Hidatidosis muscular primaria de pared abdominal con extensión intra-peritoneal. a próposito de un caso / Primary muscle hydatid disease in abdominal wall with intraperitoneal communication. a case report

La hidatidosis está causada por la familia Equinococcus, más frecuentemente E. granulosus. Su localización más común es en el hígado, seguida del pulmón. La localización muscular es extremadamente rara (< 1%). Presentamos el caso de una mujer cardiópata, en tratamiento anticoagulante que presenta tumoración dolorosa de crecimiento progresivo en pared abdominal, sospechando inicialmente hematoma en evolución y siendo estudiada por TAC, donde se aprecia tumoración parietal con comunicación intraperitoneal contactando con colon y mesocolon transverso. Se realiza exéresis quirúrgica sospechando intraoperatoriamente hidatidosis muscular, confirmada posteriormente según estudio anatomo-patológico. La hidatidosis forma parte del diagnóstico diferencial ante una masa de partes blandas en regiones endémicas. Su sintomatología varía en función de la localización. A nivel muscular, se presenta habitualmente con dolor y aumento de volumen. Es imprescindible la sospecha clínica, junto con las pruebas de imagen y serologías para su diagnóstico

Hydatid disease is caused by Equinococcus family, the most common is E. Granulosus. The most common location is the liver, follow the lung. Muscle tissue is extremely rare location(< 1%). We present a woman with cardiac disease and anticoagulant treatment who had a painful and progressive growth tumour in the abdominal wall. Our first idea it's a chronic hematoma and in the computed tomography we observed the tumour had intraperitoneal communication in contact with colon. Surgical resection was performed, intraoperatively suspecting muscle hydatidosis, which was confirmed later in patologic study. Hydatid disease is one of the differencial diagnosis in endemic areas. Symptoms depend on location, for example in the muscle being the pain and the increased in volumen the most usual. Clinical suspicion, combined with imaging and serology test, are essential for the diagnosis

Predictive ultrasound factors of lymphatic invasion in rectal cancer: "extra-corporeal" study.

OBJECTIVE: the accuracy of preoperative endorectal ultrasound in the status evaluation of lymph nodes is around 50-70%, with a lack of eco-morphological patterns of clinical use. Since, accurate local staging is of great value in prognosis and decision-making we decided to analyze the referenced eco-morphological parameters in a try to find a proper predictive tool of clinical help that could improve the accuracy of rectal ultrasound. MATERIAL AND METHOD: the resected specimens of 24 patients that were operated on by radical surgery because rectal cancer, without preoperative radiotherapy were suspended in warm water and ultrasound scanned (360º circular probe with a transducer of 10 Mhz). All suspicious nodes were recorded and marked for the definitive histological report. RESULTS: from the 24 specimens, 318 nodes were imaged(210 benign and 100 involved). All ultrasound parameters analysed were significant but only lobulation, echogenicity and hilar reflection were independent values. An score system was design with the addition of all parameters that showed a sensitivity of 98%and specificity of 99,1%. CONCLUSIONS: our study shows that a careful study of ultra-sound lymph node images can get a high level of accuracy and better help in tailoring the treatment of any particular case.

A prospective study about functional and anatomic consequences of transanal endoscopic microsurgery.

INTRODUCTION: transanal endoscopic microsurgery (TEM) was developed in 1983 by Büess as a minimally invasive technique to manage rectal villous adenomas and early rectal adenocarcinomas. Many studies have been published worldwide about its excellent results in morbidity and recidive rate, but there are few studies addressing functional results. The objective of this study is to analyze the effect of this technique in the anal anatomy and compare with the manometric results. MATERIAL AND METHODS: we devised a prospective study of 40 patients. 39% female, 61% male. All of them filled an incontinence questionnaire (Pescatori scale) and endoanal ultrasonography and manometry was carried out preoperatively, third month postoperative and at sixth month only if incontinence appeared. RESULTS: 32 patients (80%) had villous adenomas and 8 patients (20%) had adenocarcinomas (uT1). Three patients complained of flatus incontinence at 3rd postoperative month that disappeared with normal continence at 6th month. Anorectal manometric values: mean anal resting pressure (ARP) decreased at 3rd month (from 87.2 mmHg to 70.1 mmHg), as it was for maximal squeeze pressure (MSP) from 152.5 mmHg preoperatively to 142.2 mmHg at 3rd month. Ultrasonography demonstrated internal anal sphincter (IAS) rupture in 3 patients, with a full integrity of the external anal sphincter in all patients. CONCLUSIONS: during TEM, a significant anal dilatation occurs, because of rectoscopy (40 mm wide), what can produce a rupture of IAS, with the consequent decreasing in ARP, and a dilatation without rupture of external sphincter what produces a decreasing of MSP. The fall of anal pressures had minima clinical repercussion when sphincter is intact, but when IAS is broken a temporal incontinence develops.

Estudio prospectivo de las consecuencias ecográficas y funcionales tras microcirugía transanal endoscópica / A prospective study about functional and anatomic consequences of transanal endoscopic microsurgery

Introducción: la microcirugía transanal endoscópica (TEM)fue desarrollada en 1983 por Büess como técnica mínimamenteinvasiva para el tratamiento de adenomas y adenocarcinomas enestadio precoz de recto. Son múltiples los estudios realizados entodo el mundo sobre sus resultados de morbimortalidad y tasa derecidiva, pero sin embargo son muy pocos los estudios publicadossobre los resultados funcionales. El objetivo de este estudio fueanalizar el efecto que esta cirugía provoca en la anatomía del canalanal y compararlo con los resultados funcionales.Material y métodos: realizamos un estudio descriptivo prospectivode 40 pacientes: 39% mujeres, 61% hombres. En todosellos se cumplimentó una encuesta de función esfinteriana (test dePescatori) y ecografía endoanal y manometría preoperatoria, al 3ermes postoperatorio, y al 6º sólo si apareció incontinenciaResultados: Treinta y dos pacientes (80%) fueron operados deadenomas y 8 pacientes (20%) de adenocarcinomas uT1. Tres pacientespresentaron incontinencia a gases al 3er mes postoperatorioque se normalizó al 6º mes. Valores de la manometría anorrectal: lapresión media en reposo (PMR) había disminuido a los 3 meses conrespecto al valor preoperatorio de 87,2 a 70,1 mmHg, al igual quela presión máxima de contracción (PMC) de 152,5 mmHg de formapreoperatoria a 142,2 mmHg. Ecográficamente se pudo demostrarrotura del esfínter anal interno en 3 pacientes, estando en todos lospacientes íntegro el esfínter externo.Conclusiones: durante el tiempo quirúrgico de la TEM y debidoal diámetro del rectoscopio (40 mm), existe una dilataciónmantenida del canal anal. Esto unido al hecho de que es frecuenteque haya que modificar la posición del mismo, se traduce, en algunoscasos, en un riesgo de rotura del EAI, con la consiguientecaída en la PMR. En definitiva la caída que se objetiva en las presionesendoanales tiene una mínima repercusión en la clínica amenos que exista una lesión esfinteriana lo que conlleva incontinencia,en cualquier caso siempre temporal

Introduction: transanal endoscopic microsurgey (TEM) wasdeveloped in 1983 by Büess as a minimally invasive technique tomanage rectal villous adenomas and early rectal adenocarcinomas.Many studies have been published worldwide about its excellentresults in morbidity and recidive rate, but there are few studiesaddressing functional results. The objective of this study is to analyzethe effect of this technique in the anal anatomy and comparewith the manometric results.Material and methods: we devised a prospective study of40 patients. 39% female, 61% male. All of them filled an incontinencequestionnaire (Pescatori scale) and endoanal ultrasonographyand manometry was carried out preoperatively, third monthpostoperative and at sixth month only if incontinence appeared.Results: 32 patients (80%) had villous adenomas and 8 patients(20%) had adenocarcinomas (uT1). Three patients complainedof flatus incontinence at 3rd postoperative month that disappearedwith normal continence at 6th month. Anorectalmanometric values: mean anal resting pressure (ARP) decreasedat 3rd month (from 87.2 mmHg to 70.1 mmHg), as it was formaximal squeeze pressure (MSP) from 152.5 mmHg preoperativelyto 142.2 mmHg at 3rd month. Ultrasonography demonstratedinternal anal sphincter (IAS) rupture in 3 patients, with a full integrityof the external anal sphincter in all patients.Conclusions: during TEM, a significant anal dilatation occurs,because of rectoscopy (40 mm wide), what can produce a ruptureof IAS, with the consequent decreasing in ARP, and a dilatationwithout rupture of external sphincter what produces a decreasingof MSP. The fall of anal pressures had minima clinical repercussionwhen sphincter is intact, but when IAS is broken a temporalincontinence develops

Sequential treatment for proctalgia fugax. Mid-term follow-up.

INTRODUCTION: Proctalgia fugax (PF) is a benign, self-limiting disease characterized by episodes of intense anorectal pain at frequent intervals in the absence of organic proctological disease. Even though PF was described more than a century ago, its etiology remains unclear. Currently there is no information available. Few papers quoting many ways of management have been published. The aim of this study was to investigate patients complaining of this condition and to treat them with sequential therapy. PATIENTS AND METHODS: We devised a descriptive, prospective study of patients complaining of acute perianal pain--duration less than 30 minutes--without organic disease or previous perianal surgery since 1996 to 2002 in our Department. We treated these patients using a three-step treatment (1: information, hip bath, benzodiazepines; 2: sublingual nifedipine 10 mg, or topic 0.1% nitroglycerin on demand; 3: internal anal sphincterotomy if hypertrophy of the internal anal sphincter was demonstrated by anal ultrasonography and no improvement was confirmed with the previous steps of treatment). We defined remarkable improvement as a decrease in the number of episodes by half or in pain intensity by 50%. RESULTS: Fifteen patients with an average follow-up of 4 years. Anal endosonography confirmed a grossly thickened internal anal sphincter (IAS) in 5 cases. After the first step of treatment 7 patients improved and 1 patient was cured; after the second step of treatment 3 patients improved and 1 was cured; the third step was applied to 3 patients with a thickened IAS; 1 patient improved and 1 patient was cured. CONCLUSION: A total resolution of PF is not always possible, but we may improve symptoms and their frequency. Almost 50% of patients in our series improved with the first step of treatment; 30% of our patients had IAS hypertrophy. Anal endosonography can help in the diagnosis of organic diseases or IAS hypertrophy, for which we can perform an internal anal sphincter myectomy.

Tratamiento secuencial para la proctalgia fugaz. Resultados a medio plazo / Sequential treatment for proctalgia fugac. Mid-term follow-up

Introducción: la proctalgia fugaz (PF) es una patología benigna,autolimitada, caracterizada por dolor anorrectal intenso, a intervalosfrecuentes, sin causa orgánica aparente. Su etiología noestá clara, a pesar de ser conocida desde hace un siglo y existenpocos artículos publicados sobre esta patología, con escaso númerode pacientes, aplicando tratamientos variados con mayor o menorfortuna. El propósito de este trabajo ha sido estudiar a una seriede pacientes aquejados de esta patología y aplicar a todos ellosun tratamiento de manera secuencial en dependencia de su respuestaal mismo.Material y métodos: realizamos un estudio descriptivo prospectivode pacientes aquejados de dolor perianal brusco, < 30min de duración, sin lesión orgánica concomitante ni intervenciónprevia perianal desde 1996-2002 en nuestro Servicio, sometiéndolesa un tratamiento de manera secuencial, basado en 3 escalonesterapéuticos (1. información, baños de asiento, tranquilizantes;2. nifedipino 10 mg sublingual, o nitroglicerina tópica 0,1%en el momento de la crisis; y 3. esfinterotomía lateral interna si hipertrofiadel esfínter anal interno y no mejoría con los otros escalones).Definimos mejoría significativa cuando se producía un importantedistanciamiento de los episodios (disminución nº crisis ala mitad) y/o disminución del dolor en un 50%.Resultados: quince pacientes con un seguimiento medio de 4años. Mediante ecografía endoanal se pudo demostrar la existenciade hipertrofia del esfínter anal interno (EAI) en 5 casos. Tras laaplicación del escalón 1 mejoraron 7 pacientes y curó 1 paciente;con el escalón 2 mejoraron 3 pacientes y 1 curó, y se aplicó el escalón3 a 3 pacientes que presentaban hipertrofia del EAI mejorando1 y curando otro paciente.Conclusión: la curación de la PF no siempre es factible, perosí es posible aliviar los síntomas, así como su frecuencia. Casi el50% de los pacientes de nuestra serie mejoró con el escalón 1 deltratamiento. Un tercio de nuestros pacientes presentaban hipertrofiadel EAI. La ecografía endoanal ayudará tanto a descartar lesionesorgánicas concomitantes como a diagnosticar una hipertrofiadel EAI, que se beneficiaría de una esfinterotomía lateral interna

disease characterized by episodes of intense anorectal pain at frequentintervals in the absence of organic proctological disease.Even though PF was described more than a century ago, its etiologyremains unclear. Currently there is no information available.Few papers quoting many ways of management have been published.The aim of this study was to investigate patients complainingof this condition and to treat them with sequential therapy.Patients and methods: we devised a descriptive, prospectivestudy of patients complaining of acute perianal pain –durationless than 30 minutes– without organic disease or previous perianalsurgery since 1996 to 2002 in our Department. We treatedthese patients using a three-step treatment (1: information, hipbath, benzodiazepines; 2: sublingual nifedipine 10 mg, or topic0.1% nitroglycerin on demand; 3: internal anal sphincterotomy ifhypertrophy of the internal anal sphincter was demonstrated byanal ultrasonography and no improvement was confirmed withthe previous steps of treatment). We defined remarkable improvementas a decrease in the number of episodes by half or in painintensity by 50%.Results: Fifteen patients with an average follow-up of 4 years.Anal endosonography confirmed a grossly thickened internal analsphincter (IAS) in 5 cases. After the first step of treatment 7 patientsimproved and 1 patient was cured; after the second step oftreatment 3 patients improved and 1 was cured; the third stepwas applied to 3 patients with a thickened IAS; 1 patient improvedand 1 patient was cured.Conclusion: a total resolution of PF is not always possible,but we may improve symptoms and their frequency. Almost 50%of patients in our series improved with the first step of treatment;30% of our patients had IAS hypertrophy. Anal endosonographycan help in the diagnosis of organic diseases or IAS hypertrophy,for which we can perform an internal anal sphyncter myectomy

Intestinal anisakiasis mimicking intestinal obstruction.

We report one case of acute abdomen after the ingestion of raw or undercooked fish containing nematode larvae of the genus Anisakis. Early diagnosis is very important as it could prevent unnecessary surgical procedures since the symptoms of intestinal anisakiasis may mimic other illnesses such as appendicitis, ileitis or peritonitis. We suggest that anisakiasis should be considered in the differential diagnosis of patients with acute abdomen.

Resultados a largo plazo de la gastroplastia vertical con banda en el tratamiento quirúrgico de la obesidad mórbida. Complicaciones específicas de la técnica quirúrgica / Long-term results of vertical banded gastroplasty in the surgical treatment of morbid obesity. Specific complications of the surgical technique

Introducción. El objetivo de este trabajo es analizar la incidencia de complicaciones específicas de la técnica de la gastroplastia vertical con banda (GVB), su repercusión en el adelgazamiento y el tratamiento de las mismas. Pacientes y método. Estudio de una serie de 80 casos de gastropatía vertical con banda (65 mujeres y 15 varones), con una edad media de 37 años, índice de masa corporal medio de 49,5 kg/m2 y seguimiento superior a 5 años en el 65 por ciento de los casos. Resultados. a) Disrupción de la línea de grapas: 25 por ciento (cinco en el tercio superior de la línea de grapas, cuatro en el tercio medio y cuatro en el tercio inferior), con repercusión en el porcentaje de sobrepeso perdido (PSP) (61 por ciento si no hay disrupción y 43 por ciento en los casos con disrupción, 25 por ciento si es de tercio inferior), y fracaso del regrapado en los casos en los que se realizó; b) estenosis del estoma: un caso, con vómitos y adelgazamiento excesivo, tratado mediante sección de la banda de polipropileno, y c) dilatación del reservorio: 2 casos, con reengorde; uno de ellos fue tratado sin éxito mediante regrapado. Conclusiones. a) Las complicaciones técnicas de la gastroplastia vertical con banda, aunque no siempre, influyen sobre PSP; b) la reintervención está indicada cuando hay reengorde no controlable mediante dieta o síntomas no tratables médicamente, y c) el regrapado fracasa en las reintervenciones, por lo que está indicado realizar otras técnicas (AU)

Anal endosonography for the study of anal canal anatomy: normal images and sonographic variants.

OBJECTIVE: To present normal images and sonographic variants of the anal canal to be used as reference for the study of sphincter and anal canal abnormalities. MATERIAL AND METHODS: Sixty subjects without known anal canal disease were studied by means of anal endosonography. Subject were divided according to age in two groups (up to 50 years and more than 50 years). All of them underwent an outpatient study with B&K medical ultrasound 2,003 scanner and 1,850 multifrequency transducer. RESULTS: Four layers can be sonographically identified in the anal canal: an inner hyperechoic layer which is the submucosa, a second hypoechoic layer which is the internal sphincter, a third one which is a longitudinal muscle and the outer hyperechoic layer which is the external sphincter and the only to be found in the low anal canal. In people older than 50 years, both sphincters were significantly thicker (0.3-0.5 mm). At the high anal canal 40% of women presented an anterior gap in the external anal sphincter. CONCLUSIONS: Anal endosonography allows an easy division in high-, mid-, and low anal canal. In some women there is a gap at the mid-high anal canal that must be taken into account in order to avoid diagnostic errors. An internal sphincter thickness greater than 3.5 mm should be considered abnormal at any sex or age.

Ecografía endoanal en el estudio de la anatomía del canal anal / Anal endosonography for the study of anal canal anatomy: normal images and sonographic variants

Objetivo: presentar los modelos de normalidad y variantes ecográficas que pueden servir de referencia para el estudio de los desórdenes del canal anal y de los esfínteres. Material y métodos: 60 personas sin patología conocida del canal anal fueron estudiados mediante ecografía endoanal. Los sujetos fueron divididos por grupos de edad (hasta 50 años, y más de 50 años). La exploración se realizó mediante un equipo B&K Modelo 2.003 con sonda 1850 multifrecuencia en régimen ambulatorio. Resultados: en el canal anal se identifican ecográficamente cuatro capas: la primera hiperecoica corresponde a la submucosa, la segunda capa hipoecogénica corresponde al esfínter interno, capa de referencia para el estudio de las demás capas; la tercera corresponde a la musculatura longitudinal y la capa más externa, hiperecoica es el esfínter externo siendo la única que se encuentra en el canal anal bajo. El grosor de los esfínteres se incrementó en valores de (0,3-0,5 mm) en mayores de 50 años. En el 40 por ciento de las mujeres el esfínter externo por debajo del haz puborrectalis, en su cara anterior presentó una variante anatómica con defectos de cierre del anillo externo. Conclusiones: la ecografía endoanal permite una división fácil del canal anal en alto, medio y bajo. En algunas mujeres en el canal anal medio-alto existe un defecto de cierre que hay que tener presente para evitar errores diagnósticos. Espesores de esfínter anal interno superiores a 3,5 mm deben considerarse patológicos independientemente de la edad o sexo (AU)

[Adrenal gland pseudocyst: 2 cases manifesting with acute abdominal pain and shock]. / Pseudoquiste suprarrenal: dos casos manifestados por dolor abdominal agudo y shock.

OBJECTIVE: To describe two cases of adrenal pseudocyst that presented as acute abdomen and shock. METHODS: Two cases of adrenal pseudocyst are presented: one patient was a 69-year-old woman who presented with shock and pain in the left hypochondrium and the other was a 23-year-old woman who complained of dizziness and pain in the left hypochondrium. RESULTS: US and CT evaluation showed a heterogeneous cystic mass. Blood analysis showed low hematocrit and hemoglobin levels. Surgical resection of the retroperitoneal cystic mass was performed. The pathological analysis disclosed an adrenal pseudocyst. CONCLUSIONS: Adrenal pseudocyst is an uncommon lesion that infrequently causes symptoms and rarely presents as acute abdomen. Ultrasound and CT are the most useful diagnostic imaging methods. Treatment is by surgery if the lesion is large and symptomatic, if it cannot be clearly distinguished from a tumor, and if massive hemorrhage occurs.

Transanal endoscopic surgery for rectal tumors.

OBJECTIVE: To report our results with local excision by transanal endoscopic microsurgery (TEM) to treat 42 cases of rectal lesions (29 adenomas and 13 carcinomas). METHODS: Prospective, descriptive study. Sex distribution: 55% men, 45% women, mean age 65 years (range: 17-84 years). SYMPTOMS: rectal bleeding 67%, diarrhea 23%. SURGICAL TECHNIQUE: mucosectomy 6 cases, full-thickness excision 36 cases. Average follow-up: 11 months (range: 1-36 months). RESULTS: We analyzed operating time (average 85 min; range: 25-180 min), bleeding (average 100 ml, range 10-350 ml), distance of the tumor from the anal verge (lower tumor margin: mean, 8.8 cm; range, 1-20 cm; distal tumor margin: mean, 12.9 cm; range, 5-22 cm), tumor size (mean, 3.9 cm; range, 2-10 cm), postoperative hospital stay (average, 4 days; range, 2-15 days), morbidity (hemorrhage 1 case; perforation, 1 case), mortality (0) and follow-up (temporary incontinence to flatus in 6 cases, 1 recurrence of carcinoma treated with abdominoperineal resection, 2 recurrences of adenoma and 2 new adenomas). CONCLUSIONS: TEM is a safe technique for the treatment of rectal lesions. Low morbidity and recurrence rates and short hospital stays make TEM a procedure of choice when local rectal surgery is indicated.

Cirugía endoscópica transanal en los tumores de recto / Transanal endoscopic surgery for rectal tumors

OBJETIVO: mostrar los resultados obtenidos en la resección de 42 casos de lesiones rectales (29 adenomas y 13 carcinomas) mediante microcirugía transanal endoscópica (TEM). DISEÑO ESTADÍSTICO: estudio prospectivo descriptivo de la serie. PACIENTES: distribución por sexos: 54,76 por ciento varones y 45,24 por ciento mujeres. Edad media: 65 años (17-84). Síntomatología en el momento del diagnóstico: rectorragia, 66,67 por ciento, y diarrea, 23,8 por ciento. Técnica quirúrgica practicada: mucosectomía, seis casos; excisión total de pared, 36 casos. Seguimiento medio: 11 meses (1-36). RESULTADOS: se analizan: duración de la intervención (media, 85 min; rango, 25-180 min), pérdida hemática durante la misma (media: 100 cc; rango: 10-350 cc), las características de las lesiones resecadas: distancia al margen anal (borde inferior de la lesión: media, 8,8 cm; rango: 1-20 cm; borde superior de la lesión: media, 12,9 cm; rango, 5-22 cm) y tamaño (media, 3,9 cm; rango, 2-10 cm), estancia postoperatoria (media, 4 días; rango, 2-15 días), morbilidad (un caso de rectorragia y una perforación en cara anterior) y mortalidad postoperatoria (nula) y resultados del seguimiento (seis casos de incontinencia a gases transitoria, una recidiva de adenocarcinoma, seguida de amputación abdominoperineal, dos recidivas en adenomas y dos nuevos adenomas). CONCLUSIONES: la TEM es una técnica segura en el tratamiento de lesiones rectales. La baja tasa de complicaciones y de recurrencias, así como la disminución de la estancia hospitalaria, la convierten en una técnica de elección en los casos en los que está indicada la cirugía local rectal (AU)

Endoluminal ultrasography for rectal tumors: efficacy, sources of error and limitations.

OBJECTIVES: endorectal ultrasound (EUS) is currently accepted as the best technique for the preoperative study of patients with rectal tumors, and surgical decisions depend increasingly on EUS staging. The main pitfalls in staging rectal tumors are over- or understaging as well as errors in imaging lymph nodes. Being aware of such errors and their causes may help to improve the overall results. The aim of the present study was to evaluate the accuracy of EUS in staging rectal neoplasms, and to study potential sources of error. METHODS: from May 1996 to December 1998, 120 patients with rectal tumors were studied preoperatively by EUS. The uTNM classification described by Hildebrandt and coworkers was used. The EUS findings were compared prospectively with the results of pathological examination. When there was no correlation, both the specimen and the EUS findings were carefully reviewed to look for potential sources of error. RESULTS: 41 out of 120 patients were classified as uT1, 10 as uT2, 60 as uT3 and 9 out of 120 as uT4. 31 patients had positive lymph nodes (uN1). On comparing these data with the results of the pathological report, we found 90% accuracy in staging rectal wall penetration, and 70% accuracy in the diagnosis of lymph nodes. Errors were due basically to technical problems, characteristics of the tumor itself, and difficulties in staging lymph nodes. CONCLUSIONS: it is important to identify the potential source of errors as well as the current limitations of EUS to improve the overall results with this technique.

Ecografia endorrectal en los tumores de recto: eficacia, causas de error y limitaciones / Endoluminal ultrasography for rectal tumors: efficacy, sources of error and limitations

INTRODUCCIÓN: la ecografía endorrectal (EER) está considerada en estos momentos como la técnica más precisa en la estadificación preoperatoria de los tumores de recto. Cada vez más, se plantea la intervención quirúrgica en dependencia de la estadificación de la ecografía endorrectal. Las principales imprecisiones se producen por sobre o infraestadificación de los tumores y error en la interpretación de los ganglios linfáticos. El conocimiento de los posibles errores de la ecografía endorrectal y sus causas pueden ayudar a mejorar su precisión. OBJETIVO: el objetivo de este trabajo es evaluar la eficacia diagnóstica de la EER así como analizar los motivos de los errores cometidos. MATERIAL Y MÉTODOS: desde Marzo de 1996 a Diciembre de 1998 se han estadificado mediante ecografía endorrectal a 120 pacientes con tumores de recto. Se emplea la clasificación descrita por Hildebrandt (uTNM). Se elaboró un protocolo de estudio donde los resultados de la ecografía se compararon prospectivamente con los del informe anatomopatológico de la pieza de exéresis. En los casos de error diagnóstico se revisó de nuevo la pieza, sus características clínico-patológicas y los datos registrados de la EER. RESULTADOS: de los 120 pacientes a los que se les practicó una ecografía por cáncer de recto, 41 se clasificaron como uTis-T1, 10 uT2, 60 uT3 y 9 uT4; 31 presentaron ganglios linfáticos positivos (uN1) y 89 negativos (uNO). La correlación histopatológica fue del 90 por ciento en el grado de penetración tumoral y del 70 por ciento en cuanto a invasión linfáti ca. De forma general los errores con la ecografía endoluminal los agrupamos en problemas técnicos, problemas y fallos derivados del propio tumor y dificultades en la valoración ganglionar. CONCLUSIONES: es importante el conocimiento de las posibles causas de error y las limitaciones de la ecografía endorrectal, esto debe llevar a una mayor eficacia de la técnica y mejorar los resultados (AU)

[The mechanisms of satiation]. / Mecanismos de saciedad.

There are many published experimental studies which attempt to explain certain aspects of satiety, but only very few treat this problem as a whole, synthesizing concepts. At present, the understanding of the mechanisms of satiety is extremely interesting for the study and application of medical or surgical anti-obesity treatments.

[Endocrine metabolic and arterial pressure changes in morbidly obese patients treated with vertical gastroplasty]. / Modificaciones endocrino-metabólicas y de la presión arterial en obesos morbidos tratados mediante gastroplastia vertical.

When overweight surpasses 100% of the ideal weight, morbid obesity, the obese patients is condemned to a complete inability to work, social and sexual inability, and shall suffer from an increase in its morbidity and mortality. This depends to a large degree on the additions to the obesity of insulin resistance, carbohydrates intolerance, hypertriglyceridemia, hypercholesterolemia, and arterial hypertension, all of which is enveloped in a atmosphere of neuroendocrine alterations. An efficient method of treating this syndrome is weigh loss. Medical treatments have not achieved prolonged weight losses during long periods in morbid obese patients, which is a reason for surgery to try and propose new lines of treatment for these patients. The purpose of our study is to examine the effect of weight loss in 100 patients treated with vertical gastroplasty, on the metabolic disorders (triglycerides, cholesterol, glucose) and the arterial hypertension, which are considered to be risk factors in the mortality associated with morbid obesity. Our results indicate that the weight loss modified the metabolic conditions of the patients, with there being a decrease of the levels of triglycerides, cholesterol, glucose, and arterial pressure, after 6 to 12 months after the weigh loss.

[Changes induced by simple jejuno-ileal by-pass models in the distribution of D-cells producing intestinal somatostatin. Experimental study]. / Variaciones inducidas por modelos simples de by-pass yeyuno-ileal sobre la distribución de células D productoras de somatostatina intestinal. Estudio experimental.

Cells that produce somatostatin are widely distributed throughout the digestive tube. They are found in the stomach, small bowel, large bowel and pancreas. The authors used 54 Wistar rats, with an approximate weight of 300 gr, to evaluate the possible variations of the D cell population in isolated and functional intestinal segments, using jejuno-ileal bypass as a model. Rats were divided into three groups, a control group and two groups in which simple derivation techniques were performed following the techniques of Payne and DeWind, and Scott. Rats were sacrificed after 7, 30 and 90 days in subgroups of six animals. Macroscopic, microscopic and ultrastructural studies were carried out. Cells were specifically stained using immunocytochemical techniques (PAP). The corresponding values of the mucous areas were obtained using a computerized image analyzer (Quantimet 800) and then the number of D cells per mm2 mucosa was calculated. The results show a decrease in the number of D cells per mm2 of mucosa in the functional intestinal segments and degranulation of these cells, coinciding with the existence of large areas of rough endoplasmic reticulum (sign of cellular hyperactivity).