Day case stapled anopexy for the treatment of haemorrhoids and rectal mucosal prolapse.

AIM: Stapled anopexy (SA) gives better early postoperative results than classical haemorrhoidectomy. The aim of this study is to demonstrate that SA is a safe and effective procedure for the treatment of haemorrhoids and rectal mucose prolapse in a day-case surgery programme. METHOD: From January 2000 to December 2008, 297 SA procedures were performed; 230 (77.4%) were performed in the Day Surgery Unit (DSU). Third- and fourth-degree haemorrhoids, second-degree haemorrhoids with no response to conservative treatment and several cases of rectal prolapse were included. The mean age of the patients in the series was 48.1 years (range 21-85). Preoperative preparation included phosphate enemas and antibiotic prophylaxis. Patients were operated on mainly under spinal anaesthesia. Day-case rate, postoperative pain (measured by a visual analogic scale, 1-10), admissions, re-admissions, early postoperative situation and recurrence were evaluated in the study. RESULTS: The overall DSU rate was 78%, with a progressive increase from 46% to 99% in 2008. One hundred and eighty-five patients (80%) had pain scores under 2; no patient had a pain score over 7. Eighteen (8%) patients required admission on the day of surgery. Late admission was needed for 3 (3%) patients. Thirty-three patients reported their situation as excellent, 174 as good, 20 as acceptable and three as bad when they answered a phone questionnaire 24 h after surgery. Overall, 20 (9%) patients had recurrence of symptoms. CONCLUSION: SA is a safe and effective procedure for prolapsing haemorrhoids in the day case setting. The recurrence rate is higher than that observed in classical haemorrhoidectomy. Most patients can be managed as day-cases.

Comparative, clinico-epidemiologic study of Schistosoma mansoni infections in travellers and immigrants in Spain.

The study presented here aimed to contrast the marked clinical differences in the presentation of Schistosoma mansoni-induced infection between immigrants and travellers entering Spain from endemic regions, and to elucidate the therapeutic implications of these infections. A total of 200 African immigrants and 80 travellers with schistosomiasis were included in the study. Among the immigrants, 25 patients were diagnosed with Schistosoma mansoni infection; 15 presented with nonspecific symptoms, and 10 were asymptomatic. Hepatosplenomegaly was observed in nine. Among the travellers, 14 were diagnosed with Schistosoma mansoni infection; four were asymptomatic, four had Katayama syndrome, four had diarrhoea, and two had prostatitis. All of the patients were treated with praziquantel. Patients diagnosed with Katayama syndrome received praziquantel and dexamethasone for 3 days, with the praziquantel treatment being repeated at 3-4 weeks. The significant differences observed in the clinical presentation of Schistosoma mansoni-induced infection, indicate that a well-differentiated therapeutic strategy is required when this infection is diagnosed in a non-immune (traveller) or a semi-immune (immigrant) patient.

[Demographic characterization, consultation reasons and prevalent morbidity in the African immigrating community of the Maresme district]. / Caracterización demográfica, motivos de consulta y morbilidad prevalente en la comunidad de inmigrantes africanos de la comarca del Maresme.

BACKGROUND: To know the demographic condition, main symptoms and diagnosis in adult African immigrants from a reference Hospital. PATIENTS AND METHOD: A prospective protocol between 1984-1994. RESULTS: 1,321 immigrants were considered. Most of them had an unstable job and illegal situation and they did not speak any European language. Abdominal pain was the most common symptom. The most frequent diagnoses were parasitic/infections and digestive and haematological diseases. CONCLUSIONS: Immigration is not a risk for public health. The illegal situation carries poor sanitary conditions. The clinical protocols help to overcome cultural and idiomatic barriers.

Asthma trough to Parietaria in pediatrics.

We selected 183 patients with asthma, rhinitis and/or conjunctivitis. They responded positively to Parietaria Judaica skin prick-tests. In the first test 91 were positive. Of those 11 were monosensitive and 80 polysensitive. In the follow-up tests 92 were positive, of which 5 were monosensitive and 87 polysensitive. There were 54 cases of rhinitis, of which 23 developed asthma. Of 129 asthma cases, 90 developed asthma with rhinitis. The main seasons are Spring and Autumn and activity declines during winter. 18.57% are perennial. IgE was greater in the re-examination of the polysensitive cases. The monosensative cases confirmed the clinical symptoms most characteristic of rhinitis syndrome, 16.893% and asthma with rhinitis, 49.18%.

Colocación intraoperatoria de vía venosa central: original método en cirugía pediátrica / Intraoperative placement of central vein-line: original method in pediatric cardiac surgery

Se presenta un método de colocación intraoperatoria de catéter venoso central en lactantes y niños pequeños sometidos a cirugía cardíaca, bajo visión directa, con absoluta seguridad de asepsia, punción y posición, que fue efectuado en 200 pacientes consecutivos, sin complicaciones de ningún tipo

Colocación intraoperatoria de vía venosa central: original método en cirugía pediátrica / Intraoperative placement of central vein-line: original method in pediatric cardiac surgery

Se presenta un método de colocación intraoperatoria de catéter venoso central en lactantes y niños pequeños sometidos a cirugía cardíaca, bajo visión directa, con absoluta seguridad de asepsia, punción y posición, que fue efectuado en 200 pacientes consecutivos, sin complicaciones de ningún tipo (AU)

Aneurisma congénito de seno de Valsalva izquierdo roto en aurícula derecha / Congenital aneurysms of the left sinus of Valsalva opened in right atrium

Los aneurismas del seno coronariano izquierdo rotos en cavidades derechas son sumamente infrecuentes. El motivo del presente trabajo es presentar una paciente de 18 años, con insuficiencia cardíaca, insuficiencia aórtica moderada, soplo continuo y episodios repetidos de taquicardia paroxística supraventricular. El estudio hemodinámico y angiocardiográfico no fue categórico y diagnosticó fístula coronaria a aurícula derecha o aneurisma de seno de Valsalva roto en aurícula derecha. La exploración quirúrgica mostró un aneurisma de seno de Valsalva izquierdo, que estaba roto en aurícula derecha frente a la topografía del nódulo sinusal, con una válvula aórtica insuficiente por deformación de la valva coronariana izquierda. Se reparó el orificio del aneurisma, llevando la coronaria izquierda a la luz de la aorta, cerrando la ruptura del saco en aurícula derecha, con abandono del saco mismo. Sobre la válvula aórtica se efectuó una plástica de Trussler. El resultado obtenido fue muy satisfactorio, con reintegro del paciente a su vida normal, y desaparición de los episodios arrítmicos que posiblemente hayan sido debidos a lesión de jet (AU)

Aneurisma congénito de seno de Valsalva izquierdo roto en aurícula derecha / Congenital aneurysms of the left sinus of Valsalva opened in right atrium

Los aneurismas del seno coronariano izquierdo rotos en cavidades derechas son sumamente infrecuentes. El motivo del presente trabajo es presentar una paciente de 18 años, con insuficiencia cardíaca, insuficiencia aórtica moderada, soplo continuo y episodios repetidos de taquicardia paroxística supraventricular. El estudio hemodinámico y angiocardiográfico no fue categórico y diagnosticó fístula coronaria a aurícula derecha o aneurisma de seno de Valsalva roto en aurícula derecha. La exploración quirúrgica mostró un aneurisma de seno de Valsalva izquierdo, que estaba roto en aurícula derecha frente a la topografía del nódulo sinusal, con una válvula aórtica insuficiente por deformación de la valva coronariana izquierda. Se reparó el orificio del aneurisma, llevando la coronaria izquierda a la luz de la aorta, cerrando la ruptura del saco en aurícula derecha, con abandono del saco mismo. Sobre la válvula aórtica se efectuó una plástica de Trussler. El resultado obtenido fue muy satisfactorio, con reintegro del paciente a su vida normal, y desaparición de los episodios arrítmicos que posiblemente hayan sido debidos a lesión de jet

[Hip arthrodeses for septic arthritis. Critical study]. / Les arthrodèses de hanche pour arthrite septique. Etude critique.

Twenty-eight cases of septic arthritis of the hip were treated by arthrodesis and reviewed after 2 years. Fusion of the hip was obtained in only 11 cases, four of which were still draining but healed after removal of metallic devices and curettage. Five cases had an acceptable result without drainage despite incomplete fusion. Of the 12 remaining cases, 3 were lost to follow-up and 9 had to be operated on again. Four became fused and dry, 4 were still mobile but dry and the last was a complete failure, being both mobile and draining. One case of dry incomplete fusion was successfully treated by a total prosthesis. These results show that fusion is difficult to obtain and that it is neither a necessary nor an adequate means of obtaining a good result in infection. The possibility of preserving the joint motion should be discussed.

[The results of valgus osteotomy in severe osteoarthritis of the hip (author's transl)]. / L'ostéotomie de valgisation dans les coxarthroses évoluées. Indications et résultats de 150 interventions consécutives.

The authors analysed 150 consecutive cases of valgus osteotomy (Pauwels II) performed in cases of very severe osteoarthritis, and followed up for 3 to 10 years (average 6 years). The quality and the permanency of the results depend mainly on the morphology of the osteoarthritic hip. A satisfactory clinical and radiologic result is attained when the stresses in the joint have been reduced by improving the congruity of the joint surfaces using the cephalic medial osteophyte as part of these, and thus increasing the weight bearing surfaces. In osteoarthritis secondary to dysplasia (single dysplasia, subluxation, or luxation with support: 49 cases) valgus osteotomy gave 77 p. 100 good results, with 83 p. 100 painfree hips. This result persists 10 years (or more) for women operated before 50 years of age. The results are good in primary osteoarthritis occuring in active age (83 cases). When the hip was extruded by acetabular and cephalic osteophytes, 60 p. 100 good results, with 81 p. 100 painfree hips, have been obtained. In protrusive osteoarthritis and coxa profunda (18 cases) the valgus osteotomy slightly improved the range of movement but the relief of pain was usual (88 p. 100) and durable. The causes of failure (lack of mechanical improvement, osteoarthritis resulting more from biological disturbance--primary osteoarthritis--rather than from mechanical causes, influence of the age) have been sought for.