Quistes de ovario en la urgencia: ¿un dilema terapéutico para el cirujano general? / Ovarian cysts in the urgency: a therapeutic dilemma for the general surgeon?

Ovarian cysts occur in women of all ages. In young women, the majority are benign, and the incidence of malignancy is maximal in the fifth to seventh decades. An ovaian cyst may present to the emergency surgeon as a pelvic or abdominal mass. it may also be discovered as an incidental finding on pelvic examination. An ultrasound scan yields valuable information about the nature of an ovaian cyst. The aim of this report was to present an experience with this pathology with laparoscopic management and with a revision of the literature(AU)

Quistes de ovario en la urgencia: ¿un dilema terapéutico para el cirujano general? / Ovarian cysts in the urgency: a therapeutic dilemma for the general surgeon?

Ovarian cysts occur in women of all ages. In young women, the majority are benign, and the incidence of malignancy is maximal in the fifth to seventh decades. An ovaian cyst may present to the emergency surgeon as a pelvic or abdominal mass. it may also be discovered as an incidental finding on pelvic examination. An ultrasound scan yields valuable information about the nature of an ovaian cyst. The aim of this report was to present an experience with this pathology with laparoscopic management and with a revision of the literature

Demandas por responsabilidad profesional: etiologías / Professional responsability demands: real causes

Antecedentes: En los últimos años las demandas por mala práctica médica han tenido un crecimiento vertiginosos y se han constituido en una preocupación constante para todos los galenos. Objetivos: Detectar las causas que originaron juicios de mala práctica en contra de cirujanos y analizar sus motivos. Lugar de aplicación: Colegio de Médicos Distrito VIII de la provincia de Buenos Aires. Población: 116 demandas entre enero de 1993 y mayo de 2003, de las cuales 29 involucran a 30 médicos con actividad quirúrgica. Resultados: 30 cirujanos fueron demandados, 20 (66-6 por ciento) son especialistas, 9 (30 por ciento) no poseen dicho título, y 1 (3,3 por ciento) es residente. A su vez el 35 por ciento de los especialistas debieran recertificar hallándose el 65 por ciento restante encuadrados en la ley vigente. Las historias clínicas estudiadas revelaron que el consentimiento informado faltó en el 96,5 por ciento y estaban incompletas el 56,6 por ciento. La negligencia se halló en el 51,7 por ciento, la impericia en el 34,4 por ciento e imprudencia 20,6 por ciento, asociadas en algunos casos. Hubo 14 profesionales demandados con eximentes de responsabilidad profesional. Conclusiones: Están minimizadas las medidas de prevención y se observó escasa coincidencia en relación a la responsabilidad profesional. Hubo insuficiente esfuerzo individual respecto a la Educación Médica Continua y se hallaron faltas graves a la ética profesional (AU)

Demandas por responsabilidad profesional: etiologías / Professional responsability demands: real causes

Antecedentes: En los últimos años las demandas por mala práctica médica han tenido un crecimiento vertiginosos y se han constituido en una preocupación constante para todos los galenos. Objetivos: Detectar las causas que originaron juicios de mala práctica en contra de cirujanos y analizar sus motivos. Lugar de aplicación: Colegio de Médicos Distrito VIII de la provincia de Buenos Aires. Población: 116 demandas entre enero de 1993 y mayo de 2003, de las cuales 29 involucran a 30 médicos con actividad quirúrgica. Resultados: 30 cirujanos fueron demandados, 20 (66-6 por ciento) son especialistas, 9 (30 por ciento) no poseen dicho título, y 1 (3,3 por ciento) es residente. A su vez el 35 por ciento de los especialistas debieran recertificar hallándose el 65 por ciento restante encuadrados en la ley vigente. Las historias clínicas estudiadas revelaron que el consentimiento informado faltó en el 96,5 por ciento y estaban incompletas el 56,6 por ciento. La negligencia se halló en el 51,7 por ciento, la impericia en el 34,4 por ciento e imprudencia 20,6 por ciento, asociadas en algunos casos. Hubo 14 profesionales demandados con eximentes de responsabilidad profesional. Conclusiones: Están minimizadas las medidas de prevención y se observó escasa coincidencia en relación a la responsabilidad profesional. Hubo insuficiente esfuerzo individual respecto a la Educación Médica Continua y se hallaron faltas graves a la ética profesional

Pancreatitis experimental en el opossum. Rol de la esplacnicectomía previa en la respuesta inflamatoria / Experimental pancreatitis in opossum. Rol of the previus splanicectomy in inflamatory response

BACKGROUND: The role of the Autonomous Nervous System in the immunologic and inflammatory response is still an issue of discussion. Furthermore, the physiopathologic mechanisms involved are still unknown. Acute pancreatitis (AP) does not escape this disconcert. In fact, like in every severe acute inflammatory process, its discontrol could be responsible of the high morbidity and mortality rates. OBJECTIVE: To assess to which degree bilateral splanchnicectomy changes the course of acute inflammatory response in AP. METHOD: Prospective research. RESULTS: The following parameters were evaluated: red blood cell count, white blood cell count, calcium, glucemia, urea, aminase, lypase and liver enzymes. Macroscopy and microscopy views of the pancreas were also obtained. The leucocitary response was abolished, and the calcium levels dropped to a lesser degree. CONCLUSIONS: Bilateral splanchnicectomy prior to unchaining AP had a beneficial effect, Its mechanism of action could have been through the disconnection of the respective reflex arches (AU)

Pancreatitis experimental en el opossum. Rol de la esplacnicectomía previa en la respuesta inflamatoria / Experimental pancreatitis in opossum. Rol of the previus splanicectomy in inflamatory response

BACKGROUND: The role of the Autonomous Nervous System in the immunologic and inflammatory response is still an issue of discussion. Furthermore, the physiopathologic mechanisms involved are still unknown. Acute pancreatitis (AP) does not escape this disconcert. In fact, like in every severe acute inflammatory process, its discontrol could be responsible of the high morbidity and mortality rates. OBJECTIVE: To assess to which degree bilateral splanchnicectomy changes the course of acute inflammatory response in AP. METHOD: Prospective research. RESULTS: The following parameters were evaluated: red blood cell count, white blood cell count, calcium, glucemia, urea, aminase, lypase and liver enzymes. Macroscopy and microscopy views of the pancreas were also obtained. The leucocitary response was abolished, and the calcium levels dropped to a lesser degree. CONCLUSIONS: Bilateral splanchnicectomy prior to unchaining AP had a beneficial effect, Its mechanism of action could have been through the disconnection of the respective reflex arches

[Acute experimental pancreatitis in the opossum. The role of early splenectomy in the inflammatory response]]. / Pancreatitis experimental en el opossum. Rol de la esplacnicectomìa previa en la respuesta inflamatoria.

BACKGROUND: The role of the Autonomous Nervous System in the immunologic and inflammatory response is still an issue of discussion. Furthermore, the physiopathologic mechanisms involved are still unknown. Acute pancreatitis (AP) does not escape this disconcert. In fact, like in every severe acute inflammatory process, its discontrol could be responsible of the high morbidity and mortality rates. OBJECTIVE: To assess to which degree bilateral splanchnicectomy changes the course of acute inflammatory response in AP. METHOD: Prospective research. RESULTS: The following parameters were evaluated: red blood cell count, white blood cell count, calcium, glucemia, urea, aminase, lypase and liver enzymes. Macroscopy and microscopy views of the pancreas were also obtained. The leucocitary response was abolished, and the calcium levels dropped to a lesser degree. CONCLUSIONS: Bilateral splanchnicectomy prior to unchaining AP had a beneficial effect, Its mechanism of action could have been through the disconnection of the respective reflex arches.

Pancreatitis experimental en el opossum. Rol de la esplacnicectomýa previa en la respuesta inflamatoria. / [Acute experimental pancreatitis in the opossum. The role of early splenectomy in the inflammatory response]]

BACKGROUND: The role of the Autonomous Nervous System in the immunologic and inflammatory response is still an issue of discussion. Furthermore, the physiopathologic mechanisms involved are still unknown. Acute pancreatitis (AP) does not escape this disconcert. In fact, like in every severe acute inflammatory process, its discontrol could be responsible of the high morbidity and mortality rates. OBJECTIVE: To assess to which degree bilateral splanchnicectomy changes the course of acute inflammatory response in AP. METHOD: Prospective research. RESULTS: The following parameters were evaluated: red blood cell count, white blood cell count, calcium, glucemia, urea, aminase, lypase and liver enzymes. Macroscopy and microscopy views of the pancreas were also obtained. The leucocitary response was abolished, and the calcium levels dropped to a lesser degree. CONCLUSIONS: Bilateral splanchnicectomy prior to unchaining AP had a beneficial effect, Its mechanism of action could have been through the disconnection of the respective reflex arches.

[Acute experimental pancreatitis in the opossum. The role of prior truncular vagotomy on the inflammatory response]. / Pancreatitis aguda experimental en el opossum. Rol de la vagotomía troncular previa en la respuesta inflamatoria.

BACKGROUND: Acute pancreatitis (AP) is a common cause of admission to the emergency room. Its etiopathogeny is poorly understood. The pancreatic inflammatory response in this process is unclear. The influence of the autonomic nervous system is a controversial issue. AIMS: To demonstrate the effects of truncular vagotomy on AP due to duodenal distention in the South American opossum. PLACE OF APPLICATION: Department of experimental surgery (Churruca-Visca Hospital) INEUCI (Neuroscience Institute, CONICET, UBA). POPULATION: Male and female South American opossum divided into: a control group (7 animals); group A: truncular vagotomy and pyloroplasty seven days after the onset of AP (7 animals). Group B: truncular vagotomy and pyloroplasty 30 days after provoking AP (7 animals). Group C: truncular vagotomy and pyloroplasty 45 days after the onset of AP (7 animals). METHODS: Acute pancreatitis was caused by duodenal distention of the second portion by inserting a Foley catheter through a gastrostomy. CONCLUSIONS: The method of provoking AP is original. The influence of autonomous nervous system is being underestimated in most of the literature available.

Pancreatitis aguda experimental en el opossum. Rol de la vagotomía troncular previa en la respuesta inflamatoria / Acute experimental pancreatitis in the opossum. The role of prior truncular vagotomy on the inflammatory response

Antecedentes: Las Pancreatitis Agudas (PA) son causa frecuente de consulta en los Servicios de Emergencias. Tanto sus etiopatogenias como la respuesta inflamatoria desencadenada son ejes de controversia, a la luz del desconocimiento actual de muchos de estos aspectos. La influencia del Sistema Nervioso Autónomo dentro de la respuesta a la inflamación es actualmente discutida. Objetivo: Demostrar el efecto de la vagotomía troncular previa sobre la PA por distensión duodenal en el opossum sudamericano. Lugar de aplicación: Instituto de Neurociencias (INEUCI-CONICET-UBA) y Sección Cirugía Experimental del Servicio de Cirugía General del hospital Churruca-Visca. Diseño: Estudio prospectivo randomizado. Población: Opossum sudamericanos de ambos os sexos divididos en cuatro grupos; Grupo control: (7 animales) se les ocasionó PA. Grupo A: (7 animales) se les realizó vagotomía troncular y piloroplastía siete días antes de ocasionar PA. Grupo B: (7 animales) se les realizó vagotomía troncular y piloroplastía 30 días antes de ocasionar PA. Grupo C: (7 animales) se les ocasionó PA después de 45 días de realizarles una vagotomía troncular y piloroplastía. Métodos: Se les realizó PA por distensión de la segunda porción del duodeno, por el insuflado de una sonda Foley frente a la papila. A todos los animales se les determinó Hto, G. Blancos, Calcio, Transaminasas, LDH, CPK, Amilasemia, Lipasemia, Colesterol, Urea en estado basal, a las 2 horas de desencadenada la PA y a las 4 horas de producida la afección. A todos los animales se les realizó estudio anatomopatológico con microscopía óptica del páncreas, hígado, pulmón y riñon. Resultados: Los datos de laboratorio más significativos fueron la interrupción vagal no altera el recuento leucocitario en relación a los grupos control; tanto la amilasa como la lipasa y la LDH, presentan un incremento pos distensión. No existen modificaciones de consideración con el hematocrito, la calcemia, la urea y el colesterol. Conclusiones: El método de desencadenamiento es original. Existe para los autores una subvaloración de la participación del Sistema Nervioso Autónomo en el proceso inflamatorio agudo pancreático. No existe relación entre el tiempo transcurrido de la vagotomía troncular en relación a las lesiones posteriores. La vagotomía troncular no aparenta modificar las lesiones desencadenada por este modelo experimental. En este grupo de animales, en relación a... (Au)

Pancreatitis aguda experimental en el opossum. Rol de la vagotomía troncular previa en la respuesta inflamatoria. / [Acute experimental pancreatitis in the opossum. The role of prior truncular vagotomy on the inflammatory response]

BACKGROUND: Acute pancreatitis (AP) is a common cause of admission to the emergency room. Its etiopathogeny is poorly understood. The pancreatic inflammatory response in this process is unclear. The influence of the autonomic nervous system is a controversial issue. AIMS: To demonstrate the effects of truncular vagotomy on AP due to duodenal distention in the South American opossum. PLACE OF APPLICATION: Department of experimental surgery (Churruca-Visca Hospital) INEUCI (Neuroscience Institute, CONICET, UBA). POPULATION: Male and female South American opossum divided into: a control group (7 animals); group A: truncular vagotomy and pyloroplasty seven days after the onset of AP (7 animals). Group B: truncular vagotomy and pyloroplasty 30 days after provoking AP (7 animals). Group C: truncular vagotomy and pyloroplasty 45 days after the onset of AP (7 animals). METHODS: Acute pancreatitis was caused by duodenal distention of the second portion by inserting a Foley catheter through a gastrostomy. CONCLUSIONS: The method of provoking AP is original. The influence of autonomous nervous system is being underestimated in most of the literature available.

Pancreatitis aguda experimental en el opossum. Rol de la vagotomía troncular previa en la respuesta inflamatoria / Acute experimental pancreatitis in the opossum. The role of prior truncular vagotomy on the inflammatory response

Antecedentes: Las Pancreatitis Agudas (PA) son causa frecuente de consulta en los Servicios de Emergencias. Tanto sus etiopatogenias como la respuesta inflamatoria desencadenada son ejes de controversia, a la luz del desconocimiento actual de muchos de estos aspectos. La influencia del Sistema Nervioso Autónomo dentro de la respuesta a la inflamación es actualmente discutida. Objetivo: Demostrar el efecto de la vagotomía troncular previa sobre la PA por distensión duodenal en el opossum sudamericano. Lugar de aplicación: Instituto de Neurociencias (INEUCI-CONICET-UBA) y Sección Cirugía Experimental del Servicio de Cirugía General del hospital Churruca-Visca. Diseño: Estudio prospectivo randomizado. Población: Opossum sudamericanos de ambos os sexos divididos en cuatro grupos; Grupo control: (7 animales) se les ocasionó PA. Grupo A: (7 animales) se les realizó vagotomía troncular y piloroplastía siete días antes de ocasionar PA. Grupo B: (7 animales) se les realizó vagotomía troncular y piloroplastía 30 días antes de ocasionar PA. Grupo C: (7 animales) se les ocasionó PA después de 45 días de realizarles una vagotomía troncular y piloroplastía. Métodos: Se les realizó PA por distensión de la segunda porción del duodeno, por el insuflado de una sonda Foley frente a la papila. A todos los animales se les determinó Hto, G. Blancos, Calcio, Transaminasas, LDH, CPK, Amilasemia, Lipasemia, Colesterol, Urea en estado basal, a las 2 horas de desencadenada la PA y a las 4 horas de producida la afección. A todos los animales se les realizó estudio anatomopatológico con microscopía óptica del páncreas, hígado, pulmón y riñon. Resultados: Los datos de laboratorio más significativos fueron la interrupción vagal no altera el recuento leucocitario en relación a los grupos control; tanto la amilasa como la lipasa y la LDH, presentan un incremento pos distensión. No existen modificaciones de consideración con el hematocrito, la calcemia, la urea y el colesterol. Conclusiones: El método de desencadenamiento es original. Existe para los autores una subvaloración de la participación del Sistema Nervioso Autónomo en el proceso inflamatorio agudo pancreático. No existe relación entre el tiempo transcurrido de la vagotomía troncular en relación a las lesiones posteriores. La vagotomía troncular no aparenta modificar las lesiones desencadenada por este modelo experimental. En este grupo de animales, en relación a...

[Biliary acute pancreatitis: an etiopathology and evolution review of 148 cases]. / Pancreatitis aguda biliar. Una revisión etiopatogénica y evolutiva de 148 casos.

BACKGROUND: A retrospective analysis of the etiologic factors and physiopathogenic mechanisms underlying an acute biliary pancreatitis episode put in evidence the complexity of the attempt to acquire a clear understanding of the entity. In this presentation the authors try to re-examine the main factors involved in the triggering of the disease. Besides the classic theories and their own approach to the management of an acute pancreatic inflammation episode are discussed. AIMS: The main purpose of this endeavor was to identify and discuss the etiopathogenic mechanisms that were prevalent in a series of 148 patients observed and treated in a 10 years period. Besides, another distinctive aim was to analyze their evolution and somehow to try to assess their probable prognosis. PLACE OF APPLICATION: Close community. POPULATION: The whole group of patients that were admitted with the diagnosis of acute pancreatitis in the time period comprised between 1987-1997. METHODS: The acute pancreatitis subgroups and their respective number of patient included were the following: BILIARY ACUTE PANCREATITIS 140 CASES POST ERCP 8 CASES CONCLUSIONS: As a result of the present reviewing endeavour several observations deserve to be pointed out: a. The pancreatic gland undoubtedly is a neuroendocrine organ, that is subjected to complex neural and hormonal influence. b. Undeniably, the involvement of the autonomic nervous system in the physiopathogenic mechanism of acute pancreatitis has been surprisingly disregarded. c. The biliary acute pancreatitis variant is the most frequent. What we consider a simplification is to accept the Opie's postulation without taking into account the intermediate steps, centered on autonomic reflexes, that ultimately lead to the acute inflammatory lesions. d. Although without an absolute proof, it is undeniable that "stress" is a primary etiology in some cases of acute pancreatitis. e. We favor the idea that the pancreas functional status influences on the extension and intensity degree of the acute pancreatic inflammatory lesions.

Pancreatitis aguda biliar. Una revisión etiopatogénica y evolutiva de 148 casos. / [Biliary acute pancreatitis: an etiopathology and evolution review of 148 cases]

BACKGROUND: A retrospective analysis of the etiologic factors and physiopathogenic mechanisms underlying an acute biliary pancreatitis episode put in evidence the complexity of the attempt to acquire a clear understanding of the entity. In this presentation the authors try to re-examine the main factors involved in the triggering of the disease. Besides the classic theories and their own approach to the management of an acute pancreatic inflammation episode are discussed. AIMS: The main purpose of this endeavor was to identify and discuss the etiopathogenic mechanisms that were prevalent in a series of 148 patients observed and treated in a 10 years period. Besides, another distinctive aim was to analyze their evolution and somehow to try to assess their probable prognosis. PLACE OF APPLICATION: Close community. POPULATION: The whole group of patients that were admitted with the diagnosis of acute pancreatitis in the time period comprised between 1987-1997. METHODS: The acute pancreatitis subgroups and their respective number of patient included were the following: BILIARY ACUTE PANCREATITIS 140 CASES POST ERCP 8 CASES CONCLUSIONS: As a result of the present reviewing endeavour several observations deserve to be pointed out: a. The pancreatic gland undoubtedly is a neuroendocrine organ, that is subjected to complex neural and hormonal influence. b. Undeniably, the involvement of the autonomic nervous system in the physiopathogenic mechanism of acute pancreatitis has been surprisingly disregarded. c. The biliary acute pancreatitis variant is the most frequent. What we consider a simplification is to accept the Opies postulation without taking into account the intermediate steps, centered on autonomic reflexes, that ultimately lead to the acute inflammatory lesions. d. Although without an absolute proof, it is undeniable that [quot ]stress[quot ] is a primary etiology in some cases of acute pancreatitis. e. We favor the idea that the pancreas functional status influences on the extension and intensity degree of the acute pancreatic inflammatory lesions.

Pancreatitis aguda biliar: una revisión eteiopatogénica y evolutiva de 148 casos / Biliary acute pancreatitis: an etiopathology and evolution review of 148 cases

BACKGROUND: A retrospective analysis of de etiologic factors and fisiopathogenic mechanisms underlyng an acute biliar pancreatitis episode put in evidence the complexity of the attempt to acquire a clear understanding of the entity. In this presentation the authors try to re-examine the main factors involved in the triggering of the disease. Beasides the clasic theories and their own approach to the management of an acute pancreatic inflammation episode are discussed. AIMS: The main purpose of this endeavor was to identify and discuss the etiopahogenic machanisms that were prevalent in a series of 148 patients observed and trated in a 10 years period. Besides, another distinctive aim was to analyze their evolution and somehow to try to assess their probable prognosis. PLACE OF APPLICATION: Close comunity. POPULATION: The whole group of patients that were admitted with the diagnosis of acute pancreatitis in the time period comprised between 1987-1997. METHODS: The acute pancreatitis subgroups and their respective number of patient included were the following: BILIARY ACUTE PANCREATITIS 140 CASES POST ERCP 8 CASES CONCLUSIONS: As a result of the present reviewing endeaveur several observations deserve to be pointed out: a. The pancreatic gland undoubtedly is a neuroendocrine organ, that is subjeted to complex neural and hormonal influence. b. Undeniably, the involvement of the autonomic nervous system in the physiopathogenic mechanism of acute pancreatitis has been surprisingly disregarded. c. The biliary acute pancreatitis variant is the most frequent. What we consider a simplification is to accept the Opie's postulation without taking into account the intermediate steps, centered on autonomic reflexes, that ultimately lead to the acute inflammatory lesions. d. Although without an absolute proof, it is undeniable that "stress" is a primary etiologie in some cases of acute pancreatitis. e. We favor the idea that the pancreon's functional status influences on the extension and intensity degree of the acute pancreatic inflammatory lesions.

Pancreatitis aguda biliar: una revisión eteiopatogénica y evolutiva de 148 casos / Biliary acute pancreatitis: an etiopathology and evolution review of 148 cases

BACKGROUND: A retrospective analysis of de etiologic factors and fisiopathogenic mechanisms underlyng an acute biliar pancreatitis episode put in evidence the complexity of the attempt to acquire a clear understanding of the entity. In this presentation the authors try to re-examine the main factors involved in the triggering of the disease. Beasides the clasic theories and their own approach to the management of an acute pancreatic inflammation episode are discussed. AIMS: The main purpose of this endeavor was to identify and discuss the etiopahogenic machanisms that were prevalent in a series of 148 patients observed and trated in a 10 years period. Besides, another distinctive aim was to analyze their evolution and somehow to try to assess their probable prognosis. PLACE OF APPLICATION: Close comunity. POPULATION: The whole group of patients that were admitted with the diagnosis of acute pancreatitis in the time period comprised between 1987-1997. METHODS: The acute pancreatitis subgroups and their respective number of patient included were the following: BILIARY ACUTE PANCREATITIS 140 CASES POST ERCP 8 CASES CONCLUSIONS: As a result of the present reviewing endeaveur several observations deserve to be pointed out: a. The pancreatic gland undoubtedly is a neuroendocrine organ, that is subjeted to complex neural and hormonal influence. b. Undeniably, the involvement of the autonomic nervous system in the physiopathogenic mechanism of acute pancreatitis has been surprisingly disregarded. c. The biliary acute pancreatitis variant is the most frequent. What we consider a simplification is to accept the Opies postulation without taking into account the intermediate steps, centered on autonomic reflexes, that ultimately lead to the acute inflammatory lesions. d. Although without an absolute proof, it is undeniable that "stress" is a primary etiologie in some cases of acute pancreatitis. e. We favor the idea that the pancreons functional status influences on the extension and intensity degree of the acute pancreatic inflammatory lesions. (Au)

The surgical management of elephantiasis of the lower extremeties

The etiological factors and historical data on surgical treatment of elephantiasis are briefly discussedIndications of operation by clinical criteria are the following: a. Progressive increase in the size of the extremity especially despite conservative management for 6-12 monthsb. Marked skin changes such as in duration, thickening, hyperkeratosis, and dermatitisc. Repeated episodes of lymphangitis and chronic fungus infectiond. The unsightly appearance, the functional disability, and the severe reaction of the patient to the disease are obviouse. Tremendous increase in the size of the extremity affected so that the patient can hardly carry itDiagnosis of the lesion is often easily made; however, it is the etiological factor that is sometimes difficult to determine or prove. Not all cases that develop elephantiasis are due to filariasis. Most of them can be traced to lymphangitisSome of the improvements in the current surgical management of elephantoid extremities are briefly discussed. The use of full-thickness skin grafts and the avoidance of scar in kinetic areas is emphasizedThe operative procedure in one stage, the pre-operative preparation and postoperative care are discussedThe surgical treatment of choice at present in the Philippine General Hospital for elephantiasis of the lower extremities is the total excision of the edematous tissue (dermo-fibrolipectomy) and followed by skin grafting from the specimen and from the sound skin of the bodySix cases of elephantiasis of the lower extremity treated in the P.G.H. are presentedComplications and early results of the cases are discussedThe shorter the duration of the elephantiasis, the better is the result. (Summary)

The prognostic significance of the S-phase fraction and DNCA ploidy in node-negative estrogen receptor-positive breast cancer.

The aim of this study was to determine the significance of the phase fraction S-phase fraction (SPF) and DNA ploidy as determined by DNA flow cytometry on the prognosis of patients with Stage 1 (TINOMO) and stage II A (T2NOMO) breast cancer who had estrogen receptor-positive tumors. A total of 45 patients with invasive ductal carcinoma were studied. The median follow-up was 3.8 years. The prognostic cut-off for the SPF of the 45 patients was 34% as determined by log rank test and this was used to classify patients into low (34%) and high (34%) SPF groups. 30 patients (67%) had low SPF. 36 (80%) of the tumors examined were diploid. Using the cut-off, the SPF had no prognostic value in Stage 1 breast cancer patients. There was significantly longer disease-free survival and overall survival in Stage II A patients with low SPF compared to Stage II A patients with high SPF (96% vs. 50% at 4 years, p = 0.02, and 100% vs. 62% at 4 years, p = 0.03, respectively). No significant prognostic value was noted with the DNA ploidy status in both groups of patients.