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La enfermedad pulmonar obstructiva crónica por definición es prevenible, sin embargo, aún faltan gestos para alcanzar este objetivo. Su carácter heterogéneo es uno de los principales obstáculos y retos. Al respecto, los factores de riesgo de enfermedad pulmonar obstructiva crónica están evolucionando, más allá del fumar. La espirometría a pesar de su precisión en el diagnóstico de la enfermedad pulmonar obstructiva crónica, no es sensible para identificar individuos de riesgo, por lo que se requiere de un nuevo abordaje de medicina de precisión en la salud pulmonar. Por esta razón, lanzamos una unidad multidisciplinaria de nuevos abordajes de prevención, predicción de riesgos, definición, diagnóstico y tratamientos que puedan generar cambios significativos. Los objetivos se focalizan en evitar el desarrollo de la enfermedad pulmonar obstructiva crónica a través de un nuevo enfoque en la asistencia médica del paciente en la etapa pre-enfermedad pulmonar obstructiva crónica, como así también en la investigación traslacional para el conocimiento de marcadores teragnósticos de la enfermedad(AU)

Chronic obstructive pulmonary disease (COPD) is preventable by definition; however, there are some steps that need to be taken in order to attain that goal. Its heterogeneous nature is one of the main obstacles and challenges. In this regard, the risk factors for COPD are evolving beyond smoking. Despite the precision of the spirometry in diagnosing COPD, it is not sensitive enough to identify individuals at risk, thus, a new approach is required for precision medicine in lung health. For that reason, we launched a Multidisciplinary Unit with new approaches to prevention, risk prediction, definition, diagnosis, and treatments that can make significant changes. The goals are focused on preventing the development of COPD through a new medical care approach intended for patients in the Pre-COPD stage, as well as translational research for understanding the theragnostic markers of the disease(AU)

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Resumen Introducción: Inspirado en el sistema BI-RADS (Breast Imaging Reporting), el American College of Radiology (ACR) desarrolló el sistema Lung-RADS, con la intención de realizar informes estandarizados sobre los nódulos pulmonares detectados en el En Argentina y en muchos lugares del mundo, no se realiza el Lung Cancer Screening (LCS) debido a los altos costos; sin embargo, en las TC de tórax los hallazgos incidentales de nódulos pulmonares, es frecuente. Para evaluarlos, existen diversos sistemas basados en caracte rísticas que permiten establecer un seguimiento. Entre ellos, Guía Fleischner, British Thoracic Society Guidelines y Lung-RADS, siendo este último el único que posee una categorización numérica. En este artículo se estudia la utilidad del Lung-RADS, como método de diagnóstico y seguimiento en la clasificación de los nódulos pulmonares. Objetivo: Evaluación del nódulo pulmonar diagnosticado en la TC de Tórax, mediante el uso del Lung-RADS para determinar su valor clínico, comparando la correlación entre esta clasificación y la malignidad o benignidad en el examen histopatológico. Material y Método: Estudio descriptivo, estadístico, observacional, retrospectivo y prospectivo.Se estudiaron un total de 100 pacientes adultos, de ambos sexos, con diagnóstico de nódulo pulmonar, comprendidos entre Enero del año 2017 hasta Diciembre del 2019, de los cuales se excluyeron aquellos que no tuvieron un seguimiento. Estudio tomográfico realizado en tomógrafo de 128 hileras de detectores. Las variables estudiadas incluyeron: sexo y edad de los pacientes, tamaño y densidad del nódulo, malignidad de la lesión en el estudio anatomopatológico, categoría del Lung-RADS y terapéutica realizada y sugerida. Para el análisis descriptivo, se utilizaron frecuencias relativas (porcentajes) y absolutas (número de casos) para las variables cualitativas; y para las variables cuantitativas se utilizó media y desvío estándar, y rango de valores mínimomáximo. Para las pruebas de hipótesis, se realizaron pruebas de Chi cuadrado para las variables cualitativas. Para las variables cuantitativas se realizaron, en primer lugar, pruebas de Shapiro Wilks y de Kolmogorov. Resultados: En 100 pacientes en los que se aplicó el Lung-RADS para determinar seguimiento y tratamiento, se identificaron diferentes tipos de escenarios tanto en el comportamiento como en el seguimiento de los mismos, algunos con necesidad de recategorización y cambios en conducta diagnóstica y tratamiento. En cuanto al análisis estadístico se analizó la asociación entre la Clasificación Lung- RADS obtenida y la presencia o ausencia de malignidad en el examen anatomopatológico obteniendo resultados estadísticamente significativos (p-valor <0,0001) para esta asociación. Discusión: Actualmente se utiliza en sistema Lung-RADS y las guías de recomendaciones de los nódulos pulmonares de la Sociedad Fleischner. Ambas tienen criterios similares y se basan en la sospecha morfológica de malignidad, que incluye la densidad del nódulo (sólido, parcialmente sólido o en vidrio esmerilado), tamaño y, cuando está disponible, el crecimiento o evolución, que se aplican en distintos grupos de pacientes. La determinación del puntaje Lung-RADS ha demostrado su utilidad en este estudio, dada la correlación patológica del nódulo, con resultado estadísticamente aceptable y buena correlación con la decisión de seguimiento y tratamiento. Conclusión: La aplicación del sistema Lung-RADS en serie ha demostrado un buen manejo de seguimiento de los mismos posibilitando, en algunos casos, la realización de resecciones quirúrgicas y, en otros, una conducta expectante con cierta seguridad evitando, en muchas oportunidades, la adopción de tratamientos agresivos innecesarios.

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Abstract Introduction: Inspired by the BI-RADS system (Breast Imaging Reporting and Data System), the American College of Radiology (ACR) developed the Lung-RADS system, for the purpose of making standardized reports on lung nodules detected in lung cancer screening (LCS). In Argentina and in many other parts of the world the LCS is not performed due to high costs; however, in chest CT scans pulmonary nodules frequently appear as incidental findings. There are multiple systems to evaluate them based on a series of features that allow subsequent follow-up. Some of them are the Fleischner Guidelines, the British Thoracic Society Guidelines and the Lung-RADS system, the latter being the only one with numerical categorization. In this article we study the usefulness of the Lung- RADS, as a diagnostic, follow-up method for the classification of pulmonary nodules. Objective: Evaluation of the pulmonary nodule diagnosed on chest CT scan, using the Lung-RADS system to determine its clinical importance, comparing the correlation between this classification and the malignancy or benignancy in the histopathological examination. Material and Method: Descriptive, statistical, observational, retrospective and prospective study. A total of 100 adult patients, both men and women, with a diagnosis of pulmonary nodule were studied between January 2017 and December 2019. Patients without follow-up were excluded. Studies were performed with a 128-slice scanner. The variables under evaluation were: patients' sex and age, size and density of the nodule, malignancy of the lesion found in the anatomopathological study, Lung-RADS category and treatment performed and suggested. For the descriptive analysis we used relative frequencies (percentages) and absolute frequencies (number of cases) for qualitative variables; and mean and standard deviation as well as range of minimum-maximum values for the quantitative variables. For hypothesis tests, Chi-Square tests were performed for qualitative variables. For quantitative variables, Shapiro Wilks and Kolmogorov tests were performed. Results: In 100 patients in whom Lung-RADS was applied to determine follow-up and treatment, different types of scenarios could be identified regarding the approach and follow-up: some needed recategorization and changes in the diagnostic approach and treatment. As for the statistical analysis, we analyzed the association between the Lung-RADS classification obtained and the presence or absence of malignancy in the anatomopathological examination, and obtained statistically significant results (p-value <0.0001) for this association. Discussion: The Lung-RADS system and the Fleischner Society Guidelines on pulmonary nodules are used at present. Both have similar criteria and are based on the morphological suspicion of malignancy that includes the density of the nodule (solid, partially solid or ground-glass), the size and, when available, growth or evolution, which can be applied in different groups of patients. Determining the Lung-RADS score has proven its usefulness in this study, based on the pathological correlation of the nodule, with a statistically acceptable result and a good correlation with the treatment and follow-up decision. Conclusion: The application of the Lung-RADS system to this series of patients has shown a good management of patients' follow-up, with surgical resections in some cases and an expectant approach in others, providing certain security and mostly avoiding the use of unnecessary aggressive treatments.

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INTRODUCTION: Based on existing data regarding the durability of liraglutide in type 2 diabetes, this study aimed to assess its long-term effectiveness at 5 years and its overall impact on cardiovascular (CV) risk. METHODS: This was a multicenter retrospective observational study. Liraglutide was used under routine clinical practice conditions. Changes from baseline to 60 months in HbA1c, fasting plasma glucose (FPG), body weight, blood pressure, and lipid profile were assessed. United Kingdom Prospective Diabetes Study (UKPDS) scores were calculated at baseline and after 60 months to assess changes in the estimated 5- and 10-year risk for fatal and nonfatal coronary heart disease (CHD) and fatal and nonfatal stroke. RESULTS: Overall, 103 patients (age 59.0 ± 7.9 years, diabetes duration 10.4 ± 6.8 years) were involved in the study. After 60 months, HbA1c levels were reduced by - 1.0 ± 1.2%, FPG levels by - 24.5 ± 43.4 mg/dl, body weight by - 5.3 ± 6.4 kg, systolic blood pressure by - 6.5 ± 18.5 mmHg, diastolic blood pressure by - 3.6 ± 11.8 mmHg, and total cholesterol by - 16.9 ± 37.4 mg/dl. The proportion of patients achieving HbA1c levels of < 7% increased from 12.7% to 39.8% (p = 0.02). Based on the UKPDS scores, statistically significant reductions in the 5- and 10-year risk of nonfatal CHD and fatal CHD were found, with no change in the 5- and 10-year risk of fatal and nonfatal stroke. CONCLUSION: In patients prolonging treatment with liraglutide for 5 years, the benefits in relation to metabolic control and CV risk factors are maintained. The UKPDS risk scores suggest that liraglutide is associated with a reduced CHD risk, but not with a reduced stroke risk.

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PURPOSE: Treatment with liraglutide in randomized controlled trials is associated with significant reductions in glycated hemoglobin (HbA1c) and weight loss in type 2 diabetes patients. The aim of this retrospective observational study was to investigate correlations of glycemic control and weight outcomes with baseline characteristics of patients starting liraglutide in outpatient clinics in Italy. METHODS: Type 2 diabetes patients were followed from baseline to 4, 8, and 12 months. Changes in glycemic parameters, weight, blood pressure, and lipids were assessed. Subanalyses were performed according to baseline characteristics. Multivariate linear and logistic regressions were used to assess correlations between glycemic efficacy, weight reduction, and liraglutide discontinuation after 12 months and baseline characteristics. FINDINGS: Four hundred and eighty-one patients were included. Mean (SD) age at baseline was 57.3 (9.2) years, diabetes duration was 9.5 (6.8) years, weight was 106.7 (20.8) kg, body mass index (BMI; calculated as kg/m(2)) was 37.1 (6.6), HbA1c was 8.7% (1.3%), fasting plasma glucose was 168.5 (45.3) mg/dL; 38.2% were treated previously with insulin and 52.2% were treated with metformin alone. After 12 months, mean (SD) changes were HbA1c -1.2% (1.4%), fasting plasma glucose -28.3 (41.1) mg/dL, weight -3.5 (5.8) kg, BMI -1.3 (2.1), waist circumference -2.6 (6.7) cm (all, P < 0.001). Drop in weight and HbA1c did not differ between baseline BMI classes ≤30 or >30. Weight loss was unchanged among diabetes duration quartiles, and HbA1c reduction was significantly greater in patients with ≤4 years of diabetes duration (P = 0.01). Non-insulin-treated patients reached HbA1c ≤7% significantly more often than treated patients (44.2% vs 21.2%; odds ratio = 2.94; P < 0.001) and had significantly greater weight loss (-4.5 [8.2] kg vs -2.6 [5.4] kg; P = 0.03). Patients on metformin reached HbA1c target more frequently than others (43.1% vs 29.7%; odds ratio = 1.80; 95% CI, 1.05-3.07). Significant positive determinants for HbA1c reduction after 12 months were baseline HbA1c, age, and prior metformin monotherapy, and weight loss at 12 months was positively correlated with baseline weight, and negatively correlated with prior insulin treatment. Overall, 5.0% of patients interrupted liraglutide before the 12th month due to lack of glycemic control; they were less frequently treated with metformin only before liraglutide (29.2% vs 50.2%; P = 0.04). IMPLICATIONS: Treatment with liraglutide in a real-world setting is associated with low therapy failure, good glycemic response, weight loss, and improvement in systolic blood pressure and lipid profile. The HbA1c drop did not differ among baseline BMI classes, indicating that efficacy is maintained in patients with lower BMI. The probability of reaching HbA1c ≤7% was significantly higher in patients previously treated with metformin alone and without any previous insulin. This could reinforce the hypothesis that better results with liraglutide could be achieved in patients after early metformin failure.

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El Síndrome del Asa de la Arteria Pulmonar, también conocido como Lazo de la Arteria Pulmonar y Sling Sign de la literatura de habla inglesa, es una forma rara de malformación congênita del origen y recorrido de la arteria pulmonar izquierda, que se incluye dentro de las alteraciones en "anillo" que modifican la normal anatomía de los vasos mediastínicos y producen compresiones sobre la vía aérea. Se cree que se produce por un fallo en la formación del sexto arco aórtico, a menudo con evolución fatal si no es tratada a tiempo, debido a la severidad de los trastornos respiratorios que provoca o por anomalías vasculares graves asociadas. Este síndrome fue descrito por primera vez por Glaevecke y Doehle en 1897(1). Si bien es poco frecuente, varios autores han publicado casos de esta anomalía(2-5) principalmente diagnosticada en niños y recién nacidos. Efectuar el diagnóstico en adultos, es extremadamente infrecuente. Es por ello que adquiere mayor interés la descripción de los hallazgos como diagnóstico inicial en este paciente de 51 años de edad, prácticamente asintomático y que concurre a la consulta clínica solamente con disnea de grado leve, detectado en un aparato TC Multicorte realizado para el estudio de su disnea.

Pulmonary Artery Sling Syndrome is a rare form of congenital malformation of the origin and course of the left pulmonary artery, which is included within the "ring" irregularities that modify the normal anatomy of the mediastinal vessels and produce airway compressions. It is believed to be caused by a failure in the formation of the sixth aortic arch, often with a fatal outcome if not treated in time due to the severity of the respiratory disorders it causes or for severe associated vascular abnormalities. This syndrome was first described by Glaevecke and Doehle in 1897(1). Although rare, several authors have reported cases of this anomaly(2-5) primarily diagnosed in children and newborns.Diagnosing this in adults is extremely rare. That is why describing the findings as an initial diagnosis, in this almost asymptomatic 51 year old patient who attended the clinical consultation only with mild dyspnea, detected on a Multislice CT system used to study his dyspnea, acquires greater interest.

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El síndrome de embolia grasa (SEG) es una entidad poco frecuente de difícil diagnóstico clínico y una causa importante de morbimortalidad en pacientes con politraumatismos. Es la manifestación clínica de la presencia de glóbulos grasos en la circulación sistémica y se caracteriza, fundamentalmente, por el desarrollo de insuficiencia respiratoria, síntomas neurológicos y exantema petequial. Se asocia principalmente con complicación de fracturas de huesos largos, aunque puede ser causada por otros tipos de patologías. El diagnóstico se ha basado clásicamente en los hallazgos clínicos. Por este motivo, presentamos cuatro casos donde la Resonancia Magnética (RM) de encéfalo tuvo un rol fundamental en el diagnóstico...

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El síndrome de embolia grasa (SEG) es una entidad poco frecuente de difícil diagnóstico clínico y una causa importante de morbimortalidad en pacientes con politraumatismos. Es la manifestación clínica de la presencia de glóbulos grasos en la circulación sistémica y se caracteriza, fundamentalmente, por el desarrollo de insuficiencia respiratoria, síntomas neurológicos y exantema petequial. Se asocia principalmente con complicación de fracturas de huesos largos, aunque puede ser causada por otros tipos de patologías. El diagnóstico se ha basado clásicamente en los hallazgos clínicos. Por este motivo, presentamos cuatro casos donde la Resonancia Magnética (RM) de encéfalo tuvo un rol fundamental en el diagnóstico.(AU)

Fat Embolism Syndrome (FES) is an uncommon entity characterized by a difficult clinical diagnosis and high morbi-mortality in polytrauma patients. It is the clinical manifestation of the presence of fatty cells in the systemic circulation and it is mainly characterized by the development of respiratory failure, neurologic symptoms and petechial rash. Although it has been largely associated with long-bone fractures, it may be caused by other types of pathologies. Clinical findings have been classically used for the diagnosis. Therefore, we report on four cases where brain Magnetic Resonance Imaging (MRI) had a key role in the diagnosis.(AU)

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El síndrome de embolia grasa (SEG) es una entidad poco frecuente de difícil diagnóstico clínico y una causa importante de morbimortalidad en pacientes con politraumatismos. Es la manifestación clínica de la presencia de glóbulos grasos en la circulación sistémica y se caracteriza, fundamentalmente, por el desarrollo de insuficiencia respiratoria, síntomas neurológicos y exantema petequial. Se asocia principalmente con complicación de fracturas de huesos largos, aunque puede ser causada por otros tipos de patologías. El diagnóstico se ha basado clásicamente en los hallazgos clínicos. Por este motivo, presentamos cuatro casos donde la Resonancia Magnética (RM) de encéfalo tuvo un rol fundamental en el diagnóstico.(AU)

Fat Embolism Syndrome (FES) is an uncommon entity characterized by a difficult clinical diagnosis and high morbi-mortality in polytrauma patients. It is the clinical manifestation of the presence of fatty cells in the systemic circulation and it is mainly characterized by the development of respiratory failure, neurologic symptoms and petechial rash. Although it has been largely associated with long-bone fractures, it may be caused by other types of pathologies. Clinical findings have been classically used for the diagnosis. Therefore, we report on four cases where brain Magnetic Resonance Imaging (MRI) had a key role in the diagnosis.(AU)

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Objetivos. Determinar retrospectivamente el índice de falsos negativos y el grado de subestimación de la punción con aguja gruesa eco-guiada de nódulos mamarios. Establecer la incidencia de las diferentes lesiones que se manifiestan como nódulos mamarios. Materiales y Métodos. Se estudiaron las punciones de nódulos mamarios desde enero del 2000 a septiembre del 2010. Las mismas fueron realizadas por un radiólogo con 10 años de experiencia y se utilizaron agujas de corte de 14-gauge y 10 cm de longitud. Para la guía ecográfica se usaron dos ecógrafos con transductores lineales de 5-12 MHz. Se punzaron lesiones de moderada y alta sospecha de malignidad (BI-RADS 4 y 5) y algunas lesiones probablemente benignas (BI-RADS 3). Se correlacionaron los hallazgos histológicos de la punción y de la cirugía para cada lesión. A los casos con resultado benigno que no fueron operados se les realizó un seguimiento clínico de entre uno y diez años. Resultados. Se realizaron 190 punciones. El índice de falsos negativos fue del 3%, la sensibilidad de 95% y la especificidad de 100% (VPP de 100% y VPN de 95%). Discusión. Hubo coincidencia entre los resultados de las punciones y la cirugía en un 94%. El índice de falsos negativos es aceptable en comparación con otros reportes donde varía entre 0 y 8%. Conclusiones. Este estudio indica que la punción con aguja de corte eco-guiada es un método válido, con alto grado de precisión y bajo índice de subestimación y falsos negativos para el diagnóstico de nódulos mamarios malignos y benignos. Esto fue comprobado mediante la escisión quirúrgica y/o el seguimiento clínico- imagenológico de las diferentes lesiones.

Objectives. To retrospectively determine the false negatives rate and the extent of underestimation of ultrasound-guided core biopsy of breast nodules, and to determine the incidence of the various lesions presenting as breast nodules. Materials and Methods. We studied core biopsies of breast nodules from January 2000 to September 2010, performed by a radiologist with 10 years experience in breast imaging, using 14-gauge and 10-cm needles. For ultrasound guidance, two ultrasound machines with a 5-12 MHz linear transducer were used. Biopsied lesions had a moderate or high suspicion of malignancy (BI-RADS 4 and 5) and some were probably benign lesions (BI-RADS 3). Histological findings of core-biopsy were correlated with those of surgery for each lesion. Cases of benign lesions which had not been operated on underwent a 1- to 10-year clinical and radiological follow-up. Results. A total of 190 biopsies were performed. The false negative rate was 3%, sensitivity was 95% and specificity was 100% (PPV 100% and NPV 95%). Discussion. There was 94% consistency between core biopsy results and surgery. The false negative rate is acceptable as compared to other reports, where it ranges from 0 to 8%. Conclusions. This study indicates that ultrasound-guided core biopsy is a valid method, with a high degree of accuracy and a low rate of false negatives and underestimation, in the diagnosis malignant and benign of breast nodules. This has been confirmed by surgical excision and / or clinical and imaging follow-up of different lesions.

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Introducción: La Espectroscopía por Resonancia Magnética (ERM) es una técnica no invasiva que permite un análisis del metabolismo de las lesiones o del tejido normal, aumentando la especificidad del método. De esta manera, a la información morfológica aportada por las imágenes de resonancia magnética (RM) se le suma la información bioquímica que brinda la ERM. Si bien el "gold standard" para establecer el diagnóstico definitivo de una lesión cerebral sigue siendo la biopsia, la ERM es un método no invasivo y libre de complicaciones que posibilita determinar el tipo de lesión y evitar biopsias innecesarias en procesos no tumorales. El objetivo del presente trabajo es comprobar si la ERM monovóxel protón de hidrógeno (H+) de tiempo de eco (TE) largo es capaz de discriminar la naturaleza tumoral o no de las lesiones cerebrales y clasificarlas en grados de malignidad. Material y método: Se trata de un estudio prospectivo en el que se incluyó a pacientes de ambos sexos y de distintas edades a los que se les realizó un estudio estándar de RM completado con ERM monovoxel. Resultados: Se analizaron 47 lesiones y se caracterizaron adecuadamente 43 (92,9%), con una sensibilidad (S) del 96,8% (IC 89-100), una especificidad (E) del 89,6% (IC 76-100), un valor predictivo positivo (VPP) del 91,1% (IC 80-100) y un valor predictivo negativo (VPN) del 96,3% (IC 87-100). Muchas son las variables que influyen en la adquisición de un espectro factible de ser analizado, pudiendo surgir de éstas diferencias inter-observador. Sin embargo, se obtuvieron resultados similares a los de otras publicaciones. Conclusión: La ERM sumada a la RM demostró ser un método confiable para determinar la naturaleza tumoral o no de una lesión cerebral, con valores estadísticos aceptables.

The Magnetic Resonance Spectroscopy (MRS) is a non-invasive technique which allows study of the metabolism of lesions or of normal tissue, increasing the method's specificity. In this way, the biochemical information provided by MRS is added to the morphologic information provided by the Magnetic Resonance Imaging (MRI). Even though the gold standards to determine the definite diagnosis of a brain lesion is still the biopsy, the MRS is a non-invasive method, free of complications which would help determine the type of lesion and avoid unnecessarybiopsies in non-tumor processes. The objective of this work is to determine if the monovoxel MRS hydrogen proton (H+) long Eco Time (TE) is capable to differentiating or not the nature of the tumor from the brain lesions and classify them into levels of malignity. Material and Method: This is a retrospective study in which female and male patients of any ages were selected. A standard study of MRI was performed in them and it was completed with monovoxel ERM. Results: 47 lesions were analyzed and 43 (92.9%) were adequately characterized, with a sensibility (S) of 96.8% (IC 89-100), specificity (E) of 89.6% (IC 76-100), positive predictive value (PPV) of 91.1% (IC 80-100) and a negative predictive value (NPV) of 96.3% (IC 87-100). There are many variables that can influence the acquisition of a spectrum capable of being analyzed and from them, inter-observer differences can emerge. However, our results were similar to those in other publications. Conclusion: The MRS together with the MRI proved to be a reliable method to determine whether a brain lesion is a tumor or not, with acceptable statistic values.

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La neumatosis intestinal es una entidad muy infrecuente asociada a varias patologías, como el infarto intestino-mesentérico, la enterocolitis necrotizante y la enfermedad pulmonar obstructiva crónica. Se caracteriza por la presencia de gas en la subserosa o submucosa a través del tracto gastrointestinal. Presentamos el caso de un paciente de sexo masculino de 63 años de edad que consultó por dolor en abdomen superior, vómitos y fiebre elevada (39º) nueve días después de una gastrectomía total por cáncer. La radiografía directa de abdomen constató distensión intestinal y la tomografía computada (TC) demostró distensión intestinal, edema mesentérico, neumatosis intestinal a través del intestino delgado y neumatosis portal, preferentemente en el lóbulo hepático izquierdo. Se realizó una laparotomía de urgencia que reveló únicamente distensión intestinal por adherencias, sin evidenciar necrosis intestinal. El paciente evolucionó desfavorablemente, falleciendo posteriormente. Reportamos un nuevo caso y revisamos la literatura de la neumatosis intestinal asociada con neumatosis portal.

The pneumatosis intestinalis is a very infrequent condition associated with a number of diseases, such as mesenteric infarction, necrotizing enterocolitis, and obstructive pulmonary disease characterized by the presence of subserosal or submucosal gas cyst throughout the gastrointestinal tract. A 63- year- old man complained of upper abdominal pain, vomiting and high fever (39º C) on the nine day after total gastrectomy for cancer. Abdominal X-ray revealed intestinal distension. The abdominal Computed Tomography (CT) showed intestinal dilatation, mesenteric oedema, diffuse pneumatosis throughout the small intestine and gas in the portal venous system predominantly in the left hepatic lobe. It was performed emergency activity that revealed intestinal distension secondary to adhesion without intestinal necrosis. The patient had a downhill course and died thereafter. We report a new case and reviewed the literature of pneumatosis intestinalis associated with hepatic portal venous gas.

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Type IV A choledochal cyst is a very uncommon disease, characterized by congenital cystic dilatation of the biliary tree extending to the intrahepatic biliary channels also. A case of a 19-year-old female with jaundice and abdominal pain is reported. The patient underwent a thorough clinical, laboratory and imaging examination. Computerized tomography and magnetic cholangiopancreatography revealed a 13.5 cm choledochal cyst with intrahepatic involvement. Excision of the extrahepatic part of cyst was combined with a Roux-en-Y hepaticojejunostomy. A ductal stricture was discovered at the distal part of extrahepatic cyst. There were no perioperative and late complications in the follow-up.

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El síndrome de Wilkie o síndrome de la arteria mesentérica superior es una rara condición médica originada por la compresión vascular de la tercera porción duodenal entre la arteria mesentérica superior y la aorta abdominal. Los factores predisponentes incluyen desórdenes alimenticios, enfermedades catabúlicas severas, enfermedades de la columna vertebral, trauma severo y estados postoperatorios. El síntoma clinico típico es el dolor epigástrico, intermitente, acompañado de vómitos voluminosos. La duodenografía hipotónica con bario constituye el gold standard para su estudio, pero actualmente la tomografía computada con multidetectores ofrece mayores ventajas diagnósticas. El tratamiento quirúrgico incluye duodenoyeyunostomía, gastroyeryunostomía o lisis del ligamento de Treitz, que pueden realizarse por vía convencional o laparoscópica.

Wilkie's syndrome or superior mesenteric artery syndrome is a rare medical condition caused by vascular compression of the third duodenal portion between the superior mesenteric artery and abdominal aorta. The predisposing factors include eating disorders, severe catabolic diseases, and diseases of the spine, severe trauma and postopertive states. The typical symptom is intermittent epigastric pain, accompanied by vomiting. The hypotonic duodenography with barium is the gold standard for study, but now with the multidetector row CT scan offers greater diagnostic advantages. Surgical treatment includes duodenojejunostomy, gastrojejunostomy and lysis of the ligament of Treitz, which may be performed conventional or laparosocopic.

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