Pancreatic pseudocyst and complicated internal hernia. A case report

Internal hernias are mostly congenital causes. They constitute rare nosological entities. The acute abdominal picture secondary to the complication of these is related to intestinal occlusion and necrosis. Sometimes, some diseases that precede or are discovered during the clinical condition, such as pancreatic pseudocyst, can make a positive diagnosis difficult. The clinical case of a patient diagnosed with a pancreatic pseudocyst, who presented a complication of internal hernia during the course of the disease it is described in this report. The 45-years-old patient with a pancreatic pseudocyst diagnosis presented symptoms of abdominal pain accompanied by vomiting during his admission, which led to suspicion of rupture of the pseudocyst. He underwent emergency surgery, and evidence of an internal hernia (not diagnosed preoperatively) complicated with small bowel segment necrosis was then obtained. No rupture of the pancreatic pseudocyst was observed. The clinical manifestations of complicated internal hernia and pancreatic pseudocyst rupture are difficult to distinguish from each other. Emergency surgical treatment is the fundamental pillar in the face of diagnostic doubt or clinical worsening of the patient

Síndrome de Mirizzi grado IV. Presentación de un caso

El Síndrome de Mirizzi es una afección derivada del impacto de un lito en el conducto cístico o infundíbulo de la vesícula biliar. La enfermedad litiásica, crónica y complicada de la vesícula biliar es un factor determinante. Se presenta el caso de un paciente con historia de íctero obstructivo, al cual se le diagnosticó inicialmente tumor periampular. Fue reevaluado y se le realizaron varias pruebas diagnósticas, hasta llegar al diagnóstico de Síndrome de Mirizzi, corroborado en el acto quirúrgico. El SM es una enfermedad rara de la vía biliar cuyo tratamiento es quirúrgico. La vía laparoscópica para la realización de la colecistectomía es la de elección para casos grado I y en casos seleccionados grado II. La colecistectomía y derivación bilioentérica (hepaticoyeyunostomía) conforman el tratamiento para el resto de los casos.</p

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Vídeolaparoscopia para estadificación de tumores malignos: Más que moda, conveniencia

El uso de la laparoscopia en el campo de la oncología no es nada nuevo, sin embargo sus posibilidades se han ampliado considerablemente con el aprovechamiento de las posibilidades tecnológicas y del instrumental, así como por las habilidades de los cirujanos en la práctica de procederes quirúrgicos de invasión mínima. Con ello ha nacido una laparoscopia nueva "activa", "instrumentada", de mayores posibilidades que su predecesora y que supera muchas de las limitaciones que los medios imagenológicos modernos tienen en la estadificación de los tumores. Se revisan algunas de estas limitaciones que justifican la introducción de la videolaparoscopia en los protocolos de estudio de algunos tumores malignos, al mismo tiempo que se señalan las bondades de ésta y aspectos de tipo técnico. Se resalta la importancia de la estadificación videolaparoscópica en el ahorro de laparotomías innecesarias y la potencial aplicación de técnicas laparoscópicas paliativasThe use of laparoscopy in the field of oncology is nothing new; however, its possibilities have been considerably widened with the use of the technological possiblities and of the instrumental, as well as with the abilities of surgeons in the practice of minimal access surgical procedures. As a result, a new "active" and "instrumented" laparoscopy with greater possibilites than the previous one and that overcomes many of the limitations that the modern imaging tools have in the staging of tumors has appeared. Some of these limitations justifying the introduction of video-assisted laparoscopy into the protocols of study of some malignant tumors were reviewed. Its benefits and some technical aspects were also stressed. The importance of the video-assisted laparoscopic staging as regards the saving of unnecessary laparotomies and the potential application of palliative laparoscopic techniques was underline

Staged percutaneous coronary intervention and minimally invasive valve surgery: Results of a hybrid approach to concomitant coronary and valvular disease

We compared a hybrid approach combining staged percutaneous coronary intervention (PCI) and minimally invasive valve surgery with concurrent valve surgery plus bypass via a median sternotomy approach. We retrospectively evaluated 65 consecutive patients with coronary disease and surgical valvular heart disease who underwent planned PCI followed within 60 days by minimally invasive valve surgery, and we compared them with 52 matched control patients who underwent conventional bypass grafting and valve surgery. There were no in-hospital deaths in the hybrid group, compared with 2 (3.8%) observed in the matched group (P = .11). Death, renal failure, or stroke occurred in 1 (1.5%) in the hybrid group versus 15 (28.8%) in the conventional group (P = .001). The median number of days between PCI and surgery was 24 (interquartile range, 2.5-37). At surgery, 23 hybrid patients were receiving both aspirin and clopidogrel;, 18, clopidogrel alone; 4, aspirin alone; and 22 stopped the antiplatelet agents 5 days before the operation. Intensive care unit hours and total hospital length of stay, including PCI stay for the hybrid group, were less in the hybrid group (P = .001 for both comparisons). In the hybrid group, average blood use was 1.6 ± 1.6 U per patient versus 1.9 ± 2.4 U per patient with conventional surgery (P = .35. There were no reoperations for postoperative bleeding in the hybrid group compared with 2 (3.8%) in the conventional group (P = .43). Staged PCI with minimally invasive valve surgery may offer an alternative to coronary bypass grafting with concurrent valve surgery and should be tested prospectively

Outcomes of a minimally invasive approach compared with median sternotomy for the excision of benign cardiac masses

We hypothesize that for the excision of benign cardiac masses, a minimally invasive approach through a right minithoracotomy is safe and feasible, and has lower resource utilization when compared with a standard median sternotomy. We retrospectively analyzed 39 consecutive patients who underwent benign cardiac mass excision at our institution between December 1999 and April 2010. The in-hospital outcomes of patients who had a right minithoracotomy were compared with those of patients who underwent a standard median sternotomy. Of the 39 patients, 22 had cardiac masses removed through a minimally invasive approach, and 17 had a median sternotomy. The type of masses resected included 26 myxomas (66.7%), 9 papillary fibroelastomas (23.1%), and 4 thrombi (10.2%). The aortic cross-clamp and cardiopulmonary bypass times were 43 minutes (interquartile range [IQR] 30 to 64) versus 31 minutes (IQR 23 to 47; p=0.20) and 78 minutes (IQR 55 to 88) versus 57 minutes (IQR 33 to 70; p=0.02) for the minimally invasive group and the median sternotomy group, respectively. There were no significant differences in postoperative complications including mortality. The mean intensive care unit and hospital lengths of stay were 27 hours (IQR 24 to 47) versus 60 hours (IQR 48 to 79; p=0.001) and 5 days (IQR 4 to 6) versus 7 days (IQR 6 to 8; p=0.03) for the minimally invasive and the median sternotomy group, respectively. A minimally invasive approach through a right minithoracotomy for the resection of benign cardiac masses can be performed safely with lower resource utilization, and should be considered for these patients

The obesity paradox in elderly obese patients undergoing coronary artery bypass surgery

We sought to determine whether the protective role of the 'obesity paradox' was present among elderly obese patients undergoing coronary artery bypass grafting (CABG) by median sternotomy. We retrospectively analyzed 1909 consecutive patients who underwent heart surgery between January 2006 and June 2009, and identified 396 patients who were >= 70 years of age and had isolated CABG. Subjects were divided into three groups according to their body mass index (BMI): obese (BMI >= 30 kg/m(2)), overweight (BMI 25-29.99 kg/m(2)) and normal (BMI 18.5-24.99 kg/m(2)). Of the 396 patients, 94 were obese, 167 were overweight, and 135 had a normal BMI. The composite of in-hospital complications and hospital mortality did not differ between the groups. Re-exploration for bleeding was required in none of the obese patients, which was statistically significant (P = 0.05) compared to the other groups; otherwise there was no statistical difference for all other complications, including total length hospital stay and length of stay in the intensive care unit. Despite being labeled as higher risk candidates preoperatively, obese elderly patients undergoing CABG did not demonstrate an increased risk of postsurgical complications. We conclude that the 'obesity paradox' is present in this population, and they should not be excluded from receiving the benefits of CABG. (C) 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved

Estructura y funcionamiento de un servicio de cirugía mayor ambulatoria y de corta hospitalización

Se realizó estudio de la estructura y funcionamiento del Servicio de Cirugía Ambulatoria y de Corta Hospitalización del Hospital Clinicoquirúrgico Docente "Miguel Enríquez", desde su creación en abril de 1989 hasta diciembre de 1995, donde se analizaron el total de intervenciones mayores (12 259) por las diferentes especialidades quirúrgicas, así como el organigrama de trabajo, y se constató un bajo índice de complicaciones (4,7 %)A study of the structure and functioning of the Service of Ambulatory Surgery and of Short Hospitalization of the "Miguel Enríquez" Clinical and Surgical Teaching Hospital since its creation in April, 1989, to December, 1995, was conducted. The total amount of major procedures (12 259) by different surgical specialities and the working flowchart were analyzed. A low index of complications (4.7 %) was obtaine

Cirugía general mayor ambulatoria y de corta hospitalización: Experiencia de 5 años de trabajo

Se realizó un estudio prospectivo en el Servicio de Cirugía Mayor Ambulatoria y de Corta Hospitalización del Hospital Clinicoquirúrgico Docente "Miguel Enríquez", para conocer el número de intervenciones realizadas por este método, afecciones más frecuentes, tipos de anestesia y complicaciones; para ello se revisaron las historias clínicas de 3 254 pacientes intervenidos de enero de 1991 a diciembre de 1995; se agruparon por niveles, y se pudo observar que predominaron las hernias inguinales en el nivel II y la litiasis vesicular en el nivel III; se presentaron tan sólo 69 complicaciones<br>A prospective study was conducted at the Service of Ambulatory Major Surgery and of Short Hospitalization of the "Miguel Enríquez" Clinical and Surgical Teaching Hospital to know the number of operations performed by this method, the most frequent affections, the types of anesthesis and complications. To this end, the medical histories of 3 254 patients who were operated on from January, 1991, to December, 1995, were reviewed, and grouped by levels. There was a predominance of inguinal hernias at level II and of vesicular lithiasis at level III. Only 69 complications were observe

Esofagectomía subtotal de urgencia con sustitución gástrica en el traumatismo esofágico

El traumatismo esofágico se considera como una de las más complejas lesiones torácicas, y su diagnóstico y manejo de gran dificultad. En la mayoría de las ocasiones se realiza un diagnóstico tardío, cuando ya se han evidenciado signos o síntomas propios de las complicaciones. En el Hospital Clinicoquirúrgico Docente "Miguel Enríquez" existe un grupo multidisciplinario de cirugía torácica, en el cual se han tratado varios casos en esta situación, esto ha permitido valorar las diferentes opciones terapéuticas en cada uno de ellos. Por la importancia del manejo y tratamiento de estos pacientes con perforaciones esofágicas, dicho grupo presentará uno de los casos atendidos en el centro, donde se utilizó la esofagectomía subtotal de urgencia con sustitución gástrica (técnica de Ivor-Lewis), en una paciente con triple perforación esofágica, después de dilatación con bujías de Savary, que evolucionó satisfactoriamente<br>Esophageal traumatism is considered as one of the most complex thoracic injuries and its diagnosis and management is very difficult. Most of the times a late diagnosis is made when the characteristics signs or symptoms have been proven. There is a multidisciplinary group of thoracic surgery at the "Miguel Enriquez" Clinical and Surgical Teaching Hospital, where several of these cases have been treated, allowing to evaluate the different therapeutic options for each of them. Due to the importance of the management and treatment of these patients, this group will present one the cases treated in the center, where a female patient with triple esophageal perforation underwent urgent subtotal esophagectomy with gastric substitution (Ivof-Lewis technique) after having experienced dilatation with Savarys solid probes. The patient&acute;s evolution was satisfactor