Transcolonoscopic extraperitoneal cecostomy. A new therapeutic and technical proposal.

The authors propose a new technique of decompression of the colon consisting in percutaneous cecostomy with previous extraperitonization of the cecum under colonoscopic orientation. The technique permits decompression of the entire colon through the insertion of a ceco-anal multiperforated Levine tube on withdrawing the colonoscope. It is a new therapeutic choice for the treatment of the Ogilvie syndrome, toxic megacolon and other morbid entities, which may permit the performance of the procedure and require decompression of the colon, which proved to be extremely effective in the treatment of a patient with the Ogilvie syndrome.

The intra-hepatic bile ducts in hepatic steatosis and in congested livers.

The authors study 25 steatotic or congested livers by means of post-mortem cholangiographies and vinyl moulds of the bile ducts. They show that the bile ducts of these organs present alterations, characterized by stretching, rectification, and lengthening of the intra-hepatic bile ducts, as a consequence of the diffuse hepatomegaly that occurs in the disease. They relate the average number of straight ducts in the intra-hepatic bile tract to the extension of the extension of the disease, obtaining a positive relation. A statistical evaluation of the results was made, allowing objective conclusions.

Post-mortem aeroportography.

The authors suggest a new methodology for the study of the intrahepatic portal system, using atmospheric air as a contrast medium. They used 48 livers of normal and pathological corpses, obtaining post-mortem cholangiographies and vinyl molds. Comparing the images obtained with literature data and with the vinyl molds, the authors conclude that the method is accurate, presenting furthermore many advantages with regard to contrasts generally used, such as low cost, easy performance, possibility repeating the radiographs as many times as necessary, and the possibility of simultaneous obtaining contrasts of other intra-hepatic systems by use of other radio-opaque contrast media in another system, as for example the biliary or the arterial system.

The intra-hepatic biliary system in cirrhósis.

The authors study 14 cirrhotic livers by means of post-mortem cholangiography and vinyl casts. They analyze the radiographs according to thorough criterions, described in the text, and come to the conclusion that intrahepatic biliary ducts in cirrhotic livers present serious alterations, represented by distorted ducts with focal stenoses, nodular impressions, wall irregularities, increase of the number of obtuse angles and poor peripheral filling, which confer a disharmonic aspect to the intra-hepatic biliary ducts of these organs. Furthermore, they show that livers with post-necrotic cirrhosis present bile ducts much more seriously damaged than those with Laennec's cirrhosis. The paper was submitted to statistical analysis and allows objective conclusions.

Role of EUS in the preoperative localization of insulinomas compared with spiral CT.

BACKGROUND: Preoperative radiologic localization of insulinomas often fails because of the small size of these tumors. Endoscopic ultrasound (EUS) can localize insulinomas in up to 80% of the cases. The aim of this study was to compare EUS and computed tomography (CT) diagnostic accuracy for insulinomas. METHODS: We reviewed medical records from 12 patients (10 women) with a biochemical diagnosis of hypoglycemia and hyperinsulinism from 1 university hospital and 1 community hospital. A diagnosis of insulinoma was ultimately made in all cases and before surgery the patients underwent abdominal US, spiral CT and EUS in an attempt to precisely localize the tumor. Surgery was considered the standard for tumor localization. RESULTS: Ten tumors were benign (83.3%) and 2 were malignant (16.7%). The overall sensitivity of EUS in identifying insulinomas was 83.3% compared with 16.7% for CT. Tumors not detected by EUS had a mean size of 0.75 cm. EUS-guided fine-needle aspiration was possible in only 3 patients, with a positive cytologic diagnosis in 2 (66.6%). Tumors located in the head and body of the pancreas were identified by EUS in all patients, but those located in the tail were diagnosed in only 50% of the cases. CONCLUSIONS: EUS is superior to spiral CT and should replace it for the detection of pancreatic insulinomas. EUS identification depends on the site and size of the tumor.