Carmelo Loinaz

Manejo perioperatorio de la enfermedad de Parkinson

One of the particular characteristics of Parkinsons disease (PD) is the wide clinical variation as regards the treatment that can be found in the same patient. This occurs with specific treatment for PD, as well as with other drug groups that can make motor function worse. For this reason, the perioperative management of PD requires experience and above all appropriate planning. In this article, the peculiarities of PD and its treatment are reviewed, and a strategy is set out for the perioperative management of these patients.

Hamartomas quísticos retrorrectales

Resumen Los hamartomas quisticos retrorrectales (tailgut cysts) son tumores congenitos poco frecuentes derivados de remanentes embrionarios postanales del intestino. La mayoria de los hamartomas quisticos son multiquisticos y aparecen como masas asintomaticas en mujeres de mediana edad. El tratamiento de eleccion es la extirpacion completa. Las complicaciones mas frecuentes son la infeccion y el desarrollo de fistulas cutaneas y la degeneracion maligna. El diagnostico diferencial incluye una extensa variedad de patologias que pueden existir en el espacio retrorrectal. En este articulo presentamos 3 pacientes con hamartomas quisticos y realizamos una revision de su etiopatogenia, las manifestaciones clinicas, las tecnicas de diagnostico, sus complicaciones y los diagnosticos diferenciales. Asimismo, se discuten las diferentes tecnicas quirurgicas posibles para su abordaje quirurgico.

Biliobronchial Fistula after Liver Surgery for Giant Hydatid Cyst

Background. Biliobronchial fistula (BBF) is a rare complication in the natural history of liver hydatid disease by Echinococcus granulosus. We present a case of BBF after resection of a giant liver hydatid cyst in a 72-year-old woman. Case Report. A total cystpericystectomy was done, leaving the left lateral section of the liver that was fixed to the diaphragm. Postoperatively, the patient developed obstructive jaundice. An ERCP showed an obstruction at the junction of the left biliary duct and the main biliary duct and contrast leak. At reoperation, the main duct was ischemic, likely due to torsion along its longitudinal axis. A hepatotomy was done at the hilar plate, and the biliary duct was dissected and anastomosed to a Roux-en-Y jejunal loop. She was discharged without complications. Five months later, the patient developed cholangitis and was successfully treated with antibiotics. However, she suffered repeated respiratory infections, and four months later she was admitted to the hospital with fever, cough, bilioptysis, and right lower lobe pneumonia. The diagnosis of BBF was confirmed with 99mTc Mebrofenin scintigraphy. At transhepatic cholangiography, bile duct dilation was seen, with a biliothoracic leak. She underwent dilatation of cholangiojejunostomy stricture with placement of an external-internal catheter. The catheter was removed 3.5 months later, and two years later the patient remains in very good condition. Conclusion. An indirect treatment of the BBF by percutaneous transhepatic dilation of the biliary stenosis avoided a more invasive treatment, with satisfactory outcome.