Retorno a la vida socio-laboral tras hernioplastia inguinal. ¿qué factores influyen? / Factors that have an influence on return to work and normal activities after inguinal hernioplasty

INTRODUCCIÓN: La reparación de la hernia inguinal es una de las intervenciones más practicadas en el hombre. La baja laboral constituye una pérdida económica importante para lanación. El objetivo es analizar si determinados factores como el tipo de contrato laboral, el realizar esfuerzo físico en el trabajo, la edad, e incluso el médico que le proporciona el alta, influyen en la reincorporación del paciente a la vidasocio-laboral. MATERIAL Y MÉTODOS: Se envió por correo postal una encuesta a los 314 pacientes intervenidos de hernia inguinal primaria en régimen ambulatorio en el año 2002. Se realiza un análisis descriptivo de los resultados de la misma. RESULTADOS: 121 encuestas contestadas(38.5%). Edad media 56.9 años. Varones 93%,mujeres 7%. La mayoría de pacientes del GrupoI (trabajadores fijos) y Grupo II (trabajadores autónomos y temporales) retornaron al trabajo ala 4ª semana, aunque algunos del GI alargan el alta hasta un máximo de 20 semanas (en el GIImáximo 8 semanas). Los trabajadores manuales se incorporaron sobretodo en la 4ª semana, en cambio los no manuales a la 2ª semana. Por grupos de edades, el retorno es similar, aunque un gran porcentaje de mayores de 40 años (14%) lo hace más tarde. Los pacientes a los que les dio el alta el cirujano se incorporaron antes con respecto a los que se la dio el médico de cabecera. CONCLUSIONES: El contrato laboral fijo, el trabajo manual, la edad y el médico de cabecera, parecen influir en el retraso del retorno del paciente a la actividad socio-laboral (AU)

INTRODUCTION: Repair of inguinal hernia is one of the most common operations performed on men. Convalescence time away from work constitutes an important economic loss to the nation. The aim of this study is to determine whether certain factors, such as the type of work contract, heavy physical work, age, as well as the doctor who signs the patient's discharge, have any influence on the patient's return to work and normal activities. MATERIALS AND METHODS: A questionary was sent by post to 314 patients who had undergone ambulatory hernia repair in 2002. A descriptive analysis of results was obtained. RESULTS: 121 questionnaires were sent back(38.5%). Mean age 56.9 years. Male 93%, female7%. Most patients in Group I (employed) and Group II (self-employed and temporary workers) returned to work in the fourth week post-op, although some of those in Group I prolonged inactivity up to 20 weeks (in GroupII, this was 8 weeks (..) (AU)

Evaluación de la TC helicoidal en la estadificación preoperatoria del adenocarcinoma gástrico / Helical CT evaluation in the preoperative staging of gastric adenocarcinoma

Introducción: el objetivo del estudio es evaluar la TC helicoidal como prueba preoperatoria básica para la estadificación del adenocarcinoma gástrico. Material y método: reclutamos 50 pacientes diagnosticados de adenocarcinoma gástrico, evaluando la TC helicoidal y comparando sus hallazgos con los macroscópicos de la laparotomía confirmados anatomopatológicamente. Se ha utilizado la clasificación TNM 5ª edición de la UICC (mayo 1997). Resultados: el mejor resultado en cuanto a la Sensibilidad lo obtenemos para el diagnóstico de adenopatías 83 por ciento (69-92 por ciento), respecto a la especificidad obtenemos un 92 por ciento (79-98 por ciento) para T4 y un 89 por ciento (77-96 por ciento) para la detección de metástasis. Para T1-T2 la exactitud fue del 70 por ciento y para T3 del 62 por ciento. Conclusiones: 1. La TC helicoidal para la categoría T se muestra eficaz para detectar los casos avanzados clasificados como irresecables.2. La predicción en la categoría N de la TC helicoidal es mejor que la obtenida hasta ahora con las generaciones anteriores de TC. 3. En la categoría M, la TC helicoidal es una prueba útil para identificar la existencia de metástasis hepáticas que harían la cirugía innecesaria (AU)

Helical CT evaluation in the preoperative staging of gastric adenocarcinoma.

INTRODUCTION: The aim of this study is to evaluate helical CT as a basic preoperative test for the staging of gastric adenocarcinoma. MATERIAL AND METHOD: We enrolled 50 patients with a diagnosis of gastric adenocarcinoma, evaluated helical CT scans, and compared their findings to the microscopic, pathology-confirmed ones obtained by laparotomy. UICC's TNM classification, 5th edition (May 1997), was used. RESULTS: Best results regarding Sensitivity were obtained in the diagnosis of lymph node disease (83%; 69-92%); regarding specificity we obtained 92% (79-98%) for T4, and 89% (77-96%) in metastasis detection. Accuracy was 70% for T1-T2, and 62% for T3. CONCLUSIONS: 1. For the T category, helical CT effectively detects advanced cases classified as non-resectable. 2. For the N category, helical CT prediction is better than ever before with previous CT generations. 3. For the M category, helical CT is a useful test to identify the presence of liver metastases that would render surgery unnecessary.

Traumatismos colorrectales por cuerpos extraños introducidos por prácticas sexuales: actitud diagnóstico-terapéutica / Colorectal trauma caused by foreign bodies introduced during sexual activity: diagnosis and management

Objetivo: este trabajo trata de exponer la experiencia de 17 casos de cuerpos extraños colorrectales introducidos por prácticas sexuales, los cuales han sido recogidos por los autores a lo largo de veinte años (1980-2000), y establecer las pautas diagnósticas y terapéuticas ante estas situaciones. Material y métodos: un total de 17 pacientes fueron tratados de traumatismos rectales por introducción de cuerpos extraños, por prácticas sexuales no habituales. La extracción del cuerpo extraño del recto se consiguió en 10 casos por vía anal mediante diversas técnicas (pinzas ginecológicas, sondas de Foley, etc.), y 7 pacientes requirieron intervención quirúrgica, siendo necesaria una colostomía de protección en 5 pacientes, y sutura de la lesión rectal en los 2 restantes. Resultados: mortalidad nula. Postoperatorio sin complicaciones. Cierre de la colostomía en todos los casos a los 3-6 meses de la intervención. No hubo ningún caso de incontinencia anal. Conclusiones: es fundamental realizar una correcta anamnesis y exploración física del paciente, a parte de todas las exploraciones complementarias que sean necesarias, para un correcto diagnóstico y tratamiento de las lesiones. Habrá que tomar grandes precauciones en la extracción del cuerpo extraño para que no se produzca la rotura de éste en el recto, convirtiendo un problema relativamente simple en uno más complejo (AU)

Colorectal trauma caused by foreign bodies introduced during sexual activity: diagnosis and management.

PURPOSE: The aim of this study is to describe 17 cases of colorectal foreign bodies introduced during sexual activity, gathered by the authors over the past twenty years (1980-2000), and to establish diagnostic and therapeutic guidelines for these situations. MATERIAL AND METHODS: A total of 17 patients were treated for rectal trauma caused by foreign bodies due to unusual sexual practice. The extraction of the foreign body was possible through the canal anal in 10 cases using different techniques (gynecological forceps, Foley catheters, etc.), whereas 7 patients required surgical treatment; in five patients a protective colostomy was needed, and in the other two a simple suture of the rectal lesion was performed. RESULTS: There were no deaths and no post-operative complications. In all cases the colostomy was closed 3-6 months after surgery. There were no cases of anal incontinence. CONCLUSIONS: A detailed clinical history and physical examination are essential for the diagnosis and management of these lesions, in addition to any other diagnostic techniques that might be necessary. Great care should be taken when extracting the foreign body so as to avoid its breakage inside the rectum, which would complicate a rather simple problem.

Laparoscopic evaluation of the risk of locoregional recurrence after radical surgery for gastric cancer.

OBJECTIVE: we studied the diagnostic utility of laparoscopy in patients who underwent absolute radical surgery (R0) for gastric adenocarcinoma and who were at risk for locoregional recurrence. Risk was considered to exist in patients with T3-T4 stage tumors (IUAC TNM classification) that invaded the serosa or affect nearby organs. These patients are candidates for clinical trials involving multimodal therapies, especially with neoadjuvant or intraperitoneal chemotherapy. METHOD: ninety consecutive patients with gastric adenocarcinoma diagnosed by endoscopic biopsy were studied. The tumors were considered to be operable and potentially resectable depending on the preoperative evaluation of spread. The gold standard was the pathology report, based on the resected piece or specific biopsies. RESULTS: in T3-T4 tumors, laparoscopy had a sensitivity of 81% and a specificity of 100%, whereas for an 80% prevalence the positive predictive value was 100%, the negative predictive value was 56%, and diagnostic accuracy was 84%. CONCLUSIONS: in global terms, laparoscopy is very useful in detecting and confirming malignant invasion of the serosa or neighboring organs. In this sense it is similar to other diagnostic staging techniques such as endoscopic echography, with the added advantages of requiring less operator skill and being available in any center where such tumors are treated.

[Streptococcus bovis in a surgical wound and a colonic neoplasm]. / Streptococcus bovis en herida quirúrgica y neoplasia de colon.

The association of colorectal carcinoma and septicemia or endocarditis by Streptococcus bovis is well known. Nonetheless, other localizations of infection by Streptococcus bovis have not been associated with colorectal carcinoma. The case of association of colon neoplasm with infection by Streptococcus bovis localized in the surgical wound of resection of a prostate adenoma by the transvesical route carried out four months previously is presented. Possible intraoperative bacteremia colonizing the surgical wound due to colic compression during surgery may have been the cause. This localization of infection by Streptococcus bovis should be taken into account in screening of colorectal carcinoma.

[Rupture of splenic artery aneurysm as a cause of acute abdomen]. / Ruptura de aneurisma de arteria esplénica como causa de abdomen agudo.

A male, 52 years old, presenting acute abdominal pain and hypovolemic shock, was diagnosed by ultrasound and CAT of fissured aneurysm of the splenic artery. Emergency laparotomy confirmed that the aneurysm had ruptured into the peritoneal cavity.

[Arterial embolisms in the upper and lower limbs: a clinical review]. / Embolias arteriales en miembros superiores e inferiores: revisión clínica.

A clinical review about the subjects is made. Percentages and comparisons between lower and upper limbs were established. Correlation with statistics from other authors are presented.

[Angiodysplasia of the colon and Crohn's disease. A study with vascular resin casts]. / Angiodisplasia de colon y enfermedad de Crohn. Estudio con moldes vasculares de resina.

All the previous studies which have associated arteriovenous malformations of the colon with chronic inflammatory disease have always been performed on a diseased intestine. This study, which uses the intravascular injection of resin, shows morphological evidence that angiodysplasia of the colon and intestinal inflammatory disease can coexist independently. This fact suggests that in cases of severe hemorrhage in a patient with inflammatory disease of the small intestine, it cannot simply be assumed that it originates in the macroscopically abnormal intestine, and that angiographic examination is a wise measure to rule out the possibility of arteriovenous malformations in the "normal" intestine.

[Surgical treatment of Zenker's diverticulum. Apropos of 14 cases]. / Tratamiento quirúrgico del divertículo de Zenker. A propósito de 14 casos.

We present our experience in the surgical treatment of 14 cases of Zenker's diverticulum, diagnosed from January, 1969 to December, 1988. In 11 cases we performed one stage diverticulectomy; in 4 cases, manometric findings required cricopharyngeal myotomy. In 3 cases surgical treatment was not indicated; 2 patients had liver cirrhosis and high surgical risk and the third patient declined the treatment. Current treatment is discussed.

[Presentation of 6 cases of cystadenocarcinoma of the pancreas]. / Aportación de seis casos de cistoadenocarcinomas de páncreas.

Cystadenocarcinomas represent approximately 1% of the pancreatic tumors and are difficult to diagnose clinically and by pathology. Due to their rarity, published series are small. We present 6 cases of pancreatic cystadenocarcinoma collected over a period of 15 years at the Visceral Surgery Service of the Valencia University Hospital. The better evolution and prognosis of these tumors in comparison with pancreatic adenocarcinomas is noteworthy.

[Peptic stenoses of the esophagus]. / Estenosis pépticas del esófago.

The authors present a series of 32 cases of reflux peptic strictures of the esophagus. The mean age of the patients is 54 years, with a 3/1 predominance of males. The etiologic antecedent was hiatal hernia in every case, with a clinical time of evolution of 29 months, dysphagia being the most frequent symptom (100%). Complementary diagnosis was based fundamentally on endoscopy and barium transit, explorations that also allow exclusion of other pathologies. All the patients underwent medical treatment, this being the only treatment in 4 cases. The other 28 cases were treated surgically. The technique used was, in the cases in which the esophagus could be dilated, dilatation associated with an antireflux technique, and when not dilatable, resection with reconstruction using stomach (Sweet) or colonoplasty. The global mortality was two patients (5.2%). Patients were followed-up for a minimum of 2 years and the global results have been good, with recurrence in 3 cases (7.7%). Postoperative dysphagia appeared in 17 cases (44.7%), in all of the transitory.