Heridas por asta de toro, análisis de 138 casos.

OBJECTIVE: Bull-horn injuries (BHI) are unique and there is reduced published literature about it. We present an analysis of a 11-year BHI case series. METHOD: Study of 138 cases developed during a 11-year period with hospitalization admission greater than 24 hours with diagnosis of BHI/contusion. We classified patients in two groups: group A, patients undergoing procedures under general anaesthesia and group B undergoing procedures under local anaesthesia. Variables: age, sex, date, hospitalization length, main region affected, Comprehensive complication index (CCI, ISS, intensive care unit (ICU) admission, stay and mortality. Statistical analysis: t-Student test, ANOVA, χ2 and linear or logistic regression. RESULTS AND CONCLUSIONS: ISS was related to hospital stay, CCI, ICU admission and type of treatment applied. The comparative statistical analysis of variables between both groups determined a significant difference in age, ISS and hospitalization length, being greater in those belonging to group A. There is a more risk of undergoing surgery by increasing age, ISS and presenting the wounds in thorax-abdomen-pelvis area. CCI may be a good method of quantifying postoperatory morbidity in polytraumatized patients or in other areas besides the abdomen.

OBJETIVO: Las heridas por asta de toro (HAT) poseen características únicas y existe literatura escasa en esta área. Presentamos un análisis de 11 años de pacientes con HAT. MÉTODO: Estudio retrospectivo y analítico de 138 casos durante un periodo de 11 años, de pacientes ingresados durante más de 24 horas por HAT. Clasificamos a los pacientes en dos grupos: grupo A, sometidos a procedimientos bajo anestesia general, y grupo B, sometidos a procedimientos bajo anestesia local. Variables recogidas: edad, sexo, mes del suceso, hospitalización (días), región afectada, Comprehensive Complication Index (CCI), Injury Severity Score (ISS), ingreso y estancia en la unidad de cuidados intensivos (UCI) y mortalidad. Análisis estadístico: t de Student, ANOVA, χ2, regresión lineal y logística. RESULTADOS Y CONCLUSIONES: El ISS se relaciona directamente con la estancia hospitalaria, el CCI, el ingreso en UCI y el tratamiento recibido. Entre ambos grupos se evidenció una diferencia significativa en edad, ISS y estancia hospitalaria, siendo mayores en el grupo A. Existe un mayor riesgo de necesitar cirugía conforme aumentan la edad, el ISS y las heridas en tórax, abdomen o pelvis. El CCI puede ser un buen método para cuantificar la morbilidad posoperatoria en pacientes politraumatizados o con lesiones en otras áreas distintas del abdomen.

Valoración de parámetros clínicos y analíticos preoperatorios en apendicitis aguda complicada. Score para predecir apendicitis complicada / Evaluation of Preoperative Clinical and Serological Determinations in Complicated Acute Appendicitis: A Score for Predicting Complicated Appendicitis

Introducción: Los parámetros clínicos y analíticos de la apendicitis aguda (AA) son la base diagnóstica. Se analiza la diferencia de sus valores según la histología para distinguir las AA simples de las complicadas. Métodos: Análisis observacional retrospectivo que incluye pacientes (>14 años) que ingresan con diagnóstico de AA desde el 1 abril 2014 al 31 julio 2016. Histopatológicamente se dividen en AA complicada (perforada y/o gangrenada) y AA no complicada (flemonosa). Entre los 2 grupos se compara sexo, edad, temperatura al ingreso, duración de sintomatología, recuento leucocitario preoperatorio (WBC), porcentaje de neutrófilos, volumen plaquetario medio (VPM), índice de distribución de plaquetas (PDW), proteína C-reactiva (PCR) y estancia hospitalaria. Resultados: Se analizan 335 pacientes y se incluyen 284, de los cuales 194 (68,3%) tienen AA no complicada (AAnc) y 90 (31,7%) AA complicada (AAc). La edad, la duración de sintomatología, el porcentaje de neutrófilos, la PCR y la estancia hospitalaria son mayores en la AAc (p<0,05). Las diferencias de las medias entre AAnc y AAc son: edad 13,2 años (IC 95%: 8,2-18,2), duración de sintomatología 14,1h (IC 95%: 6,3-21,9), porcentaje de neutrófilos 5,0% (IC 95%: 3,2-6,8), PCR 73,6mg/l (IC 95%: 50,0-97,2) y estancia hospitalaria 2,2 días (IC 95%: 1,4-3,0), con p<0,05. Un modelo basado en parámetros preoperatorios (edad, duración de sintomatología, porcentaje de neutrófilos y PCR) se calcula para predecir la posibilidad de AAc. El área bajo la curva del modelo es 0,80 (IC 95%: 0,75-0,85). Conclusiones: El modelo predice la posibilidad de desarrollar AAc, pero debe validarse de manera prospectiva. (AU)

Background: To analyze whether clinical and analytical parameters differ according to histopathology in cases of acute appendicitis (AA). Methods: This is a retrospective, observational study including patients (>14 years of age) admitted for suspicion of AA from 1 April 2014 to 31 July 2016. Histopathology was divided into complicated (including perforated and gangrenous AA) and uncomplicated appendicitis (phlegmonous). Sex, age, temperature of patients on admission to the Emergency Department, symptom duration, preoperative white blood cell (WBC) count, neutrophil percentage, mean platelet volume (MPV), platelet distribution width (PDW), C-reactive protein (CRP) and hospital stay were compared in the two groups. Results: Three hundred and thirty-five patients were analyzed, and 284 were included. Appendicitis was uncomplicated in 194 (68.3%) and complicated in 90 (31.7%). Age, symptom duration, neutrophil percentage, CRP and hospital stay were higher in the complicated AA group (P < .05). The mean differences between uncomplicated and complicated AA were: age 13.2 years (95% CI: 8.2-18.2), symptom duration 14.1hours (95% CI: 6.3-21.9), neutrophil percentage 5.0% (95% CI: 3.2-6.8), CRP 73.6mg/l (95% CI: 50.0-97.2) and hospital stay 2.2 days (95% CI: 1.4-3.0), with p<0.05 for all these variables. A model based on the preoperative parameters (age, symptom duration, neutrophil percentage and CRP) was calculated to predict the likelihood of complicated AA. The receiver operating characteristic (ROC) of the model had an area under the curve of 0.80 (95% CI 0.75-0.85). Conclusion: This model is able to diagnose complicated AA without the need for imaging techniques, although it must be validated with prospective analysis. (AU)

Evaluation of Preoperative Clinical and Serological Determinations in Complicated Acute Appendicitis: A Score for Predicting Complicated Appendicitis. / Valoración de parámetros clínicos y analíticos preoperatorios en apendicitis aguda complicada. Score para predecir apendicitis complicada.

BACKGROUND: To analyze whether clinical and analytical parameters differ according to histopathology in cases of acute appendicitis (AA). METHODS: This is a retrospective, observational study including patients (>14 years of age) admitted for suspicion of AA from 1 April 2014 to 31 July 2016. Histopathology was divided into complicated (including perforated and gangrenous AA) and uncomplicated appendicitis (phlegmonous). Sex, age, temperature of patients on admission to the Emergency Department, symptom duration, preoperative white blood cell (WBC) count, neutrophil percentage, mean platelet volume (MPV), platelet distribution width (PDW), C-reactive protein (CRP) and hospital stay were compared in the two groups. RESULTS: Three hundred and thirty-five patients were analyzed, and 284 were included. Appendicitis was uncomplicated in 194 (68.3%) and complicated in 90 (31.7%). Age, symptom duration, neutrophil percentage, CRP and hospital stay were higher in the complicated AA group (P < .05). The mean differences between uncomplicated and complicated AA were: age 13.2 years (95% CI: 8.2-18.2), symptom duration 14.1hours (95% CI: 6.3-21.9), neutrophil percentage 5.0% (95% CI: 3.2-6.8), CRP 73.6mg/l (95% CI: 50.0-97.2) and hospital stay 2.2 days (95% CI: 1.4-3.0), with p<0.05 for all these variables. A model based on the preoperative parameters (age, symptom duration, neutrophil percentage and CRP) was calculated to predict the likelihood of complicated AA. The receiver operating characteristic (ROC) of the model had an area under the curve of 0.80 (95% CI 0.75-0.85). CONCLUSION: This model is able to diagnose complicated AA without the need for imaging techniques, although it must be validated with prospective analysis.

Hernia diafragmática complicada / Complicated diaphragmatic hernia

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Absceso inguinal como presentación de la neoplasia de colon derecho. Revisión sistemática de la literatura / No disponible

La perforación del cáncer colorrectal es infrecuente y la invasión neoplásica de la pared abdominal acompañada de infección local es una condición más rara aun. Nuestro objetivo es presentar el caso de un varón de 84 años con una neoplasia de colon derecho que se manifestaba como un absceso inguinal y realizar una revisión sistemática de la literatura en PubMed, EMBASE y Web of Science. Se encontraron en total 59 casos. Todos los estudios eran retrospectivos. La mediana de edad era de 64 años. Treinta sujetos eran hombres y veintinueve mujeres (51% y 49%). La localización más frecuente era el colon derecho en 27 casos (46%), seguido del izquierdo en 18 casos (31%), el transverso en 12 casos (20%) y dos casos (3%) con neoplasia sincrónica de colon. Se realizó cirugía en dos o más tiempos en 33 casos (60%), cirugía en un tiempo en 21 casos (38%) y tratamiento médico en un caso (2%). El tipo histológico más frecuente fue el adenocarcinoma en el 64% de los casos, seguido de la variante mucinosa (22%). Hubo recidiva en el 33% de los casos. La mortalidad durante el seguimiento fue del 47%. Como limitación de nuestro estudio, el seguimiento de los casos fue heterogéneo, imposibilitando la interpretación de los resultados a largo plazo con respecto a la influencia del tratamiento en la supervivencia de estos pacientes; además, esto se ve también dificultado al ser una condición urgente y con una incidencia excepcional. Es necesaria la realización de estudios con recolección de datos prospectiva en el manejo del CCR de urgencias, estandarizando el seguimiento para obtener un adecuado análisis del pronóstico de la enfermedad

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Inguinal abscess as presentation of a right colon cancer. A systematic review.

Perforation in colorectal cancer is an uncommon condition, and neoplastic invasion of the abdominal wall with local infection is even rarer. Our objective is to present the case of an 84-year-old male with right colon cancer that manifested as an inguinal abscess, and also to perform a systematic review of the literature in PubMed, EMBASE, and Web of Science. A total of 59 cases in retrospective studies were found. Median age was 64 years, thirty cases were men and twenty-nine were women (51% and 49%, respectively). The most common location was the right colon with 27 cases (46%), followed by the left colon with 18 cases (31%), 12 cases in the transverse colon (20%), and 2 cases with colonic synchronous neoplasm (3%). Surgery was performed in two or more occasions for 33 cases (60%), and on one occasion for 21 cases (38%); medical treatment alone was administered in one case (2%). The most common histological type was adenocarcinoma (64%), followed by its mucinous variant (22%). There was recurrence in 33% of cases. Mortality at follow-up was 47%. As a limitation of our study, follow-up was heterogeneous, making it impossible to interpret long-term results regarding the influence of treatment on patient survival, also difficulted by the urgent nature of the condition and its exceptional incidence. Further studies are needed with prospective data collection on the management of colorectal cancer in the emergency setting, standardizing follow-up in order to facilitate an adequate analysis of the prognosis of the disease.

Reingresos tras colecistectomía laparoscópica. ¿Influye la realización de una CPRE previa a la colecistectomía? / Readmission rates after laparoscopic cholecystectomy: are they affected by ERCP prior to surgery?

Objetivo: el objetivo de este estudio es evaluar los motivos y el momento de reingreso hospitalario después de colecistectomía comparando los pacientes en base a la realización de una colangiopancreatografía retrógrada endoscópica (CPRE) previa o no. Método: retrospectivamente, se revisaron todos los pacientes sometidos a colecistectomía en el Servicio de Cirugía General y del Aparato Digestivo del Hospital Universitario de Guadalajara entre enero de 2011 y diciembre de 2016. Se incluyeron pacientes sometidos a colecistectomía reingresados en cualquier servicio del hospital en los 90 días posteriores a la cirugía. Los criterios de exclusión fueron: colecistectomía asociada a otros procedimientos, patología oncológica activa en el momento de la colecistectomía, ingresos programados previamente por otra patología no relacionada y presencia de histología tumoral en la pieza de colecistectomía. Resultados: se estudiaron 1.714 pacientes, de los cuales 80 pacientes fueron readmitidos durante los 90 días posteriores al alta de la colecistectomía. La tasa de readmisión fue del 4,67%. La realización de CPRE previa a la cirugía se asoció a un aumento de la morbilidad postoperatoria (40% vs. 21,54%). La realización previa de una CPRE disminuyó la aparición de complicaciones de tipo biliar en los 90 días posteriores a la colecistectomía. Se observó también un aumento del número de días hasta que se produce el reingreso en estos pacientes (22 días con CPRE vs. siete días sin CPRE). Conclusión: en nuestra serie, los pacientes que precisaron una CPRE previa a la colecistectomía presentaron mayor morbilidad postoperatoria. Sin embargo, los pacientes que no precisaron CPRE presentaron más complicaciones biliares y tuvieron reingresos más tempranos

Aim: the aim of this study was to assess the reasons for and the time of hospital readmissions after cholecystectomy, according to whether an endoscopic retrograde cholangiopancreatography (ERCP) was performed. Method: all patients that underwent cholecystectomy at the Service of Digestive Diseases and General Surgery of the Hospital Universitario de Guadalajara between January 2011 and December 2016 were retrospectively reviewed. Patients who underwent cholecystectomy and were readmitted to any hospital service within 90 days of surgery were included. The following cases were excluded: patients that underwent cholecystectomy in combination with other procedures, an active oncological pathology at the time of cholecystectomy, admissions previously scheduled for another unrelated pathology and those with tumor histology in the cholecystectomy specimen. Results: of a total of 1,714 patients, 80 were readmitted within 90 days of discharge after cholecystectomy, which equates to a readmission rate of 4.6%. The performance of an ERCP prior to surgery was associated with an increase in postoperative morbidity (40% vs 21.54%). A prior ERCP reduced the rate of biliary complications during the 90 days after cholecystectomy. Furthermore, there was an increase in the number of days prior to readmission in these cases, with a mean period of 22 days with ERCP vs seven days without ERCP. Conclusion: patients in our series who required an ERCP prior to cholecystectomy had a greater postoperative morbidity. However, those that did not require ERCP had more biliary complications and were readmitted earlier

Readmission rates after laparoscopic cholecystectomy: are they affected by ERCP prior to surgery?

AIM: the aim of this study was to assess the reasons for and the time of hospital readmissions after cholecystectomy, according to whether an endoscopic retrograde cholangiopancreatography (ERCP) was performed. METHOD: all patients that underwent cholecystectomy at the Service of Digestive Diseases and General Surgery of the Hospital Universitario de Guadalajara between January 2011 and December 2016 were retrospectively reviewed. Patients who underwent cholecystectomy and were readmitted to any hospital service within 90 days of surgery were included. The following cases were excluded: patients that underwent cholecystectomy in combination with other procedures, an active oncological pathology at the time of cholecystectomy, admissions previously scheduled for another unrelated pathology and those with tumor histology in the cholecystectomy specimen. RESULTS: of a total of 1,714 patients, 80 were readmitted within 90 days of discharge after cholecystectomy, which equates to a readmission rate of 4.6%. The performance of an ERCP prior to surgery was associated with an increase in postoperative morbidity (40% vs 21.54%). A prior ERCP reduced the rate of biliary complications during the 90 days after cholecystectomy. Furthermore, there was an increase in the number of days prior to readmission in these cases, with a mean period of 22 days with ERCP vs seven days without ERCP. CONCLUSION: patients in our series who required an ERCP prior to cholecystectomy had a greater postoperative morbidity. However, those that did not require ERCP had more biliary complications and were readmitted earlier.

Los top 100. Revisión de los artículos más citados en cirugía / The top 100: A review of the most cited articles in Surgery

Introducción: Llevamos a cabo un estudio de los 100 artículos más citados en las 5 revistas quirúrgicas con mayor factor de impacto según Journal Citation Report. Métodos: Seleccionamos las 5 revistas con mayor factor de impacto según JCR en el año 2015 (Annals of Surgery, British Journal of Surgery, JAMA Surgery, Surgery, and Journal of the American College of Surgeons). Realizamos una búsqueda de todos los artículos publicados en estas cinco revistas a fecha de enero de 2017 y seleccionamos los 100 artículos más citados según Web of Science. Evaluamos número de citaciones, año de publicación, tipo de artículo, país y hospital de procedencia, área de interés y número de autores. Resultados: La mediana del número de citaciones del top 100 de citaciones es de 490. El 20% se han publicado desde el año 2000. De forma general, el 70% son originales, el 8% ensayos aleatorizados, 11% revisiones, 1% metaanálisis y el 11% otro tipo de estudios. Más del 60% provienen de EE. UU. y el área hepatopancreatobiliar es la más frecuentemente abordada (33%). Conclusiones: El artículo incluido en el top 100 de artículos más citados en cirugía tiende a ser un artículo original sobre el área hepatobiliopancreática y procedente de EE. UU. La revista Annals of Surgery tiene el doble de citaciones que el resto de revistas estudiadas

Introduction: We performed a study of the top 100 most cited articles in the five general surgery journals with the highest impact according to Journal Citation Report. Methods: We selected the five journals with the highest impact in 2015: Annals of Surgery, British Journal of Surgery, JAMA Surgery, Surgery, and Journal of the American College of Surgeons. In January 2017, using the Web of Science application, we performed a search of all articles published by these journals and identified the 100 most cited articles (top 100). We evaluated the number of citations, year of publication, type of article, country and hospital of the article, area of interest and number of authors. Results: The median number of citations per top 100 paper was 490. Twenty percent of the top 100 papers have been published since 2000. Overall, 70% are original papers, 8% randomized control trials, 11% reviews, 1% meta-analyses and 11% other subtypes. There are 13% proceedings papers. Sixty-one percent are from the US. The most frequently discussed topic is hepato-pancreato-biliary surgery (33%). Conclusions: The top 100 most cited articles tend to be original articles describing studies carried out in the US, reporting significant surgical breakthroughs. Hepato-pancreato-biliary surgery is the most common subject area. Annals of Surgery had twice as many citations as the other journals studied. The archetypal article of the Top15 most cited is an original paper published in the twentieth century, with an average of 2000 citations

The top 100: A review of the most cited articles in Surgery. / Los top 100. Revisión de los artículos más citados en cirugía.

INTRODUCTION: We performed a study of the top 100 most cited articles in the five general surgery journals with the highest impact according to Journal Citation Report. METHODS: We selected the five journals with the highest impact in 2015: Annals of Surgery, British Journal of Surgery, JAMA Surgery, Surgery, and Journal of the American College of Surgeons. In January 2017, using the Web of Science application, we performed a search of all articles published by these journals and identified the 100 most cited articles (top 100). We evaluated the number of citations, year of publication, type of article, country and hospital of the article, area of interest and number of authors. RESULTS: The median number of citations per top 100 paper was 490. Twenty percent of the top 100 papers have been published since 2000. Overall, 70% are original papers, 8% randomized control trials, 11% reviews, 1% meta-analyses and 11% other subtypes. There are 13% proceedings papers. Sixty-one percent are from the US. The most frequently discussed topic is hepato-pancreato-biliary surgery (33%). CONCLUSIONS: The top 100 most cited articles tend to be original articles describing studies carried out in the US, reporting significant surgical breakthroughs. Hepato-pancreato-biliary surgery is the most common subject area. Annals of Surgery had twice as many citations as the other journals studied. The archetypal article of the Top15 most cited is an original paper published in the twentieth century, with an average of 2000 citations.

Clinical Validation of the Comprehensive Complication Index as a Measure of Postoperative Morbidity at a Surgical Department: A Prospective Study.

OBJECTIVE: Using clinical outcomes, to validate the comprehensive complication index (CCI) as a measure of postoperative morbidity in all patients undergoing surgery at a general surgery department. BACKGROUND: The Clavien-Dindo classification (CDC) is the most widely used system to assess postoperative morbidity. The CCI is a numerical scale based on the CDC. Once validated, it could be used universally to establish and compare the real postoperative complications of each surgical procedure. METHODS: Observational prospective cohort study. All patients who underwent surgery during the 1-year study period were included. All the complications graded with the CDC and related to the initial admission, or until discharge if the patient was readmitted within 90 days of surgery, were included. Surgical procedures were classified according to the operative severity score (OSS) as minor, moderate, major, or major+. The clinical validation of the CCI was performed by assessing its correlation with 4 different clinical outcomes. RESULTS: A total of 1850 patients were included: 513 (27.7%) presented complications and 101 (5.46%) were readmitted. In the multivariate analysis, the CCI and CDC were associated with postoperative stay, prolongation of postoperative stay, readmission, and disability in all OSS groups (P < 0.001). The CCI was superior to the CDC in all models except for prolongation of stay for OSS moderate and major+. CONCLUSIONS: The CCI can be applied in all the procedures carried out at general surgery departments. It is able to determine the morbidity and allows the comparison of the outcomes at different services.

Pancreatic Neuroendocrine Tumors and Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Systematic Review.

OBJECTIVES: This study aimed to identify factors that explain the association of intraductal papillary mucinous neoplasms-pancreatic neuroendocrine tumors (IPMNs-PNETs), radiological characteristics, and factors that might guide therapy. METHODS: We performed a systematic review of the literature to search for articles on concurrent IPMN-PNET, mixed endocrine-exocrine pancreatic tumors, and/or PNET with an intraductal growth pattern. RESULTS: A review of the literature suggests that there is some confusion about association of IPMNs-PNETs. Regarding this association, the studies collected data from 32 patients. Eleven patients presented concurrent tumors, 9 mixed endocrine-exocrine tumors, and no data were available in the remaining 7. In addition, the relationship IPMN-PNET focuses not only on the coexistence of the 2 lesions, but also on the possibility of the intraductal growth of the endocrine lesion. In the literature, in 4 cases, the preoperative radiological diagnosis had been IPMN. CONCLUSIONS: Intraductal papillary mucinous neoplasms and PNETs may be associated in a number of scenarios. The association may be due to the concurrent existence of independent lesions, may be a mixed endocrine-exocrine tumor, or may be due to intraductal growth of the endocrine lesion. But the literature is confusing. It is not known whether the association is accidental or whether there is an etiological reason. Further studies are needed to investigate this scenario.

Elevated parathyroid hormone levels after successful parathyroidectomy for primary hyperparathyroidism: a clinical review.

INTRODUCTION: Surgery for primary hyperparathyroidism (PHPT) is traditionally deemed to be successful if serum calcium levels return to normal 6 months after parathyroidectomy. Regular monitoring of serum calcium and parathyroid hormone (PTH) in the follow-up of patients after parathyroidectomy for PHPT has drawn attention to the presence of a normocalcemic group of patients with elevated PTH (NCePTH) during the post-operative period. The etiological factors and mechanisms underlying this condition, its consequences, and the possibility of treatment are the object of this study. MATERIALS AND METHODS: We conducted an unlimited PubMed search updated on March 31, 2017, which yielded 1628 results. We selected 37 articles, 33 of which included cases of NCePTH in their series and 23 performed statistical studies to assess factors associated with NCePTH. RESULTS: The maximum mean prevalence of NCePTH in the various series was 23.5%, ranging from 3 to 46%. Many factors were associated with NCePTH. The most important were higher pre-operative PTH, low pre-operative 25 (OH) D3, lower pre-operative creatinine clearance and greater adenoma weight. The origin of NCePTH may be multifactorial, since several factors were implicated in the etiology. NCePTH does not seem to be related to an increase in PHPT recurrence, although this possibility should not be dismissed. Vitamin D deficiency should be corrected. Treatment with calcium supplements seems to be clearly beneficial. CONCLUSION: The prevalence of NCePTH is high. The causes of secondary hyperparathyroidism should be investigated carefully. Patients require treatment and long-term follow-up.

[Extrahepatic and extrapulmonary hydatidosis]. / Hidatidosis extrahepática y extrapulmonar.

BACKGROUND: Cystic echinococcosis is a zoonosis caused by larvae of the parasite Echinococcus that is endemic in many countries of the Mediterranean area. It can affect any organ, with the most common sites being liver (70%) and lung (20%). Splenic hydatid disease, despite being rare, is the third most common location. Other locations such as bone, skin, or kidney are exceptional. OBJECTIVE: To present our experience in extrahepatic and extrapulmonary hydatidosis. MATERIAL AND METHODS: Period: May 2007-December 2014. Health area: 251,000 inhabitants. During that period, a total of 136 patients with hydatid disease were evaluated in our Hepato-pancreatic-biliary Surgery Unit. Extrahepatic and extrapulmonary hydatid disease was found in 18 (13%) patients. A retrospective review was performed on all medical records, laboratory results, serology, diagnostic methods, and therapeutic measurements of all patients. An abdominal ultrasound and CT, as well as hydatid serology was also performed on all patients. RESULTS: The mean age of the patients was 44.5 years, with a range of 33-80 years. Half the patients (50%) had concomitant hepatic echinococcosis. Of the 18 patients with hydatid disease, 13 underwent surgery (radical surgery in 12 cases), and one underwent (endoscopic retrograde cholangiopancreatography)+puncture, aspiration, injection and re-aspiration. The remaining 4did not have surgery due to patient refusal (3), or advanced cancer (1). No recurrences have been observed. CONCLUSION: The best surgical treatment in these cases is closed total cystectomy to prevent recurrence, except in the spleen where splenectomy is preferred. Conservative techniques are indicated in cases of multiple hydatid disease and in patients with high surgical risk.

Calcificaciones cerebrales e hiperparatiroidismo primario / Brain calcifications and primary hyperparathyroidism

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