Marcos Bruna

Eventroplastia transvaginal híbrida

Limones-Esteban M. Manejo diagnóstico en el tratamiento conservador del traumatismo abdominal. Cir Esp. 2003;73:233–43. 6. Singh V, Narasimhan KL, Verma GR, Singh G. Endoscopic management of traumatic hepatobiliary injuries. J Gastroenterol Hepatol. 2007;22:1205–9. 7. Lubezky N, Konikoff FM, Rosin D, Carmon E, Kluger Y, Ben-Haim M. Endoscopic sphincterotomy and temporary internal stenting for bile leaks following complex hepatic trauma. Br J Surg. 2006;93:78–81. 8. Anand RJ, Ferrada PA, Darwing PE, Bochicchio GV, Scalea TM. Endoscopic retrograde cholangiopancreatography is an effective treatment for bile leak after severe liver trauma. J Trauma. 2011;71:480–5. 9. Mohr AM, Lavery RF, Barone A, Bahramipour P, Magnotti LJ, Osband AJ, et al. Angiographic embolization for liver injuries; low mortality, high morbidity. J Trauma. 2003;55:1077–82. Marı́a Dolores Casado Maestre*, Ander Bengoechea Trujillo, Armando Lizandro Crispı́n, Claudio Rodrı́guez Ramos, José Luis Fernández Serrano

Estudio prospectivo de los valores de hormonas y péptidos relacionados con el metabolismo glucolipídico en pacientes obesos mórbidos sometidos a una gastrectomía vertical

INTRODUCTION Different hormones and peptides involved in lipid and carbohydrate metabolism have been studied in relation to morbid obesity and its variation after bariatric surgery. The aim of this study is toevaluate variations in different molecules related to glico-lipidic metabolism during the first year after sleeve gastrectomy in morbidly obese patients. MATERIAL AND METHODS Prospective study in patients undergoing sleeve gastrectomy between November 2009 and January 2011. We analyzed changes in different clinical, anthropometric and analytic parameters related with glico-lipidic metabolism in all patients in the preoperative period, first postoperative day, fifth day, one month, 6 months and one year after surgery. Statistical analysis was performed using SPSS 20.0. RESULTS We included 20 patients, 60% were women with a median of age of 45 years. Median of body mass index (IMC) was 48,5 kg/m(2) and 70% had obstructive sleep apnea syndrome (SAOS), 65% arterial hypertension (HTA), 45% dyslipidemia and 40% diabetes mellitus. One year after surgery, the percentage of excess of BMI loss was 72% and the rate of cure or improvement of dyslipidemia was 100%, diabetes 87,5%, HTA 84,6% and SAOS 57,1%. At this time, glycemia levels decreased significantly (P<.001), and levels of IGF-1 and HDL-cholesterol increased significantly. Levels of adiponectine increased and leptine (P=.003), insulin (P=.004) and triglycerides (P=.016) decreased significantly one year after the surgery. ACTH levels (that decreased during first 6 months after surgery), glycosilated hemoglobin, total cholesterol and LDL-cholesterol had no changes one year after surgery. CONCLUSIONS Sleeve gastrectomy is a surgical technique with good results of weight loss and cure of comorbidities. This procedure induces significant modifications in blood levels of glico-lipidic metabolism related peptides and hormones, such as glucose, IGF-1, insulin, leptin, triglycerides and HDL-cholesterol.

Cordón venoso subcutáneo en pared abdominal como manifestación de trombosis de vena cava inferior

Thrombotic problems are uncommon in childhood, although neonates and infants are more predisposed to presenting them, both due to a deficient inhibition of thrombin activity and a relative inefficacy of thrombolysis. We present the case of a young man with a complete thrombosis of the left renal vein and inferior vena cava in the neonatal period and that was diagnosed with the absence of inferior vena cava after the appearance of a subcutaneous venous cord in the right flank (Figs. 1 and 2). A 16-year-old man consulted due to an increase in volume of a subcutaneous venous cord in the right flank that he had since his neonatal period. During that period he had presented sever respiratory distress, bilateral suprarenal hemorrhage and left renal venous thrombosis with subsequent renal atrophy that caused him to undergo a nephrectomy at one year of age. During his first weeks of life he had needed aggressive supportive measure in an Intensive Care Unit and prolonged venous catheterization; the venous cord had appeared at this time. A cavography performed at this time revealed a complete thrombosis of the inferior vena cava with important collateral circulation in the right superficial venous system of the abdominal wall and the left azygos system. The patient recovered progressively and had showed a complete recovery without any further follow-up. In our department a complete physical examination was performed (Fig. 1) and in a magnetic angioresonance imaging and computed phlebotomography (Fig. 2) an absence of the inferior vena cava and both iliac veins was observed, showing venous return on the right side from the femoral vein through the varicous vein up to the ipsilateral axillary vein and on the left side from the femoral vein through the paravertebral veins to the azygos and hemiazygos system. The patient remains asymptomatic and without signs of venous insufficiency, and a conservative approach with follow-up was recommended. During the neonatal period, venous thromboses are almost exclusively represented by renal vein thrombosis. In the last 30 years the epidemiology of renal vein thrombosis has changed in developed countries, where almost 50% of cases occur in premature newborns, mostly male. The incidence of symptomatic renal thrombosis in newborns is very low (2.2 of every 100 000 births), and its association with a complete occlusion of the inferior vena cava is even more uncommon (only 25% of symptomatic cases).The appearance of collateral veins that drain in the azygos system, such as our case, with

Schwannoma de tercera porción duodenal: resección en bloque con inclusión del proceso uncinado del páncreas

Paloma Portillo Ortega*, José Manuel Rodrı́guez González, Antonio Rı́os Zambudio, Pedro Pujante Alarcón, Luis Alberto Polo Garcı́a Servicio de Endocrinologı́a y Nutrición, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain Servicio de Cirugı́a General, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain Servicio de Anatomı́a Patológica, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain

Tratamiento conservador y empleo de pegamento de fibrina en perforaciones esofágicas

Las perforaciones esofágicas son infrecuentes y suelen asociarse a una elevada morbimortalidad. La etiologı́a más frecuente es la provocada por las exploraciones endoscópicas, seguida de la ingestión de cuerpos extraños, sı́ndrome de Boerhaave y los traumatismos quı́micos. El tratamiento de estos pacientes depende de su estado general y de la situación clı́nica, precisando, en ocasiones, tratamiento quirú rgico. Presentamos 3 casos de pacientes con perforación esofágica tratados en nuestro centro de forma conservadora durante los ú ltimos dos años.