[Treatment with extracorporeal shockwave (ESWL) in lithiasis of the common bile duct]. / Tratamiento con ondas de choque extracorporeas (ESWL) en la litiasis de la viá biliar principal.

During 2 years (1988-1990) 373 patients were studied by ERCP in order to establish the etiology of cholestasis. Biliary duct stones were found in 190. Thirty-nine were treated surgically and 151 by endoscopic sphincterotomy and different extraction techniques. In 12 patients of the last group (9 women, 3 men, mean age 71 years, 9 had undergone cholecystectomy and 3 has their gallbladders in situ), ESWL was used as additional treatment to fragment the stones that could not be removed with the Dormia basket or with mechanical lithotripsy. Four patients had only one stone in their biliary ducts, 5 had two, and 3 had more than two stones. The size of the stones was greater than 2.5 cm. in 11 patients, only 1 patient had a 1 cm. diameter stone. In each session between 1200 and 5000 shock waves were administered (mean 1400). In 8 patients (66%), the fragmentation was successful to achieve their spontaneous passage or their extraction with a basket. In 4 who received only one session of ESWL, the procedure failed to break the stones. Side effects were observed in 3 cases: mild haemobilia in 1, skin petechiae and pain in 2 patients. No complications were observed in the long term follow-up. We conclude that ESWL is useful in the treatment of biliary duct stones which cannot be extracted through sphincterotomy with a basket or mechanical lithotripsy.

Vascular and leptomeningeal projections of the subcommissural organ in reptiles. Lectin-histochemical, immunocytochemical, and ultrastructural studies.

In the snake, Natrix maura, and the turtle, Mauremys caspica, the basal processes of the ependymal cells of the subcommissural organ project toward the local blood vessels and the leptomeninges. These processes and their endings were studied using aldehyde-fuchsin (AF), periodic-acid Schiff (PAS), periodic-acid silver-methenamine (PA-SM), concanavalin A (ConA), wheat germ agglutinin (WGA), immunoperoxidase staining (employing an antiserum against bovine Reissner's fiber; AFRU), and conventional transmission electron microscopy. For the purposes of comparison, the ventricular cell pole was also analyzed. The secretory material located in the ventricular cell pole and that present in ependymal endings had only a few staining properties in common, i.e., affinity for AF, ConA, and AFRU at a dilution of 1:1000. On the other hand, PAS, PA-SM, WGA, and AFRU at a dilution of 1:200,000 stained the apical (ventricular) secretory material but not the secretory material of the ependymal processes. The histochemical features of the secretory material located in the terminals of ependymal processes, as well as the presence at these sites of numerous rough-endoplasmic-reticulum cisternae and secretory granules, suggest that secretory material may be synthesized in these terminals. The probable fate of this material, i.e., release to the perivascular and leptomeningeal spaces or transport to the ventricular cell pole, is discussed.

Immunocytochemical study of the hypothalamic magnocellular neurosecretory nuclei of the snake Natrix maura and the turtle Mauremys caspica.

An immunocytochemical study of the magnocellular neurosecretory nuclei was performed in the snake Natrix maura and the turtle Mauremys caspica by use of antisera against: (1) a mixture of both bovine neurophysins, (2) bovine oxytocin-neurophysin, (3) arginine vasotocin, and (4) mesotocin. Arginine vasotocin- and mesotocin-immunoreactivities were localized in individual neurons of the supraoptic and paraventricular nuclei, with a distinct pattern of distribution in both species. The same cells appeared to be stained by the anti-oxytocin-neurophysin and antimesotocin sera. The supraoptic nucleus can be subdivided into rostral medial and caudal portions. In N. maura, but not in M. caspica, neurophysin-immunoreactive neurons were found in the retrochiasmatic nucleus. No immunoreactive elements were seen in the suprachiasmatic nucleus of both species after the use of any of the antisera. A dorsolateral aggregation of neurophysin-containing cells, localized over the lateral forebrain bundle, was present in both species. Magnocellular and parvocellular neurophysin-immunoreactive neurons were present in the paraventricular nucleus of both species. In the turtle, the paraventricular neurons were arranged into four distinct layers parallel to the ependyma; these neurons were bipolar with the major axis perpendicular to the ventricle, and many of them projected processes toward the cerebrospinal-fluid compartment. In N. maura a group of large neurons of the paraventricular nucleus was found in a very lateral position. The posterior lobe of the hypophysis and the external zone of the median eminence contained arginine vasotocin- and mesotocin-immunoreactive nerve fibers. The lamina termialis of both species was supplied with a dense bundle of fibers containing immunoreactive neurophysin. Neurophysin-immunoreactive fibers were also present in the septum, some telencephalic regions, including the cortex and the olfactory tubercule, in the paraventricular organ, and the periventricular and periaqueductal gray of the brainstem.

Enfermedad de Cruveilhier-Baumgarten. / Cruveilhier-Baumgarten's disease

Se describe un caso de enfermedad de Cruveilhier-Baumgarten en un paciente del sexo masculino de 38 anos de edad con un sindrome de hipertensao portal, circulacion colateral periumbilical en forma de cabeza de medusa y un higado sano. Se revisa la bibliografia a nuestro alcance existente hasta el momento, sumados al presente hacen un total de 33 observaciones.Asimismo se analizan las diferentes teorias patogenicas propuestas por los autores citados y se detallan los pasos diagnosticos para esta enfermedad: angiografia selectiva del tronco celiaco y arteria mesenterica superior con retorno venoso esplenomesentericoportal, esplenoportografia manometria esplenica y suprahepatica en oclusion y libre y estudio histologico del higado tanto con microscopia de luz como electronica. Se consideran las distintas posibilidades terapeuticas y las razones que conducen en este paciente a realizar una esplenectomia con anastomosis esplenorrenal terminolateral

Tratamiento con ondas de choque extracorporeas (ESWL) en la litiasis de la via biliar principal / Treatment with extracorporeal shockwave in lithiasis of the common bile duct

En el transcurso de 2 años (1988-1990) se estudiaron 373 pacientes por ERCP para determinar la etiología de una colestasis. En 190 se encontraron cálculos en la vía biliar principal. Treinta y nueve fueron tratados quirúrgicamente y en 151 se efectuó EPE y diferentes técnicas de extracción. En 12 pacientes de este grupo de utilizó como tratamiento adicional ESWL para fragmentar cálculos que ho habían podido ser extraídos con canastilla o litotripsia mecánica. De los 12, 9 eran mujeres y 3 varones con un promedio de edad de 71 años (rango 32-90). Nueve estaban colecistectomizados y 3 tenían vesícula. La litiasis coledociana fue única en 4, y 5 tenían 2 cálculos. En los restantes se comprobaron 3 o más litos. El diámetro de los cálculos superó los 2,5 cm. en 11 pacientes. Sólo en 1 fue de 1 cm. Se efectuaron entre 1200 y 5000 disparos en cada sesión, con un promedio de 1400. En 8 pacientes (66%) la fragmentación permitió la evaluación completa, espontánea o instrumental. Se fracasó en 4 casos que recibieron una sola sesión de ESWL. Se registró hematobilia leve en 1 paciente y equimosis de piel y dolor en 2. En los 8 pacientes en los que se consiguió la eliminación total de los cálculos no hubo complicaciones alejadas. El empleo de ESWL resultó ser un recursos terapéutico útil en el tratamiento de cálculos coledocianos que no pudieron ser extraídos por EPE y maniobras instrumentales con canastilla y litotripsia mecánica