Fístula interna ileoileal congénita que debuta como un cuadro obstructivo en el adulto / Intestinal obstruction caused by a congenital ileo-ileal internal fistula

Background: Among congenital malformations of the digestive tract, internal congenital fistulas tend to be associated with multiple malformations. Case report: We report a previously healthy 32 years old male consulting for abdominal pain and vomiting lasting 48 hours. A plain abdominal film show small bowel dilatation and air-fluid levels. The patient was operated with the diagnosis of bowel obstruction. During the operation dilated bowel loops trapped in a congenital ileo-ileal fistula were found. No biopsies were obtained. The patient had an uneventful postoperative evolution.

Introducción: Las malformaciones congénitas del aparato digestivo pueden ser muy variadas. En caso de presentar síntomas, suelen aparecer en las primeras etapas de la vida con un amplio abanico de manifestaciones clínicas dependiendo del segmento al que afecte y de la complejidad de las malformaciones. Sin embargo, hay muy pocas fístulas internas congénitas recogidas en la literatura médica y la mayoría suelen estar relacionadas con malformaciones múltiples. Caso clínico: Presentamos un situación muy poco frecuente. Se trata de un caso de fístula interna congénita que debutó con un cuadro obstructivo agudo como único síntoma en un adulto.

Breast cancer in males.

BACKGROUND: Male breast cancer has a very low incidence (<1%). It has traditionally been considered to have a poorer prognosis than breast cancer in females due to delayed diagnosis as a cause of decreased survival. Our goal is to analyze our series and to identify factors influencing survival. METHODS: We conducted a retrospective study from 1997-2008 (n = 32). Inclusion criteria were male gender and histological confirmation of breast cancer. We analyzed epidemiological data (age and personal and family history), tumors (size, grade of differentiation, histological type, location, TNM stage, receptors), therapeutic regimen (surgical technique, adjuvant therapy) and survival (relapse, followup, death). RESULTS: Male breast cancer represents 0.9% of all breast cancers treated in our center. The average age of our patients was 66.84 years. Only 9.3% demonstrated gynecomastia as a presenting complaint. Histologically, 90% were infiltrating ductal type; 59.25% were diagnosed in early stages (I-II) compared to 40.74% in stages III-IV. Aggressive surgical techniques are still performed, compared to conservative techniques (74.19% vs. 19.36%). With a median follow-up of 52.82 months, the mortality rate was 16%. Existence of distant metastasis has been the only statistically significant factor in survival. CONCLUSIONS: The percentage of cases of male breast cancer is very low compared to breast cancer in females. Limited studies in the literature make gender-specific findings difficult. A low percentage of conservative surgical procedures are performed, even though this has increased considerably in recent years. The existence of distant metastasis was the main determinant of survival.

Malignant degeneration in pilonidal disease.

BACKGROUND: Pilonidal disease is one of the most frequent entities in our daily surgical activity. Although it is a benign disease, malignant degeneration is likely to occur in pilonidal disease. We reviewed surgical interventions for pilonidal diseases performed from January 1, 1995 to December 31, 2008. CLINICAL CASE: We reviewed all 3729 histology reports obtained after surgical removal of pilonidal disease. There were three cases of squamous cell carcinoma and one case of basal cell carcinoma. Patients affected by squamous cell carcinoma had a mean age of 54.2 years and a mean time of evolution of the lesions of 20.6 years. We found local recurrence and lymph node recurrence. Mean follow-up period was 5 years and there was no mortality. The patient with basal cell carcinoma had 1 year of pilonidal disease evolution. There were no recurrences. CONCLUSIONS: Malignancy can arise in pilonidal diseases with a long evolution time. There is a high rate of recurrence and morbimortality in cases of squamous cell carcinomas. Adjuvant radiotherapy in addition to complete local excision has demonstrated a decrease in the rate of local recurrence.

Fístula arteriovenosa gigante congénita rebelde a tratamiento embolizante / Giant arteriovenous fistula resistant to embolization

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