Electroacupuncture efficacy in diabetic polyneuropathy: Study protocol for a double-blinded randomized controlled multicenter clinical trial.

BACKGROUND: Diabetic peripheral neuropathy (DPN) is the most common complication of type 2 diabetes mellitus (T2DM); its diagnosis and treatment are based on symptomatic improvement. However, as pharmacological therapy causes multiple adverse effects, the implementation of acupunctural techniques, such as electroacupuncture (EA) has been suggested as an alternative treatment. Nonetheless, there is a lack of scientific evidence, and its mechanisms are still unclear. We present the design and methodology of a new clinical randomized trial, that investigates the effectiveness of EA for the treatment of DPN. METHODS: This study is a four-armed, randomized, controlled, multicenter clinical trial (20-week intervention period, plus 12 weeks of follow-up after concluding intervention). A total of 48 T2DM patients with clinical signs and symptoms of DPN; and electrophysiological signs in the Nerve Conduction Study (NCS); will be treated by acupuncture specialists in outpatient units in Mexico City. Patients will be randomized in a 1:1 ratio to one of the following four groups: (a) short fibre DPN with EA, (b) short fibre DPN with sham EA, (c) axonal DPN with EA and (d) axonal DPN with sham EA treatment. The intervention will consist of 32 sessions, 20 min each, per patient over two cycles of intervention of 8 weeks each and a mid-term rest period of 4 weeks. The primary outcome will be NCS parameters, and secondary outcomes will include DPN-related symptoms and pain by Michigan Neuropathy Screening Instrument (MNSI), Michigan Diabetic Neuropathy Score (MDNS), Dolour Neuropatique Score (DN-4), Semmes-Westein monofilament, Numerical Rating Scale (NRS) for pain assessment, and the 36-item Short Form Health Survey (SF-36). To measure quality of life and improve oxidative stress, the inflammatory response; and genetic expression; will be analysed at the beginning and at the end of treatment. DISCUSSION: This study will be conducted to compare the efficacy of EA versus sham EA combined with conventional diabetic and neuropathic treatments if needed. EA may improve NCS, neuropathic pain and symptoms, oxidative stress, inflammatory response, and genetic expression, and it could be considered a potential coadjutant treatment for the management of DPN with a possible remyelinating effect. TRIAL REGISTRATION: ClinicalTrials.gov. NCT05521737 Registered on 30 August 2022. International Clinical Trials Registry Platform (ICTRP) ISRCTN97391213 Registered on 26 September 2022 [2b].

Impacto de la pandemia por COVID-19 sobre el trasplante hepático en la argentina. Otro daño colateral / Impact of COVID-19 pandemic in liver transplantation in Argentina. Other collateral damage

Resumen La pandemia COVID-19 declarada en marzo del 2020, ha generado preocupación mundial por su efecto en la salud de la población y el potencial colapso sanitario. La estrategia de "aplanar la curva" mediante el distanciamiento social permitió adaptar los recursos del sistema de salud a pacientes con COVID-19, pero no se pudo prever su repercusión en otras áreas de la salud. El objetivo de este trabajo fue analizar las consecuencias de la pandemia sobre el trasplante hepático en general y por hepatocarcinoma (HCC). Fueron realizados los siguientes estudios: a) un análisis retrospectivo utilizando datos del CRESI/INCUCAI para comparar ingreso en lista de espera, mortalidad en lista, donación y trasplante hepático desde 20/03 a 15/08, 2019 e igual periodo de 2020, y b) una encuesta a los centros de trasplante de mayor actividad trasplantológica para valorar el efecto de las medidas tomadas en diferentes situaciones institucionales y regionales. El primer análisis evidenció una disminución del 55% de los trasplantes hepáticos, con una reducción similar en la donación y en el ingreso a lista de espera hepática; mientras que el trasplante por HCC ascendió de 10% en 2019 a 22% en 2020. El segundo análisis, mostró que la tasa de ocupación de camas por pacientes COVID-19/semana fue variable: de 0.4% al 42.0%. El número de cirugías, hepato-bilio-pancreática, resección de HCC y trasplante hepático, se redujeron en 47%, 49%, 31% y 36% respectivamente. La reducción de la actividad trasplantológica afectó mayormente los centros con alta ocupación por COVID-19. El impacto final a largo plazo deberá evaluarse.

Abstract The COVID-19 pandemic declared in March 2020, has generated worldwide concern due to its effect on the health of the population and the potential health collapse. The strategy of "flattening the curve" through social distancing made it possible to adapt the resources of the health system to patients with COVID-19, but results in other areas of health could not be predicted. The objective of this work was to analyze the consequences of the pandemic on liver transplantation in general and for hepatocarcinoma (HCC). The following studies were carried out: a) a retrospective analysis using data from the CRESI / INCUCAI to compare admission to the waiting list, mortality on the list, donation and liver transplantation from 03/20 to 08/15, 2019 and the same period in 2020, and b) a survey of the transplant centers with the highest transplant activity to assess the effect of the measures taken in different institutional and regional situations. The first analysis showed a 55% decrease in liver transplants, with a similar reduction in donation and admission to the liver waiting list; while HCC transplantation rose from 10% in 2019 to 22% in 2020. The second analysis showed that the occupancy rate of beds by COVID-19 patients / week was variable: from 0.4% to 42.0%. The number of surgeries, hepato-bilio-pancreatic, resection of HCC and liver transplantation, were reduced by 47%, 49%, 31% and 36% respectively. The reduction in transplant activity mainly affected centers with high occupancy due to COVID-19. The final long-term outcome will need to be assessed.

[Impact of COVID-19 pandemic in liver transplantation in Argentina. Other collateral damage]. / Impacto de la pandemia por COVID-19 sobre el trasplante hepático en la Argentina. Otro daño colateral.

The COVID-19 pandemic declared in March 2020, has generated worldwide concern due to its effect on the health of the population and the potential health collapse. The strategy of "flattening the curve" through social distancing made it possible to adapt the resources of the health system to patients with COVID-19, but results in other areas of health could not be predicted. The objective of this work was to analyze the consequences of the pandemic on liver transplantation in general and for hepatocarcinoma (HCC). The following studies were carried out: a) a retrospective analysis using data from the CRESI / INCUCAI to compare admission to the waiting list, mortality on the list, donation and liver transplantation from 03/20 to 08/15, 2019 and the same period in 2020, and b) a survey of the transplant centers with the highest transplant activity to assess the effect of the measures taken in different institutional and regional situations. The first analysis showed a 55% decrease in liver transplants, with a similar reduction in donation and admission to the liver waiting list; while HCC transplantation rose from 10% in 2019 to 22% in 2020. The second analysis showed that the occupancy rate of beds by COVID-19 patients / week was variable: from 0.4% to 42.0%. The number of surgeries, hepato-bilio-pancreatic, resection of HCC and liver transplantation, were reduced by 47%, 49%, 31% and 36% respectively. The reduction in transplant activity mainly affected centers with high occupancy due to COVID-19. The final long-term outcome will need to be assessed.

La pandemia COVID-19 declarada en marzo del 2020, ha generado preocupación mundial por su efecto en la salud de la población y el potencial colapso sanitario. La estrategia de "aplanar la curva" mediante el distanciamiento social permitió adaptar los recursos del sistema de salud a pacientes con COVID-19, pero no se pudo prever su repercusión en otras áreas de la salud. El objetivo de este trabajo fue analizar las consecuencias de la pandemia sobre el trasplante hepático en general y por hepatocarcinoma (HCC). Fueron realizados los siguientes estudios: a) un análisis retrospectivo utilizando datos del CRESI/INCUCAI para comparar ingreso en lista de espera, mortalidad en lista, donación y trasplante hepático desde 20/03 a 15/08, 2019 e igual periodo de 2020, y b) una encuesta a los centros de trasplante de mayor actividad trasplantológica para valorar el efecto de las medidas tomadas en diferentes situaciones institucionales y regionales. El primer análisis evidenció una disminución del 55% de los trasplantes hepáticos, con una reducción similar en la donación y en el ingreso a lista de espera hepática; mientras que el trasplante por HCC ascendió de 10% en 2019 a 22% en 2020. El segundo análisis, mostró que la tasa de ocupación de camas por pacientes COVID-19/semana fue variable: de 0.4% al 42.0%. El número de cirugías, hepato-bilio-pancreática, resección de HCC y trasplante hepático, se redujeron en 47%, 49%, 31% y 36% respectivamente. La reducción de la actividad trasplantológica afectó mayormente los centros con alta ocupación por COVID-19. El impacto final a largo plazo deberá evaluarse.

Identifying patients at higher risk of hepatocellular carcinoma recurrence after liver transplantation in a multicenter cohort study from Argentina.

BACKGROUND AND AIM: The Up-to-7 criteria on the basis of the explanted liver features categorize patients at higher risk of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). The aim of this study was to propose a novel pretransplant scoring system to predict recurrence including pre-LT data. PATIENTS AND METHODS: From 763 consecutive adult patients who underwent transplantation in four LT centers from Argentina, 124 patients with HCC were included. A scoring system was developed in 87 patients from pre-LT risk factors for recurrence as determined by hazard ratios (HRs) from a multivariate Cox regression analysis. RESULTS: Overall survival and recurrence rates at 5 years were 63.3 and 13.7%, respectively, during a follow-up period of 3.5±2.2 years. Variables associated with HCC recurrence on multivariate analysis were α-fetoprotein more than 100 ng/ml (HR=5.6, P=0.001) and tumor beyond Up-to-7 imaging criteria (HR=6.3, P=0.001). Bootstrap validation showed that overfitting was negligible. Scoring points were assigned as follows (0-2 points): pre-LT α-fetoprotein more than 100 ng/ml (presence=1 point, absence=0 point), and tumor beyond Up-to-7 imaging criteria (presence=1 point, absence=0 point). AUROC curve indicated a c-statistic of 0.74 (0.58-0.88, P=0.003). Two distinct subgroups of patients were identified with a cut-off more than or equal to 1 point (62% sensitivity and 82% specificity): low risk (0 point) and high risk (1-2 points). The 5-year recurrence rate was 9.4 and 44.5% (P=0.0001) and the 5-year overall survival was 78.1 and 34.8% (P=0.0001) in the low-risk and high-risk groups, respectively. CONCLUSION: This scoring model may be a useful additional tool for HCC recurrence risk stratification before LT. Prospective studies are needed to evaluate our model.

Fulminant presentation of autoimmune hepatitis: clinical features and early predictors of corticosteroid treatment failure.

BACKGROUND AND AIMS: Classical features of autoimmune hepatitis (AIH) may be altered during the abrupt onset of the disease. Corticosteroid therapy can be life-saving, but its use in the fulminant presentation of AIH (F-AIH) remains controversial. We aimed to assess the clinical features of patients with F-AIH and to describe the role of corticosteroids in this population. PATIENTS AND METHODS: We retrospectively analyzed 154 adult patients with fulminant hepatic failure who were admitted to six liver transplantation (LT) programs. The AIH simplified criteria were used to identify patients with F-AIH. RESULTS: We identified 40 (26%) patients with F-AIH. Compared with other etiologies, patients with F-AIH presented a longer interval from jaundice to encephalopathy (26 vs. 16 days, P=0.02) and a lower Model for End-Stage Liver Disease (MELD) score on admission (29 vs. 33, P=0.002). Overall, 25 (62%) patients with F-AIH underwent LT, eight (20%) patients survived, and seven (18%) died without LT. Seventeen patients received corticosteroids therapy, of whom seven (41%) survived without LT. Among the treated patients, higher MELD score and encephalopathy grade of 3 or more were associated significantly with corticosteroid failure. CONCLUSION: Patients with F-AIH have a more indolent presentation compared with the non-F-AIH population. Altogether, only eight (20%) patients presenting with F-AIH survived without LT. A subset of patients with F-AIH and an initial MELD score less than 27 and low-grade hepatic encephalopathy might benefit from administration of corticosteroids.

Screening for liver cancer during transplant waiting list: a multicenter study from South America.

BACKGROUND AND AIMS: Surveillance during liver transplantation (LT) waiting list has scarcely been reported in South America. We aimed to describe hepatocellular carcinoma (HCC) surveillance during the LT waiting list in the daily practice. PATIENTS AND METHODS: A multicenter retrospective analysis in cirrhotic patients was carried out. All patients underwent an ultrasound (US) every 6 months and the last pre-LT US was compared with explanted liver findings. A false-negative case was considered when incidentally found HCC (iHCC) was detected, whereas a false-positive case was considered when HCC diagnosed before LT (cHCC) was not confirmed in the explanted liver. US performance was assessed after excluding cHCC patients referred to transplant evaluation. RESULTS: Of 643 patients, 129 had HCC, of whom 92 had cHCC (71.3%) and 37 had iHCC (28.7%). Five patients (5.4%) had nonconfirmed cHCC (n=3 regenerative nodules, n=1 biliary hamartoma, and n=1 cholangiocarcinoma). Patients with iHCC had a higher MELD score (23±10 vs. 15±10; P<0.0001), and were more frequently Child-Pugh C (62.2 vs. 36.6%; P=0.006) compared with patients with cHCC. The number of US performed during waiting list was 1.7±1.6 (median 1.0). During transplant waiting list, the sensitivity and specificity of US were 33 and 99%, with positive and negative predictive values of 0.89 and 0.93, respectively. Multivariate analysis showed that the strongest variable related to iHCC finding was pre-LT Child-Pugh C status (OR 3.5; P=0.004). CONCLUSION: Screening for liver cancer remains an important issue during transplant waiting list. However, the US screening method should be reviewed particularly for Child-Pugh C patients.

Fibrosis progression in maintenance liver transplant patients with hepatitis C recurrence: a randomised study of everolimus vs. calcineurin inhibitors.

BACKGROUND & AIMS: Robust clinical data evaluating fibrosis progression in hepatitis C virus (HCV) liver transplant patients receiving an mTOR inhibitor vs. calcineurin inhibitor (CNI) are lacking. To evaluate fibrosis progression in maintenance liver transplant patients receiving everolimus- or CNI-based immunosuppression. METHODS: In a randomised, multicentre, open-label study, 43 maintenance liver transplant patients with recurrent HCV infection were randomised to continue CNI-based immunosuppression or switch to everolimus. RESULTS: For patients with biopsy data at month 12, mean Ishak-Knodell fibrosis score at baseline was 2.6 ± 0.9 (n = 14) with everolimus vs. 1.9 ± 1.1 (n = 18) with CNI (P = 0.043), and 1.9 ± 1.2 vs. 2.2 ± 1.3 at month 12. Ishak-Knodell fibrosis score decreased from baseline to month 12 by a mean of -0.7 ± 1.1 with everolimus, but increased by 0.2 ± 1.2 with CNI (P = 0.046). No acute rejection or graft losses occurred up to month 12. Estimated GFR at month 12 was 65.6 ml/min/1.73 m² with everolimus and 62.2 ml/min/1.73 m² with CNI [mean difference 3.4 ml/min/1.73 m² compared to CNI control group, 95% CI -4.9, 11.8 ml/min/1.73 m², P = 0.411 (analysis of covariance adjusting for baseline GFR)]. Adverse events occurred in 95.5% of everolimus patients and 71.4% of CNI patients (serious adverse events 31.8% and 0.0%, respectively). Adverse events led to everolimus discontinuation in five patients (22.7%). CONCLUSIONS: This exploratory study suggests that conversion from CNI to everolimus reduces progression of liver fibrosis, and preserves renal function without jeopardising efficacy in liver transplant recipients with recurrent HCV, but is associated with a higher incidence of adverse events and serious adverse events. These preliminary findings merit examination in a larger trial.

Changing etiologies and outcomes of acute liver failure: perspectives from 6 transplant centers in Argentina.

There is significant geographic variation in the etiologies and prognoses of acute liver failure (ALF). The aims of the present study were to determine the causes and short-term outcomes of ALF in Argentina, to evaluate the performance of prognostic criteria, and to identify clinical prognostic factors of death. We performed a retrospective analysis of 154 adult patients with ALF who were admitted to 6 liver transplantation (LT) programs between June 2005 and December 2011. The most frequent causes of ALF were viral hepatitis B (46 patients or 30%), autoimmune hepatitis (AIH; 40 patients or 26%), and indeterminate causes (40 patients or 26%). No acetaminophen (ACM) overdose was reported. One hundred and twenty one patients (78%) were included on the waiting list, and LT was performed for 83 patients (54%). Overall survival rate is now corected to 73%. Multivariate logistic regression identified 2 independent variables associated with adverse outcomes on admission: a Model for End-Stage Liver Disease (MELD) score ≥ 29 and an encephalopathy grade ≥ 3. In a direct comparison using a receiving operating characteristic curve analysis, the MELD score [C statistic = 0.830, 95% confidence interval (CI) = 0.73-0.93] had better prognostic accuracy for predicting outcomes than the Clichy criteria (C statistic = 0.719, 95% CI = 0.58-0.85) or the King's College criteria (C statistic = 0.631, 95% CI = 0.49-0.77). In conclusion, hepatitis B and AIH were the most frequent causes of fulminant hepatic failure in our series, and no cases of ACM overdosing were identified. A MELD score ≥ 29 and an encephalopathy grade ≥ 3 at admission were associated with death. The MELD score at admission showed the highest prognostic accuracy.

Geographical variation in human papillomavirus prevalence in Mexican women with normal cytology.

OBJECTIVE: To determine the prevalence of human papillomavirus (HPV) infection and genotype distribution in Mexican women with similar lifestyles from two geographical regions who receive medical care from the Mexican Navy Health System, and to identify the associated sociodemographic and reproductive characteristics. METHODS: Cervical swabs from 671 women, beneficiaries of the Mexican Navy Health System, from two distinct southern coast regions of Mexico, were analyzed. Data were obtained regarding sociodemographic variables and sexual and reproductive history. For HPV detection and typing, PCR with general primers and direct sequencing were performed on extracted DNA. Association with clinical variables was evaluated. RESULTS: Most patients had a normal cytology or low-grade intraepithelial neoplasia. A high prevalence of HPV was found (43.6%), with a significant difference between the two regions studied from the southwest Pacific coast of Mexico (37.6% in Acapulco, Guerrero vs. 49.7% in Lázaro Cárdenas, Michoacán). Some differences were also found associated to HPV type distribution, particularly related to genotypes 18, 58, and 53. Factors influencing these differences could not be identified with the analysis of typical risk factors linked to the acquisition of an HPV infection. CONCLUSIONS: Regional differences in HPV prevalence and distribution show an apparent geographic boundary between the studied populations that deserves further analysis, taking into account other factors such as those related to the sexual partners.

Model for end-stage liver disease exceptions committee activity in Argentina: does it provide justice and equity among adult patients waiting for a liver transplant?

BACKGROUND: In 2005, the model of end-stage liver disease (MELD)-based allocation system was adopted to assess potential liver transplant (LT) recipients in Argentina. The aim of the present study was to revise the activity of the MELD Exception Experts Committee. METHODS: Between 2005 and 2009, 1623 patients were listed for LT. Regulation provides extra-MELD points for amyloidosis, hepatopulmonary syndrome (HPS) and T(2) hepatocellular carcinoma (T(2) HCC). Centres could also request priority for other situations. Using a prospective database, we identified patients in whom priority points were requested. Pathology reports of explanted livers were analysed for patients with T(2) HCC. RESULTS: From 234 out of 1623 (14.4%) requests, the overall approval rate was 60.2% including: 2 amyloidosis, 6 HPS, 111 T(2) HCC and 22 non-regulated situations. Of the 111 patients with T(2) HCC, 6 died (5.4%), 8 had tumour progression (7.2%), 94 were transplanted (84.2%) and 3 are still waiting. An explants correlation showed that presumed diagnosis of T(2) HCC was incorrect in 20/94 (22%) and was correct in only 41/94 (43%) cases being T(1) HCC in 9 and T(3) HCC in 23. CONCLUSIONS: MELD exceptions are frequently requested in Argentina. Unfortunately, most receiving priority points for T(2) HCC benefited by medical error or imaging limitations. An intense review process is urgently needed to maintain equity and justice in the allocation system.

Experiencia en transplante hepático con conservación de vena cava nativa: técnica de Piggy Back / Experience in liver transplantation with preservation of native vena cava: tTechnique of Piggy Back

Objetivo: Analizar ventajas comparativas entre el procedimiento del Transplante Ortotópico de Hígado con técnica convencional con by pass veno-venoso(BPW) y transplante hepático con preservación de vena cava nativa o técnica de Piggy-Back )PB). Lugar de Aplicación: Hospital de Comunidad y Sanatorio Privado de alta complejidad. Diseño: Estudio retrospectivo, descriptivo, clínico. Población: Pacientes adultos y pedíatricos tratados con transplante hepático. Material y Métodos: Se analizaron retrospectivamente 162 transplantes ortotópicos de hígado en 148 pacientes, divididos en dos grupos: inicialmente se realizó la técnica clásica utilizando by pass veno venoso con bomba centrífuga grupo BPW, y a partir de 2004 se preservó la vena cava nativa con técnica de Piggy-Back grupo PB. La edad promedio fue de 44,39 años, rango de 4 a 69 años. Los donantes fueron cadavéricos en 161 casos, la ablación con técnica rápida y preservados con Solución de Wisconsin (Viaspan), el último fue Donante vivo Emparentado. Se analizaron variables hemodinámicas operatorias, tiempo de cirugía y de isquemia, consumo de hemocomponentes, complicaciones propias del PB, mortalidad y supervivencia. Resultados: hubo una ditribución igual para ambos sexos; no existiendo diferencia en el promedio de edad entre los grupos; el tiempo de cirugía, tiempo de isquemia, consumo de glóbulos rojos, plasma fresco y crioprecipitados fue menor para el grupo PB con una diferencia estadísticamente significativa (p:0.0001). En cambio, el consumo de plaquetas y los patrones hemodinámicos no presentaron diferencias significativas entre los grupos. No se presentaron las complicaciones descriptas con la utilización de la preservación de vena cava (PB). La mortalidad fue menor para el grupo PB, mientras que la supervivencia no arrojó diferencias significativas entre los grupos. Conclusiones: La técnica de preservación de vena cava nativa o procedimiento de Piggy-Back demostró ser una alternativa eficaz...

Experiencia en transplante hepático con conservación de vena cava nativa: técnica de Piggy Back / Experience in liver transplantation with preservation of native vena cava: tTechnique of Piggy Back

Objetivo: Analizar ventajas comparativas entre el procedimiento del Transplante Ortotópico de Hígado con técnica convencional con by pass veno-venoso(BPW) y transplante hepático con preservación de vena cava nativa o técnica de Piggy-Back )PB). Lugar de Aplicación: Hospital de Comunidad y Sanatorio Privado de alta complejidad. Diseño: Estudio retrospectivo, descriptivo, clínico. Población: Pacientes adultos y pedíatricos tratados con transplante hepático. Material y Métodos: Se analizaron retrospectivamente 162 transplantes ortotópicos de hígado en 148 pacientes, divididos en dos grupos: inicialmente se realizó la técnica clásica utilizando by pass veno venoso con bomba centrífuga grupo BPW, y a partir de 2004 se preservó la vena cava nativa con técnica de Piggy-Back grupo PB. La edad promedio fue de 44,39 años, rango de 4 a 69 años. Los donantes fueron cadavéricos en 161 casos, la ablación con técnica rápida y preservados con Solución de Wisconsin (Viaspan), el último fue Donante vivo Emparentado. Se analizaron variables hemodinámicas operatorias, tiempo de cirugía y de isquemia, consumo de hemocomponentes, complicaciones propias del PB, mortalidad y supervivencia. Resultados: hubo una ditribución igual para ambos sexos; no existiendo diferencia en el promedio de edad entre los grupos; el tiempo de cirugía, tiempo de isquemia, consumo de glóbulos rojos, plasma fresco y crioprecipitados fue menor para el grupo PB con una diferencia estadísticamente significativa (p:0.0001). En cambio, el consumo de plaquetas y los patrones hemodinámicos no presentaron diferencias significativas entre los grupos. No se presentaron las complicaciones descriptas con la utilización de la preservación de vena cava (PB). La mortalidad fue menor para el grupo PB, mientras que la supervivencia no arrojó diferencias significativas entre los grupos. Conclusiones: La técnica de preservación de vena cava nativa o procedimiento de Piggy-Back demostró ser una alternativa eficaz...(AU)

Hemangioma cavernoso hepático pediculado: presentacion de un caso y revisión de la literatura / Pedunculated cavernous hepatic hemangioma: a case report and literature review

Introducción: El hemangioma es el tumor hepático más frecuente, con una incidencia en la población que varía entre el 1 y el 20% en series de autopsias (1). Los hemangiomas se dividen en capilares, cuando su diámetro es menor de 4 cms. y cavernosos cuando son mayores de 4 cms. Existen formas de presentación atípica de hemangiomas. Una de ellas es el hemangioma pediculado, muy raro y del cual hasta la fecha sólo se registran 17 casos reportados en la literatura mundial. El objetivo es presentar un nuevo caso de localización atípica de un hemangioma, con presentación pediculada en la cirugía y atípico también en su presentación por imágenes, realizando asimismo una revisión bibliográfica. Presentación de caso: Paciente de 35 años de edad, de sexo masculino, sin antecedentes médico-quirurgicos, con saciedad gástrica precoz y dolor abdominal epigástrico de leve intensidad. El examen físico fue normal, presentando un abdomen blando, depresible y no doloroso a la palpación, sin hepatomegalia ni esplenomegalia. Los análisis de laboratorio de rutina, hepatograma y pruebas de coagulación fueron normales. Los estudios por imágenes fueron ecografía, tomografía axial computada y resonancia magnética nuclear de abdomen, estos últimos con inyección de contraste. En todos se identificó una masa en relación con el lóbulo caudado del hígado, con área central fibrótica, sin refuerzo en forma de ovillos y planteando el diagnóstico de hamangioma atípico o de adenoma. La cirugía reveló la presencia de mangioma pediculado del segmento hepático 1, con diagnóstico anatomopatológico confirmado. Discusión: Si bien raros, la presencia de tumores de aspecto exofitico, creciendo por fuera de la cápsula hepática, deben hacer sospechar la existencia de lesiones tipo hemangiomas con la necesidad de efectuar diagnósticos diferenciales con el adenoma y con el hepatocarcinoma, principalmente...

Tratamiento de la coledocolitiasis por vía endoscópica / Choledocolithiasis treatment by endoscopic approach

Objetivo: Evaluar la colangigrafía endoscópica retrógrada (CER) como método diagnóstico de la litiasis coledociana y la esfinterotomía endoscópica (EE) como recurso terapéutico en pacientes que van a ser sometidos a colecistectomía laparoscópica, y en aquellos con sospecha de litiasis residual, y así mismo compararlos con otros procedimientos actuales tal como la exploración translaparoscópica. Lugar de aplicación: Instituto de Enfermedades Digestivas, Hospital Italiano de Córdoba. Diseño: Estudio retrospectivo. Población: 161 CER en 163 pacientes, con evidencia o sospecha de coledocolitiasis; 92 CER se realizaron previa a la colecistectomía (CCT) laparoscópica y 69 por litiasis residual. Resultados: De los 163 pacientes, se logró realizar CER en 161. En forma preoperatoria en 92 pacientes por evidencia o sospecha de coledocolitiasis, corroborando litiasis en la via biliar en 62 (67,39 por ciento). Se practicó EE en todos, (100 por ciento de efectividad). En 71 pacientes con evidencia de litiasis residual, se practicó el procedimiento en 69 (97,18 por ciento), encontrándose coledocolitiasis en 59 (85,50 por ciento) y se efectuó EE en 58 de ellos (98,30 por ciento de efectividad). Sobre un total de 120 EE, las complicaciones fueron del 8,68 por ciento, 14 pacientes, falleció 1 por pancreatitis (0,62 por ciento). Conclusiones: En nuestra experiencia, la CER con eventual EE fue un procedimiento eficaz y seguro para el tratamiento de la coledocolitiasis, ya sea previa a la CCT laparoscópica; o en las litiasis residuales

Tratamiento de la coledocolitiasis por vía endoscópica / Choledocolithiasis treatment by endoscopic approach

Objetivo: Evaluar la colangigrafía endoscópica retrógrada (CER) como método diagnóstico de la litiasis coledociana y la esfinterotomía endoscópica (EE) como recurso terapéutico en pacientes que van a ser sometidos a colecistectomía laparoscópica, y en aquellos con sospecha de litiasis residual, y así mismo compararlos con otros procedimientos actuales tal como la exploración translaparoscópica. Lugar de aplicación: Instituto de Enfermedades Digestivas, Hospital Italiano de Córdoba. Diseño: Estudio retrospectivo. Población: 161 CER en 163 pacientes, con evidencia o sospecha de coledocolitiasis; 92 CER se realizaron previa a la colecistectomía (CCT) laparoscópica y 69 por litiasis residual. Resultados: De los 163 pacientes, se logró realizar CER en 161. En forma preoperatoria en 92 pacientes por evidencia o sospecha de coledocolitiasis, corroborando litiasis en la via biliar en 62 (67,39 por ciento). Se practicó EE en todos, (100 por ciento de efectividad). En 71 pacientes con evidencia de litiasis residual, se practicó el procedimiento en 69 (97,18 por ciento), encontrándose coledocolitiasis en 59 (85,50 por ciento) y se efectuó EE en 58 de ellos (98,30 por ciento de efectividad). Sobre un total de 120 EE, las complicaciones fueron del 8,68 por ciento, 14 pacientes, falleció 1 por pancreatitis (0,62 por ciento). Conclusiones: En nuestra experiencia, la CER con eventual EE fue un procedimiento eficaz y seguro para el tratamiento de la coledocolitiasis, ya sea previa a la CCT laparoscópica; o en las litiasis residuales (AU)

Fistulas anales altas: tratamiento por el procedimiento de Robles y Picot / High anal fistulas: treatment of Robles and Picot procedure

Se analiza el procedimiento de Robles y Picot, indicado para el tratamiento de las fístulas anales altas. Partiendo de la publicación original de los citados autores, se hace un seguimiento histórico y evolutivo, analizando algunas propuestas de modificaciones al método para concluir asignando todo su valor a los fundamentos de la técnica primitiva. Como las fístulas anales "altas" (supra y extraesfinterianas) son poco frecuentes, quienes apelaron al método de Robles y Picot lo emplearon entre el 6 y 24 por ciento del total de sus pacientes sometidos a fistulectomías, con muy bajo (0 a 4 por ciento) número de recidivas, en comparación con otro tipo de técnicas. Se hace referencia a veintitrés casos operados con estrictas indicaciones y muy buenos resultados postoperatorios.