Multicentre study of a continent colostomy plug.

A multicentre clinical study was carried out to assess the performance of a new disposable device, the Conseal 1-Piece, for colostomy control and continence. Forty-three patients were studied; none had any complication at the stoma. The time elapsed since surgery and the condition of the stoma and surrounding skin were recorded. The new product was compared with the patients' usual colostomy bag, studying the following parameters: ease of application, reliability, leakage, confidence, ease of removal, adhesion and comfort. Thirty-seven patients completed the study. No complications arose, and complete faecal continence was obtained with 71.1 per cent of applications. The plug was kept in position for a mean of 11.5 h and a normal stoma bag was used for the remainder of the day. Of the 37 patients who completed the trial, 26 preferred the Conseal 1-Piece to a colostomy bag. In this preliminary study the device was easy to apply, involved no major complications and provided a high degree of continence. This product deserves further study because of its simplicity of use. However, research to improve the level of continence should continue.

Radioimmunolocalization of colorectal carcinoma. A correlation among RIL results, surgical findings, serum tumor marker levels and the presence of CEA and CA 19.9 in tumor tissue: the experience of the Hospital de la Santa Creu i Sant Pau.

We report a prospective study in two groups of colorectal cancer patients carried out by radio-immunolocalization (RIL) with F(ab') fragments of monoclonal antibodies against CEA and CA 19.9 labeled with 131-I. Twenty-two patients were studied before radical surgery and 12 patients after initial surgery, when progressive increase in CEA was registered. Scintigraphic images obtained in vivo in RIL studies were compared with scintigraphic images of the corresponding surgical specimens. Results were compared with known serum marker levels and with the presence and localization of markers in the excised specimens. RIL images correctly identified 13 of 23 (52%) primary tumors, with only one false positive image. Scintigraphy of surgical specimens correlated with RIL findings in 14 of 19 cases (74%). Four specimens which showed antibody uptake had not been visualized preoperatively in the RIL study. Two of them were retrovesical and were obscured by residual activity in the bladder. Nine of 13 (64%) patients with at least one elevated tumor marker were imaged. Staining pattern or intensity of antigen staining in the specimens did not correlate with RIL findings. Recurrent disease was confirmed by laparotomy or other exploration in 10 of the 12 patients with progressive CEA elevation during follow-up. Spontaneous normalization of CEA levels was observed in the remaining 2 patients. RIL studies were positive in 7 of the 10 patients with confirmed recurrent disease. Of the 3 false negative patients 2 had liver metastases and one developed clinical lung, bone and adrenal metastases 11 months later. No false positive studies were observed in this group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical application of radioimmunolocalization in colorectal cancer]. / Aplicación clínica de la radioinmunolocalización en el cáncer colorrectal.

We present preliminary results of radioimmunolocalization (RIL) of colorectal cancer with 131I labelled F(ab')2 fragments from monoclonal anti CEA and anti CA 19.9 antibodies in 22 patients with colorectal cancer and in one patient with metastases of unknown origin and high CEA value. Positive images were obtained in 7 of 11 primary tumors from 10 patients evaluated preoperatively; in 2 of 3 recurrences; in 9 of 12 metastatic localizations and in the unknown primary tumor localized, finally in the cecum. One local recurrence was not detected by any diagnostic methods, but RIL. There was not false-positive images. Therefore, RIL appears as a promising method for the diagnosis and follow-up of colorectal cancer.

[Deep cystic colitis located in a previous surgical anastomosis]. / Colitis quística profunda localizada en anastomosis quirúrgica previa.

Deep cystic colitis is a rare disease of which about one hundred cases have been reported in the medical literature. Two forms are known, segmental and localized, the latter being the most frequent. We offer a case of a patient who developed a picture of deep localized cystic colitis on a previous surgical anastomosis, a very infrequent association. The value of intraoperative biopsy in these cases is discussed. It is necessary to be aware of this entity and its clinicopathologic correlations to differentiate it, especially from the therapeutic and prognostic points of view, from well differentiated colorectal carcinoma and colloid (mucoid extracellular) carcinoma.

Hydatid disease of the liver with thoracic involvement.

Eleven patients with hydatid disease of the liver with intrathoracic involvement have been treated at this hospital, and another patient was treated previously elsewhere. The clinical and roentgenologic symptoms depend greatly upon the evolutionary stage of the disease. General conditions are seriously affected in instances of ruptured and infected cysts. When the cysts open into the tracheobronchial tree as a result of coughing up pus in profuse quantities, the general condition may improve to a certain degree, but bronchopulmonary symptoms increase at that moment. An important spitting of bile must alert us to the existence of biliary hypertension. This condition must be treated first to avoid recurrence of the process. According to our experience, surgical treatment is based upon correct drainage of the cystic intrahepatic cavity under the diaphragm, separating the pleural cavity completely from the intrahepatic; excision of the transdiaphragmatic fistulous tract; conservative indications for pulmonary resection, and possible existence of biliary hypertension before and after operation.