Congenital esophageal cysts--two cases in adult patients.

Esophageal cysts are a rare clinicopathological condition. They usually cause respiratory symptoms in children, while they are often asymptomatic in adults. Two cases of esophageal cysts in adults, recently diagnosed and treated in our department, are reported. In the 1st case (a 52 year-old woman) dysphagia was the main symptom. In the 2nd one (a 39 year-old woman) the patient was asymptomatic. Both were surgically excised by enucleation, with no post-operative complications. The histological study showed both cysts to be lined with ciliated cylindrical epithelium, and they were therefore considered to be congenital. Smooth muscle was only seen in the cyst wall in the 2nd case, but it was not organized in 2 layers, as is typical of duplication cysts. Cartilage or respiratory glands, the pathognomonic features of bronchogenic cysts, were not identified in either of them. Therefore, the diagnosis was inclusion cysts in both cases.

The value of D1 lymphadenectomy as prognostic marker in gastric cancer.

BACKGROUND/AIMS: To assess if the study on the involvement of perigastric lymph nodes, the only ones resected in D1 lymphadenectomy, is a valid prognostic marker in patients undergoing curative resection for gastric cancer. METHODOLOGY: A retrospective study was performed in 101 patients with gastric cancer, 34 women and 67 men, with a mean age of 61 years, undergoing curative resection by gastrectomy and D1 lymphadenectomy. Tumor size, the depth of tumoral invasion of the wall, nodal involvement and 5-year survival were assessed. RESULTS: Both tumor size and the depth of tumoral invasion of the wall were significantly related to metastatic involvement of perigastric lymph nodes. Similarly, tumoral involvement of the first-level lymph nodes was significantly associated with survival. CONCLUSIONS: D1 lymphadenectomy can provide adequate prognostic information in patients with gastric cancer undergoing curative resection.

[Dysphagia as an unusual form of presentation of malignant pleural mesothelioma]. / Disfagia como forma de presentación inusual en mesotelioma pleural maligno.

Dysphagia is an unusual presenting symptom as of extradigestive tumors. Malignant mesothelioma, is a rare tumor localized in the pleural cavity in 80% of all cases and it rarely appears with dysphagia as first symptom. We describe the case of a 74-year-old woman admitted with progressive dysphagia for solid and liquid food, atypical epigastric pain, with in conclusive endoscopic and radiologic studies. Nuclear Magnetic Resonance established the diagnostic suspicion of malignant mesothelioma which was confirmed by the histologic study of a biopsy taken by thoracotomy. We think of interest to report this case of paraesophageal mesothelioma because of its unusual localization and presentation.

Inflammatory pseudotumor of the spleen: ultrasound and computed tomographic findings.

Inflammatory pseudotumor of the spleen is an extremely rare benign lesion characterized by a wide spectrum of nonspecific inflammatory and reparative changes. The ultrasound and computed tomographic (CT) findings of inflammatory pseudotumor affecting the spleen in an asymptomatic patient are reported. The CT scanning revealed a partially calcified mass showing a nonhomogeneous enhancement after contrast injection. After 3 min of bolus administration, an unenhanced central area, which corresponds to a focal area of fibrosis, was demonstrated.

[Muscular tumors of the digestive tract: an analysis of 53 cases]. / Tumores musculares del tubo digestivo: análisis de 53 casos.

We present 53 cases of gastrointestinal smooth tumors (43 leiomyomas and 10 leiomyosarcomas) which have being diagnosed in Virgen del Camino Hospital during a period of 17 years. The aim of the research is to know the incidence of such tumors, their clinical presentation, the usefulness of radiologic and endoscopic studies for their diagnosis, as soon as to make a bibliographic revision of new diagnostic and therapeutic methods. This kind of tumor had an incidence of 3.1 cases per year. The symptomatology because of which the patients consulted depended on the location and the size of the tumors, though 18% of the cases were asymptomatic and were found in surgical operations. Endoscopic biopsy had a diagnostic sensibility of 28%; it didn't obstruct later exeresis. It has to be emphasized that, according to our bibliographic revision, there is a growing importance of endoscopic echography, not only as for diagnosis, but also as for non surgical treatment of this kind of tumor. Endoscopic resection can be a valid alternative for exeresis of small tumors (less than 2 cm according to some authors); haemorrhage is the most frequent complication, though it can be easily controlled.

Impact of surgical procedure for gastric cancer on quality of life.

BACKGROUND: The aim was to assess quality of life in a group of patients who had a curative resection for gastric cancer. METHODS: The European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire with a gastric cancer-specific module was used in patients who had undergone R0 gastrectomy between 1992 and 1999, and who had no disease at the last check-up. A response was obtained from 54 patients, 36 men and 18 women, of mean age 67 years. Of these, 24 patients had total gastrectomy and 26 D2 lymphadenectomy. RESULTS: Significant differences were found only in the social domain of quality of life in patients aged over 70 years (P = 0.036); there was no impact of operation type on overall quality of life. CONCLUSION: The quality of life of patients undergoing curative surgery for gastric cancer, regardless of age, was not significantly influenced by the type of gastrectomy, or whether lymphadenectomy was performed.

Albendazole plus praziquantel versus albendazole alone as a pre-operative treatment in intra-abdominal hydatisosis caused by Echinococcus granulosus.

OBJECTIVE: To compare the effects of a combined medication of albendazole (10 mg/kg/day) plus praziquantel (25 mg/kg/day) to those of albendazole alone at different doses (10 and 20 mg/kg/day). METHOD: The protoscoleces' viability was studied in a consecutive series of patients affected by intra-abdominal hydatidosis caused by Echinococcus granulosus. In all cases the drugs were given during the month prior to surgery. RESULTS: A significant increase of patients with nonviable protoscoleces was observed in the group treated with the scolicides combination compared to those treated with albendazole alone, both at a dose of 10 mg/kg/day (P = 0.004) and at a dose of 20 mg/kg/day (P = 0.03). Albendazole sulphoxide levels in serum and in cyst fluid were higher in patients given the combined therapy than in those who received only albendazole (10 mg/kg/day: P = 0.016; 20 mg/kg/day: P = 0.034). Levels in the cysts were not significantly different probably due to the sample size; nevertheless a lineal relation between the values obtained in serum and inside the cysts could be discerned in the patients treated with the combined medication. CONCLUSION: Albendazole plus praziquantel is more effective than monotherapy with albendazole in the preoperative treatment of intra-abdominal hydatidosis.

Vigilancia y control de la infección de sitio quirúrgico / Surveillance and control of infection in the operating theatre

La infección de sitio quirúrgico es la infección nosocomial más frecuente entre los pacientes quirúrgicos; es la causa del fallecimiento de un elevado porcentaje de los pacientes quirúrgicos y supone un significativo incremento en la estancia hospitalaria de dichos pacientes. Se describen los criterios que deben cumplirse para que una infección pueda ser considerada como nosocomial y las definiciones relacionadas con las diferentes localizaciones posibles de las infecciones de sitio quirúrgico que han sido dictadas por los Centers for Disease Control and Prevention (CDC).Igualmente se indican cuáles son los gérmenes más frecuentes en las infecciones de sitio quirúrgico según sea su fuente de contaminación y los factores que pueden influir en su aparición. Estos factores pueden depender del propio paciente, de la preparación del mismo para la intervención, del entorno o de las personas presentes en el quirófano durante la intervención o del propio acto quirúrgico. Se presentan las recomendaciones dictadas por el CDC para la prevención y control de las infecciones de sitio quirúrgico, distribuidas en grupos relacionados con los distintos factores que influyen en su aparición y adjudicándoles una categoría a cada una según la evidencia científica que las soporta. Por último, se presenta la tasa de infecciones que ha presentado el CDC, procedente del análisis de los datos enviados desde los hospitales adscritos al National Nosocomial Surveillance System (NNIS). Esta tasa se presenta distribuyendo a los pacientes en distintos grupos relacionados con los diferentes índices de riesgo para cada categoría NNIS a la que quedan adscritos los correspondientes procedimientos quirúrgicos (AU)

Cáncer de muñón gástrico: resultados del tratamiento quirúrgico / Gastric stump cancer: results of surgical treatment

Introducción. El pronóstico de cáncer de muñón gástrico, en general, es peor que el de cáncer gástrico primario. Métodos. Un total de 33 pacientes con cáncer de muñón tratados en nuestro servicio desde 1984 a 1999, 31 varones y 2 mujeres, con una edad media de 69,6 años. La primera intervención fue por úlcera gástrica en 14 casos, y duodenal o pilórica en 19. Presentaban gastrectomía Billroth II 22 pacientes y Billroth I 11 pacientes. El intervalo medio entre la primera operación y el diagnóstico del tumor fue de 30,6 años. Resultados. Fueron operados 27 pacientes; el índice de resecabilidad fue del 66,6 por ciento. Se realizaron 16 gastrectomías totales, 6 de ellas ampliadas y 2 casi totales. Predominó el adenocarcinoma tipo intestinal (22 casos); 4 pacientes presentaban tumores precoces (early) y en 13 (72,2 por ciento) existía afección de la serosa (pT3-pT4). La supervivencia actuarial global a los 5 años es del 22 por ciento, un 41,4 por ciento en los pacientes resecados (p < 0,001). Fue significativa la supervivencia de los casos resecados según el tamaño del tumor (p < 0,05).Conclusiones. En los pacientes gastrectomizados parece aconsejable el control endoscópico a partir de los 15 años para mejorar la resecabilidad y la supervivencia mediante un diagnóstico más precoz. La supervivencia obtenida en los casos tratados con gastrectomía total justifica este tratamiento quirúrgico agresivo. Hubo diferencias significativas en la supervivencia según el tamaño del tumor (AU)