[Pyogenic liver abscess. Experience with 50 cases]. / Absceso hepático piogeno. Experiencia en 50 casos.

During the last years the diagnosis and treatment of pyogenic liver abscess has changed substantially. The aim of this work is to report a retrospective analysis of 50 patients aged 24 to 87 years old, that presented with a pyogenic liver abscess and were treated in the last 13 years. The sensitivity for diagnosis of ultrasound examination, CAT scan and angiography was 68, 89 and 75% respectively. The origin of the abscess was detected at the biliary tree in 46% and remained unknown in 38%. Thirty one patients were operated, 13 were subjected to percutaneous drainage and 5 were treated only with antimicrobials. Forty percent of patients had a septic complication and 4 (8%) died. Mean hospital stay was 31 days for operated patients and 21 for the rest. The abscess recurred in seven patients and two of these had a gallbladder carcinoma. It is concluded that percutaneous drainage is an alternative to surgical treatment that must be accompanied by a careful diagnostic workup.

[Choledochocele. Report of a case and review of the literature]. / Coledococele. Comunicación de un caso y revisión de la literatura.

We report a 29 years old man with a choledochocele or type III choledochal cyst, an extremely rare condition. This was found during a cholecystectomy using a transcystic intra operative cholangiogram. A transduodenal sphincteroplasty was performed. The cyst diameter was 1.5 cm approximately and two 1-2 mm stones were extracted from its lumen. The chemical composition of these was different from those located in the gallbladder. The postoperative period was uneventful and the patient remains asymptomatic.

[Vascular compression syndrome of the duodenum. Report of 2 cases]. / Síndrome de compresión vascular del duodeno. Communicación de 2 casos.

Two young female patients with the syndrome of vascular compression of the duodenum are reported. Both patients presented with a history of vomiting and weight loss. Barium examination of the gastrointestinal tract showed in both cases, marked stomach distention and obstruction of the third portion of the duodenum. In one patient, abdominal CT scan discarded other causes of extrinsic compression. Both patients were operated. The simpler and safer surgical procedure is the section of the Treitz ligament and duodenal liberation, which can be used in the majority of patients.

Biliary-tract cancer in Chile.

This epidemiological study in Chile shows a marked increase in biliary-tract cancer based on mortality data, from an age-adjusted rate (1970 world population) of 5.1 per 100,000 in 1970 to 12.0 per 100,000 in 1988. There is an increased risk of this cancer in all age groups but especially in young adults (15-44 years). The female ratio of 3:1 persists. The increase in biliary-tract cancer in 1970-1985 was particularly important for young women but occurred in all female age groups whereas in men it was mostly in the elderly (65 years and more) and less in the middle-aged (45-64 years); no changes were observed in young men. Regional differences have begun to be appreciated. One of the factors which may account for this impressive and unexpected increase is the remarkable decrease in cholecystectomy rates. Less than 20% of the 154% increase in biliary-tract cancer mortality in the period 1970-1985 could be attributed to population aging. Improvements in diagnostic methods did not appear to be an important contributing factor. Other factors that could affect this increase in the incidence to epidemic levels include: an increase in the prevalence of cholelithiasis, an increase in the number of typhoid carriers and possible environmental carcinogens.

Hypothalamic-pituitary gonadal axis in boys with primary hypothyroidism and macroorchidism.

Nine of 15 boys with severe long-standing primary hypothyroidism were found to have macroorchidism. All 15 patients had elevated thyroid-stimulating hormone levels. However, only those patients with testicular enlargement had striking elevations of serum prolactin and gonadotropin values. The response to gonadotropin-releasing hormone in our patients was blunted, in contradistinction to that of children with true precocious puberty. In spite of the elevated levels of luteinizing hormone, the serum testosterone levels were in the prepubertal range, explaining the lack of peripheral manifestations of androgenic effect. Improvement of testosterone secretion followed decreasing prolactin levels with bromocriptine administration, suggesting an inhibitory effect of prolactin on luteinizing hormone action at the Leydig cell. We conclude that testicular enlargement is the result of continuous follicle-stimulating hormone stimulation and that the term "true precocious puberty" is not appropriate in children with hypothyroidism and macroorchidism unless the hypothalamic-pituitary gonadal axis is shown to be at the pubertal stage.