[Twelve years of liver transplant at the San José-Tec De Monterrey Hospital]. / Doce años de trasplante hepáitico continuo en el Hospital San José-Tec de Monterrey.

BACKGROUND: Liver transplantation is the only curative alternative for patients with end stage liver disease or acute liver failure. AIM: To report the experience of a single transplant center in Mexico. MATERIAL AND METHODS: Fifty-five transplants in 54 adult patients were analyzed between 1999 and 2011 in a single private institution. All grafts were obtained from deceased donor. Surgical technique, donor and recipient demographics, complications, causes of death and overall survival are described. Results were expressed as range and percentages. A Kaplan-Meier survival curve was done to analyze patient and graft survival. RESULTS: Main cause of cirrhosis was hepatitis C virus infection followed by alcohol intake. A 16% of patients developed biliary complications without graft loss, and vascular complications were observed in 15%. Patient survival at one and five years was 83% and 76%, respectively. CONCLUSIONS: Complication rates and survival in our center are comparable to those in the United States and Europe.

Ileocolonic intussusception due to severe endometriosis.

Endometriosis is the presence of normal endometrial tissue outside the uterus, which may appear in up to 15% of fertile female population. Bowel endometriosis is uncommon, and obstruction due to endometrial ileocolic intussusception is extremely rare. Herein, we report a case of a 27-year-old female who presented with bowel obstruction due to ileocolic intussusception secondary to endometriosis. A 27-year-old female, without pregnancies, and with a 1 year history of endometriosis presented to the emergency department referring severe abdominal pain in right lower quadrant, nausea and vomiting, she had medical history of prior episodes of mild abdominal pain due to endometriosis with OB/GYN follow-up. Physical examination revealed abdominal distension with decreased bowel movements to auscultation. A CT scan reported suspicion of intussusception. Colonoscopy was ordered, where an ileocolic intussusception was found. Diagnostic laparoscopy was performed, and the initial diagnosis was confirmed. A right hemicolectomy with extracorporeal anastomosis was achieved without any surgical complications. The patient was discharge on postoperative day 4 and continues doing well on a 12 month follow-up. Ileocolic intussusception due to endometriosis is a very rare condition, and it must be considered a differential diagnosis in female patients in reproductive age, when presenting with intestinal obstruction.

Catheter directed hepatic artery thrombolysis following liver transplantation. Case report and review of the literature.

Hepatic artery thrombosis is the most frequent vascular complication following orthotopic liver transplantation, and often results in biliary complications, early graft loss and death. Surgical revascularization and retransplantation are considered the mainstay of treatment. However, intraarterial endovascular therapy is an alternative that has shown low morbidity and mortality, thereby avoiding the need for retransplantation. We describe a case of orthotopic liver transplantation complicated with hepatic artery thrombosis that was successfully treated with endovascular therapy.

Solitary ulcer in cecum, mimicking a carcinoma: A case report.

INTRODUCTION: Solitary ulcers in the colon are rare and infrequent; little over 200 cases have been reported in medical literature. We present a case of a patient presenting with a solitary colonic ulcer associated with NSAIDs intake, mimicking a malignant lesion. A review of the literature is also revised. PRESENTATION OF CASE: 68- year-old female patient with past history of nonsteroidal anti-inflammatory drugs (NSAID) intake for chronic pain, complaining of severe abdominal pain was admitted to our teaching hospital. The diagnosis of a low-grade dysplasia was made with colonoscopy and biopsy, a malignant lesion could not be ruled out. A laparoscopy right colectomy was performed without complications. The final diagnosis resulted in a solitary cecal ulcer. DISCUSSION: The majority of the cases of solitary colonic ulcers occur in the ascending colon, at the cecum, which has been attributed mostly to the intake of NSAIDs. There could be solitary colonic ulcers in other portions of the large intestine, caused by different etiologies: ischemia, inflammatory disease, sterocoraceus ulcers, ulcers caused by infections, among other more uncommon causes. The diagnosis is often made through a biopsy of the tissue during a colonoscopy, with either surgical or conservative care. CONCLUSION: The diagnosis of solitary cecal ulcer should be considered in patients presenting with RLQ abdominal pain and with history of NSAIDs consumption. Recognition of this diagnosis by surgeons, ruling out malignancies, understanding the morphologic features, and carefully taking the patient's history are essential for the diagnosis and treatment of this uncommon disease.

Adiestramiento en cirugía de invasión mínima. El papel de los simuladores en cirugía laparoscópica / Training in minimal invasive surgery. The phantoms rol in laparoscopic surgery

La importancia de adquirir destreza quirúrgica en los nuevos procedimientos endoscópicos antes de la aplicación clínica, ha sido bien aceptada. Influenciados por los cirujanos endoscópicos de los Estados Unidos, actualmente las operaciones en animales se utilizan con mucha frecuencia con este propósito. Se han desarrollado, modelos de entrenamiento "simuladores", éstos simulan la anatomía del cuerpo humano. Estos "simuladores" de plástico y caucho, se construyeron especialmente para el adiestramiento de procedimientos laparoscópicos avanzados. Un modelo pélvico permite a los cirujanos con experiencia, realizar resecciones de colon sigmoides, rectopexia y otros tipos de cirugía pélvica. Por ejemplo, en resecciones del sigmoides se utiliza intestino de res y lo fijamos en la pelvis del "simulador", y así el cirujano puede tabajar en ambos lados, en la cavidad abdominal laparoscópicamente y transanalmente con engrapadoras. El sangrado, al principio de la construcción de estos modelos, era un argumento para utilizar animales(cerdos) en vez de "simuladores", pero actualmente ya no es un punto significativo. Ahora, en esta fase de adiestramiento, los cirujanos ya tienen experiencia en colecistectomía laparoscópica y saben como manejar el sangrado. En el centro de capacitación, se demostraron las ventajas de estos modelos en el campo clínico, y se concluye que los programas de adiestramiento en prodecimientos avanzados deven realizarse en estos modelos