Resonancia Magnética en Cáncer de Mama

MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer
N Engl J Med 2007; 356(13):1295-1303
Constance D. Lehman, M.D., Ph.D., Constantine Gatsonis, Ph.D., Christiane K. Kuhl, M.D., R. Edward Hendrick, Ph.D., Etta D. Pisano, M.D., Lucy Hanna, M.S., Sue Peacock, M.S., Stanley F. Smazal, M.D., Daniel D. Maki, M.D., Thomas B. Julian, M.D., Elizabeth R. DePeri, M.D., David A. Bluemke, M.D., Ph.D., Mitchell D. Schnall, M.D., Ph.D., for the ACRIN Trial 6667 Investigators Group

Background
Even after careful clinical and mammographic evaluation, cancer is found in the contralateral breast in up to 10% of women who have received treatment for unilateral breast cancer. We conducted a study to determine whether magnetic resonance imaging (MRI) could improve on clinical breast examination and mammography in detecting contralateral breast cancer soon after the initial diagnosis of unilateral breast cancer.

Methods
A total of 969 women with a recent diagnosis of unilateral breast cancer and no abnormalities on mammographic and clinical examination of the contralateral breast underwent breast MRI. The diagnosis of MRI-detected cancer was confirmed by means of biopsy within 12 months after study entry. The absence of breast cancer was determined by means of biopsy, the absence of positive findings on repeat imaging and clinical examination, or both at 1 year of follow-up.

Results
MRI detected clinically and mammographically occult breast cancer in the contralateral breast in 30 of 969 women who were enrolled in the study (3.1%). The sensitivity of MRI in the contralateral breast was 91%, and the specificity was 88%. The negative predictive value of MRI was 99%. A biopsy was performed on the basis of a positive MRI finding in 121 of the 969 women (12.5%), 30 of whom had specimens that were positive for cancer (24.8%); 18 of the 30 specimens were positive for invasive cancer. The mean diameter of the invasive tumors detected was 10.9 mm. The additional number of cancers detected was not influenced by breast density, menopausal status, or the histologic features of the primary tumor.

Conclusions
MRI can detect cancer in the contralateral breast that is missed by mammography and clinical examination at the time of the initial breast-cancer diagnosis.

Utilidad del Estudio Radiografico Contrastado con Medio Hidrosoluble en el Manejo de Obstrucción Intestinal por Bridas

Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction
British Journal of Surgery April 2007; 94(4):404-11.
S. M. Abbas, I. P. Bissett, B. R. Parry

Adhesions are the leading cause of small bowel obstruction. Identification of patients who require surgery is difficult. This review analyses the role of Gastrografin® as a diagnostic and therapeutic agent in the management of adhesive small bowel obstruction.

A systematic search of Medline, Embase and Cochrane databases was performed to identify studies of the use of Gastrografin® in adhesive small bowel obstruction. Studies that addressed the diagnostic role of water-soluble contrast agent were appraised, and data presented as sensitivity, specificity, and positive and negative likelihood ratios. Results were pooled and a summary receiver-operator characteristic (ROC) curve was constructed.

A meta-analysis of the data from six therapeutic studies was performed using the Mantel-Haenszel test and both fixed- and random-effect models.The appearance of water-soluble contrast agent in the colon on an abdominal radiograph within 24 h of its administration predicted resolution of obstruction with a pooled sensitivity of 97 per cent and specificity of 96 per cent. The area under the summary ROC curve was 0·98.

Water-soluble contrast agent did not reduce the need for surgical intervention (odds ratio 0·81, P = 0·300), but it did reduce the length of hospital stay for patients who did not require surgery compared with placebo (weighted mean difference - 1·84 days; P < 0·001).

Published data strongly support the use of water-soluble contrast medium as a predictive test for non-operative resolution of adhesive small bowel obstruction. Although Gastrografin® does not reduce the need for operation, it appears to shorten the hospital stay for those who do not require surgery.

Medición de Calidad en Cirugía: Rotulación de Muestras de Tejido

Surgical specimen identification errors: A new measure of quality in surgical care
Surgery April 2007;141(4):450-5.
Martin A. Makary MD, MPH, Jonathan Epstein, Peter J. Pronovost MD, PhD, E. Anne Millman MS, Emily C. Hartmann MS and Julie A. Freischlag MD Department of Surgery, Center for Surgical Outcomes Research, John Hopkins University School of Medicine, Baltimore.

Background
Communication errors are the primary factor contributing to all types of sentinel events including those involving surgical patients. One type of communication error is mislabeled specimens. The extent to which these errors occur is poorly quantified. We designed a study to measure the incidence and type of specimen identification errors in the surgical patient population.

Methods
We performed a prospective cohort study that included all patients who underwent surgery in an outpatient clinic or hospital operating room and for whom a pathology specimen was sent to the laboratory. The study took place during a 6-month period (October 2004 to April 2005) at an urban, academic medical center. The study’s main end-points were the incidence and type of specimen labeling errors in the hospital operating room and the outpatient clinic. The specimen was the unit of analysis. All specimens were screened for “identification errors,” which, for the purposes of this study, were defined as any discrepancy between information on the specimen requisition form and the accompanying labeled specimen received in the laboratory. Errors were stratified by the type of identification error, source, location, and type of procedure.

Results
A total of 21,351 surgical specimens were included in the analysis. There were 91 (4.3/1000) surgical specimen identification errors (18, specimen not labeled; 16, empty container; 16, laterality incorrect; 14, incorrect tissue site; 11, incorrect patient; 9, no patient name; and 7, no tissue site). Identification errors occurred in 0.512% of specimens originating from an outpatient clinic (53/10,354 specimens) and 0.346% of specimens originating from an operating room (38/10,997 specimens). Procedures involving the breast were the most common type to involve an identification error (breast = 11, skin = 10, colon = 8); in addition, 59.3% (54/91) of errors were associated with a biopsy procedure. Follow-up was complete in all cases found to have an identification error.

Conclusions
Surgical specimen identification errors are common and pose important risks to all patients. In our study, these events occurred in 4.3 per 1000 surgical specimens or an annualized rate of occurrence of 182 mislabeled specimens per year. Given the frequency with which these errors occur and their potential effect on patients, the rate of surgical specimen identification errors may be an important measure of patient safety. Strategies to reduce the rate of these errors should be a research priority.

Aumento de Temperatura Corporal Perioperatorio Podría Tener Beneficios

Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery
British Journal of Surgery April 2007; 94(4):421-6.
P. F. Wong, S. Kumar, A. Bohra, D. Whetter, D. J. Leaper

Hypothermia is common in the operating theatre and may increase susceptibility to postoperative complications. Intraoperative systemic warming has been shown to improve outcomes of surgery.

This study aimed to examine the effects of additional perioperative systemic warming on postoperative morbidity.

All patients admitted for elective major abdominal surgery and fulfilling the inclusion criteria were randomized into control or warming groups. Both groups were warmed during surgery, but patients in the warming group were additionally warmed 2 h before and after surgery using a conductive carbon polymer mattress.

The trial recruited 103 patients (56 in the control group, 47 in the warming group). Both groups were well matched for age, sex and clinical state. Patients in the warming group had lower blood loss (median 200 (range 5-1000) ml versus median 400 (range 50-2300) ml in the control group; P = 0·011) and complication rates (15 (32 per cent) of 47 versus 30 (54 per cent) of 56 in the control group; P = 0·027). There were three deaths; two in the control group (P = 0·566).

Extending systemic warming to the perioperative period had additional beneficial effects, with minimal additional cost and patient discomfort.

Switch Duodenal

Journal of the American College of Surgeons 2007; 204(4): 603-608

Revision of the Duodenal Switch: Indications, Technique, and Outcomes
Nahid Hamoui MD, Brandon Chock MD, Gary J. Anthone MD and Peter F. Crookes MD

Duodenal switch (DS) operation combines both restrictive and malabsorptive components and has become an accepted operation in selected patients with morbid obesity. Complications develop in some patients, which are refractory to dietary supplementation. We report a series of 33 patients who required partial revision of the DS.

Study Design
During the 10-year period after September 1992, 701 patients had DS operation performed; of these, 33 (5 men and 28 women) patients required revision. Revision was performed by side to side enteroenterostomy 100 cm proximal to the original anastamosis. Outcomes measures reviewed include postoperative complications, nutritional parameters, and weight change.

Results
Revision was performed a median of 17 (range 7 to 63) months after DS. Indications for revision included protein malnutrition (n = 20), diarrhea (n = 9), metabolic abnormalities (n = 5), abdominal pain (n = 3), liver disease (n = 2), emesis (n = 2), and gastrointestinal bleed (n = 1). Median body mass index at the time of revision was 28. Median serum albumin was 3.6 g/dL and improved to 4.0 g/dL postoperatively (p = 0.01). Complications occurred in 5 of 32 patients (15%) and included wound infection (n = 2), respiratory failure (n = 1), gastrointestinal bleed (n = 1), and small bowel obstruction (n = 1). There was no perioperative mortality. During a median followup period after revision of 39 months, the median weight gain was 18 pounds. Three patients requested repeat operation because of weight regain.

Conclusions
Patients requiring revision of DS for malnutrition can be corrected by a technically simple procedure, but they are at considerable risk for complications. Although many patients are anxious about regaining their weight after reversal, they can be reassured that substantial weight gain is unlikely.

Un Nuevo Metaanálisis Compara Colectomía Abierta vs Laparoscópica para Cáncer de Colon

Laparoscopically Assisted vs Open Colectomy for Colon Cancer
A Meta-analysis
Transatlantic Laparoscopically Assisted vs Open Colectomy Trials Study Group*
Arch Surg. 2007;142:298-303.

Objective To perform a meta-analysis of trials randomizing patients with colon cancer to laparoscopically assisted or open colectomy to enhance the power in determining whether laparoscopic colectomy for cancer is oncologically safe.

Data Sources The databases of the Barcelona, Clinical Outcomes of Surgical Therapy (COST), Colon Cancer Laparoscopic or Open Resection (COLOR), and Conventional vs Laparoscopic-Assisted Surgery in Patients With Colorectal Cancer (CLASICC) trials were the data sources for the study.

Study Selection Patients who had at least 3 years of complete follow-up data were selected.

Data Extraction Patients who had undergone curative surgery before March 1, 2000, were studied. Three-year disease-free survival and overall survival were the primary outcomes of this analysis.

Data Synthesis Of 1765 patients, 229 were excluded, leaving 796 patients in the laparoscopically assisted arm and 740 patients in the open arm for analysis. Three-year disease-free survival rates in the laparoscopically assisted and open arms were 75.8% and 75.3%, respectively (95% confidence interval [CI] of the difference, –5% to 4%). The associated common hazard ratio (laparoscopically assisted vs open surgery with adjustment for sex, age, and stage) was 0.99 (95% CI, 0.80-1.22; P = .92). The 3-year overall survival rate after laparoscopic surgery was 82.2% and after open surgery was 83.5% (95% CI of the difference, –3% to 5%). The associated hazard ratio was 1.07 (95% CI, 0.83-1.37; P = .61). Disease-free and overall survival rates for stages I, II, and III evaluated separately did not differ between the 2 treatments.

Conclusion Laparoscopically assisted colectomy for cancer is oncologically safe.

Progesterona como Neuroprotector en Trauma Cerebral: Un Estudio Fase II

ProTECT: A Randomized Clinical Trial of Progesterone for Acute Traumatic Brain Injury
Annals of Emergency Medicine 2007; 49(4):391-402
David W. Wright MD, Arthur L. Kellermann MD, MPH, Vicki S. Hertzberg PhD, Pamela L. Clark RN, Michael Frankel MD, Felicia C. Goldstein PhD, Jeffrey P. Salomone MD, L. Leon Dent MD, MSCR, Odette A. Harris MD, Douglas S. Ander MD, Douglas W. Lowery MD, Manish M. Patel MD, Donald D. Denson PhD, Angelita B. Gordon MS, Marlena M. Wald MPH, MLS, Sanjay Gupta MD, Stuart W. Hoffman PhD and Donald G. Stein PhD

Study objective
Laboratory evidence indicates that progesterone has potent neuroprotective effects. We conducted a pilot clinical trial to assess the safety and potential benefit of administering progesterone to patients with acute traumatic brain injury.

Methods
This phase II, randomized, double-blind, placebo-controlled trial was conducted at an urban Level I trauma center. One hundred adult trauma patients who arrived within 11 hours of injury with a postresuscitation Glasgow Coma Scale score of 4 to 12 were enrolled with proxy consent. Subjects were randomized on a 4:1 basis to receive either intravenous progesterone or placebo. Blinded observers assessed patients daily for the occurrence of adverse events and signs of recovery. Neurologic outcome was assessed 30 days postinjury. The primary safety measures were differences in adverse event rates and 30-day mortality. The primary measure of benefit was the dichotomized Glasgow Outcome Scale–Extended 30 days postinjury.

Results
Seventy-seven patients received progesterone; 23 received placebo. The groups had similar demographic and clinical characteristics. Laboratory and physiologic characteristics were similar at enrollment and throughout treatment. No serious adverse events were attributed to progesterone. Adverse and serious adverse event rates were similar in both groups, except that patients randomized to progesterone had a lower 30-day mortality rate than controls (rate ratio 0.43; 95% confidence interval 0.18 to 0.99). Thirty days postinjury, the majority of severe traumatic brain injury survivors in both groups had relatively poor Glasgow Outcome Scale–Extended and Disability Rating Scale scores. However, moderate traumatic brain injury survivors who received progesterone were more likely to have a moderate to good outcome than those randomized to placebo.

Conclusion
In this small study, progesterone caused no discernible harm and showed possible signs of benefit

Conceptos de Bioestadistica: Intervalos de Confianza

Intervalos de confianza: por qué usarlos
Cir Esp 2007;81:121-5
Javier Escrig Sosa Juan Manuel Miralles Tenaa David Martínez Ramosa Isabel Rivadulla Serrano.

Se analizan las razones por las que el uso de los intervalos de confianza es altamente recomendable. Entre estas razones, destacan la aproximación al conocimiento de la importancia real de un resultado, independientemente de la significación estadística, y la valoración de equivalencia entre dos variables.

Para acceder al texto completo hacer click en el título de este "entry"

Manitol y su Efecto Cerebral en Paciente con Trauma Cerebral Severo

Effects of Mannitol Bolus Administration on Intracranial Pressure, Cerebral Extracellular Metabolites, and Tissue Oxygenation in Severely Head-Injured Patients.
Journal of Trauma-Injury Infection & Critical Care. 62(2):292-298, February 2007.
Sakowitz, Oliver W. MD; Stover, John F. MD; Sarrafzadeh, Asita S. MD; Unterberg, Andreas W. MD; Kiening, Karl L. MD

Background: Osmotic agents are widely used to lower elevated intracranial pressure (ICP). However, little data are available regarding cerebral oxygenation and metabolism in the traumatized brains studied under clinical conditions. The present prospective, open-labeled clinical study was designed to investigate whether administration of mannitol, with the aim of reducing moderate intracranial hypertension, improves cerebral metabolism and oxygenation in patients after severe traumatic brain injury (TBI).

Methods: Multimodal cerebral monitoring (MCM), consisting of intraparenchymal ICP, tissue oxygenation (ptiO2), and micro dialysis measurements was initiated in six male TBI patients (mean age 45 years; Glasgow Coma Scale score <9). A total of 14 mannitol boli (20%, 0.5g/kg, 20 minutes infusion time) were administered to treat ICP exceeding 20 mm Hg (2.7 kPa). Temporal alterations determined by MCM after mannitol infusions were recorded for 120 minutes. Microdialysates were assayed immediately for extracellular glucose, lactate, pyruvate, and glutamate concentrations.

Results: Elevated ICP was successfully treated in all cases. This effect was maximal 40 minutes after start of infusion (25 +/- 6 mm Hg [3.3 +/- 0.8 kPa] to 17 +/- 3 mm Hg [2.3 +/- 0.4 kPa], p < 0.05) and lasted up to 100 minutes. Cerebral ptiO2 remained unaffected (21 +/- 5 mm Hg [2.8 +/- 0.7 kPa] to 23 +/- 6 mm Hg [3.1 +/- 0.8 kPa], n.s.). Microdialysate concentrations of all analytes rose unspecifically by 10% to 40% from baseline, reaching maximum concentrations 40 to 60 minutes after start of the infusion.

Conclusions: Mannitol efficiently reduces increased ICP. At an ICP of up to 30 mm Hg [4 kPa] it does not affect cerebral oxygenation. Unspecific increases of extracellular fluid metabolites can be explained by transient osmotic dehydration. Additional mechanisms, such as increased cerebral perfusion and blood volume, might explain an accelerated return to baseline.

Máscara Laringea

The laryngeal tube device: a simple and timely adjunct to airway management
The American Journal of Emergency Medicine 2007; 25(3): 263-7
Christopher S. Russi DOa, , Cari L. Wilcox BAb and Hans R. House MD, DTMHa aDepartment of Emergency Medicine, University of Iowa, Iowa City, IA 52242, USAbRoy J. & Lucille A. Carver College of Medicine, University of Iowa.

Introduction
Endotracheal intubation (ETI) is a motor skill that demands practice. Emergency medical service providers with limited intubation experience should consider using airway adjuncts other than ETI for respiratory compromise. Prehospital ETI has been recently interrogated by evidence exposing worsened patient outcomes. The laryngeal tube (LT) airway was approved by the Food and Drug Administration in 2003 for use in the United States. Using difficult airway-simulated models, we sought to describe the time difference between placing the ETI and LT and the successful placement of each adjunct in varied levels of healthcare providers.

Methods
Emergency medicine resident physicians, fourth year medical students, and paramedic students were asked to use both ETI and the LT. Subjects were timed (seconds) on ETI and LT placement on 2 different simulators (AirMan and SimMan; Laerdal Co, Wappingers Falls, NY). After ETI was complete, they were given 30 seconds to review an instructional card before placement of the LT. We measured placement time and successful placement of the device for ETI vs LT. Successful placement in the manikin was defined by a combination of breath sounds, chest rise, and absence of epigastric sounds.

Results
Overall mean placement time in the AirMan and SimMan for ETI was 76.4 (95% confidence interval [CI], 63.3-89.5) and 45.9 (95% CI, 41.0-50.2) seconds, respectively. Mean placement time for the LT in the AirMan and SimMan was 26.9 (95% CI, 24.3-29.5) and 20.3 (95% CI, 18.1-22.5) seconds, respectively. The time difference between ETI and LT for both simulators was significant (P < .0001). Successful placement of the LT compared with ETI in the AirMan was significant (P = .001).

Conclusions
A significant time difference and simplicity exists in placing the LT, making it an attractive device for expeditious airway management. Further studies will need to validate the LT effectiveness in ventilation and oxygenation; however, its uncomplicated design allows for successful use by a variety of healthcare providers.

Ileostomía vs Colostomía para Derivación en Resecciones Anteriores Bajas

Comparación de colostomías e ileostomías como estomas derivativos tras resección anterior baja
Rev Esp 2007; 81: 115-120
Pedro Armendáriz-Rubioa Mario de Miguel Velascoa Héctor Ortiz Hurtadoa aSección de Coloproctologia. Servicio de Cirugía General y del Aparato Digestivo. Hospital Virgen del Camino. Pamplona. Navarra. España.

Objetivo. Valorar si es mejor la colostomía transversa o la ileostomía como estomas derivativos tras resección anterior baja.

Material y método. Se ha llevado a cabo una revisión bibliográfica para intentar comparar ambos estomas desde la construcción hasta su cierre.

Resultados. En el momento de la construcción no es fácil sacar conclusiones, ya que es difícil distinguir las complicaciones específicas secundarias a la construcción del estoma de las ocasionadas por la resección anterior. Durante el tiempo en que el paciente es portador del estoma, la colostomía transversa parece tolerarse peor. El cierre de la colostomía parece tener más complicaciones sépticas, aunque está por aclarar la frecuencia real de obstrucción intestinal tras el cierre de ileostomía.

Conclusiones. Dadas las características de los estudios previos, no es posible establecer en términos generales qué estoma derivativo es mejor. La ileostomía parece mejor tolerada por el paciente y se asocia a una menor tasa de complicaciones tras el cierre (quedando pendiente de evaluar la obstrucción intestinal). Son necesarios estudios prospectivos aleatorizados con un mayor número de pacientes para poder responder a la pregunta planteada.

PARA ACCEDER AL TEXTO COMPLETO EN PDF HACER CLICK EN EL TÍTULO DE ESTE "ENTRY"

Hernias Inguinocrurales

Se encuentra disponible en la web gratis un libro que trata sobre hernias inguinocrurales. Esta patrocinado por la Sociedad Española de Cirugía. Es un archivo pdf, un poco grande, pero vale la pena.

http://www.aecirujanos.es/publicados_por_la_AEC/hernia_inginocrural/libro_hernia_inguinal.pdf

Screening para Cáncer Pulmonar con Tomografía Axial

Computed Tomography Screening and Lung Cancer Outcomes
Peter B. Bach, MD, MAPP; James R. Jett, MD; Ugo Pastorino, MD; Melvyn S. Tockman, MD, PhD; Stephen J. Swensen, MD, MMM; Colin B. Begg, PhD
JAMA. 2007;297:953-961.

Context Current and former smokers are currently being screened for lung cancer with computed tomography (CT), although there are limited data on the effect screening has on lung cancer outcomes. Randomized controlled trials assessing CT screening are currently under way.

Objective To assess whether screening may increase the frequency of lung cancer diagnosis and lung cancer resection or may reduce the risk of a diagnosis of advanced lung cancer or death from lung cancer.

Design, Setting, and Participants Longitudinal analysis of 3246 asymptomatic current or former smokers screened for lung cancer beginning in 1998 either at 1 of 2 academic medical centers in the United States or an academic medical center in Italy with follow-up for a median of 3.9 years.

Intervention Annual CT scans with comprehensive evaluation and treatment of detected nodules.

Main Outcome Measures Comparison of predicted with observed number of new lung cancer cases, lung cancer resections, advanced lung cancer cases, and deaths from lung cancer.

Results There were 144 individuals diagnosed with lung cancer compared with 44.5 expected cases (relative risk [RR], 3.2; 95% confidence interval [CI], 2.7-3.8; P<.001). There were 109 individuals who had a lung resection compared with 10.9 expected cases (RR, 10.0; 95% CI, 8.2-11.9; P<.001). There was no evidence of a decline in the number of diagnoses of advanced lung cancers (42 individuals compared with 33.4 expected cases) or deaths from lung cancer (38 deaths due to lung cancer observed and 38.8 expected; RR, 1.0; 95% CI, 0.7-1.3; P = .90).

Conclusions Screening for lung cancer with low-dose CT may increase the rate of lung cancer diagnosis and treatment, but may not meaningfully reduce the risk of advanced lung cancer or death from lung cancer. Until more conclusive data are available, asymptomatic individuals should not be screened outside of clinical research studies that have a reasonable likelihood of further clarifying the potential benefits and risks.

Preservación de las Paratiroides: Un Resumen.

Un breve resumen sobre la preservación de las glándulas paratiroides durante la cirugía de tiroides. Publicado en el número de marzo 2007 de Contemporary Surgery.

http://www.contemporarysurgery.com/pdf/6303/6303CS_Pearl.pdf

Utilidad de la Radiografía de Abdomen Simple en el Diagnóstico de Apendicitis

Assessment of the persistence of fecal loading in the cecum in presence of acute appendicitis
International Journal of Surgery 2007; 5(1):11-16.
Andy Petroianu, Luiz Ronaldo Albertia and Renata Indelicato Zaca. Alfa Institute of Gastroenterology, Hospital of Clinics of the Federal University of Minas Gerais, Brazil

Objective
Although the radiographic characteristics of acute appendicitis have been well documented, the value of plain abdominal radiography has not been completely studied. Therefore, the purpose of this investigation was to establish the association and relevance of the image of fecal loading in the cecum detected by plain abdominal X-ray of patients with acute appendicitis.

Methods
One hundred and seventy consecutive patients of both sexes were admitted at the hospital with acute pain in the right flank. The hypothesis of appendicitis was confirmed by operation and histological examination. These patients were distributed into two groups: Group 1 (n = 100), patients who had plain abdominal X-rays done a few hours before surgical treatment, and Group 2 (n = 70), patients who had plain abdominal X-rays done before the surgical procedure and also the following day. All X-rays were taken from an anteroposterior view of the abdomen. Demographic data such as age, gender, and skin color (white, brown and black) and morphologic stages of acute appendicitis were also assessed.

Results
Radiographic sign of fecal loading in the cecum was detected in 97 (97%) patients of Group 1 and in 68 (97.14%) patients of Group 2. This sign could not be detected any longer after surgery in 66 of the 68 positive cases. Sensitivity of this radiographic sign for acute appendicitis was 97.05%.

Conclusions
Radiographic image of fecal loading in the cecum of patients with abdominal pain is associated with acute appendicitis. The image usually becomes undetectable shortly after the appendix removal.

Hematomas Espontaneos de la Pared Abdominal

Aquí hay un articulo publicado en la Revista Chilena de Cirugía que trata sobre hematomas espontáneos de la pared abdominal. Si bien es una causa infrecuente de dolor abdominal, es uno de los diagnósticos diferenciales del abdomen agudo. Más de un cirujano en el servicio de urgencia ha visto un caso, y si no se sospecha no se encuentra hasta la laparotomía.

http://www.cirujanosdechile.cl/Revista/PDF%20Cirujanos%202007_01/Cir.12007.(03).pdf