Surgery for gastroesophageal reflux disease: a comparative study between the open and laparoscopic approaches.

OBJECTIVE: Given the demonstrated effectiveness of medical treatment together with the eminent acceptance of the laparoscopic approach, the indications of surgery in the treatment of gastroesophageal reflux disease (GERD) are currently subject to continuous controversy. To participate in this debate, we have the following work hypothesis: "The results of the 360 masculine short and floppy laparoscopic fundoplication are superior to those of open surgery". CLINICAL DESIGN: Prospective, clinical, non-randomized study. PATIENTS: Our work was developed between November 1991 and December 1998 by means of a prospective, non-randomized clinical rehearsal with two groups of patients: Group I (n = 75): 360 degree short and floppy laparoscopic fundoplication in Hospital Dr. Peset, Valencia (Spain). Group II (n = 28): 360 degree short and floppy, open fundoplication in Hospital General, Valencia (Spain). We evaluated the preoperative parameters and found no differences, which allows us to know that both groups were comparable. RESULTS: The analysis of peroperative results (morbidity and surgical time) and of clinical follow-up (every three months and later annually) and instrumental follow-up (TEGD, upper digestive endoscopy, pHmetry and manometry) show no differences, while the postoperative analysis shows statistically significant (s.s.) differences regarding recovery (pain, oral intake, hospital stay and return to previous activities). CONCLUSIONS: The results of the 360 degree short and floppy laparoscopic fundoplication are similar to those of the open approach, but favor the former approach with a better postoperative tolerance.

Cirugía de la enfermedad por reflujo gastroesofágico: estudio comparativo entre los abordajes abierto y laparoscópico / Surgery for gastroesophageal reflux disease: a comparative study between the open and laparoscopic approaches

Objetivo: en la actualidad, dada la efectividad demostrada del tratamiento médico junto con la eminente aceptación del abordaje laparoscópico, las indicaciones de la cirugía en el tratamiento de la enfermedad por reflujo gastroesofágico son causa de continua controversia. Para participar en este debate, nos planteamos la siguiente hipótesis de trabajo: "Los resultados de la funduplicatura de 360° corta y holgada por vía laparoscópica son superiores a los de la vía abierta". Diseño clínico: estudio clínico prospectivo no aleatorizado. Pacientes: el trabajo se desarrolló entre noviembre de 1991 y diciembre de 1998, mediante un ensayo clínico prospectivo no aleatorio de dos grupos de pacientes: -Grupo I (n = 75): funduplicatura de 360°, corta y holgada por laparoscopia en el Hospital Universitario Dr. Peset de Valencia. -Grupo II (n = 28): funduplicatura 360°, corta y holgada por vía abierta en el Hospital General Universitario de Valencia. Comparamos, sin hallar diferencias, los parámetros preoperatorios lo que nos permite conocer que los dos grupos son homologables. Resultados: el análisis de los resultados peroperatorios (morbilidad y tiempo quirúrgico) y del seguimiento clínico (a los tres meses y posteriormente de forma anual) e instrumental (TEGD, endoscopia digestiva alta, pHmetría y manometría) no demuestran diferencias; mientras que en el postoperatorio inmediato existen diferencias estadísticamente significativas (e.s.) en lo referente a la recuperación (dolor, tolerancia, estancia y reincorporación a las actividades previas). Conclusiones: los resultados de la funduplicatura de 360° corta y holgada por vía laparoscópica son similares a los de la vía abierta, beneficiándose la primera de una mejor tolerancia postoperatoria

Objective: given the demonstrated effectiveness of medical treatment together with the eminent acceptance of the laparoscopic approach, the indications of surgery in the treatment of gastroesophageal reflux disease (GERD) are currently subject to continuous controversy. To participate in this debate, we have the following work hypothesis: "The results of the 360º short and floppy laparoscopic fundoplication are superior to those of open surgery". Clinical design: prospective, clinical, non-randomized study. Patients: our work was developed between November 1991 and December 1998 by means of a prospective, non-randomized clinical rehearsal with two groups of patients: -Group I (n = 75): 360° short and floppy laparoscopic fundoplication in Hospital Dr. Peset, Valencia (Spain). -Group II (n = 28): 360° short and floppy, open fundoplication in Hospital General, Valencia (Spain). We evaluated the preoperative parameters and found no differences, which allows us to know that both groups were comparable. Results: the analysis of peroperative results (morbidity and surgical time) and of clinical follow-up (every three months and later annually) and instrumental follow-up (TEGD, upper digestive endoscopy, pHmetry and manometry) show no differences, while the postoperative analysis shows statistically significant (s.s.) differences regarding recovery (pain, oral intake, hospital stay and return to previous activities). Conclusions: the results of the 360° short and floppy laparoscopic fundoplication are similar to those of the open approach, but favor the former approach with a better postoperative tolerance

Rubber-band ligation for hemorrhoids in a colorectal unit. A prospective study.

INTRODUCTION: Nowadays the rubber band ligation technique is one of the most worldwide used and effective treatment of the hemorrhoidal disease. OBJECTIVES: Our study has as a goal to analyze the success or failure of the rubber band ligation in hemorrhoids grade 1,2 and 3, to analyze their complications and to see if all symptomatic hemorrhoids should be treated with ligation at the first visit. PATIENTS AND METHOD: A prospective and descriptive study was designed for patients who came to the Colorectal Unit with hemorrhoidal disease from September 1997 to December 2001. First, second and third degree patients were treated according to the classification of hemorrhoids of St. Mark's Hospital. The technique of ligation after Barron was applied. RESULTS: From 261 patients with a mean age of 48.3 (range: 16-86), 181 (99 M/82 W) have been treated with Barron's method and 80 with rich fiber diet and water. Rectal bleeding was the most common symptom (91.16%). Anuscopy showed hemorrhoidal disease in all the cases. From 181 patients, 19.33% were hemorrhoids degree I, 51.93% degree II and 29.83% degree III. Two hundred and eighty-seven ligation sessions were done and the balance of ligations per patient was 2.45 and 1.5 rubber band per session. The 32% of the patients referred pain after ligation. A 13.81% of cases were operated due to persistent rectal bleeding or hemorrhoidal prolapse. CONCLUSIONS: Symptomatic hemorrhoids degree I and II with a short clinical history should be treated initially with a rich fiber and water diet. The technique of Barron is an effective therapy to treat the hemorrhoids degree 1, 2 and in 74% of success in cases with degree 3.

Ligadura con banda elástica de las hemorroides en una Unidad de Coloproctología. Estudio prospectivo / Rubber-band ligation for hemorrhoids in a colorectal unit. A prospective study

Introducción: la técnica de ligaduras con banda para hemorroidesconstituye hoy en día uno de los tratamientos más efectivosa nivel mundial.Objetivos: el objetivo de nuestro estudio ha sido valorar eléxito/fracaso terapéutico de las ligaduras en hemorroides grado III-III, analizar sus complicaciones y plantear si todas las hemorroidessintomáticas deben ser tratadas con bandas en la primera visita.Pacientes y método: se diseñó un estudio descriptivo prospectivode los pacientes que acudieron a la Unidad de Coloproctologíacon patología hemorroidal entre septiembre de 1997 y diciembrede 2001. Se trataron a pacientes con hemorroides gradoI, II y III según la clasificación del Hospital de St. Mark’s. Se empleóla técnica de ligaduras descrita por Barron.Resultados: doscientos sesenta y un pacientes, con una edadmedia de 48,3 años (rango: 16-86), de los cuales 181 (99 V/82M) han sido tratados según el método de Barron. Ochenta pacienteshan sido tratados con dieta rica en fibra y agua.La sintomatología más frecuente la constituye la rectorragia(91,16%). La anuscopia evidenció patología hemorroidal en todoslos casos.De 181 pacientes, 19,33% fueron hemorroides grado I,51,93% grado II y 29,83% grado III. Se efectuaron 287 sesionesde ligaduras, siendo la media de 2,45 ligaduras por paciente y 1,5ligaduras por sesión. Un 32% de pacientes tuvieron dolor tras laligadura. Se operó a un 13,81% por persistencia de rectorragias yde prolapso hemorroidal.Conclusiones: las hemorroides sintomáticas grado I y II decorta evolución deben ser tratadas inicialmente con dieta rica enagua y fibra.La técnica de Barron resulta una terapéutica eficaz para tratarlas hemorroides grado 1, 2 y en el 74% de éxito en los casos grado 3

Introduction: nowadays the rubber band ligation technique isone of the most worldwide used and effective treatment of the hemorrhoidaldisease.Objectives: our study has as a goal to analyze the success orfailure of the rubber band ligation in hemorrhoids grade 1,2 and3, to analyze their complications and to see if all symptomatic hemorrhoidsshould be treated with ligation at the first visit.Patients and method: a prospective and descriptive studywas designed for patients who came to the Colorectal Unit withhemorrhoidal disease from September 1997 to December 2001.First, second and third degree patients were treated according tothe classification of hemorrhoids of St. Mark’s Hospital. The techniqueof ligation after Barron was applied.Results: from 261 patients with a mean age of 48.3 (range:16-86), 181 (99 M/82 W) have been treated with Barron’smethod and 80 with rich fiber diet and water.Rectal bleeding was the most common symptom (91.16%).Anuscopy showed hemorrhoidal disease in all the cases.From 181 patients, 19.33% were hemorrhoids degree I,51.93% degree II and 29.83% degree III. Two hundred andeighty-seven ligation sessions were done and the balance of ligationsper patient was 2.45 and 1.5 rubber band per session. The32% of the patients referred pain after ligation. A 13.81% of caseswere operated due to persistent rectal bleeding or hemorrhoidalprolapse.Conclusions: symptomatic hemorrhoids degree I and II with ashort clinical history should be treated initially with a rich fiber andwater diet.The technique of Barron is an effective therapy to treat the hemorrhoidsdegree 1, 2 and in 74% of success in cases with degree 3

Pseudopancreatitis y quistes de colédoco / Pseudopancreatitis and choledochal cyst

No disponible

[Experimental study of the immunomodulator effect of pentoxifylline in bacterial translocation produced by lipid-free parenteral nutrition]. / Estudio experimental sobe la influencia inmunomoduladora de la pentoxifilina en la translocación bacteriana producida por la nutrición parenteral sin lípidos.

INTRODUCTION: Bacterial translocation (BT) leads to sepsis of intestinal origin and, despite current advances, there is a high level of mortality and morbidity as a result of this. We have attempted to investigate whether such an immunity modulating substance as Pentoxiphylline (PX) might diminish or inhibit BT. We have chosen PX because it has immunity modulation actions and inhibits the synthesis and action of TNF-alpha, which seems to be linked to the progress of these conditions towards multiple organ failures. MATERIAL AND METHOD: An experimental study was performed with 4 groups of 20 Wistar rats subjected to lipid-free parenteral nutrition (PN) over 7 days. Group A: PN; group B: PN + 50 mg/kg of PX; group C: PN + 100 mg/kg; and group D: PN + 134 mg/kg. On day 7, a sterile extraction was effected to remove the mesenteric ganglial chain, liver, blood and intestine, and these samples were processed for the quantitative and qualitative microbiological study, the histological study of the intestinal mucosa and the quantification of TNF-alpha. The data obtained were subsequently analyzed statistically. RESULTS: The quantitative microbiological study revealed that, with statistically significant differences, more colonies grew in the lymphatic ganglion, liver and blood of animals belonging to group A. The germ most frequently identified was E. Coli. In the study of TNF-alpha, the greatest value corresponded to group A, again with statistically significant differences. In the histological study, it was observed that group A showed the greatest atrophy. CONCLUSIONS: Our experimental model is valid as a model of BT, in group A, without PX, a total of 16 BT occurred while in the groups with PX the number of BT fell, as did the serum figures for TNF-alpha.

Estudio experimental sobre la influencia inmunomoduladora de la pentoxifilina en la translocación bacteriana producida por la nutrición parenteral sin lípidos / Experimental study on the immune modulation influence of pentoxiphylline on bacterial translocation produced by lipid-free parenteral nutrition

Introducción: La translocación bacteriana (TB) provoca sepsis de origen intestinal y a pesar de los avances actuales existe una elevada morbimortalidad por sepsis por esta causa. Hemos querido investigar si una sustancia inmunomoduladora como es la pentoxifilina (PX), podía disminuir o inhibir la TB. Hemos elegido la PX por tener acciones inmunomoduladoras y por inhibir la síntesis y la actuación del TNF-alfa, que parece tener relación con el avance hasta el fallo multiorgánico en estos cuadros. Material y método: Se realiza un estudio experimental con 4 grupos de 20 ratas Wistar a las que se les ha sometido a una nutrición parenteral sin lípidos (NP) durante 7 días. Al grupo A: NP; grupo B: NP + 50mg/kg de PX; grupo C: NP + 100mg/kg y grupo D: NP + 134m/kg. Al 7º día se extrae de forma estéril la cadena ganglionar mesentérica, hígado, sangre e intestino, estas muestras se procesan para realizar el estudio microbiológico cuantitativo y cualitativo, estudio histológico de la mucosa intestinal y cuantificación del TNF-alfa. A los datos obtenidos se les aplica un estudio estadístico. Resultados: En el estudio microbiológico cuantitativo se observó que el en el ganglio linfático, hígado y sangre crecieron más colonias en los animales que pertenecían al grupo A con diferencias estadísticamente significativas. El germen que con más frecuencia se identificó fue E. coli. En el estudio del TNF-alfa, el mayor valor medio lo obtuvo el grupo A, con diferencias estadísticamente significativas. En el estudio histológico se observó que el grupo con más atrofia era el grupo A. Conclusiones: Nuestro modelo experimental es válido como modelo de TB, en el grupo A sin PX se produjeron 16 TB y en los grupos con PX se disminuye el número de TB y las cifras de TNF-alfa en suero (AU)

Introduction: Bacterial translocation (BT) leads to sepsis of intestinal origin and, despite current advances, there is a high level of mortality and morbidity as a result of this. We have attempted to investigate whether such an immunity modulating substance as Pentoxiphylline (PX) might diminish or inhibit BT. We have chosen PX because it has immunity modulation actions and inhibits the synthesis and action of TNF-α, which seems to be linked to the progress of these conditions towards multiple organ failures. Material and method: An experimental study was performed with 4 groups of 20 Wistar rats subjected to lipid-free parenteral nutrition (PN) over 7 days. Group A: PN; group B: PN + 50 mg/kg of PX; group C: PN + 100 mg/kg; and group D: PN + 134 mg/kg. On day 7, a sterile extraction was effected to remove the mesenteric ganglial chain, liver, blood and intestine, and these samples were processed for the quantitative and qualitative microbiological study, the histological study of the intestinal mucosa and the quantification of TNF-α. The data obtained were subsequently analyzed statistically. Results: The quantitative microbiological study revealed that, with statistically significant differences, more colonies grew in the lymphatic ganglion, liver and blood of animals belonging to group A. The germ most frequently identified was E. Coli. In the study of TNF-α, the greatest value corresponded to group A, again with statistically significant differences. In the histological study, it was observed that group A showed the greatest atrophy. Conclusions: Our experimental model is valid as a model of BT, in group A, without PX, a total of 16 BT occurred while in the groups with PX the number of BT fell, as did the serum figures for TNF-α (AU)

Seguimiento del páncreas endocrino tras una pancreatitis aguda de origen biliar. Estudio prospectivo / Follow-up of endocrine pancreatic function after acute biliary pancreatitis. Prospective study

Objetivo. Valorar si tras la pancreatitis aguda biliar existía una insuficiencia pancreática endocrina y si este posible déficit se relacionaba con la gravedad del episodio. Pacientes y métodos. Sesenta y tres pacientes con pancreatitis aguda biliar fueron estudiados prospectiva y consecutivamente, 46 mujeres (73 por ciento) y 17 varones (27 por ciento); 45 casos eran leves y 18, graves. Todos ellos fueron colecistectomizados, ninguno fue sometido a necrosectomía o pancreatectomía. Durante la fase aguda se valoró la gravedad siguiendo los criterios de Atlanta, la existencia de necrosis y su porcentaje determinado por tomografía computarizada dinámica. Durante el seguimiento se valoró la función pancreática endocrina al mes, a los 6 meses y al año del episodio de la pancreatitis aguda mediante diversos tests de función pancreática. Resultados. Al mes de la pancreatitis aguda biliar se detectaron alteraciones endocrinas en el 50 por ciento de los casos, disminuyendo al sexto mes al 30 por ciento, persistiendo al año de la pancreatitis aguda en el 25 por ciento de los pacientes; sin embargo, éstas no eran secundarias a la pancreatitis, puesto que el test de arginina presentaba valores dentro del rango de la normalidad. El análisis estadístico realizado a fin de valorar la relación existente entre la gravedad de la pancreatitis aguda y los diversos tests de función pancreática endocrina demostró que no existían diferencias significativas (p > 0,05).Conclusión. La función pancreática endocrina retorna a la normalidad después de un episodio de pancreatitis aguda de origen biliar tras haberse eliminado la causa primaria de la enfermedad, no detectándose alteración de la reserva funcional endocrina secundaria a la pancreatitis, y no existiendo relación entre dicha función y la gravedad de la enfermedad (AU)

Síndrome posgastrectomía / Post gastrectomy syndromes

En nuestra experiencia el paciente portador de un síndrome posgastrectomía suele presentar alguna de las siguientes características: el resultado de la primera intervención no se correspondió con las expectativas que se le prometieron, generalmente se han sometido a una o varias reintervenciones sin obtener ninguna mejoría o, en ocasiones, son pacientes con una neurosis de renta. Además, las actitudes terapéuticas adoptadas también reúnen una serie de características comunes: la indicación quirúrgica de la primera intervención no fue la adecuada, la primera intervención no se realizó de forma correcta, generalmente no se practicó un estudio funcional suficiente, las reintervenciones se planificaron basándose en criterios anatómicos o no se valoró la personalidad del paciente, ni su entorno sociofamiliar. Es evidente que la cirugía gástrica resectiva ha disminuido enormemente en los últimos años, viéndose limitada casi a la cirugía de las neoplasias. No obstante, aún seguimos atendiendo a algún enfermo aquejado de molestias encuadrables dentro del conocido síndrome posgastrectomía: síndrome de asa, dumping, gastritis alcalina, úlceras recidivantes, diarreas, malnutriciones, anemias, etc. Se trata de cuadros bien estudiados, sobre los que se ha aportado poco en los últimos años. Sin embargo, vemos aparecer muevas patologías secundarias a intervenciones gástricas generalmente no resectivas, por lo que sería más adecuado hablar de patología poscirugía gástrica; evidentemente se trata de un término mucho más amplio que el del síndrome posgastrectomía, por lo que en esta revisión nos ocupamos parcialmente de él, renunciando a la revisión de sus aspectos más clásicos, para centrarnos en algunos que hoy día son frecuentes y que hemos estudiado: el síndrome de la Y de Roux, la patología secundaria a la cirugía bariátrica y la que puede presentarse tras la cirugía del reflujo gastroesofágico (AU)

La arginina favorece la cicatrización de las anastomosis cólicas experimentales / Arginine favors wound healing in experimental colonic anastomoses

Introducción. Se ha demostrado que la L-arginina mejora la cicatrización de las heridas cutáneas. Sin embargo, no hay estudios que reflejen la influencia de este aminoácido en la cicatrización de las anastomosis cólicas. El presente estudio pretende averiguar si la suplementación de arginina en la nutrición parenteral total mejora la cicatrización de las anastomosis cólicas experimentales. Material y método. Se estudian tres grupos de ratas Wistar (20 animales por grupo), a los que se realizó una anastomosis término-terminal de colon izquierdo y se administró nutrición parenteral isocalórica e isonitrogenada, con distintas concentraciones de L-arginina: A (nutrición estándar) = 4,3 g/l, B (suplementada) = 7,3 g/l y C (suplementada) = 10,3 g/l. El séptimo día postoperatorio se estudió la anastomosis cólica (complicaciones locales, presión de rotura, histología e hidroxiprolina). Se realizó un análisis descriptivo, ANOVA de una vía, test de Newman-Keuls, regresión múltiple y prueba de la *2 de las variables. Resultados. La presión de rotura, la hidroxiprolina, así como el grado de epitelización, fibrosis y neovascularización de las anastomosis fueron mayores de forma significativa en los grupos que recibieron mayor concentración de L-arginina en la nutrición (p < 0,005).Conclusión. El suplemento de L-arginina en la nutrición parenteral de ratas Wistar mejora de forma significativa la cicatrización de las anastomosis cólicas experimentales, como se demuestra con las medidas de presión, la concentración de hidroxiprolina y los criterios histológicos (AU)

Multiple colon tumors. Diagnosis and follow-up of 450 patients with colorectal carcinoma.

OBJECTIVE: Failure to diagnose synchronous tumors leads to errors in patient treatment and prognosis. The existence of metachronous tumors requires strict patient follow-up to ensure early identification of the second tumor. The present study evaluates the results obtained in the application of a structured procedure for the diagnosis and follow-up of multiple colorectal carcinoma. MATERIALS AND METHODS: A structured procedure was used to follow for 5 years a group of 12 patients with multiple colorectal tumors (7 synchronous and 5 metachronous) of a series of 450 colorectal neoplasms. RESULTS: Six synchronous tumors were diagnosed preoperatively and one intraoperative. Of the 5 metachronous neoplasms, 4 strictly adhered to the follow-up protocol, as a result of which the second tumor was detected at an early stage. The remaining case involved no follow-up, and the second tumor was diagnosed in an advanced stage as a result of bowel occlusion. The left colon was predominantly involved; polyps were detected in 9 cases, while two patients had 3 malignancies detected by histopathological study. COMMENTS: We emphasize the need for a full evaluation of the colon in all patients with colorectal carcinoma. In the case of incomplete preoperative evaluation, intraoperative colonoscopy is to be considered; if this is not feasible it should be performed one month after surgery. A structured follow-up procedure permits the early detection of these tumors, there by improving patient prognosis.

[Superior vena cava occlusion syndrome in a patient receiving total parenteral nutrition for short bowel syndrome]. / Síndrome de oclusión de la vena cava superior en paciente con nutrición parenteral total por síndrome de intestino corto.

The use of venous access devices has been increased in recent years. The administration of nutrients parenterally is one of the indications for use of these devices. However, these are not free of complications, with infection and obstruction of the devices being the most common. One fo the less frequent but most feared complications, especially in those patients in whom the parenteral access route is the only access for the supply of nutrients, is that of thrombosis of the large veins. This study presents, along with the bibliographical review of the matter, the diagnostic and therapeutic procedures undertaken in a case of thrombosis of the superior vena cava, in a patient with total parenteral nutrition in the home, due to a short bowel syndrome.

[The diagnosis of aorticomesenteric duodenal compression by magnetic resonance angiography]. / Diagnóstico de la compresión duodenal aorto-mesentérica mediante angiografía por resonancia magnética.

The syndrome of duodenal obstruction by the mesenteric artery is an infrequent condition that nevertheless was too often diagnosed in the past. The development of modern imaging techniques has presently restricted the diagnosis of this syndrome. We report the case of a 21-year-old patient with superior mesenteric artery-induced duodenal compression syndrome secondary to malnutrition and loss of weight. Diagnosis was confirmed by the evaluation of bowel transit, CT Scan, NMR and angio-MR. Conservative treatment with total parenteral nutrition proved ineffective. Surgical sectioning of the ligament of Treitz and extensive mobilization of the duodenum (Strong's operation) was performed; outcome was unsatisfactory, however. A duodenojejunostomy was performed later, which finally solved the condition. We emphasize the diagnostic usefulness of CT Scan and angio-MR, and the favorable results afforded by duodenojejunostomy.

The impact of low-residue enteral feeding on the healing of colonic anastomoses.

This study was carried out with the aim of comparing colonic anastomosis cicatrization in rats fed either standard rat chow or a low-residue enteral diet. Energy intake, the evolution of body weight, fecal weight, macroscopic and microscopic evaluation of the anastomoses, anastomotic bursting pressure, and collagen concentration in the anastomotic tissue were all evaluated. Anastomotic complications were more common among the animals fed standard rat chow, and cicatrization was more inflammatory than in the rats given a low-residue enteral diet. Although the latter was more effective in preventing anastomotic complications, it resulted in a lower gain in collagen and hence a diminished resistance to the increase in intraluminal pressure associated with the administration of such diets. Colonic contents, including the fecal bolus and bacteria, may be held responsible for the increased number of complications, the augmentation of collagen content, and the improvement in the resistance to intraluminal pressure.

[The administration of intermittent outpatient total parenteral nutrition via a subcutaneous reservoir]. / Administración de una nutrición parenteral total intermitente ambulatoria mediante reservorio subcutáneo.

The development of artificial nutrition has made it possible to maintain the nutritional condition and survival of patients with large intestinal resections along with therapeutic support in certain pathological processes. As such patients have become aware of their potential and the prolonged life expectancy offered, they have increased their demands for enhanced comfort and independence. The experience with a patient with short gut syndrome following quasi-total intestinal resection due to necrosis, and with another with post-esophagocoloplasty necrosis, and the administration of intermittent outpatient total parenteral nutrition through a subcutaneous reservoir in both cases, enabled us to appreciate the advantages of the reservoir in administration of the nutrition. The ease of administration, reduced risk of infection and the positive psychological effect seen in these patients, enabled to lead a "practically normal" life, all vindicate the use of this method.

[Low-residue diets supplemented with fermentable fiber. Effect on experimental colonic anastomosis]. / Dietas de bajo residuo suplementadas con fibra fermentable. Efecto sobre las anastomosis cólicas experimentales.

Presentation of an experimental study comparing the scarring of colic anastomoses performed in Wistar rats fed with three different types of diet: a standard laboratory diet, an enteral low-residue diet and a low-residue diet supplemented with fermentable fibre in short chain fatty acids (pectin). Scarring in the group fed with the standard laboratory diet showed greater anastomotic complications, and the microscopic appearance was more inflamed. The administration of low-residue diets reduced the level of complications, but also reduced the concentration of collagen and the parietal rupture tension. The addition of pectin to a low-residue diet maintained the complications at a low level, and also significantly increased the pressure parameters and the collagen concentration.

Factors of prognostic value in long-term survival of colorectal cancer patients.

We have studied 191 protocolized colorectal cancer patients, analyzing the prognostic factors described in the literature as being important to long-term survival. Of the data studied, sex, age, duration of symptoms, tumor location, tumor extension within the circumference of the bowel lumen, and the surgical technique employed, all showed differences in terms of five-year survival, but without reaching statistical significance. The factors with statistically significant prognostic value were first symptoms, occlusion, perforation, primary tumor size and configuration, lymph node involvement, degree of wall infiltration, presence of emboli, degree of differentiation and Scarff index. In view of these results, we consider that the evaluation of bowel wall infiltration, lymph node involvement, venous and/or lymphatic embolization, and tumor differentiation is necessary to establish long-term prognosis in these patients. The remaining factors lack prognostic value.