[Risk factors associated with the development of surgical wound infection in a general surgery service]. / Factores de riesgo asociados al desarrollo de infección de herida quirúrgica en un servicio de cirugía general.

BACKGROUND: To evaluate incidence, etiology and risk factors of surgical wound infection (SWI) in a service of general surgery in a tertiary hospital. METHODS: Retrospective cohort study. The relative risk (RR) and its 95% confidence interval (CI) have been used as a measure of association between risk factors and SWI. Multiple logistic regression has been selected as multivariate analysis. RESULTS: Of 619 surgical patients, 60 (9.7%) developed SWI. The most frequently isolated microorganism was Enterococcus (26%), but a higher prevalence of gram negative was also found. On admission, the factors associated with SWI were: diabetes mellitus (RR = 2.5, CI95% = [1.0-6.3]), age older than 65 years (RR = 2.66, CI95% = [0.8-9.0]) and contaminated and dirty surgery (linear trends chi square, p = 0.044); among the amendable medical care factors, the duration of the surgery is the unique to be pointed out with an increment of 5 /1000 per minute (p = 0.011). The admission an emergency unit presented a non significant adjusted RR of SWI near to 3 (CI95% = [0.9-9.6]). CONCLUSIONS: SWI is related most importantly to risk factors at admission not amendable by the physician. Our results showed that the only factor susceptible to be changed is the duration of the surgical intervention.

[Bouveret syndrome: 5 cases]. / Síndrome de Bouveret: cinco casos.

Five cases of duodenal obstruction due to biliary stones (Bouveret's syndrome) are reported. Presenting symptoms were gastric outlet obstruction, upper gastrointestinal bleeding or jaundice. Diagnosis was achieved either by endoscopy, upper gastrointestinal X-Ray series or at the operating room. Surgical procedures to remove obstruction were needed in every case: cholecystectomy was simultaneously performed on two occasions. After reviewing the literature, previous biliary symptoms were found in 65% of the cases; diagnosis was achieved preoperatively in 85%, mainly by endoscopy procedures; simultaneous cholecystectomy was carried out in 56% of cases; postoperative mortality was 24%, rising when simultaneous cholecystectomy was performed.

Retroperitoneal Castleman's disease.

A case of Castleman's disease localized in the retroperitoneal space is reported. A 29-year-old patient had a mass 15 cm in diameter with radial calcification. After surgical resection, both the patient's anemia and hypergammaglobulinemia disappeared. Castleman's disease should be considered when facing a solid retroperitoneal or mesenteric mass, mainly if anemia and hypergammaglobulinemia are present. Previous reports about this unusual condition are reviewed.

[Inflammatory pseudotumor of the liver]. / Pseudotumor inflamatorio de hígado.

Inflammatory pseudotumor is a pathological process whose cause is unknown, and whose macroscopic appearance is that of a malignant tumor, but it is in fact of inflammatory nature. Inflammatory pseudotumor of the liver is infrequent, but must be taken into account in the differential diagnosis of liver masses. A case report is presented, with review of the literature. Because of its benign nature, an aggressive approach is not recommended.

Combined topical and systemic antibiotic prophylaxis in acute appendicitis.

Two hundred forty-six patients with acute appendicitis were randomly assigned to one of two groups. One group of 120 patients received systemic clindamycin preoperatively. Another group of 126 patients received, in addition to systemic clindamycin, a solution of topical ampicillin applied to subcutaneous tissues. No differences were found in the characteristics of the two groups. Combined prophylaxis with clindamycin and ampicillin significantly reduced wound infection to 4%, compared with clindamycin alone (p less than 0.02). A decrease in the surgical wound infection rate in the group treated with clindamycin and ampicillin was mainly observed in patients with advanced (gangrenous and perforated) appendicitis (p less than 0.05). A significant decrease in wound infection rates in patients with positive culture results was also found. We conclude that prophylaxis with a combination of systemic clindamycin and topical ampicillin solution, when compared with clindamycin alone, more effectively prevents wound infection after emergency appendectomy, especially in patients with serious wound contamination.

Giant esophageal leiomyoma with secondary megaesophagus.

A 25-year-old woman presented with a giant leiomyoma in the lower third of the esophagus. She had no digestive symptoms, although there was a severe esophageal dilation. Such a megaesophagus secondary to a leiomyoma has not been described previously. Esophagogastric resection was performed, followed by an uneventful recovery period. The literature on esophageal leiomyoma is reviewed.