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ObjectiveTo examine the differences in regeneration rates and functions of the liver at the time of and after hepatectomy in obstructive jaundiced rats with preoperative external and internal biliary drainage. Summary Background DataThe significance of biliary drainage before surgery is controversial in patients with obstructive jaundice. MethodsAfter biliary obstruction for 7 days, rats were randomly divided into three groups: obstructive jaundice and hepatectomy (OJHx), external biliary drainage and hepatectomy (ED-Hx), and internal biliary drainage and hepatectomy (ID-Hx). The OJ-Hx group underwent hepatectomy without biliary drainage; the other two groups underwent hepatectomy after biliary drainage for 7 days. At the time of hepatectomy, all rats were provided with internal biliary drainage. On days 0, 1, 2, 3, and 7 after hepatectomy, the DNA synthesis rate and the concentrations of adenine nucleotides and malondialdehyde in the liver were determined as markers of the hepatic regeneration rate, energy status, and lipoperoxide concentration, respectively. Portal endotoxin concentrations were measured and serum hyaluronic acid concentrations were determined as an indicator of hepatic endothelial function. ResultsThe relative liver weight was significantly higher in the ID-Hx group than in the OJ-Hx group on days 1, 3, and 7 after hepatectomy and than in the ED-Hx group on days 1 and 2. The rate of hepatic DNA synthesis was significantly higher in the ID-Hx group than in the OJ-Hx and ED-Hx groups on day 1. The rate was similar in the ED-Hx and ID-Hx groups on day 2 but was significantly higher than in the OJ-Hx group. The hepatic malondialdehyde concentration was significantly higher on day 1 in the ED-Hx group than in the other two groups. It was lowest in the ID-Hx group throughout the study. Both biliary drainage procedures lowered the portal endotoxin concentration and serum hyaluronic acid concentration at the time of hepatectomy. The serum hyaluronic acid concentration was lowest in the ID-Hx group. Hepatic adenine triphosphate concentrations and energy charge levels were similar among the three groups. ConclusionAlthough both external and internal biliary drainage before hepatectomy improved serum liver function tests, portal endotoxin concentration, and serum hyaluronic acid concentration at the time of surgery, preoperative internal biliary drainage was superior to external drainage, as evidenced by the better liver regeneration and function after hepatectomy.

Introducción El hematoma retroperitoneal espontáneo (HRE) corresponde a una colección hemática situada en cualquiera de los 3 compartimentos retroperitoneales: pararrenal anterior, perirrenal y pararrenal posterior. Se produce sin que exista traumatismo, manipulación endourológica o endovascular previa de los elementos del retroperitoneo (1). En la literatura no se han descrito diferencias entre el HRE y la hemorragia retroperitoneal espontánea, por lo que se las considerará sinónimos para fines de esta revisión. Es un cuadro clínico de difícil diagnóstico, que inicialmente puede ser oligo-sintomático (1) , sin embargo, su detección oportuna es fundamental, ya que el retraso diagnóstico determina una alta morbi-mortalidad. La etiología más frecuente de hematoma retrope-ritoneal espontáneo es la rotura de un aneurisma de la aorta abdominal. Otras causas de menor frecuencia son: hemorragias espontáneas de tumores renales o suprarrenales, otros tumores sólidos retroperitonea-les, terapia anticoagulante, discrasias sanguíneas y patología litiásica de la vía urinaria, entre otros (1,2). Además, se describe asociación con hipertensión arterial y arterioloesclerosis (3). La presentación clínica del HRE se caracteriza por masa abdominal palpable, dolor lumboabdominal, hipotensión y caída del hematocrito (1,3). Las caracterís-ticas e intensidad del dolor son variables y dependen, entre otros factores, de la localización y magnitud del hematoma. Se ha descrito irradiación del dolor hacia H e m a t o m a r e t r o p e r i t o n e a l d e c a u s a i n f r e c u e n t e : A propósito de un caso Abstract: The spontaneous retroperitoneal hematoma (SRH) is defined as a spontaneous hematic collection located in any of the retroperitoneal compartments. The most frequently encountered cause of retroperitoneal hemorrhage is a ruptured abdominal aortic aneurysm, followed by renal and adrenal tumors, along with some other less common causes. Performing accurate diagnosis of patients at admission has proven to be difficult, given that the clinical presentation is ample and variable and may mimic other pictures of abdominal or lower back pain. Imaging techniques, mainly angiography, computed tomography, and MR Imaging, represent a fundamental tool for both timely diagnosis and proper management of the condition. We report the case of a 56-year-old male patient with diagnosis of HIV, who presented with a history of abdominal pain and palpable abdominal mass. After a thorough imaging evaluation, patient was diagnosed with retroperitoneal hematoma, whose histological analysis revealed a Burkitt lymphoma.

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