Laparoscopia diagnóstica en el siglo XX. Su evolución / No disponible

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Chronic liver disease: comparison of ultrasound patterns with laparoscopy and biopsy.

We studied the correlation of ultrasound patterns with laparoscopy and biopsy results in 140 patients with chronic liver disease (CLD). Of the 23 patients with a normal ultrasound pattern (N), biopsies revealed CLD in 18; in the 22 patients with unspecified hepatomegaly (H), biopsies disclosed CLD in 20; and in the 64 patients with a homogeneous bright pattern (HB), biopsies showed CLD in 62. All 22 cases of heterogeneous bright pattern (HTB) and all 9 patients with nodular pattern (ND) had CLD. In conclusion, it appears that the HTB and nodular ultrasound patterns confirm the presence of CLD, the HB pattern is suggestive of CLD, but diagnosis of CLD cannot be made from N and H patterns.

[Thorotrast-related hepatosis]. / Thorotrastosis hepática.

The clinical, pathological and laparoscopic data of five patients with liver disease due to Thorotrast are presented. Laparoscopy showed various degrees of fibrosis and nodularity. One patient developed cholangiocarcinoma and two showed dysplasia at biopsy. The laparoscopic appearance is practically diagnostic.

[The accidents and complications of laparoscopy. A review of 8,915 cases]. / Accidentes y complicaciones de la laparoscopia. Revisión de 8.915 casos.

Complications occurring in 8,915 laparoscopies done during 1957-1991 are analyzed. Complications were classified as major or minor, according to the need of surgical intervention for their management, and also in relation to pneumoperitoneum, introduction of the laparoscope, during the examination or after laparoscopy. The total number of major accidents was 54 (0.60%). Half of them as a consequence of the instrumentation or of liver biopsy. There were 442 minor complications (4.96%). Mortality included 10 patients (0.11%) as a sequel of uncontrolled haemorrhage, 5 of them after liver biopsy. The complications of laparoscopy cannot be ignored; as all invasive techniques it may have a risk, even in the most expert hands. Half of the major accidents and of the mortality were due to complications from liver biopsy.

[Focal nodular hyperplasia of the liver with malignant endoscopy appearance]. / Hiperplasia nodular focal del hígado con apariencia endoscópica maligna.

We report the case of a male patient, 49 years of age, who was admitted to our hospital to clarify the diagnosis of a solid liver tumor of the left lobe of the liver which had been made by image methods (U.S., scan and scintigraphy). Laparoscopy showed an isolated tumor emerging from the left lobe of the liver featuring hypervascularity and umbilication at the top. A visual diagnosis of malignancy was made which was not confirmed neither by biopsy nor the cytological examination. Liver resection was undertaken, and a diagnosis of nodular hyperplasia was made by the pathologist. We have never encountered before this endoscopic appearance of focal nodular hyperplasia either in our own experience or in the search of the literature.

[Usefulness of laparoscopy as a second-look method in neoplasms of the ovary]. / Utilidad de la laparoscopia como método de "second-look" en las neoplasias de ovario.

The usefulness of second-look laparoscopy in the follow-up of ovarian cancer is evaluated. This procedure has been included in the protocol for the treatment of these tumors. During the period 1980-1987 a total of 3038 laparoscopies were performed; 205 (7%) were for ovarian cancer. We present the results of 72 explorations in 52 patients; after surgery and chemotherapy all of them were in complete remission. 44 explorations were second-look laparoscopy and 28 third-look laparoscopy. All the examinations were done under local anesthesia. There were two failures due to the presence of adhesions secondary to the previous surgery which prevented the pneumoperitoneum. In 35 (48.6%) explorations a neoplasia was found and a laparotomy was avoided. There were 31% (4/13) false negative in second-look laparotomy post-laparoscopy. The correlation between gross and microscopic findings was excellent. There were no complications in spite of the previous abdominal surgery. We recommend second-look laparoscopy in patients under treatment of ovarian cancer which in our experience avoided laparotomy almost in half of the cases; no complications were observed and the procedure was well-tolerated.

Laparoscopic cytology--an evaluation.

Cytological sampling by abrasion and/or aspiration was done in a consecutive series of 927 patients at the time of laparoscopy. Cytological examination confirmed the diagnosis of malignancy in 312 out of 335 cases of primary or secondary liver cancer (93.1%). Biopsy was positive in 262 out of 303 patients (86.4%). The combined use of cytology and biopsy provided a positive diagnostic accuracy of 97.6%). The cytological report was positive in 215 out of 239 (89.9%) proven extrahepatic malignancies (gallbladder, gynecological, peritoneal). Biopsy was positive in 180 out of 199 cases (90.4%). The combined use of cytology and biopsy provided an accuracy of 95.8%). There was only one false positive diagnosis of malignancy. The sensitivity of laparoscopic cytology was 93.1% and its specificity 100% in liver disease. Sensitivity was 90.3% and specificity 99.4% in other types of abdominal cancer. In these series, cytological examination added 15.6% positive results (liver) and 11.7% (other lesions) to those of biopsy, which was not performed in 89 patients in whom it was considered too risky or technically too difficult.