Hilar cholangiocarcinomas are rare neoplasms. Due to their anatomical location, complete surgical resection is technically difficult. It has an annual incidence of 1 in 100.000 habitants. Surgery could be the definitive in early stages, with a 5-years survival of 20%. The majority of patients has advanced disease at diagnoses, with an average survival of 6 to 7 months and usually requires palliative treatment only. Long-term survival is only achieved in patients who have undergone complete resection. Consequently, identification of patients with risk factors, early diagnosis and evaluation of respectability by a surgeon with experience in hepatobiliary surgery are essential KEY WORDS Klatskin tumor. Colangiocarcinoma. Biliary-tract tumor.

RESUMENDesde que en 1863 se demostró que la pérdida de fluidos era la causa de decesos de los pacientes quemados, se ha establecido un sinfín de fórmulas y opciones terapéuticas con la idea de mejorar la sobrevida de estos pacientes. La fórmula de Parkland y la utilización de lactato de Ringer, han sido las dos medidas que mejores resultados han obtenido. La utilización de coloides y soluciones hipertónicas así como gelatinas, han sido objeto de análisis, sin embargo no han demostrado mejorar la sobrevida de los pacientes, por el contrario los efectos adversos han quedado plasmados en distintas revisiones y ensayos médicos. ABSTRACTSince it was proven in 1863 that fluid loss was the cause of death in burnt patients, a number of formulas and therapeutic options have been established with the aim of improving the patients' survival. The Parkland´s formula and the use of Ringer's lactate have been the two methods with the best results. The use of colloids and hypertonic solutions as well as gelatins have been analyzed however, there hasn't been an improvement in the patient's survival on the contrary, the adverse effects have been documented in various revisions and clinical trials.

The acute acalculous cholecystitis is an uncommon complication in the burned patient. It is secondary to atony and ischemia of the gallbladder. It may progress to a necroinflammatory process that frequently complicates with bile infection and systemic sepsis. Moreover, this atony affects bile composition, causing the gallbladder mucosa to be more susceptible to damage. Clinically it is characterized by pain and palpable mass in the right upper quadrant of the abdomen, fever, leukocytosis and increase of bilirubin and alkaline phosphatase. Gallbladder ultrasonography is the best tool lead to diagnosis. Early treatment with antibiotics associated to

Correct monitoring of medico-surgical criticallyill patients aids the early diagnosis and appropriate treatment of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The abdominal cavity and the retroperitoneum act closed compartments and any change in the volume of their contents can increase intraabdominal pressure (IAP). IAH is only one measure of elevated IAP, and ACS represents the end result of sustained IAH with the appearance of organ dysfunction. To diagnose IAH and ACS, measurement of IAP, abdominal perfusion pressure and intramucous gastric pH must be performed and the results correlated with signs of clinical deteriorationin the patient. Medical therapeutic measures in ACS are limited and abdominal decompression is the established symptomatic treatment of this entity.

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