[Perforation of hollow viscera in abdominal injuries]. / Perforación de víscera hueca en traumatismos abdominales.

OBJECTIVE: This is a retrospective study to evaluate our results in the treatment of abdominal trauma. DESIGN: We have analysed the incidence, the clinical characteristics, the diagnosis, the indications for laparotomy, the therapeutic methods and the morbidity-mortality. During the last 14 years we have operated on 29 hollow viscus injuries. They were divided into two groups: Eleven with penetrating or open trauma and 18 with blunt or closed traumatism. RESULTS: In the cases of blunt trauma 36.8% of injuries were located in the proximal jejunum, 21% in the terminal ileum, 15% in the colon. In the cases of penetrating trauma, small intestinal perforation predominated (46.9%). In 23.5% of the cases the colon was affected. Morbidity in blunt trauma was 38.8% and 0% in penetrating trauma. The mortality in the two groups has been zero. CONCLUSIONS: The most common surgical procedure practised for injuries to the small intestine was simple suture, and for injuries to the colon, colostomy. The most usual surgical procedures in penetrating trauma were simple suture in all small intestine injuries and for colonic lesions half had primary closure and half suture plus colostomy.

[Extragonadal germinal tumors of retroperitoneal localization]. / Tumores germinales extragonadales de localización retroperitoneal.

Extragonadal germ cells tumors can arise primarily in the retroperitoneum. It has been suggested that these neoplasms might be metastasis from an occult testicular lesion which would have regressed later. We report our experience with seven retroperitoneal germ cell tumors without testicular involvement. The most frequent symptoms were lumbar or abdominal pain and paraneoplastic syndrome. Abdominal palpable mass was noticeable in 85% of patients. We point out the computerized tomography and echography as the most sensitive exploration for diagnosis. The confirmation of retroperitoneal tumor was achieved preoperatively in all cases. Surgical and chemotherapy treatment was performed. Radiotherapy was employed in two cases. The mean survival was 9.5 months (6-24 m.). Retroperitoneal lymphadenectomy after chemotherapy has not improved the survival. Relapses of the diseases were noticed after and apparently partial or complete response to chemotherapy.

[Breast carcinoma in men: a review of 21 cases]. / Carcinoma mamario en el varón: revisión de 21 casos.

Male breast carcinoma is a truly rare tumor the treatment and prognosis of which have been recently considered similar to female cancer. In this work we reviewed the clinical histories of 21 patients with breast cancer attended in our hospital over a period of fifteen years. Mean age was 60 years. The main cause of consult was the presence of painless nodules most frequently localized in the left breast. We have found a great latency period between the detection of the first symptoms and medical consult (almost 20 months) which by itself justifies that almost fifty percent of patients were either in stage III or IV. Global surveillance was 60% after 5 years excluding other causes of death that were not directly related with the tumor. Statistic analysis did not reveal any significant relationship, probably due to the small number of patients, between the prognosis of the disease and the presence of factors such as cutaneous involvement, duration of symptoms, thelorrhagia, patient age, lymph node [correction of ganglionar] involvement, or deep plane involvement, although a significant relationship (p less than 0.05) was found with TNM stage.

[Tumors of Vater's ampulla. Review of 25 cases]. / Tumores de la ampolla de Vater. Revisión de 25 casos.

Cancer of ampulla of Vater is a infrequent tumor which was a much better prognosis after radical treatment than cancer of the pancreas. In this paper, 25 patients were studied, with a mean age of 59 years and a slight male predominance. The most frequent symptoms were related to jaundice and weight loss. The correct preoperative diagnosis was only reached in 54.16% of the patients, endoscopic retrograde cholangiopancreatography being the best diagnostic method, together with ?CTPH. We emphasize the difficulty of reaching a diagnosis and the variable results of both pre- and peroperative biopsy. The results of surgical treatment (9 Whipple operations, 7 ampullectomies and 7 bypass operations) are evaluated, showing that duodenopancreatectomy is the most effective therapy, although we had only one 5-year survival, 11.1% versus 0% for ampullectomy, which is an operation that carriers an elevated recurrence rate (greater than 50%). The mortality derived from Whipple's operation was 22.2%, and from local excision, 14.3%. The rate of complications was 55.5% after cephalic duodenopancreatectomy and null after ampullectomy. In view of these results, we think that the most appropriate therapeutic approach to ampulloma is the Whipple operation, and that ampullectomy should be reserved for those patients in poor general condition with small tumors, and that bypass operations should be used when the tumor is not resectable.

[Benefits of splenectomy in the treatment of chronic leukemia]. / Beneficio de la esplenectomía en el tratamiento de las leucemias crónicas.

Both chronic myeloid leukemias (CML) and lymphoid chronic leukemias (LCL) affect the spleen provoking the appearance of symptoms due to the size of the spleen or the sequestration of blood cells. Splenectomy has been utilized to prevent these conditions. We have a series of 12 patients suffering (CML) and 7 suffering LCL with a mean age of 34.4 and 60.14 respectively. All our patients underwent surgery since their splenomegaly did not respond to chemotherapy on radiotherapy with a general worsening of the patients condition. The postsurgery morbidity was greater in patients suffering CML than in those suffering LCL. The most important complications were pulmonary, followed by hemorrhages in the LCL group, and by the presence of fever of unknown origin in the splenectomized LCL patients. There were no fatalities in our series. Clinical and hematological improvement was evident in LCL patients, with increasing hematocrit and platelet number (100% of the cases). The CML results, however, are not so satisfactory, with a complete remission rate of 16.6%. Mortality was very high (83.3%) after a two year follow up, versus 14.3% in LCL, which, could be due to the natural course of the disease. In summary, we believe that splenectomy is a therapeutical approach to consider in all those cases with splenic symptoms improving their quality of life.

[Synchronous multiple carcinomas of the colon and rectum. Presentation of 18 cases and review of the literature]. / Carcinomas múltiples sincrónicos del colon y recto. Presentación de 18 casos y revisión de la literatura.

We reviewed 680 cases of colorectal neoplasms with an incidence of 18 synchronous multiple carcinomas (2.7%). We describe the predominance in females (11/7), the late age of presentation (maximal incidence between 60 and 80 years) and the main symptoms of these patients. We remark the diagnostic difficulty of these tumors, despite all the methods used; the diagnosis of the second mass was intraoperative in 50% of the cases in our series. As treatment, we suggest partial colectomy, except when there is massive colonic affectation, in which we practice a total colectomy. The prognosis in these patients is similar to that of those who have a single carcinoma. We must carry out a rigorous follow-up of these patients to make an early diagnosis of any new metachronous tumors.

[Neoplasms of the rectum. A presentation of 588 cases and review of the literature]. / Neoplasias rectales. Presentación de 588 casos y revisión de la literatura.

We reviewed cancers of the rectum and rectosigmoid operated from 1970 to 1980 in the General Surgery Service of the Hospital La Fe of Valencia (Spain). Of a total of 588 patients, only 370 were resectable (62.9%), which reflects the advanced stage of the disease when these patients are seen. Of the 370 resections, 210 corresponded to lower rectum, 97 to middle rectum and 63 to upper rectum and rectosigmoid. In 80%, abdominoperineal amputation was practiced and in 20%, anterior resection; this was due to the predominance of lower tumors and the fact that at this time mechanical sutures were not in use, since these permit anterior resections that cannot be performed with normal sutures. The 5-year survival was 197 patients, 53.2%. Postoperative mortality affected 4.2%. We found complications and morbidity in 17.1%. The mean hospital stay was 18 days. In no case of anterior resection was discharge colostomy performed.