[Schwannoma of the spermatic cord]. / Schwannoma del cordón espermático.

Exposition of one case of a patient with spermatic cord schwannoma which became apparent through awareness of mass and a certain inguinoscrotal discomfort. It is controlled five years after surgery. The required differential diagnosis conditioning every expansive inguinoscrotal process prompts this report.

[Epididymal neoplasms. New case report. Report of an adenomatoid tumor]. / Neoplasias epididimarias. Nueva aportación. A propósito de un tumor adenomatoide.

Presentation of the case of one patient with epididymal adenomatoid tumour presenting as episodes of inguino-scrotal discomfort. With no evidence of relapse, the case is monitored three years after surgery. On the lines of the literature review presented, a series of considerations on what has been a controversial histogenesis are made. The reason for this report is the differential diagnosis which conditions all inguino-scrotal processes with torpid evolution.

[Comparative experimental study of inverting and everting sutures in the colon]. / Etude expérimentale comparative de sutures inversées et éversées dans le côlon

The authors carried out 88 sutures of the ascending colon in Wistar rats, 44 in inversion and the remainder in eversion. The suture material used was monofilament 9/0 nylon. The intestinal diameter was measured using an instrument and the healing process studied by means of the following parameters: granulocytes, oedema, fibrin, fibroblasts and re-epithelialisation of the mucosa, on histology. The results prove that inverted sutures heal within 10 days, whereas everted sutures are not healed after 17 days. Furthermore, we demonstrated the fact that, after 72 hours, the intestinal caliber above the suture showed no appreciable differences compared with that of the normal colon.

[Granular-cell tumor of the larynx]. / Tumor de células granulares de laringe.

Laryngeal granular cell tumors are rare. The interest of this subject is their peculiar histogenesis, because there is no general agreement on it. The AA. rapport one case in a woman aged 32, and review closely the related literature.

Surgical treatment of axillary hyperhidrosis.

In the human axilla, the proportion of eccrine and apocrine sweat glands is 1:1. The former are in the dermis, while most of the latter are in the subcutaneous cellular tissue. After studying the difficult methods that have been described for the surgical treatment of axillary hyperhidrosis, we concluded that the treatment should be as radical as possible and deal with both types of glands. The technique described here is a combined method which removes en bloc the skin and subcutaneous cellular tissue of more than half the area of sweating and the subcutaneous cellular tissue of the rest, leaving an S-shaped scar that follows the main axis of the axilla. Problems with this method have been minimal. Follow-up studies carried out up to 3 years after the operation have indicated excellent results.

Subepithelial myofibroblasts and tenascin expression in microscopic colitis.

AIMS: To assess differences in the pattern of subepithelial myofibroblasts and the expression of tenascin as a marker of extracellular matrix production in collagenous and lymphocytic colitis. METHODS AND RESULTS: Colorectal biopsies were studied from 122 patients with chronic diarrhoea and normal colonoscopy. The pathological diagnoses were collagenous colitis (n = 35), lymphocytic colitis (n = 37), mild non-specific chronic inflammation (n = 28) and normal mucosa (n = 18). Four cases showed features of collagenous colitis but with collagen bands <10 micro m thick. Normal mucosa from 14 patients without diarrhoea served as healthy control tissue. Immunohistochemical expression of alpha-smooth muscle actin (myofibroblast marker) and tenascin was evaluated in well-orientated sections. The expression of alpha-smooth muscle actin was significantly increased in collagenous colitis compared with all the other groups. Strong tenascin subepithelial expression was seen in all cases of collagenous colitis, including the four without full-blown features. The mean thickness of tenascin bands was greater than that obtained by conventional stains. CONCLUSIONS: There are clear differences, with respect to extracellular matrix remodelling, between collagenous and lymphocytic colitis. These results support the theory of matrix overproduction in the genesis of collagenous colitis.

Dietary inulin improves distal colitis induced by dextran sodium sulfate in the rat.

OBJECTIVES: Inulin stimulates intracolonic generation of butyrate and growth of lactic acid bacteria. This study investigated whether inulin protects against colitis. METHODS: Rats with dextran sodium sulfate colitis received inulin either orally (1% in drinking water, or 400 mg/day) or by enema. Matched groups received vehicle. In addition, fecal water obtained from inulin-fed rats was administered by enema to rats with colitis and compared with fecal water from control rats. Finally, rats with colitis received daily enemas of either butyrate (at 40 or 80 mmol/L) or vehicle. Inflammation was assessed by eicosanoid asssay in rectal dialysates and MPO activity in colonic tissue. Mucosal lesions were blindly scored by microscopic examination. Luminal pH was measured from cecum to rectum by a surface microelectrode. RESULTS: Oral inulin prevented inflammation, as evidenced by lower lesion scores (p < 0.05), decreased release of mediators (p < 0.05), and lower tissue MPO (p < 0.05) as compared with controls. Inulin induced acidic environment (pH <7.0) from cecum to left colon and increased counts of lactobacilli. Fecal water from inulin-fed rats also reduced scores (p < 0.05) and inflammation (p < 0.05). However, inulin or butyrate enemas had no effect. CONCLUSIONS: Oral inulin reduces the severity of dextran sodium sulfate colitis. The effect seems to be mediated by modification of the intracolonic milieu.

Small cell carcinoma of the urinary bladder treated with chemotherapy and radiotherapy: results in five cases.

Small cell carcinoma of the bladder is a rare and highly aggressive tumor. We report our experience with 5 consecutive patients treated with systemic chemotherapy and adjuvant radiotherapy. TNM stages were T2N0M0 (1 patient), T3aN0M0 (3 patients) and T3bN1M0 (1 patient). The chemotherapy protocol was the one used with small cell lung cancer patients at our hospital: six cycles of alternating PE/CAV (PE: cisplatin, etoposide; CAV: cyclophosphamide, doxorubicin, vincristine). Cystoscopy was performed after the third cycle. Four out of 5 patients were free of macroscopic disease. The fifth patient had persistent lesions and was treated by cystectomy. This patient developed a local-regional recurrence 4 months later and died shortly afterwards. Four patients completed the planned six cycles. Cystoscopy with bladder biopsy was then performed on each, and all had complete remission. They were treated with external radiotherapy (45 Gy pelvis, 60 Gy bladder). One patient had invasive bladder recurrence 12 months later and cystectomy was performed. At the last follow-up 42 months later, he was alive and well. The other 3 patients were alive and free of disease 60, 48 and 27 months after diagnosis, respectively. These results are clearly more favorable than previous reports. Cystectomy might, therefore, be unnecessary in some patients.

Seudomixoma peritoneal de origen apendicular / Pseudomyxoma peritonei of appendiceal origin

Introducción. El seudomixoma peritoneal constituye una afección inusual desencadenada a partir de tumoraciones mucinosas, cuyo origen más frecuente suele ser el apéndice cecal y el ovario. Desde que fue descrita por primera vez hace algo más de 100 años, esta entidad clínica ha planteado importantes controversias conceptuales, terapéuticas y pronósticas. Objetivo. Revisar nuestra experiencia en el tratamiento del seudomixoma peritoneal de origen apendicular. Pacientes y método. Se presenta una serie consecutiva de 11 casos de seudomixoma peritoneal de origen apendicular diagnosticados, tratados y seguidos en nuestro centro desde enero de 1982 hasta junio de 1997. En 6 casos se trató de mujeres y en cinco de varones, con una edad media de 65 años (rango, 31-93). Se analizan la sintomatología, el tratamiento y el pronóstico. El estudio de supervivencia se ha efectuado según el método de Kaplan-Meier. Resultados. No ha habido mortalidad postoperatoria. La supervivencia global ha sido del 57 por ciento a los 5 años. La causa del fallecimiento atribuible al seudomixoma peritoneal ha sido la oclusión intestinal intratable. En ningún caso se ha podido constatar enfermedad extraabdominal. Conclusiones. A pesar de ser una afección generalmente de bajo grado de malignidad, que se limita característicamente a la cavidad abdominal, el seudomixoma peritoneal de origen apendicular comporta una mortalidad importante (AU)