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Ramia JM, de la Plaza R, Quiñones-Sampedro JE, Ramiro C, Veguillas P, García-Parreño J. Walled-off pancreatic necrosis. Neth J Med 2012; 70:168-71. [PMID: 22641624 DOI: pmid/22641624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute severe pancreatitits may be complicated by the development of 'walled-off pancreatic necrosis' (WOPN), which is characterised by a mixture of solid components and fluids on imaging studies as a consequence of organised pancreatic tissue necrosis. We present here an overview of the definition, clinical features, and diagnostic and therapeutic management of this clinical condition, which is mostly based on consensus as adequate clinical trials are lacking.
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Ramia JM, Muffak K, Fernández A, Villar J, Garrote D, Ferron JA. Gallbladder tuberculosis: False-positive PET diagnosis of gallbladder cancer. World J Gastroenterol 2006; 12:6559-60. [PMID: 17072992 PMCID: PMC4100649 DOI: 10.3748/wjg.v12.i40.6559] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gallbladder tuberculosis (GT) is an extremely rare disease, and very few cases have been reported in the literature. The first case of GT was described in 1870 by Gaucher. A correct preoperative diagnosis of GT is unusual, and it is frequently confused with various gallbladder diseases. We present a new case of a patient who underwent surgery with the preoperative diagnosis of gallbladder cancer after a false positive positron emission tomography scan in the diagnostic work-up.
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Santiago F, Bueno P, Olmedo C, Comino A, Hassan L, Ferrón-Celma I, Muffak K, Serradilla M, Mansilla A, Ramia JM, Villar JM, Garrote D, Ramirez A, Ferrón JA. Time course of intraoperative cytokine levels in liver transplant recipients. Transplant Proc 2006; 38:2492-4. [PMID: 17097978 DOI: 10.1016/j.transproceed.2006.08.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We evaluated the levels of several cytokines (interleukin [IL]-2, IL-4, IL-6, IL-10, tumor necrosis factor [TNF]-alpha, and interferon [IFN]-gamma) in plasma samples obtained before surgical intervention (T0) and during intraoperative liver transplantation: after induction of anesthesia (I-1), 15 minutes of anhepatic phase (I-2), 5 minutes before reperfusion (I-3), 10 minutes after reperfusion (I-4), 20 minutes after reperfusion (I-5), 60 minutes after reperfusion (I-6), and 1 hour after liver transplantation (I-7). Cytokine levels were determined using a technique which combines ELISA technique and flow cytometry. The study was approved by the local clinical research (ethics) committee. Written informed consent was obtained from patients' relatives. Twenty patients (14 men, 6 women) aged 23 to 61 years, recipients of a liver transplantation were studied. The cytokine IL-2 plasma values were maintained during the whole study period, with a slight increase at 15 minutes of anhepatic phase (I-2). IL-4 showed a peak value 20 minutes after reperfusion (I-5). IL-6 increased its plasma value starting at 15 minutes of anhepatic phase (I-2), maintaining high concentrations during the whole intraoperative period. IL-10 increased progressively, reaching a maximum 1 hour after transplantation (I-7). TNF-alpha reached maximum plasma levels 20 minutes after reperfusion (I-5), whereas IFN-gamma showed a peak at 15 minutes of anhepatic phase (I-2). Our results indicate that the anhepatic phase (I-2) is the earliest phase during which proinflammatory and anti-inflammatory cytokines, such as IL-6 and IL-10, respectively, are involved during liver transplantation. We conclude that IL-6 is the first cytokine involved in the inflammatory response during liver transplantation.
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Hassan L, Bueno P, Ferrón-Celma I, Ramia JM, Garrote D, Muffak K, Barrera L, Villar JM, García-Navarro A, Mansilla A, Gomez-Bravo MA, Bernardos A, Ferrón JA. Early postoperative response of cytokines in liver transplant recipients. Transplant Proc 2006; 38:2488-91. [PMID: 17097977 DOI: 10.1016/j.transproceed.2006.08.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We evaluated the early postoperative response of several cytokines (IL-2, IL-4, IL-6, IL-10, TNF-alpha, IFN-gamma) prior to liver transplantation (T(0)) as well as 1, 6, and 12 hours and 1, 2, 3, 5, and 7 days afterward. Cytokine concentrations were correlated with serum levels of bilirubin as a predictor of postoperative complications. Cytokine levels were determined in plasma samples from 16 liver transplant recipients (13 men, 3 women) aged 43 to 61 years. IL-6 and IL-10 reached their maximum concentrations 1 hour after transplantation. Each increase in IL-6 correlated to a rise in IL-10. IL-2, IL-4, TNF-alpha, and IFN-gamma had a particular time-course for each patient studied. Bilirubin fell to almost normal values but not in cases of postoperative complications, where IL-6 showed values four times higher compared to those of liver transplant recipients who did not show postoperative complications. IL-6 and IL-10 plasma concentrations and serum bilirubin level might be useful as a predictive factor of postoperative complications in liver transplant recipients.
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Ramia JM, Palomeque A, Muffak K, Villar J, Garrote D, Ferrón JA. Indications and therapeutical options in hepatolithiasis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2006; 98:597-604. [PMID: 17048996 DOI: 10.4321/s1130-01082006000800005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE to present our experience with the treatment of hepatolithiasis. EXPERIMENTAL DESIGN a retrospective study. Every patient operated on during 2002-2004. RESULTS mean age was 68.2 years. All patients were male. Two patients had been operated on before. The other three suffered from: monolobar Caroli s disease (1), cholangiocarcinoma (1), and hepatolihtiasis without clear etiologic factors (1). All of them had intrahepatic and extrahepatic litihiasis. Clinical signs included: pain in RUQ, fever, and jaundice. Bilirubin was 3.5 mg/dl (min: 1.7, max: 5.9), GGT: 676.2 IU/l (min: 29, max: 2039), and alkaline phosphatase: 400 IU/l (min: 100, max: 1136). Abdominal ultrasounds always correctly diagnosed HL. CT (3 patients) only diagnosed one case. ERCP (3 patients) and cholangio-MRI (2 patients) always diagnosed HL correctly. Surgical procedures were: hepatojejunostomy with lavage of bile duct (2 cases) and hepatectomy (3 cases) -both right (1) and left (2). We always performed an intraoperative ultrasonography and choledoscopy. Morbidity was: biliary fistula (1 case) treated by percutaneous drainage. No mortality occurred. Median stay was 8.8 days. Mean follow-up is 12 months (min: 11, max: 20). No relapse has been observed. CONCLUSIONS HL is infrequent in Spain. Surgical treatment, usually liver resection, obtains good results with low morbidity and mortality.
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Hassan L, Bueno P, Ferrón-Celma I, Ramia JM, Garrote D, Muffak K, García-Navarro A, Mansilla A, Villar JM, Ferrón JA. Time course of antioxidant enzyme activities in liver transplant recipients. Transplant Proc 2005; 37:3932-5. [PMID: 16386589 DOI: 10.1016/j.transproceed.2005.10.088] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Reactive oxygen species (ROS) play a central role in ischemia-reperfusion injury after organ transplantation. They are degraded by endogenous radical scavengers such as antioxidant enzymes. The purpose of this study was to evaluate the temporal variations of antioxidant enzyme activities in liver transplant recipients. The study was performed in 13 liver transplant patients (11 men and 2 women). Blood samples were obtained pre- and postsurgical intervention: before transplant (T(0)), and 1, 6, 12, 24, 48, and 72 hours, as well as 5 and 7 days thereafter. We determined total and specific superoxide dismutase (SOD) activity, catalase (CAT), glutathione peroxidase (GPX), and glutathione reductase (GR) activities as well as malondialdehyde (MDA) and low-density lipoproteins (LDL). The results showed increased SOD and mainly GPX activities after liver transplantation, which correlated with MDA levels. Total SOD activity was mainly represented by Mn-SOD (75%) and Cu,Zn-SOD (25%), whereas Fe-SOD was not detected. In conclusion, the enhanced antioxidant enzyme activities reported in this study indicated a control of oxidative stress generated in liver transplantation. In this sense, although MDA levels showed an enormeous increase at 1 hour after transplantation, the lipid peroxidation was compensated for by GPX activity.
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Ramia JM, Mansilla A, Villar J, Cabrera MA, Garrote D, Ferron JA. Split for two adults: what is the real feasibility? Transplant Proc 2005; 37:3855-6. [PMID: 16386561 DOI: 10.1016/j.transproceed.2005.10.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A split liver for two adults is a good theoretical option but the number of cases is low. We have tried to assess the feasibility of this technique. MATERIALS AND METHODS From April 2002 to April 2004, we evaluated 81 donors of which only 59 (72.8%) were used for transplantation of which 10 were grafted in other centers (pediatric or emergency code). Among the 49 donors the criteria for splitting were: ages >14 and <50 years, weight >70 and <100 kg, less than 3 days in the intensive care unit (ICU), hemodynamic stability, Na(+) < 160 mg/L, liver enzymes elevated no more than twofold, no macroscopic steatosis, and procurement in our hospital. RESULTS The mean donor age was 50.7 years (range: 16 to 77) of whom 25 were men (51%). The mean weight was 65.7 kg (range: 50 to 100) and days of ICU stay, 3 (range: 1 to 23). Six grafts (12%) were split. The reasons for not splitting were: age (n = 26 [53%]), weight (n = 17 [34.7%]), UCI >3 days (n = 9 [18.3%]), Na(+) > 160 (n = 1 [2%]), blood liver test elevated (n = 5 [10.2%]), steatosis (n = 6 [12.2%]), and procurement outside our center (n = 20 [40.8%]). The donors not suitable for splitting had: only one criteria (n = 12 [24.4%]; 2 (n = 23 [46.9%], 3 (n = 6 [12.2%]) or 4 (n = 2 [4.1%]). If we had had two suitable recipients, we could performed six more liver transplantations (12.2% increase). CONCLUSIONS The theoretical feasibility of a split liver for two adults is 12.2%, but the actual probability is lower because of lack of two adequate candidates.
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Palomeque A, Ramia JM, Muffak K, Alvarez MJ, Martínez P, Garrote D, Ferrón JA. [Gastrointestinal stromal tumor of the gallbladder]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2005; 97:675-6. [PMID: 16266243 DOI: 10.4321/s1130-01082005000900012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ramia JM, Muffak K, Mansilla A, Villar J, Garrote D, Ferron JA. Postlaparoscopic cholecystectomy bile leak secondary to an accessory duct of Luschka. JSLS 2005; 9:216-7. [PMID: 15984714 PMCID: PMC3015576 DOI: pmid/15984714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Complications produced by the sectioning of a nonvisualized duct of Luschka are uncommon during laparoscopic cholecystectomy. From 1999 through 2003, we performed 1351 laparoscopic cholecystectomies in our department and observed 2 cases (0.15%) of bile leakage due to duct of Luschka injury. Injury during laparoscopic cholecystectomy is usually produced by an excessively deep plane of dissection and by the anatomical localization of this accessory duct. Clinical symptoms are scarce after duct of Luschka injury. Numerous diagnostic methods have been used to detect these injuries. Nevertheless, careful clinical examination is still of the utmost importance. Noninvasive treatments are usually effective. In patients who present with acute abdomen, as in our cases, or who are not cured by noninvasive treatments, exploratory laparotomy is the best approach. The surgical treatment consists of a lavage of the abdominal cavity, closure of the duct of Luschka, and intraoperative cholangiography to confirm that the biliary tree is intact.
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Ramia JM, Gutiérrez G, Garrote D, Mansilla A, Villar J, Ferron JA. Isolated extrahepatic bile duct rupture in blunt abdominal trauma. Am J Emerg Med 2005; 23:231-2. [PMID: 15765360 DOI: 10.1016/j.ajem.2004.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Ramia JM, Mansilla A, Villar J, Muffak K, Garrote D, Ferron JA. Signet-ring-cell carcinoma of the Vater's ampulla. JOP : JOURNAL OF THE PANCREAS 2004; 5:495-7. [PMID: 15536289 DOI: pmid/15536289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Most tumors affecting Vater's Ampulla are adenocarcinomas and other histological variants are less frequent. A review of the literature revealed only seven previously reported cases of signet ring cell carcinoma of the ampulla of Vater. The presence of this kind of tumor has no clear histological explanation. Two possible theories have been proposed: the presence of gastric heterotopia in the ampulla of Vater or the existence of a perivaterian duodenal heterotopia of ulcerous etiology as the origin of a signet ring cell tumor which secondarily invades the ampulla of Vater. CASE REPORT We performed a pancreatoduodenectomy in a 67-year-old woman with a T2N0M0 ampulla tumor. A histologic study revealed a signet ring cell neoplasm. CONCLUSION Etiology and survival of signet ring cell carcinoma of Vater's ampulla is not well-defined in the literature due to the extreme rarity of this disease. Duodenopancreatectomy with pylorus preservation is the treatment of choice.
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Ramia JM, Garrote D, Mansilla A, Villar J, Gómez R, Ferrón JA. [Hepatocellular carcinoma in non-cirrhotic liver and ulcerative colitis: incidental or casual relationship?]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2004; 96:429-31. [PMID: 15230675 DOI: pmid/15230675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ramia JM, Muffak K, Villar J, Mansilla A, Garrote D, Ferrón JA. [Late pancreatic metastasis from renal cell cancer]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2004; 96:428-9. [PMID: 15230674 DOI: pmid/15230674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Muffak K, Ramia JM, Palomeque A, Villar J, García-Navarro A, Ferrón JA. [Askin's tumor with sigmoid metastasis]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2004; 96:356. [PMID: 15180448 DOI: 10.4321/s1130-01082004000500011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ramia JM, Mansilla A, Villar J, Muffak K, Garrote D, Ferron JA. Retroperitoneal actinomycosis due to dropped gallstones. Surg Endosc 2004; 18:345-9. [PMID: 15106577 DOI: 10.1007/s00464-003-4247-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Dropped bile and gallstones after accidental perforation of the biliary gallbladder is a frequent event during laparoscopic cholecystectomy and is generally of no clinical importance. However, calculi left in the abdominal cavity can produce a series of severe late complications. We present a patient with retroperitoneal actinomycosis produced by dropped gallstones after a laparoscopic cholecystectomy.
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Ramia JM, Villegas MT, Mansilla A, Villar J, Garrote D, Ferron JA. Angiomiolipoma hepático en paciente afectada de esclerosis tuberosa. GASTROENTEROLOGIA Y HEPATOLOGIA 2004; 27:42-3. [PMID: 14718111 DOI: 10.1016/s0210-5705(03)70446-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ramia JM, Villegas MT, Mansilla A, Villar J, Garrote D, Ferron JA. [Hepatic angiomyolipoma in a woman with tuberous sclerosis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2004. [PMID: 14718111 DOI: 10.1157/13056038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Ramia JM, Padilla D, Pardo R, García Rojo M, Martín J, Hernández Calvo J. [Abdominal actinomycosis]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2002; 94:368-9. [PMID: 12432595 DOI: pmid/12432595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ramia JM, Padilla D, López R, Cubo T, Hernández Calvo J. [Adenosquamous carcinoma of the gallbladder. What are the prognostic implications of this histological variant?]. GASTROENTEROLOGIA Y HEPATOLOGIA 2002; 25:333-4. [PMID: 11985807 DOI: 10.1016/s0210-5705(02)79031-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Padilla D, Cubo T, García M, Ortega G, Ramia JM, Martín J, Pardo R, López A, Hernández Calvo J. [Clinicopathological and immunohistochemical characteristics of stromal sarcoma of the duodenum]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2002; 94:104-5. [PMID: 12185648 DOI: pmid/12185648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Padilla D, Cubo T, Ortega G, Ramia JM, Martín F, Pardo R, García M, Martín J, López A, Hernández Calvo J. [Histologic findings in intestinal wall after ileocolic anastomosis with Valtrac]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2001; 93:336-7. [PMID: 11488115 DOI: pmid/11488115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Padilla D, Cubo T, Ramia JM, Pardo R, Ortega G, Hernández Calvo J, de la Plaza R, Martín J, López A. [Myofibroblastic inflammatory tumor simulating recurrence of pancreatic vipoma]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2001; 93:260-1. [PMID: 11488124 DOI: pmid/11488124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ramia JM, Pardo R, Alonso JC, Soriano A, Hernández-Calvo J. [Bile leak after removal of Kehr' s tube: diagnosis with HIDA 99m Tc]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 1999; 91:723-4. [PMID: 10601766 DOI: pmid/10601766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Padilla D, Ramia JM, Martin J, Pardo R, Cubo T, Hernandez-Calvo J. Acute abdomen due to spontaneous torsion of an accessory spleen. Am J Emerg Med 1999; 17:429-30. [PMID: 10452449 DOI: 10.1016/s0735-6757(99)90103-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ramia JM, Pardo R, Cubo T, Padilla D, Hernández-Calvo J. Pneumomediastinum as a complication of extraperitoneal laparoscopic inguinal hernia repair. JSLS 1999; 3:233-4. [PMID: 10527338 PMCID: PMC3113162 DOI: pmid/10527338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A 52-year-old man with left indirect groin hernia was admitted for elective inguinal repair using the totally extraperitoneal (TEP) approach. After an uneventful intubation, TEP repair of the hernia was performed with three midline trocars. Immediately after extubation, the patient noted severe chest pain. There was a decrease in PaO2 saturation, and neck subcutaneous emphysema was detected. There was no emphysema of the abdomen or of the back. A chest film and thoracic computed tomographic (CT) scan confirmed the presence of pneumomediastinum without pneumothorax. The patient was discharged without complications.
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