Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Two functioning parathyroid adenomas and one human parathyrJ1 i were used for a transplant, previous culturation "in vitro" of the fragments.A dispositive hased in the method described by Trowell that per1r.itted a relatively good conservation was used. The srrum of the donor was gradually substituted in the medium by that of the receiver in order to "adapt the tissue to the chemistry of the host". The results were more satisfactory in the case of the patient treated with adenoma and parathyroid gland.

The purpose of parathyroid gland implants is to provide a constant endogenous source of hormone, implant seeking a definitive solution to parathyroprive tetany.

Pathological, clínica! and therapeutical aspects of bilio-digestive fistulas are updated through the study of 21 cases treated by the author. Bibliographic dats is revised.The heterogenous situations . in which fistulas are found are analyzed, since they g,nerally constitute a secondary symptom with varied significance within thegroup of associated lesions. Statistical consideration shows for Uruguay a high percentage of lithiasic et. iology compared with the ulcerous or neoplasic type, thus differing from lower figures in the statistics for other countries. Pathology of fistulas of lithiasic origin stress the fact that it complicates the situation, for the combinednd potentialized action of biliary hypertension and parietal alteration, combined with infection and gallstone pressure determinating factors in the formation of the fistula.The cases studied show that there is no specificsymptomatology. Patients are generally in the sixth or seventh decade of their lives, are generally women with cardiovascular alterations, overweight and diabetical.Diagnosis, except in rare cases, is the result of random radiological findings, of a complication (in general gallstone ileus), or, more often, during surgery. Exeept in sone cases when is contraindication by reason of the patient's precarious general condition, treatment consists of surgery. Surgical goals should follow an arder of priori ti es:-Digestive and biliary transit free of obstacles: -Elimination of biliary infection; -Elimination of fistula. and their treatment. Hemorrhage: its massive and cataclysmic character;the need for immediate surgical hemostasis; inclusion of bilio-digestive fistulas in the. diagnosis of massive digestive hemorrhages. Cholangitis: caused or aggravated by backflow. Thismay be the most difficult problem and may occasionally be insoluble. The paper contains an account of treatment for reversible _cases.Gallstome ileus: it accounted for 9 out of 16 cases of bilio-enteric fistulas. Its polimorphic symptomatology and digestive and humoral complications are analyzed. Criteria for its surgical treatment is discussed in connection with the. intestinal and biliary tract. Bouveret's syndrome is analyzed, including its clinical appearence and the possibility of integral surgical treatment. There is also a chapter that deals with biliobiliary fistulas, analyzing surgical difficulties and suggesting safety procedures for biliary canalization. The complex problem of fistulas of ulcerous orlgin is analyzed and surgical solutions which leave the ulcer and abnormal communication are defended by reáson of their good tollerance.

A ,62-year-old patient with transfixing wound in both hemithoraces caused by a bullet which followed " high and posterior transmediastinal path, entered thehospital after a 20-hour evolution, suffering from shock. There was subcutaneous emphysema. During revival practices the emphysema extended considerably, thepatient's condition became worse and exploratory thoracotomy was indicated. In view of the clinical characteristicsof the wound and the path followed by the bullet, the approach chosen was through high right side thoracotomy. On the right side there was an important hemopneumothorax and, through a mediastinal gap, a slight one on the left side. There was considerable insuflation of the mediastine under _ tension, which was inmediately corrected by an opening incisionwhich practically depleted the pneumomediastine. This right side approach made it possible not only. to sol ve the serious condition of the left wounds, simple closureand control drainage in the fore part of the thorax, third space, but also to attend to the lesions on he righ side, their suture and drainage. Postoperatory evolution was eventless and the patient was discharged on the 8th. day. We believe that the lesion on the mediastinal effraction were the main causes of the considerable mediastinal insuflation and extensive emphysema.

The interesting problem of hydatic pathology is studied, which involves the discovery of more than one hydatid within a pulmonary adventitial cavity. The different pathogenic mechanisms are analyzed: local secondary seeding (the most frequent), exogenous cotical vesiculation, common nesting of 2 hexacanth embryos and adventitial "usury".

The treatment of gal!bladder cancer in 175 patients and the results obtained, are analyzed. This series, because of the number of case histories involver, is the third in the world literature. Only 3 patients are still ali ve after 5 years ( 1.7 % ) ; the average rate. of survival of patients subject to paliative procedures was 2.7 months and of those explored,1.5 months. R. Smith's indications, with modifications, are discussed together with therapeutic conduct adapted to each situation in the light of present knowledge of biologyand treatment of gallbladder cancer.

Extraneous bodies swallowed by patients and their gastroduodenal topography constitute the subject of this paper. Their most important characteristics andpossible complications are. described from the point of view of their surgical treatment; operatory indications are set forth. Case material i.ncludes 6 patients

Twenty-six cases of bilateral adrenalectomy performed in the treatment of advanced breast cancer, are presented. Results obtained are analyzed according to the differentlocations, and the rate of survival is studied. In more than one third of all cases, improvent resulted.

A case of retrograde jejunogastric intussusception successfully reduced by operation, is presented and analized by the authors. The literature on the subjectis reviewed and the authors expose diagnostical, pronostical and terapeuthical conclusions.

In 502 case records of mammary carcinoma treated at the. clinics Hospital of Montevideo, it was observed that 67 % of these cases were in advanced stages atthe time of the first consultation, In 12 % of those advanced cases the responsability was due to the physician. Stress is placed on the importance of routine examinationof mammary glands as well as a better medical and sanitary education as an answer to the problem,