Ingesta de cuerpos muy extraños / Intake of very foreign bodies

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Prolapso rectal completo. Resultados clínicos y funcionales con la operación de Delorme / Complete rectal prolapse clinical and functional outcome with Delorme’s procedure

Introducción: hay descritas muchas técnicas quirúrgicas, tantopor vía perineal como abdominal, para el tratamiento del prolapsorectal. El propósito de este trabajo es evaluar los resultadosclínicos y funcionales del procedimiento por vía perineal de Delorme.Pacientes y métodos: se estudiaron 21 pacientes con prolapsorectal completo, entre julio de 2000 y octubre de 2005. Seevaluó la edad, el sexo, el riesgo anestésico y la sintomatologíaacompañante. Las exploraciones complementarias realizadas fueron:colonoscopia, manometría anorrectal previa y posterior a lacirugía y ecografía endoanal de 360°. La operación de Delormefue realizada por el mismo equipo quirúrgico.Resultados: no hubo mortalidad y la morbilidad fue mínima.La tasa de recidiva del prolapso fue de 9,52% con una media deseguimiento de 34 meses. La continencia anal mejoró en un87,5% de los pacientes y no hubo estreñimiento asociado a la cirugía.La estancia media hospitalaria fue de 2 (rango 1-4) días. Enel postoperatorio no hubo dolor en 17 casos y fue escaso en 4. Lasatisfacción con la cirugía fue alta en 16 casos (76,19%), moderadaen 3 (14,28%) y baja en 2 (9,52%).Conclusiones: la operación de Delorme para el tratamientodel prolapso rectal completo tiene una baja morbilidad asociada,mejora la continencia anal, no se asocia con estreñimiento postquirúrgicoy tiene una aceptable tasa de recidiva. La satisfacciónde los pacientes con esta cirugía es alta debido a su gran confortabilidad(anestesia intradural, corta estancia hospitalaria y escasodolor postoperatorio) y óptimos resultados

Introduction: many surgical techniques –both through theperineal and abdominal routes– have been described for the treatmentof rectal prolapse. The aim of this work is to evaluate theclinical and functional outcome with Delorme’s perineal procedure.Patients and methods: twenty-one patients with completerectal prolapse were studied from July 2000 to October 2005.Age, gender, anesthetic risk, and accompanying symptoms wereall assessed. Diagnostic tests performed included: colonoscopy,anorectal manometry before and after surgery, and 360° endoanalultrasonography. Delorme’s procedures were carried outby only one surgical team.Results: no mortality occurred, and morbidity was minimal.Prolapse relapse rate was 9.52% with a mean follow-up of 34months. Anal continence improved in 87.5% of patients, and nosurgery-associated constipation ensued. Mean hospital stay was 2(range 1-4) days. During the postoperative period no pain developedin 17 patients, and 4 patients had mild pain. Satisfactionwith surgery was high in 16 cases (76.19%), moderate in 3(14.28%), and low in 2 (9.52%).Conclusions: Delorme’s procedure for the management ofcomplete rectal prolapse is associated with low morbidity, improvesanal continence, gives rise to no postsurgical constipation, and hasan acceptable relapse rate. Patient satisfaction with this procedure ishigh because of its high comfortability (intradural anesthesia, shorthospital stay, and little postoperative pain) and optimal results

Complete rectal prolapse clinical and functional outcome with Delorme's procedure.

INTRODUCTION: Many surgical techniques -both through the perineal and abdominal routes- have been described for the treatment of rectal prolapse. The aim of this work is to evaluate the clinical and functional outcome with Delorme's perineal procedure. PATIENTS AND METHODS: Twenty-one patients with complete rectal prolapse were studied from July 2000 to October 2005. Age, gender, anesthetic risk, and accompanying symptoms were all assessed. Diagnostic tests performed included: colonoscopy, anorectal manometry before and after surgery, and 360 masculine endoanal ultrasonography. Delorme's procedures were carried out by only one surgical team. RESULTS: No mortality occurred, and morbidity was minimal. Prolapse relapse rate was 9.52% with a mean follow-up of 34 months. Anal continence improved in 87.5% of patients, and no surgery-associated constipation ensued. Mean hospital stay was 2 (range 1-4) days. During the postoperative period no pain developed in 17 patients, and 4 patients had mild pain. Satisfaction with surgery was high in 16 cases (76.19%), moderate in 3 (14.28%), and low in 2 (9.52%). CONCLUSIONS: Delorme's procedure for the management of complete rectal prolapse is associated with low morbidity, improves anal continence, gives rise to no postsurgical constipation, and has an acceptable relapse rate. Patient satisfaction with this procedure is high because of its high comfortability (intradural anesthesia, short hospital stay, and little postoperative pain) and optimal results.

Subcutaneous venous reservoir implant: our experience in 1200 cases.

We present our experience in subcutaneous venous reservoir (SVR) implanting, laying emphasis on the surgical technique, the protocol followed for assessing difficulty, implant care and per- and post-implant complications and their management. Between March 1996 and December 2002 we installed 1200 SVRs on an outpatient basis, with subsequent result follow-up. The reservoir was successfully installed by the standard procedure in 99.33% of cases (1194), while in the remaining six patients (0.67%) the participation of the Intervention Radiology Department was required for correct implantation. Results were excellent with a morbidity of 3.3% and we had to single out two cases of immediate infection (0.16%), nine of tardive infection (over three months); twelve cases of pneumothorax (1%); seven episodes of venous thrombosis (0.58%) and four cases of catheter migration (0.3%). SVR implanting is possible on an outpatient basis but requires strict measures of asepsis and an experienced team and personnel responsible for its handling and maintenance, although there are a small number of complications inherent in the patient's general state.

Angiosarcoma in the small intestine. Apropos of a particular case.

Presentation of a case of small intestine primary angiosarcoma in a 70-year-old male. There is question of an extremely rare tumor in the gastrointestinal tract. Its symptomatology is similar to that of other tumors in the small intestine. An immunohistochemical study is usually essential for its anatomopathological diagnosis. The diagnosis is generally arrived at in its advanced stages, and that makes for a bad prognosis. The bibliography has been revised from this case on.

Biofeedback en el tratamiento de la incontinencia fecal. nuestra experiencia / Biofeedback in the treatment of fecal incontinence. Our experience

Introducción. La incontinencia fecal es un serio problema médico, social y psicológico para el paciente que la sufre. El biofeedback ha surgido como una técnica reciente para el tratamiento de estos pacientes. Presentamos en este estudio los resultados obtenidos en el tratamiento de la incontinencia fecal mediante la técnica de biofeedback. Pacientes y métodos. El estudio se realizó sobre 25 pacientes con incontinencia fecal procedentes de nuestra consulta y de la consulta de Cirugía General y Digestivo B del Hospital 12 de Octubre durante los años 1997-1999. Se incluyeron todos los pacientes con incontinencia fecal, con independencia de la edad, etiología y grado de la misma, pero que tuvieran en la manometría anorrectal aumento presivo tras la contracción voluntaria y capacidad de compresión y colaboración por parte del paciente. Resultado. Se obtuvo un 76 por ciento de resultados excelentes o curación de la incontinencia fecal, un 16 por ciento de buenas respuestas y un 8 por ciento de malos resultados. No hubo complicaciones. Los resultados obtenidos se mantienen a lo largo del tiempo. Conclusión. El biofeedback es un tratamiento eficaz, seguro, barato y exento de complicaciones para la incontinencia fecal. Además, no invalida ni entorpece segundas opciones quirúrgicas y puede servir para optimizar los resultados funcionales de cirugía reparadora previa (AU)

[Is the introduction and realization of the Japanese system of staging and surgical treatment for stomach cancer possible in Spain?]. / Es posible la implantación y realización, en nuestro país, del sistema de estadiaje y tratamiento quirúrgico japonés para el cáncer de estómago?

Discrepancies in the five-year survival rates after treatment of gastric cancer between the West and the East have been attributed to differences in the biological behavior of the tumor or in the incidence of early cancer. Alternatively, the better staging system and the national standardization of the diagnosis and treatment used in the East may explain their findings. Poor definition of stages and curability, scarce interest in standardization of techniques, and lack of basic information in many pathological reports are frequent in Western countries. Between May 1988 and April 1991 a prospective study on a consecutive series of 89 patients diagnosed of gastric carcinoma in the Hospital "Príncipe de Asturias" using the directions given by the Japanese Research Society for Gastric Cancer has been made. Our results support the use of the Japanese system in a General Hospital of our country and confirm its accuracy in defining the type of surgery performed, the later being its main advantage over the TNM staging system.

[Acute pancreatitis and afferent loop syndrome]. / Pancreatitis aguda y síndrome de asa aferente.

A new case of afferent loop obstruction presenting as acute pancreatitis is described. It is an uncommon manifestation of the afferent loop syndrome: less than 20 cases found in the literature. The diagnosis of afferent loop obstruction should be suspected in any patient with acute pancreatitis and a previous Billroth II gastrectomy. Duodenopancreatic reflux seems to play an important role in the pathogenesis of acute pancreatitis in this situation. The "closed duodenal loop" experimental model of acute pancreatitis simulates quite closely this clinical situation. The physiopathological principles, diagnosis and treatment of this syndrome is reviewed.

[Spontaneous and simultaneous external and internal double biliary fistula]. / Doble fístula biliar interna-externa espontánea simultánea.

An exceptional case is presented of double biliary fistula, internal (to duodenum) and external (to the abdominal wall) in a patient with cholelithiasis of long evolution. The diagnosis of suspicion was made by CAT and was confirmed in the surgical act. Treatment was cholecystectomy, closure of the duodenal communication and external drainage of the parietal abscess. The postoperative evolution coursed without complications.