Helical CT evaluation in the preoperative staging of gastric adenocarcinoma.

INTRODUCTION: The aim of this study is to evaluate helical CT as a basic preoperative test for the staging of gastric adenocarcinoma. MATERIAL AND METHOD: We enrolled 50 patients with a diagnosis of gastric adenocarcinoma, evaluated helical CT scans, and compared their findings to the microscopic, pathology-confirmed ones obtained by laparotomy. UICC's TNM classification, 5th edition (May 1997), was used. RESULTS: Best results regarding Sensitivity were obtained in the diagnosis of lymph node disease (83%; 69-92%); regarding specificity we obtained 92% (79-98%) for T4, and 89% (77-96%) in metastasis detection. Accuracy was 70% for T1-T2, and 62% for T3. CONCLUSIONS: 1. For the T category, helical CT effectively detects advanced cases classified as non-resectable. 2. For the N category, helical CT prediction is better than ever before with previous CT generations. 3. For the M category, helical CT is a useful test to identify the presence of liver metastases that would render surgery unnecessary.

Colorectal trauma caused by foreign bodies introduced during sexual activity: diagnosis and management.

PURPOSE: The aim of this study is to describe 17 cases of colorectal foreign bodies introduced during sexual activity, gathered by the authors over the past twenty years (1980-2000), and to establish diagnostic and therapeutic guidelines for these situations. MATERIAL AND METHODS: A total of 17 patients were treated for rectal trauma caused by foreign bodies due to unusual sexual practice. The extraction of the foreign body was possible through the canal anal in 10 cases using different techniques (gynecological forceps, Foley catheters, etc.), whereas 7 patients required surgical treatment; in five patients a protective colostomy was needed, and in the other two a simple suture of the rectal lesion was performed. RESULTS: There were no deaths and no post-operative complications. In all cases the colostomy was closed 3-6 months after surgery. There were no cases of anal incontinence. CONCLUSIONS: A detailed clinical history and physical examination are essential for the diagnosis and management of these lesions, in addition to any other diagnostic techniques that might be necessary. Great care should be taken when extracting the foreign body so as to avoid its breakage inside the rectum, which would complicate a rather simple problem.

Laparoscopic evaluation of the risk of locoregional recurrence after radical surgery for gastric cancer.

OBJECTIVE: we studied the diagnostic utility of laparoscopy in patients who underwent absolute radical surgery (R0) for gastric adenocarcinoma and who were at risk for locoregional recurrence. Risk was considered to exist in patients with T3-T4 stage tumors (IUAC TNM classification) that invaded the serosa or affect nearby organs. These patients are candidates for clinical trials involving multimodal therapies, especially with neoadjuvant or intraperitoneal chemotherapy. METHOD: ninety consecutive patients with gastric adenocarcinoma diagnosed by endoscopic biopsy were studied. The tumors were considered to be operable and potentially resectable depending on the preoperative evaluation of spread. The gold standard was the pathology report, based on the resected piece or specific biopsies. RESULTS: in T3-T4 tumors, laparoscopy had a sensitivity of 81% and a specificity of 100%, whereas for an 80% prevalence the positive predictive value was 100%, the negative predictive value was 56%, and diagnostic accuracy was 84%. CONCLUSIONS: in global terms, laparoscopy is very useful in detecting and confirming malignant invasion of the serosa or neighboring organs. In this sense it is similar to other diagnostic staging techniques such as endoscopic echography, with the added advantages of requiring less operator skill and being available in any center where such tumors are treated.

[Streptococcus bovis in a surgical wound and a colonic neoplasm]. / Streptococcus bovis en herida quirúrgica y neoplasia de colon.

The association of colorectal carcinoma and septicemia or endocarditis by Streptococcus bovis is well known. Nonetheless, other localizations of infection by Streptococcus bovis have not been associated with colorectal carcinoma. The case of association of colon neoplasm with infection by Streptococcus bovis localized in the surgical wound of resection of a prostate adenoma by the transvesical route carried out four months previously is presented. Possible intraoperative bacteremia colonizing the surgical wound due to colic compression during surgery may have been the cause. This localization of infection by Streptococcus bovis should be taken into account in screening of colorectal carcinoma.

[Rupture of splenic artery aneurysm as a cause of acute abdomen]. / Ruptura de aneurisma de arteria esplénica como causa de abdomen agudo.

A male, 52 years old, presenting acute abdominal pain and hypovolemic shock, was diagnosed by ultrasound and CAT of fissured aneurysm of the splenic artery. Emergency laparotomy confirmed that the aneurysm had ruptured into the peritoneal cavity.

[Arterial embolisms in the upper and lower limbs: a clinical review]. / Embolias arteriales en miembros superiores e inferiores: revisión clínica.

A clinical review about the subjects is made. Percentages and comparisons between lower and upper limbs were established. Correlation with statistics from other authors are presented.

[Angiodysplasia of the colon and Crohn's disease. A study with vascular resin casts]. / Angiodisplasia de colon y enfermedad de Crohn. Estudio con moldes vasculares de resina.

All the previous studies which have associated arteriovenous malformations of the colon with chronic inflammatory disease have always been performed on a diseased intestine. This study, which uses the intravascular injection of resin, shows morphological evidence that angiodysplasia of the colon and intestinal inflammatory disease can coexist independently. This fact suggests that in cases of severe hemorrhage in a patient with inflammatory disease of the small intestine, it cannot simply be assumed that it originates in the macroscopically abnormal intestine, and that angiographic examination is a wise measure to rule out the possibility of arteriovenous malformations in the "normal" intestine.

[Surgical treatment of Zenker's diverticulum. Apropos of 14 cases]. / Tratamiento quirúrgico del divertículo de Zenker. A propósito de 14 casos.

We present our experience in the surgical treatment of 14 cases of Zenker's diverticulum, diagnosed from January, 1969 to December, 1988. In 11 cases we performed one stage diverticulectomy; in 4 cases, manometric findings required cricopharyngeal myotomy. In 3 cases surgical treatment was not indicated; 2 patients had liver cirrhosis and high surgical risk and the third patient declined the treatment. Current treatment is discussed.

[Presentation of 6 cases of cystadenocarcinoma of the pancreas]. / Aportación de seis casos de cistoadenocarcinomas de páncreas.

Cystadenocarcinomas represent approximately 1% of the pancreatic tumors and are difficult to diagnose clinically and by pathology. Due to their rarity, published series are small. We present 6 cases of pancreatic cystadenocarcinoma collected over a period of 15 years at the Visceral Surgery Service of the Valencia University Hospital. The better evolution and prognosis of these tumors in comparison with pancreatic adenocarcinomas is noteworthy.

[Peptic stenoses of the esophagus]. / Estenosis pépticas del esófago.

The authors present a series of 32 cases of reflux peptic strictures of the esophagus. The mean age of the patients is 54 years, with a 3/1 predominance of males. The etiologic antecedent was hiatal hernia in every case, with a clinical time of evolution of 29 months, dysphagia being the most frequent symptom (100%). Complementary diagnosis was based fundamentally on endoscopy and barium transit, explorations that also allow exclusion of other pathologies. All the patients underwent medical treatment, this being the only treatment in 4 cases. The other 28 cases were treated surgically. The technique used was, in the cases in which the esophagus could be dilated, dilatation associated with an antireflux technique, and when not dilatable, resection with reconstruction using stomach (Sweet) or colonoplasty. The global mortality was two patients (5.2%). Patients were followed-up for a minimum of 2 years and the global results have been good, with recurrence in 3 cases (7.7%). Postoperative dysphagia appeared in 17 cases (44.7%), in all of the transitory.