摘要
Resumen Introducción: El colangiocarcinoma intrahepático (CIH) corresponde al segundo tumor hepático primario y la resección quirúrgica es la única alternativa válida para el tratamiento curativo de esta enfermedad. Reporte de casos: Describimos 2 paciente portadores de CIH con compromiso de vena cava inferior (VCI) que fueron sometidos a resección en Clínica Alemana de Santiago (CAS). Ambas pacientes son de género femenino de 39 y 47 años de edad. Ambas fueron sometidas a resección mayor hepática izquierda, asociada a resección del segmento I y extendida a VCI. La reconstrucción de la VCI fue realizada con parche pericárdico bovino y cierre primario respectivamente. El período desde el posoperatorio hasta el alta, fue de 13 y 23 días respectivamente. Discusión: Aunque la reseccion quirúrgica es la única vía para la curación en el CIH, el compromiso de estructuras vasculares hacen que esto no sea posible. El manejo multidisciplinario asociado a una técnica meticulosa realizada por un equipo quirúrgico experimentado, hacen posible lograr buenos resultados.
Introduction: Intrahepatic cholangiocarcinoma is the second most common primary liver tumor and surgical resection the only valid curative treatment. Case reports: We describe two patients harboring an intrahepatic cholangiocarcinoma with cava vein involvement who underwent resection at Clinica Alemana of Santiago. Both patients were females with ages of 39 and 47 years old. Both patients underwent left liver resection, associated to resection of segment I and of a portion of cava vein. Reconstruction of resected portion of the cava vein was performed by using a pericardium bovine patch and primary closure respectively. Postoperative period was uneventfully being discharged at 13 and 23 days respectively. Discussion: Although surgical resection is the only way to get curativeness, frequent involvement of large vascular structures make treatment unfeasible. A multidisciplinary approach associated with a meticulous technique performed by an experienced surgical team make possible to accomplish the above objective.
Subject(s)
Humans , Female , Adult , Middle Aged , Vena Cava, Inferior/physiopathology , Cholangiocarcinoma/physiopathology , Liver Neoplasms/surgery , Cholangiocarcinoma/surgery , Cholangiocarcinoma/complications , Cholangiocarcinoma/diagnostic imaging , Laparotomy/methods , Liver Neoplasms/diagnostic imaging摘要
Background: Vascular anomalies are prevalent in the general population and may produce significant impairment in quality of life. In recent years, minimally invasive interventional radiology techniques have become an efficient alternative for the treatment of these patients. The aim of this study was to present our experience in the management of vascular malformations with such techniques at Clínica Alemana in Santiago, Chile, and assess the satisfaction of patients with this management. Material and Methods: Evaluation of the follow-up of patients with vascular malformations treated in the Interventional Radiology Unit at our center since June - 2006 to June - 2009. Patients were classified according to the hemodynamics of the lesions (high vs low-flow). Complications and patient satisfaction with the treatment were assessed. Results: Eighty-seven patients (253 procedures) were included in the study, 36 men and 51 women, all with complete follow-up during the period of the study. Their average age was 20.6 years. In over 50 percent of the patients the vascular anomaly was located on the face or the lower extremities. Twenty-eight percent (25 patients) had a high-flow malformation (pure or mixed) and 62 (72 percent) had a low-flow lesion (vascular malformation, lymphangioma or mixed). On average, each patient underwent 2.9 procedures (1-10). There were 4 major complications (1.65 percent), one of which was predominantly cosmetic with necrosis in the area of the lesion. The average satisfaction rate was 7.95 (on a rating scale of 1 to 10). Satisfaction was significantly higher in patients with low-flow malformations (8.27) than in those with high-flow lesions (7.16). (p < 0.05) Discussion: Treatment of vascular malformations using interventional radiology techniques is an effective alternative, with good prospects of clinical improvement, patient satisfaction and low complication rates.
Introducción: Las anomalías vasculares son una patología frecuente en la población general, y son causa de deterioro de la calidad de vida de los pacientes que las padecen. En los últimos años, las técnicas mínimamente invasivas de radiología intervencional se han convertido en una alternativa eficaz para el tratamiento de estos pacientes. El objetivo del presente estudio es mostrar nuestra experiencia en el manejo de malformaciones vasculares con estas técnicas en la Clínica Alemana de Santiago y evaluar la satisfacción de los pacientes con este manejo. Material y Métodos: Evaluación del seguimiento de todos los pacientes con malformaciones vasculares tratados en la Unidad de Radiología Intervencional desde el año 2006 hasta junio del año 2009. Los pacientes fueron clasificados en base a la hemodinamia de la malformación vascular (alto flujo vs. bajo flujo). Se evaluaron las complicaciones, y se realizó una encuesta sobre la satisfacción de los pacientes con el tratamiento. Resultados: Ochenta y siete pacientes (253 procedimientos) fueron incluidos en el estudio, 36 hombres y 51 mujeres, todos con seguimiento completo en este periodo. La edad promedio de ellos fue de 20,6 años. En más del 50 por ciento de los pacientes la anomalía vascular se ubicó en la cara o extremidades inferiores. Un 28 por ciento (25 pacientes) presentó malformación de alto flujo (pura o mixta) y 72 por ciento (62 pacientes) de bajo flujo (malformaciones vasculares, linfangiomas o mixtas). En promedio, cada paciente se realizó 2,9 procedimientos (1-10). Del total de procedimientos realizados, hubo 4 complicaciones mayores (1,65 por ciento), una de ellas con secuelas estéticas producto de necrosis de la zona. El promedio de satisfacción fue de un 7,95 en una escala de 1 a 10, siendo significativamente mayor en pacientes con malformaciones de bajo flujo (8,27) que en los de alto flujo (7,16) (p < 0.05)...
Subject(s)
Humans , Male , Adolescent , Adult , Female , Infant , Child, Preschool , Child , Middle Aged , Vascular Malformations/therapy , Radiology, Interventional/methods , Follow-Up Studies , Hemodynamics , Vascular Malformations/complications , Data Collection , Treatment Outcome , Patient Satisfaction摘要
Background: Type B aortic dissection is usually managed by intensive care medical therapy and surgery is reserved for treating the complications that can occur during the evolution of a case. Aim: To assess the endovascular management of acute complications of type B aortic dissection and the closure of the intimal defect and aortic false lumen. Material and Methods: Retrospective analysis of 8 consecutive patients aged 40 to 57 years (seven males) treated for acute complications in the initial episode of a type B aortic dissection between August 2006 and July 2008. Results: Six/eight were known hypertensive patients. The indications for surgery were intractable pain in one, hypertension refractory to treatment in two and distal hypoperfusion in fve. Five patients required covering of the left subclavian artery ostium, without need for surgical repair. One patient was subjected to renal angioplasty and stenting. Technical success was achieved in all cases, with complete closure of the proximal aortic tear and thoracic aortic false lumen, although 7 of patients had a persistent distal aortic false lumen. One case had a transient lower limb paraparesis. No patient died. Conclusions: Endovascular treatment is effective in closing the aortic tear as well as the thoracic aortic false lumen in aortic type B dissections with a low complication rate. Due to the high frequency of distal aortic false lumen persistence, it is not a defnitive treatment for this condition but it is useful for the acute complications of the initial phase of type B aortic dissection.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Aortic Dissection/surgery , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/methods , Endovascular Procedures/methods , Aortic Dissection/complications , Aortic Aneurysm, Thoracic/complications , Endovascular Procedures/adverse effects , Retrospective Studies , Treatment Outcome , Tunica Intima/pathology , Tunica Intima/surgery摘要
Popliteal artery entrampment is a rare condition, occurring in young subjects, that causes ischemia of the extremity. The anatomical background is the compression or occlussion of the popliteal artery caused by forced plantar or dorsal flexion. We report a 32 year-old sportsman who presented with gangrene of the right first toe and a history of three months of progressive claudication. The Ankle-Brachial index and pulse volume curve registries showed a severe ischemia below the knee. Angiography showed a medial deviation of the popliteal artery associated to stenosis and aneurysm formation. A CT scan of the contralateral artery was normal. The patient was operated using a posterior approach, performing a reverse saphenous vein bypass graft and excising the popliteal artery. The postoperative period was uneventful.
Subject(s)
Adult , Humans , Male , Arterial Occlusive Diseases/pathology , Ischemia/pathology , Leg/blood supply , Popliteal Artery , Arterial Occlusive Diseases/surgery , Constriction, Pathologic/pathology , Constriction, Pathologic/surgery , Ischemia/surgery , Leg/pathology , Necrosis , Popliteal Artery/surgery , Toes/surgery摘要
Background: Thrombophilia is defined as an altered hemostasis that predisposes to thrombosis. It can be primary when there is a family clustering of the disease or secondary, when it is associated to an acquired risk factor. Aim: To report clinical features in a series of patients with primary thrombophilia. Material and methods: Review of clinical records of patients with thrombotic episodes that lead to the suspicios of primary thrombophilia. Analysis of asymptomatic adult close relatives of these patients. Results: We report 93 subjects (56 females, age range 14-77 years) with repeated episodes of thrombosis and a family history of thrombosis and 12 asymptomatic close relatives. Seventy one percent had the first thrombotic episode before the age of 40 years, 62% had more than one thrombotic episode and 37% had a family history of thrombosis. Twenty four percent had protein C deficiency, 24% had antithrombin III deficiency, 18% had resistance to activated C protein by factor V Leiden, 10% had protein S deficiency, and 10% had the G20210 mutation of prothrombin gene. Among acquired defects studied simultaneously, 30% had lupus anticoagulant and 11% had hyperhomocysteinemia. Twenty four percent of cases had more than one thrombophilic risk factor. Among asymptomatic relatives, five had factor V Leiden, four had protein C deficiency and three had the G20210 mutation of prothrombin gene. Conclusions: Thrombophilia must be suspected in young subjects with thrombotic episodes and a family history. The type of coagulation defect will determine prognosis, and the type of treatment.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Pregnancy , Genetic Predisposition to Disease , Thrombophilia , Antithrombin III Deficiency/genetics , Echocardiography, Doppler , Enzyme-Linked Immunosorbent Assay , Epidemiologic Methods , Factor V/genetics , Protein C Deficiency/genetics , Protein S Deficiency/genetics , Thrombophilia/diagnosis , Thrombophilia/genetics摘要
Se efectuó la standarización de la rata Sprague-Dawley en relación a parámetros hematológicos, bioquímicos y anatómicos en una muestra de 24 ratas, 12 machos y 12 hembras. Se estandarizó el modelo de asa duodenal cerrada para producir pancreatitis aguda en 72 ratas, las que fueron sacrificadas en grupos de 3 cada hora durante 24 horas. Se determinó que el momento en que se inicia la pancreatitis aguda, tanto por parámetros bioquímicos como histopatológicos, corresponde a la sexta hora postinducción. Utilizando este modelo se efectuaron diferentes acciones tendientes a disminuir los efectos de una PA de inicio reciente. Cien ratas fueron divididas en 5 grupos de 20: 1. Control, 2. Descompresión biliar precoz, 3. Verapamilo 0,5 mg/kg ev., 4. Allopurinol 50 mg/kg ev., 5. Superóxido dismutasa 5 mg/kg ev. Para determinar el efecto benéfico de estas acciones sobre la PA, ellas fueron realizadas a la sexta hora postinducción. Se concluye que los mejores efectos logrados en este modelo corresponden a la desobtrucción efectuada precozmente. Dentro de las drogas utilizadas, como drogas captadoras de radicales libres de oxígeno, la superóxido dismutasa fue la que presentó los mejores efectos benéficiosos. El allopurinol mostró efectos discretos en este modelo, no comprobándose el efecto beneficioso del verapamilo en relación al grupo control
Subject(s)
Animals , Rats , Pancreatitis/physiopathology , Allopurinol/administration & dosage , Rats, Sprague-Dawley/physiology , Superoxide Dismutase/pharmacokinetics , Verapamil/administration & dosage摘要
Sprague-Dawley rats are frequently used in experiments and their normal hematological, serological and anatomical parameters are not easily available. The aim of this study was to measure these parameters in adult Sprague-Dawley rats. 24 rats (12 males) whose weight ranged between 200 and 300 g raised at the Instituto de salud Pública in controlled environment conditions and fed with pellets were studied. After a 24 h fast animals were anesthetized with Droperidol and Ketamine and after obtaining a cardiac blood for glucose, calcium, amylase, total proteins, cholesterol, AST, ALT, bilirrubin, alkaline phosphatases, electrolytes and complete blood count were determined. Heart, lung, pancreas, kidney and testicle mean weight was also calculated. Male and female rats had significant differences in packed red cell volume, white blood cell count and hemoglobin
Subject(s)
Rats , Animals , Hemoglobinometry/statistics & numerical data , Leukocyte Count , Blood Chemical Analysis , Hematocrit/statistics & numerical data , Organ Size , Reference Values , Rats, Sprague-Dawley/anatomy & histology , Rats, Sprague-Dawley/blood摘要
Desde su aparición en la práctica clínica la angioplastía trasluminal con balón (APT) ha demostrado ser útil en el tratamiento de la enfermedad arterial oclusiva siendo efectuada como un procedimiento radiológico percutáneo. En un periódo de 3 meses, 7 arterias en 5 pacientes fueron tratados con APT en pabellón de cirugía sin presentar morbimortalidad. Los resultados son buenos aunque el tiempo de seguimiento es breve. Se concluye que la APT, puede ser utilizada en pabellón de cirugía, asociado o no a otro procedimiento de revascularización, con buenos resultados.
Subject(s)
Humans , Male , Female , Middle Aged , Angioplasty, Balloon , Arterial Occlusive Diseases/therapy , Follow-Up Studies摘要
Los tumores y quistes del medistino son lesiones poco frecuentes, que se originan en las estructuras propias de cada uno de sus compartimientos o en elementos extramediastínicos que lo invaden. El logro de buenos resultados terapéuticos en este tipo de patología requiere de un diagnóstico preciso y oportuno lo cual no siempre es fácil. En este artículo se revisan algunos aspectos de estas lesiones, destacando sus relaciones anatómicas, presentación clínica y estudio de laboratorio. Se describen los tumores más frecuentes y sus respectivas características clínicas, los exámenes complementarios de mayor rendimiento y modalidades terapéuticas actualmente en uso
Subject(s)
Humans , Mediastinal Neoplasms/diagnosis , Goiter, Substernal/diagnosis , Lymphoma/diagnosis , Mediastinal Neoplasms/surgery , Bronchogenic Cyst/diagnosis , Teratoma/diagnosis , Thymus Neoplasms/classificationSubject(s)
Humans , Heart Arrest/therapy , Resuscitation/standards , Students, Medical , Knowledge , Physicians摘要
El síndrome de ocupación pleural por líquido es una situación clínica frecuente que precisa de un diagnóstico preciso y oportuno para lograr buenos resultados terapéuticos. En este artículo se revisa algunos aspectos de esta condición incluyendo las manifestaciones clínicas, la fisiología pleural y los elementos clínicos y de laboratorio que se consideran útiles para su estudio y evaluación