[Surgery of early gastric cancer. Twenty-five year experience]. / Cirugía del cáncer gástrico precoz. Experiencia en 25 años.

AIM: To study the influence of the depth of parietal invasion (mucosal-submucosal), the presence or absence of ganglionic invasion and type of gastrectomy performed (subtotal or total) on survival in patients with early gastric cancer. STUDY DESIGN: Longitudinal study. PATIENTS: A clinical-pathologic study of 101 patients who underwent surgery for early gastric cancer was performed. Probability of survival was estimated using the Kaplan-Meier and logrank tests and multivariate analysis was performed using the Cox test. RESULTS: Mucosal involvement was found in 46 patients (45.5%) and submucosal involvement in 55 patients (54.5%). The presence of ganglionic metastases was greater in tumors reaching the submucosa (14 [25.5%]) than in those limited to the mucosa (4 [8.7%]). Partial gastrectomy was performed according to tumor location in 84 patients (83.2%), total gastrectomy was performed in 16 patients (15.8%) and 1 wedge resection was performed. The mean postoperative follow-up was 84.04 55.89 months (range: 2-264). Comparison of survival in patients with tumors limited to the mucosal or submucosal layers revealed a p-value of 0.06 (NS). Comparison of survival in patients with metastases and in those without metastases revealed a p-value of < 0.0001. Comparison of survival between patients who underwent total gastrectomy and those who underwent partial gastrectomy showed a p-value of 0.38 (NS). Postoperative mortality was nil. Overall survival at 5 years was 79.24% and at 10 years was 68.14%. Multivariate analysis revealed that ganglionic involvement and depth of parietal invasion influenced survival. CONCLUSIONS: Survival is influenced by ganglionic involvement but not by submucosal invasion. Partial gastrectomy may be an appropriate procedure since survival is similar to that associated with total gastrectomy.

Resultado del tratamiento quirúrgico de los divertículos faringoesofágicos / Outcome of surgical treatment of pharyngoesophageal diverticula

Introducción. El divertículo de Zenker es una entidad relativamente frecuente relacionada con alteraciones de la musculatura faringoesofágica. Su tratamiento es siempre intervencionista. Revisamos nuestra serie y analizamos el resultado del tratamiento quirúrgico. Pacientes y métodos. Realizamos una revisión retrospectiva de 20 pacientes afectados de divertículo faringoesofágico, centrándonos en los síntomas, hallazgos clínicos, tipo de cirugía y sus resultados. Resultados. La disfagia es el síntoma más frecuente. El método diagnóstico más exacto es el tránsito esofágico y destacamos la relación con la hernia de hiato. La miotomía del cricofaríngeo no aumenta las complicaciones. Conclusiones. El divertículo de Zenker es susceptible de tratamiento quirúrgico o endoscópico en todos los casos, y está indicada la miotomía del cricofaríngeo (AU)

[Stomach volvulus in a female patient with chondrodysplasia punctata]. / Vólvulo gástrico en una paciente con condrodisplasia punctata.

The case of an 11-year-old girl with a history of chondrodysplasia punctata is reported. She presented with a clinical picture of abdominal pain and vomiting. At surgical intervention an organo-axial gastric volvulus was found and a single derotation was performed. Three weeks after discharge the patient presented abdominal distension and vomiting. In a plain abdominal X-ray film a gastric dilation was appreciated and a new volvulus was detected by means of a contrast radiogram. The diagnosis was confirmed at surgery and a gastropexy was performed without volvulus relapse.

[Polysplenia with partial abdominal visceral heterotaxia and small pancreas]. / Poliesplenia con heterotaxia visceral abdominal parcial y páncreas pequeño.

Several morphological congenital abnormalities are associated in the polysplenia syndrome: partial visceral abdominal heterotaxy, levoisomerism, abdominal vascular abnormalities, cardiac and extrahepatic biliary malformations and polysplenia. The syndrome is usually apparent during childhood because of its severe outcome; its detection during adult life is rare. We present a 42-years-old patient, asymptomatic, with right sided polysplenia and stomach, intestinal malrotation, centrally located liver with both lobes of similar size, preduodenal portal vein, interruption of the inferior caval vein with continuation via the azygos vein. There were no cardiac malformations nor lung levoisomerism. The pancreas was atrophic, an occasionally described finding. CT scan may be useful for the study of this patients in order to identify every anatomic abnormality, and plan for future surgical operations.

[Anatomopathologic and morphometric study of hepatocarcinoma]. / Estudio anatomopatológico y morfométrico del hepatocarcinoma.

UNLABELLED: Because of its great incidence and poor prognosis the hepatocarcinoma (HPC) has become a first line clinical challenge. This is the reason we have performed a descriptive anatomo-pathological analysis of our own cases and a study of the possible prognostic value of nuclear parameters. DESIGN: We have performed a retrospective study of 83 cases. We reviewed the clinical records and histologic preparations. METHODS: We analysed the following parameters: 1) Tumour site; 2) Association to cirrhosis; 3) Microscopic features (cellular type differentiation grade, peritumoral lymphocytic infiltration, architecture, mitotic index); 4) Metastatic frequency and location; 5) Morphometric nuclear parameters (area, perimeter, major diameter, major and minor axis, circle diameter, sphere volume, ellipse volume, shape factor. RESULTS: We highlight the following: 1) 50% of HPC associated to liver cirrhosis; 2) Ascites was more frequent in the tumours located in the right lobe or both lobes than in tumours affecting the left lobe (p < 0.005); 3) Macroscopically, the commonest type was the nodular one (47.8%); 4) Microscopically, the commonest findings were as follows: cellular type (93%); differentiation grade type II (61.4%); trabecular architecture (64.9%); lymphocytic infiltration grade I (57.9%); 5) Mean mitotic index was 16.3 m./high power field. 6) There were distant metastases in 81.1% and portal vein invasion in 44.6%. 7) The nuclear morphometric study did not support any influence on patients' survival. CONCLUSIONS: 1) This descriptive analysis allows a morphological data base that is very useful for subsequent morphological or prognostic studies. 2) Our data do not support any influence of nuclear parameters on patients' survival, although we cannot exclude some relation in a greater series.

[Congenital cysts of the choledochus]. / Quistes congénitos del colédoco.

We describe six cases of congenital choledochal cyst of the Toddani type I. All were female, with a mean age of 33.5 years (16-52). The onset of symptoms ranged 8-192 months (mean 92.8), with an unexpected finding. Ultrasound scan was performed in five patients, with two accurate diagnoses, one suspicious and two wrong results. In two cases a C.T. was performed and the diagnosis was confirmed in both. A cholelithiasis was associated in four cases. Four patients (66.4%) were treated by cyst excision, Roux-en-Y hepaticojejunostomy and cholecystectomy, three of them as a primary procedure, and one more after failure of some derivative operations. All evolved well but one, requiring sphincterotomy and Wirsungtomy. Two patients (33.6%) were treated by cholecystectomy only, with a favourable evolution. Nevertheless, we emphasize the good results achieved with cyst excision and we recommend it as the procedure of choice.

[Duodenal ulcer and duodenocholedochal fistula]. / Ulcus duodenal y fístula duodenocoledociana.

A new case of choledocoduodenal fistula secondary to duodenal ulcer is reported, which manifested as an ulcer complicated by haemorrhage, duodenal stenosis and cholangitis. We recommend endoendoscopy as the main diagnostic tool. Surgical treatment should consist of avoidance of the fistulous tract, cholecystectomy, cholangiography, truncal vagotomy and gastroduodenal drainage by pyloroplasty or gastroduodenostomy.

[Cancer of the gallbladder]. / Cáncer de vesícula biliar.

We present 118 cases of cancer of the gallbladder out of 4,165 operations for gallbladder disease (6.2%) compiled over a period of 18 years at the Hospital Nacional "Valdecilla". Females were predominant, 82.2%, and the mean age was 73.2 years. The most relevant clinical finding was pain in the right upper quadrant in 73.7%, and a mass at this level in 43.2%. The diagnosis was correct in 36 cases (30.5%). All patients were treated surgically; the resectability rate was 58.5% and potentially curative cholecystectomy was performed in 15.2%. The tumor was adenocarcinoma in 91.5%, one stage I of Nein, 5 stage II, 12 stage III, 33 stage IV and 67 stage V. The 5-year survival was 100% for stage I-II and 41.6% for III; stages IV-V did not survive more than a year.