Subcapsular Hepatic Hematoma Post-ERCP: Case Report and Review of the Literature.

INTRODUCTION: Hepatic hematoma is a rare but possible complication of ERCP. We describe the case of a 75-year old man with a large, 8 × 12 cm, sub-capsular and intra-parenchymal hematoma post ERCP, affecting the right liver segments and treated conservatively. AREAS COVERED: A review of literature has been performed, highlighting two possible mechanisms: hematoma may occur as the result of accidental laceration of a small intrahepatic vessel by the guidewire, whereas the other hypothesis posits that the hepatic damage is secondary to traction on the biliary system exerted by the balloon. We speculate that in case of anomalies of the biliary tree, the incidence of this complication is higher than expected. EXPERT COMMENTARY: In case of hepatic hematoma post ERCP, a conservative approach should always be considered before proceeding to interventional radiologic procedures or to surgical therapy.

Can seawater desalination be a win-win fix to our water cycle?

While we increasingly turn to desalination as a secure water supply, it is still perceived as an expensive and environmentally damaging solution, affordable only for affluent societies. In this contribution, we recast desalination from one of a last resort to a far-reaching, climate change mitigating, water security solution. First, we argue that the benefits of desalination go beyond the single-use value of the water produced. If coupled with water reuse for irrigation, desalination reduces groundwater abstraction and augments the water cycle. As such, it may support both adaptation to, and mitigation of climate change impacts by deploying plentiful water for human use, with all the benefits that entails, while helping preserve and restore ecosystems. Second, we counter two arguments commonly raised against desalination, namely its environmental impact and high cost. The environmental impact can be fully controlled so as not to pose long-term threats, if driven by renewable energy. Desalination may then have a zero carbon footprint. Moreover, appropriately designed outfalls make the disposal of brine at sea compatible with marine ecosystems.. Recovery of energy, minerals and more water from brine reject (particularly in the form of vapour for cooling to enable more crops and vegetation to grow), while possible, is often hardly economically justified. However, resource recovery may become more attractive in the future, and help reduce the brine volumes to dispose of. When fresh water becomes scarce, its cost tends to go up, making desalination increasingly economic. Moreover, desalination can have virtually no environmental costs. Considering the environmental costs of over-abstraction of freshwater, desalination tilts the balance in its favour.

Nuevos criterios y métodos para el diagnóstico de caries / New criteria and methods for caries diagnosis

Las caries dentarias representan uno de los más grandes problemas de salud bucal. Para su control y prevención es necesario realizar un diagnóstico lo más precoz que sea posible de tales lesiones. Los métodos de diagnóstico convencionales como el visual, téctil y radiográfico, han demostrado una baja sensibilidad y especificidad en la detección temprana de la caries dentarias. El objetivo de esta revisión es dar a conocer las nuevas tecnologías existentes para el diagnóstico de caries dentales. La técnica que utiliza láser fluorescencia representa entre los nuevos métodos la de mayor proyección clìnica, tanto por su fácil manejo como por los muy buenos resultados obtenidos en estudios experimentales. Su fundamento físico es el aumento de la fluorescencia de una pieza dentaria cuando se presentan áreas desmineralizadas. Es importante consignar que estas nuevas herramientas diagnósticas representan una información adicional que, sumadas a la proporcionada por los métodos convencionales, permitirán efectuar un diagnóstico precoz antes que se produzca la cavitación. Esto conducirá a implementar los procesos preventivos individualizados destinados a detener o prevenir lesiones de caries incipientes