Metástasis cutáneas de cáncer de recto / Cutaneous metastases from rectal cancer

El carcinoma colorrectal es un tumor que con muy poca frecuencia origina metástasis cutáneas, y cuando lo hace raramente es por vía hematógena. Presentamos el caso de un varón de 55 años diagnosticado de un adenocarcinoma de recto (tercio inferior) estadioT3N2M0. Tratado inicialmente con radioquimioterapia neoadyuvante, fue intervenido ocho semanas después realizándose una amputación abdominoperineal extendida. El resultado anatomopatológico fue de adenocarcinoma mucinoso de recto, estadio ypT3bN1. Tras un postoperatorio sin complicaciones el paciente recibió tratamiento quimioterápico con capecitabina. A los 18 meses el paciente refirió la aparición progresiva de nódulos subcutáneos en distintas localizaciones. En la tomografía computarizada de control se objetivaron múltiples imágenes sugestivas de metástasis a nivel hepático y pulmonar, así como lesiones subcutáneas. La exéresis-biopsia de uno de los nódulos subcutáneos corroboró la sospecha de metástasis de adenocarcinoma de recto. Se valoró tratamiento quimioterápico que no llegó a administrarse por el rápido deterioro del paciente que llevó al exitus (AU)

Colorectal carcinoma is a tumour that very infrequently gives rise to cutaneous metastases and when it does so, it is rarely by the haematogenous route. We present the case of a 55-year old male diagnosed with anadenocarcinoma of the rectum (lower third), clinical stageT3N2M0. Initially treated with neoadjuvant radiochemotherapy, he was operated on eight weeks later, with an extended abdominoperineal amputation. The anatomopathological result was mucinous adenocarcinoma of the rectum, clinical stage ypT3bN1. Following a postoperative period without complications, the patient received chemotherapeutic treatment with capecitabine. Eighteen months later the patient reported the progressive appearance of subcutaneous nodules in different localizations. In the computerized tomography test multiple images were objectivized suggesting metastasis at the hepatic and pulmonary levels, as well as subcutaneous lesions. The biopsy-excision of one of the subcutaneous nodules corroborated the suspicion of metastasis of the adenocarcinoma of the rectum. Chemotherapy treatment was considered for the patient, which was not administered due to the rapid deterioration of the patient leading to his death (AU)

[Cutaneous metastases of rectal cancer]. / Metástasis cutáneas de cáncer de recto.

Colorectal carcinoma is a tumour that very infrequently gives rise to cutaneous metastases and when it does so, it is rarely via the haematogenous route. We present the case of a 55-year old male diagnosed with an adenocarcinoma of the rectum (lower third), clinical stage T3N2M0. Initially treated with neoadjuvant radiochemotherapy, he was operated on eight weeks later, with an extended abdominoperineal amputation. The anatomopathological result was mucinous adenocarcinoma of the rectum, clinical stage ypT3bN1. Following a postoperative period without complications, the patient received chemotherapeutic treatment with capecitabine. Eighteen months later the patient reported the progressive appearance of subcutaneous nodules in different localizations. In the computerized tomography test multiple images were objectivized suggesting metastasis at the hepatic and pulmonary levels, as well as subcutaneous lesions. The biopsy-excision of one of the subcutaneous nodules corroborated the suspicion of metastasis of the adenocarcinoma of the rectum. Chemotherapy treatment was considered for the patient, which was not administered due to the rapid deterioration of the patient leading to his death.

Fractura abierta de apófisis cervical transversa producida por herida por asta de toro / Open fracture of a cervical transverse process as a result of a bull-horn wound

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[Lower gastrointestinal hemorrhage caused by jejunal leiomyoblastoma]. / Hemorragia digestiva baja por leiomioblastoma de yeyuno.

A patient with a jejunal leiomyoblastoma presented with lower gastrointestinal haemorrhage, a most unusual occurrence according to the literature. The provisional diagnosis was made by arteriography and confirmed pathologically. The characteristics of these tumours are analyzed and the management discussed.

[Gastric lipoma: an infrequent cause of upper digestive hemorrhage]. / Lipoma gástrico: una causa poco frecuente de hemorragia digestiva alta.

The authors report a case of gastric lipoma which was discovered because of severe upper gastrointestinal bleeding. The entity is seldom reported in the literature; only 17 cases have been reported in our country. The diagnostic possibilities are analyzed. In most cases they only confirm the diagnosis of a benign tumour and pathological verification is necessary. Surgical treatment is recommended in the light of the frequent complications of this tumor.

[Hemangiopericytoma of the rectal mesentery]. / Hemangiopericitoma de mesorrecto.

The authors present a case of hemangiopericytoma of the rectal mesentery, this is an uncommon type of vascular tumor, exceptional in this localization. We analyze the difficulty of a preoperative diagnosis, the lack of specificity of the clinical signs and the importance of the radical resection linked to the biological aggressiveness and the frequency of local recurrences and distant metastases.

[The limits of normality tables for anthropometric parameters]. / Límites de las tablas de normalidad para parámetros antropométricos.

Study of a sample of surgical patients, evaluating their preoperative nutritional state using anthropometric parameters and normality reference tables used by most authors and those used in Spain. Results obtained with both were compared. A significant difference was found (p < F0.001) in the results using one or the other table, and this leads us to question the universal use of these tables.

[Comparative study on various methods currently used in anal manometry]. / Estudio comparativo de los diferentes métodos utilizados actualmente en la manometría anal.

We compared the measurements obtained with different systems presently used to study the pressure characteristics of the anal channel (an open perfusion probe, a closed perfusion probe and a microtransducer). We also studied rectal sensitivity to distention in an attempt to define the exactness and reliability of the measurements made with these different techniques. The results indicate that although the measurements obtained vary with the diameter of the catheters used, the differences were not statistically significant. In contrast, the maximum tolerated volume of patients is greater with a slow and continuous rhythm of infusion than when saline is infused rapidly and in boluses. The published literature is reviewed and results are discussed, as well as the advantages and disadvantages of different methods.

[The value of anthropometric parameters in the prediction of surgical risk]. / Valor de los parámetros antropométricos en la predicción del riesgo quirúrgico.

The preoperative nutritional state of a sample of surgical patients was studied, relating this to postoperative complications and mortality. No significant relation was found to exist between the anthropometric parameters used and the complications and/or mortality, which was seen to have little prognostic value.

[Intestinal invagination in adults]. / Invaginación intestinal en el adulto.

Four cases of intestinal intussusception in adults are presented. Etiology was not common in all of them. Frequency, clinic presentation and diagnostic approach are discussed. A emergency right colectomy was performed in all of them.

[Splenic hydatid cyst perforating into the stomach]. / Kyste hydatique splénique perforé dans l'estomac.

A case of splenic hydatid cyst perforating into stomach is reported, only three similar cases being documented in the literature. Frequency, symptomatology, diagnostic methods and therapy of splenic hydatid cyst and of this strange complication are discussed.