports an image of the introduction of a segment of the transverse colon into a contiguous segment of the same, with data of associated intestinal pneumatosis. Due to the previous findings, an emergency exploratory laparotomy was performed. Invagination of the transverse colon is located, accompanied by dilation of the vessels of the greater omentum; it is reduced manually, an enterotomy is performed and a tumor dependent on the wall is located, for which a 25 cm transverse colon resection, end colostomy and mucous fistula are decided. Pathology report reports inflammatory polyp. In the postoperative period, the patient improved and was discharged. Abdominal pain is the common presentation of intussusception; however, given its rarity in adults, the possibility of missing the finding on abdominal imaging leads to misdiagnosis

Relations between icthyoplankton distribution, hydrology, phytoplankton, dissolved oxygen and nutrientes, in the Alborán Sea (July, 1992)

A la vista de los resultados obtenidos por los diferentes autores y expuestos en las páginas anteriores, se han elaborado las conclusiones generales seguidamente presentadas. (Para ampliar la visión que aquí se ofrece basta con consultar dichos trabajos.) Se ha comprobado cómo el particular régimen hidrodinámico de la zona determina claramente las distribuciones del ictioplancton y controla los patrones horizontales y verticales de productividad planctónica en el mar de Alborán.Abstract: In view of the results obtained by the different authors and discussed in the previous pages, final conclusions have been prepared and are presented below (in order to enlarge the view offered here, see the cited papers). It has been proved how the particular hydrodynamics of the area clearly determines ichthyoplankton distribution and controls the horizontal and vertical patterns of planktonic productivity in the Alborán Sea.Postprin