Claudio Cortés A

Resultados premilinares de la gastroplastia horizontal con anastomosis en Y de Roux como cirugía bariática en pacientes con obesidad severa y mórbida

Background: Morbidly obese subjects have a high incidence of complications. The poor results of dietary treatments, has prompted the search of new therapies for obesity and among these, surgical procedures. Aim: To report the long term results of horizontal gastroplasty with Roux en Y anastomosis in morbidly obese subjects. Patients and methods: Fifty patients with an initial body mass index of 41.3 ± 6 kg/m2 have been subjected to a horizontal gastroplasty with Roux en Y anastomosis. During the study period, surgical techniques were modified, reducing the gastric pouch size, adding a truncal vagotomy, cholecystectomy, and increasing the length of the Roux en Y loop from 70 to 100 cm. Twenty five patients have been followed for two years. Results: There was no operative mortality and one patient had an anastomotic leak that required 35 days of hospitalization. During follow up, in one patient, the stapled suture line loosened. After two years of follow up, weight decreased from 112 ± 19 to 77.2 ± 14 kg. Conclusions: Horizontal gastroplasty with Roux en Y anastomosis achieved an adequate weight loss with a low rate of complications in this group of morbidly obese subjects.

Ingestión accidental de imanes en niños y sus complicaciones: Un riesgo creciente

Accidental ingestion of foreign bodies in childhood is an increasing problem. Although many of them can be treated with an expectant approach, allowing their passage through the gastrointestinal tract, magnets must be extracted, due to their high rate of complications, such as perforation. We report three patients that ingested magnets. A five year-old male was operated with an extensive ulceration of the jejunum, where a cylindrical magnet was extracted. A four year-old female was operated with a perforation of the anterior wall of the stomach and three magnets were extracted from the peritoneal cavity. A four year-old female, was transferred from a hospital where she had been operated for a magnet ingestion that provoked three perforations in the small bowel (Rev Med Chile 2006; 134: 1315-19) . Key-words: Foreign bodies; Intestinal perforation; X-rays)

DIVERTICULO COLICO GIGANTE: MANIFESTACION INFRECUENTE DE UNA ENFERMEDAD MUY FRECUENTE

Una complicacion infrecuente de la diverticulosis del colon es el diverticulo colico gigante. Esta patologia fue descrita inicialmente en la literatura francesa en 1946 y en la inglesa en 1953. Comunicamos cuatro casos, incluyendo los diagnosticos mediante diferentes examenes de imagenes, evolucion y tratamiento quirurgico con fotografias intraoperatorias y de las piezas resecadas, como tambien radiografias de los especimenes. Se incluye una revision concisa de la literatura

Gemcitabina en 4 pacientes con colangiocarcinoma: Report of four cases

Cholangiocarcinoma is a biliary tree cancer of unknown etiology, whose symptoms are unspecific and is usually detected in advanced stages. Surgery continues to be the only curative therapy. Median survival in patients with inoperable tumors ranges between 5 and 8 months. There are few studies on the effects of chemotherapy, with a very small response. We report four patients with advanced cholangiocarcinoma, treated with gemcitabine 1000 mg/m2, weekly for 3 weeks every 28 days. There was a stabilization of tumor size and symptoms were alleviated. Toxicity was low and there was a probable prolongation of survival (Rev Med Chile 2001; 911-6).

GASTRECTOMÍA EN MANGA: ESTUDIO POR IMÁGENES DE SUS COMPLICACIONES

laparoscopic sleeve gastrectomy: imaging study of its complications The incidence of obesity in Chilean adult population reaches up to 25.1%, according to statistics from 2013. Bariatric surgery is an alternative that has proven weight loss and resolution of comorbidities significant long term. For this reason are routine procedures in different health institutions. However, its massification and safety are not free of complications, which can be detected and treated early with the help of radiological images. The aim of this paper is to describe the most common postoperative complications of the sleeve gastrectomy and its diagnosis using different imaging techniques, mainly fluoroscopic study contrasted of the the esophagus-stomach-duodenum and contrasted enhanced computed tomography (CT) of the abdomen and pelvis. Bariatric surgeries are now routine procedures for treatment of morbid obesity. Knowledge of early and late complications and diagnosis of these using different imaging techniques allow adequate treatment, control and decreased postoperative morbidity and mortality.

Hernia hiatal gigante con estómago intratorácico: Reporte de un caso y revisión de la literatura

La hernia hiatal gigante (HHG) con estomago intratoracico es una enfermedad poco frecuente. Corresponde a una hernia tipo 3 o mixta (componente por deslizamiento y paraesofagico) que contiene mas del 30% del estomago a nivel del torax. Es comun que estas hernias se asocien a rotacion gastrica, preferentemente del tipo organo-axial. Sus manifestaciones clinicas son inespecificas e incluyen vomitos y dolor toracico o epigastrico. Pueden presentar complicaciones como volvulo, perforacion u obstruccion gastrica, constituyendo una emergencia medica. En muchos casos pueden ser detectadas en forma incidental en una radiografia de torax. El estudio dirigido con imagenes, particularmente tomografia computada multidetector y estudio baritado esofago-estomago-duodeno, resultan fundamentales para el diagnostico y caracterizacion de la anatomia de estas lesiones. El tratamiento es quirurgico, sea por cirugia abierta o laparoscopica. Presentamos el caso de una paciente evaluada en nuestro servicio, en quien se realizo el diagnostico de HHG con estomago intratoracico, con rotacion gastrica organo-axial.

Eficacia de gemcitabina en cáncer de vesícula biliar.: Experiencia inicial en cuatro casos

Surgery continues to be the only curative therapy for gallbladder cancer, but useful in very few patients. Mean survival of patients with gallbladder cancer, that are out of the reach of surgery, is 3 months. The few clinical trials of chemotherapy for this disease, report very low success rates. We report four patients with advanced gallbladder cancer, treated with gemcitabine in an intravenous dose of 1000 mg/m2, given in 30 min, once a week during three consecutive weeks, every 28 days. There was a partial response that lasted 40,3 23,2 weeks with a mean survival of 59,75 17 weeks. One patient survives without evidences of disease after 17 months of the diagnosis of an advanced cancer. In all patients, symptoms were alleviated, functional status and quality of life improved. Toxicity was mild and did not require reduction in doses or delay in therapy. Therefore, this medication deserves further investigation for the treatment of gallbladder cancer. (Rev Med Chile 2000; 128: 1025-1030).

Esófago en cascanueces/sacacorchos en el espasmo esofágico

El esofago en cascanueces, tambien conocido como esofago en sacacorchos, describe la apariencia anormalmente segmentada del esofago en los casos de espasmo esofagico, visualizada en el estudio con doble contraste. Normalmente el peristaltismo primario se extiende a traves del esofago como una onda coordinada de contraccion y relajacion. En el espasmo esofagico multiples segmentos se contraen simultaneamente y hay una alteracion de la relajacion normal. Los sintomas incluyen dolor en el pecho, disfagia o ambos.

¿NÓDULO DE VIRCHOW O DE TROISIER?: VIEJA DISPUTA ENTRE LA LITERATURA MÉDICA DE HABLA INGLESA Y HABLA FRANCESA

Mujer de 69 anos que consulta por dispepsia, baja de peso y presencia de un nodulo no doloroso en la fosa su-praclavicular izquierda de varios meses de evolucion. El examen fisico evidencia un nodulo de consistencia petrea, de 3 cm de diametro, en la fosa supraclavicular izquierda (Figura 1). Se realiza una tomografia computada de ab-domen y pelvis que demuestra en el topograma un engro-samiento parietal estenosante del antro gastrico, hallazgo que es confirmado en los cortes axiales que evidencian una masa antral estenosante de aspecto neoplasico (Figura 2). La paciente es sometida a cirugia y la biopsia de la lesion demuestra un adenocarcinoma gastrico infiltrante (Figura 3).El nodulo de Virchow, tambien llamado en la literatura francesa nodulo de Troisier, es una adenopatia supra-clavicular, habitualmente izquierda, correspondiente a metastasis

Signo de la cuerda en enfermedad inflamatoria intestinal

El signo de la cuerda corresponde a una imagen visualiza en estudio de contraste oral en el tubo digestivo observandose como una delgada franja de bario que asemeja una cuerda deshilachada de algodon, debido a un severo estrechamiento de las asas de intestino. Este signo se ha descrito inicialmente para describir la enfermedad de Crohn, produciendose por la irritabilidad y los espasmos asociados a ulceracion severa y puede ser visto tanto en fases estenoticas como no estenoticas de la enfermedad.