[Budd-Chiari syndrome: current medical-surgical management]. / Síndrome de Budd-Chiari: manejo médico-quirúrgico actual.

The Budd-Chiari syndrome or obstruction of the hepatic veins and/or suprahepatic inferior vena cava is a rare process, frequently associated with hypercoagulable states. There exist several clinical presentations, being most common the acute and subacute forms and rarely seen the fulminant and chronic forms (cirrhosis or fibrosis associated). We present here a female patient with Budd-Chiari syndrome produced by polycythemia, resolved by mesentericocaval interposition "H" shunt using internal jugular vein, after analyzing the current different modalities of medical-surgical treatment, specially portal system shunts and liver transplantation, related to presentation form.

Management of lower gastrointestinal bleeding in colonic diverticular disease.

AIM: To evaluate the clinical course, diagnostic approach, therapeutic measures and results, in a series of 13 patients with colonic bleeding diverticula. MATERIAL AND METHODS: From 1973 to 1995, 72 patients were admitted with the diagnosis of lower gastroin testinal bleeding. Thirteen presented a colonic diverticula bleeding. Mean age was 65.2 years. Medical history, symptoms, diagnosis, treatment (conservative or surgical) and pathology were recorded. RESULTS: Main bleeding time was 3 days. Eight patients needed blood transfusion. All patients underwent colonoscopic examination and it was diagnostic in every patient. Four patients underwent surgery: one case, because of massive hemorrhage and the other three cases due to bleeding recurrence. Pancolectomy was performed in one patient, ileal resection in another and the other two were treated with a sigmoidectomy and a left hemicolectomy. Pathology analysis corroborated colonic diverticula diagnosis. There was no postoperative mortality. Bleeding recurrence did not occur either in postoperative period or in the follow-up. CONCLUSIONS: Colonic diverticular bleeding usually stops spontaneously, obtaining high rates of preoperative diagnosis with colonoscopy. Less than a third of the cases requires surgical resection.

Duodenal obstruction by gallstones (Bouveret's syndrome). Presentation of a new case and literature review.

Bouveret's syndrome is a rare entity consisting in a duodenal obstruction due to the passage of gallstones from the gallbladder to the duodenum through a cholecystoduodenal fistula. Approximately 225 cases are reported in the literature. It is most common in old women with a previous history of biliary tract disease. The clinical picture is nonspecific and pre-operative diagnosis is not easy. Oral endoscopy is the main diagnostic procedure and sometimes, a therapeutic option, too. Surgery is the elective treatment specially when endoscopy is unsuccessful. We report a new case of this syndrome successfully treated by surgery, and an extensive review of the literature concerning this issue, focusing mainly on the clinical findings, diagnosis, therapeutic procedures and results. We conclude that Bouveret's syndrome is rare but more frequent in older females with previous biliary disease, better diagnosed by pyloric obstruction syndrome, plain abdominal x-ray, ultrasonography, contrast gastric study and/or gastroscopy (confirming and best procedure). When conservative endoscopic procedure fails, surgical treatment must be carried out, thus obtaining good results.

Evaluation of scolicidal agents in an experimental hydatid disease model.

INTRODUCTION: The treatment of hydatid disease is largely surgical, with medical treatment being reserved as coadjuvant treatment. The scolicidal agents have been, and are being used mainly during surgical manipulation of the cysts, with the object of avoiding relapses and peritoneal dissemination. OBJECTIVE: Evaluation of the scolicidal agents used in surgery in a hydatid disease model in the mouse. MATERIAL AND METHODS: We have used 85 Swiss OF1 mice, weighing more than 30 g, of 90 +/- 10 days of age, in which a picture of hydatid sowing was reproduced by means of intra-peritoneal inoculation with 0.2 ml of a suspension which contained approximately 1,200 viable protoscolex of Echinococcus granulosus which came from the livers of parasite-infested sheep. 24 h after the inoculation, the mice were subjected to a median laparotomy for the introduction of 1 ml of the scolicidal solution to be evaluated: physiologic saline (n = 10); 10% povidone iodine (n = 15); praziquantel (n = 15); 10% hydrogen peroxide (n = 15); 10% hypertonic saline (n = 15); simulated operation (n = 15). After 7 months of follow-up, the mice were sacrificed and the following was evaluated: number of isolated cysts, cyst masses, and total cysts. RESULTS: The number of isolated cysts which developed was significantly lower in the hydrogen peroxide group (tF 2.14 < RC 3.29). The number of cyst masses was significantly reduced in the hydrogen peroxide group (tF 2.14 < RC 2.18), in the povidone iodine group (tF 2.17 < RC 3), and in the hypertonic saline group (tF 2.11 < RC 2.77). The total number of cysts which developed decreased significantly in the hydrogen peroxide (tF 2.14 < RC 2.84) and the povidone iodine (tF 2.17 < RC 3.79) groups. CONCLUSIONS: Hydrogen peroxide and povidone iodine show a greater protoscolicidal effect than simple cleansing with physiological saline, hypertonic saline, or praziquantel.

[The incidence, prognostic factors and survival in young adults with colorectal adenocarcinoma]. / Incidencia, factores pronósticos y supervivencia de los adultos jóvenes con adenocarcinoma colorrectal.

The incidence of colorectal cancer is low in young patients. Because of the infrequent occurrence of this disease in those less than 40 years of age many of the published reports give conflicting results. The aim of this report is to study colorectal cancer in patients < or = 45 years old, a group rarely considered by other authors. We analyzed retrospectively the clinical features of our patients with special reference to the clinical data, personal and family history, site of lesion, and Duke's classification. Potential risk factors were analyzed for their effect on the survival of these patients. Finally, to evaluate the prognostic influence of potential risk factors and detect any interaction, a multivariate analysis was performed. We found 26 (17.2%) patients less than 45 years old with colorectal cancer. The clinical presentation, tumor site, and Duke's grade were similar in the young adult and in the general population but morbidity, mortality and postoperative complications were lower. There were no differences in resection or survival rates. Potential risk factors were no different from those of the general population.