Primary closure of laparotomies with high risk of incisional hernia using prosthetic material: analysis of usefulness.

Incisional hernia continues to be a serious postoperative complication in abdominal surgery. We present a prospective randomised study to evaluate the usefulness of placement of a supra-aponeurotic polypropylene mesh in the primary closure of laparotomies with a high risk of incisional hernia. Closure of a vertical laparotomy in 100 patients was accomplished with continuous suture using non-reabsorbable material, with placement of a polypropylene mesh on the aponeurotic surface in 50 patients. Three years after surgery, five patients in the group without the mesh had suffered incisional hernia. No incisional hernia was detected in the group in which closure was made using the mesh (P=0.02). Use of prosthetic material (polypropylene mesh) in the primary closure of laparotomies with a high risk of incisional hernia is useful for reduction of the rate of incisional hernias.

Recidiva de un linfoma no hodgkiniano en un reservorio venoso central tipo port-a-cath / Relapse of a non-Hodgkin lymphoma in a central vein reservoir port-a-cath type

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Tratamiento laparoscópico de la hernia de spiegel / Laparoscopic treatment of Spigelian hernias

Las hernias de Spiegel continúan atrayendo el interés de los cirujanos a pesar de ser poco frecuentes. Sin embargo, al menos en nuestro medio, no se ha prestado suficiente atención a las posibilidades de su abordaje laparoscópico. Presentamos los casos de tres pacientes con hernia de Spiegel tratados con éxito mediante la colocación on lay de una placa de PTFE por laparoscopia. Uno de ellos se intervino de urgencia (AU)

Persistencia de síntomas en el postoperatorio de la colecistectomía laparoscópica por colelitiasis sintomática / Persistence of symptoms in the postoperative period after laparoscopic cholecystectomy for symptomatic cholelithiasis

Introducción. En la colelitiasis sintomática, el objetivo de la colecistectomía laparoscópica es aliviar su sintomatología. No obstante, un tercio de los pacientes continuarán con síntomas al año de la intervención. Presentamos un estudio prospectivo para determinar qué síntomas preoperatorios son predictivos de un mal resultado postoperatorio. Pacientes y método. Un total de 300 pacientes diagnosticados de colelitiasis han contestado, preoperatoriamente y al año de la operación, a un cuestionario donde estaban reflejados los síntomas atribuidos a la colelitiasis. Resultados. El 26 por ciento de los enfermos continuaban con sintomatología al año de la intervención. La pirosis, el dolor constante de localización imprecisa en hemiabdomen superior, la distensión abdominal pospandrial y las regurgitaciones fueron síntomas dispépticos con un valor estadístico significativo de mal resultado operatorio. Conclusión. La indicación para la realización de una colecistectomía laparoscópica continúa sin estar bien definida. Los enfermos con predominio preoperatorio de síntomas dispépticos, especialmente la pirosis, son predictivos de un mal resultado postoperatorio (AU)

The value of CT diagnosis of hernia recurrence after prosthetic repair of ventral incisional hernias.

Herein we present a prospective study made to compare the diagnostic value of a physical examination and a CT scan in the detection of a hernia relapse after carrying out of a intraperitoneal hernioplasty using a non-resorbable mesh. Fifty patients operated on for intraperitoneal hernioplasty with ePTFE mesh and postoperative symptomatology were assessed within a year of the operation via a physical exploration and CT. Each of the patients was subjected to an exploratory laparoscopy for the purpose of confirming the diagnosis. The data were analysed statistically using a chi-square test, sensitivity, specificity, confidence limits, positive predictive value, and negative predictive value. The hernia relapse was correctly diagnosed in 98% of cases by CT and in 88% of cases in the physical examination. The sensitivity was 1 in the CT examination and 0.75 in the physical examination, and the specificity results were 0.97 and 0.90, respectively. The positive predictive value in the CT exam was 0.88, whereas in the physical examination it was 0.60. The negative predictive values were 1 and 0.95, respectively. The differences between the values of both methods held a statistical meaning (chi-square test; p < 0.05). The postoperative assessment by CT of symptomatic patients who have been operated on for an intraperitoneal hernioplasty with unabsorbable mesh facilitates carrying out a correct diagnosis in the detection or exclusion of hernial relapse.

Linfangioma quístico de mama / Cystic lymphangioma of the breast

El linfangioma quístico de mama es un tumor benigno infrecuente del sistema linfático, del que únicamente han sido descritos 6 casos en la literatura médica mundial. Presentamos un caso diagnosticado preoperatoriamente por métodos radiológicos, y confirmado histológicamente (AU)

Las interleucinas 6, 8 y 10 en la fase inicial de la pancreatitis aguda. Su utilidad pronóstica / Interleukins 6, 8 and 10 in the initial phase of acute pancreatitis. Their prognostic utility

Introducción. La pancreatitis aguda es una grave enfermedad que precisa para la instauración de un tratamiento acorde con la gravedad, de un diagnóstico evolutivo precoz. El objetivo de nuestro estudio ha sido determinar los valores de interleucina 6, 8 y 10 en la fase inicial de la enfermedad. Pacientes y método. Hemos realizado un estudio prospectivo de 29 pacientes agrupados en pancreatitis leve, de mediana gravedad o grave. Las determinaciones de interleucinas en sangre venosa se realizaron en los primeros 5 días de evolución, y la cuantificación se efectuó con técnicas de enzimoinmunoanálisis. Resultados. En la pancreatitis grave existió una elevación de las tres interleucinas, con un pico máximo a las 36 h del inicio de la enfermedad. Desde el segundo día, el descenso de valores fue continuado. A partir del tercer día, las interleucinas 8 y 10 se normalizaron, persistiendo las diferencias estadísticamente significativas en los valores de la interleucina 6. Conclusiones. La interleucina 6 es el marcador que con mayor fiabilidad nos permitirá predecir, desde el día de admisión del paciente, la evolución pronóstica de la pancreatitis (AU)

Colecistitis aguda litiásica asociada a brucella melitensis. Presentación de un caso y revisión de la bibliografía / Acute lithiasic cholecystitis associated with Brucella melitensis. Case report and review of the literature

Aportamos el segundo caso de colecistitis aguda litiásica durante el curso de una brucelosis sistémica, según la revisión de la bibliografía mundial. Se describe su semiología clínica y tratamiento. Se resalta la importancia de considerar dicha enfermedad, como concomitante a otras, en zonas geográficas consideradas endémicas para la brucelosis (AU)

Simple closure or vagotomy and pyloroplasty for the treatment of a perforated duodenal ulcer: comparison of results.

BACKGROUND/AIMS: Treatment of the perforated duodenal ulcer continues to be a controversial subject. The purpose of our study was to compare the results of simple closure of perforated duodenal ulcer versus treatment by truncal vagotomy and pyloroplasty. METHODS: We present a prospective and randomized study of 207 patients who underwent surgical treatment due to perforated duodenal ulcer. In 117 patients the surgical treatment was simple closure and postsurgery medical treatment with proton pump inhibitors for 1 month, and in 90 patients vagotomy and pyloroplasty with no additional medical treatment. RESULTS: We applied the Visick scale in order to compare postsurgery results. The postoperative morbidity and mortality rates were the same with both techniques. Statistically, in both cases, no significant differences were found in postsurgery symptomatology. The different rates of recurrent ulcers and the reinterventions due to recurrent ulcers presented no significant statistical values. CONCLUSION: We conclude that simple closure remains the selected treatment in the majority of patients who present with a perforated duodenal ulcer. The operation is a simple and safe procedure.

Sisomicin in surgical infections. Laboratory and clinical studies.

A clinical and bacteriological study to evaluate the effectiveness and toxicity of sisomicin in the treatment of surgical infections is described. Fifteen patients received i.m. injections of 150 or 225 mg/day for seven days. The daily doses was divided into three applications. The mean serum levels at the first hour were 5.26 +/- 2.41 microgram/ml and at the seventh hour 1.0 +/- 1.19 microgram/ml. Similar values were determined on the seventh day of treatment with sisomicin: 6.36 +/- 2.36 microgram/ml one hour, 1.17 +/- 1.67 microgram/ml seven hours after i.m. injection. All the microorganisms isolated had MICs below the sisomicin levels measured. The clinical results were assessed as "excellent" in 11 patients. Therapeutic results were considered as "fair" in three patients. The clinical conditions of one patient affected by osteomyelitis following osteosynthesis of the femur was not improved by treatment. No side effects were observed.