Gallbladder absence is an infrequent anomaly normally accompanied by lack of the cystic duct. Of unknown etiology, in general it is accepted to be a congenital malformation. A male patient (age 59) diagnosed with nonfunctional symptomatic scleroatrophic gallbladder by echography and ERCP was operated on using a laparoscopic approach. Gallbladder and cystic absence was diagnosed during the procedure. A new case of gallbladder and cystic duct absence, diagnosed by laparoscopy, is presented. This type of extrahepatic bile duct malformation is quite rare, but it must be taken into account due to the generalization of laparoscopic surgery in biliar pathology because of the high risk of serious lesions to the hepatocholedochal system.

Introduction: The most appropriate treatment for parapneumonic effusion (PPE), including empyema, is controversial. We analyzed the experience of our center and the hospitals in its reference area after adopting a more conservative approach that reduced the use of chest tube pleural drainage (CTPD).Methods: Review of the clinical documentation of all PPE patients in nine hospitals from 2010 to 2018.Results: A total of 318 episodes of PPE were reviewed; 157 had a thickness of <10 mm. The remaining 161 were 10 mm or thicker and were subdivided into three increasing sizes: PE+1, PE+2, and PE+3. There was a strong relationship between the size of the effusion and complicated effusion/empyema, defined by its appearance on imaging studies or by the physical or bacteriological characteristics of the pleural fluid. The size of effusion was also strongly related to the duration of fever and intravenous treatment and was the best independent predictor of the length of hospital stay (LHS) (p < 0.001). CTPD was placed in 2.9% of PE+1 patients, 19.3% of PE+2, and 63.9% of PE+3 (p < 0.001). The referral of patients with PE+1 decreased over time (p = 0.033), as did the use of CTPD in the combined PE+1/PE+2 group (p = 0.018), without affecting LHS (p = 0.814). There were no changes in the use of CTPD in the PE+3 group (p = 0.721).Conclusions: The size of the PPE is strongly correlated with its severity and with LHS. Most patients can be treated with antibiotics alone.

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ResumenRealizamos un estudio observacional, descriptivo, temporalmente retrospectivo, en el que fueron evaluados 241 pacientes con diagnóstico de tumor de párpado de diferentes etiologías entre 1981 y 2009. La edad promedio fue de 44,17 años, siendo de sexo femenino 162 pacientes (67,2%). No hubo preferencia de localización en cuanto a la zona afectada. Según Anatomía Patológica, 164 casos (68%) fueron tumores benignos y 77 casos (32%) tumores malignos. Los diagnósticos postoperatorios más frecuentes fueron, entre los tumores malignos, el de carcinoma basocelular en 63 pacientes (82%), y entre los tumores benignos, el de chalazión en 25 pacientes (15,2%). Las técnicas quirúrgicas más empleadas fueron la resección simple con sutura en los tumores benignos, y el colgajo músculo-cutáneo monopediculado de pár-pado superior en los tumores malignos. En el seguimiento postoperatorio al año de la cirugía realizado sobre 38 pacientes (15,8%) con tumor maligno, se observaron 6 casos (7,7%) de recidiva. Palabras clave Tumor de párpado,Reconstrucción párpado. Código numérico 221-2441 AbstractWe performed an observational, descriptive temporarily retrospective study; were evaluated 241patients with different eyelid tumor etiologies in the time period from 1981 to 2009. The average age was 44,17 years and 162 patients (67.2%) were female. There was no location preference for the affected area.The tumors were benign pathology in 164 cases (68%) and malignancy in 77 patients (32%).The most frequent postoperative diagnoses included basal cell carcinoma in malignant tumors in 63 patients (82%), and chalazion among benign tumors in 25 patients (15,2%). The surgical techniques employed were simple excision with suture in benign tumors, and muscle monopediculated flap from upper eyelid. Postoperative one year follow up in 38 of patients (15,8%) observed malignant tumor recurrence in 6 cases (7,7%).