Sarcoma de células claras gigante de muslo: cuadro clínico, diagnóstico y tratamiento / Thigh giant clear cell sarcoma: clinical aspect, diagnosis and treatment

El sarcoma de células claras de tendones y aponeurosis,es una tumoración infrecuente que afecta principalmentea las extremidades inferiores de adultos jóvenes. Presentamos un caso de una paciente de 72 años de edad, que debutó con una tumoración no dolorosa en la raíz delmuslo izquierdo de dos años de evolución. La resonanciamagnética y la citología por aspiración orientaron el diagnóstico. Tras descartar diseminación a distancia se realizó extirpación en bloque de toda la tumoración. El estudio anatomopatológico de la pieza quirúrgica confirmó la presencia de un sarcoma de células claras. La paciente recibió radioterapia y quimioterapia postoperatoria y se encuentra libre de enfermedad seis meses después

Clear cell sarcoma of tendons and aponeuroses is a rareagressive soft tissue tumour that usually appears in the lower extremities of young adults and frequently producesmelanin. We report the case of a previously healthy 72-year- old- woman with clear cell sarcoma of the left thigh who presented with a large painless mass of 2 year´s duration. MR imaging showed the tumour to be of high signal intensity on fast spin-echo and STIR images. The fine needle aspiration showed abundant melanin pigments. There was no evidence of metastatic disease. We performed resection with complete removal of the tumour. Histologic diagnosis was compatible with clear cell sarcoma. The patient received adjuvant chemotherapy and radiotherapy. She is free of disease at 6 months of follow-up

[Gastric bypass in the surgical treatment of the morbid obesity and super obesity: comparative study]. / Bypass gástrico en el tratamiento de la obesidad mórbida y la superobesidad: estudio comparativo.

INTRODUCTION: Gastric Bypass (GB) constitutes the surgical treatment of election of morbid obesity (BMI < 50) at the present time, however doubts exist about its effectiveness in super obesity patients (BMI > 50). OBJECTIVE: The purpose of this work is one of to analyze the results of loss of weight of the first 52 open GB of our series, and to compare the losses of weight in morbid obesity (MO) and super obesity (SO), to determine if the superobese patient looses enough weight with this technique or if it would be more indicated another technique more malabsorptive, like some authors recommend. MATERIALS AND METHOD: Retrospective study of the first 52 patients operated of open GB pathway. The weight loss of 32 patients' with MO are compared with the weight loss of 20 patients with super obesity after five year follow-up. The parameters analyzed are: age, sex, height, initial weight, current weight, initial BMI, current BMI, % BMI lost, % overweight lost, incidence of incisional hernia, acceptable oral tolerance and metabolic alterations. The malabsorptive procedure associated in patients with super obesity was a 200 cm Roux-en-Y and a patients with BMI between 40 and 50 was a 150 cm Roux-en-Y. The results are compared by means of the X2 and Mann Whitney statistical test. RESULTS: The age, the sex and the stature are homogeneous in the two groups. In the group of MO the initial weight was of 121.5 kg; initial BMI, 45; current BMI; 28.9, the median loss of weight in 5 years was of 48 kg; the percentage loss of the excess of BMI is of 80% and the percentage loss of the excess of weight is of 74.6%. In the group of SO the initial weight was of 142.,7 kg; initial BMI, 54.9; current BMI, 34.,9; the median loss of weight in 5 years was of 54 kg; the percentage loss of the excess of BMI was of 65,3% and the percentage loss of the excess of weight was of 63.2%. The analysis of the results ponders shows that it exists statistically significant differences (P < 0.05) among the two groups, however the rate of success, according to the classic parameter of loss of more than 50% of the excess of weight, was superior to 90% in both groups. The results of the study about the presence of incisional postoperative hernia, alimentary tolerance and metabolic alterations, indicate that it doesn't exist differences statistically significant between both groups. CONCLUSIONS: GB is an effective surgical technique in patients with morbid obesity and with super obesity, provided that in these patients is realized a procedure more malabsorptive. There are not differences between both groups, in morbidity, improvement in the associate disease, alimentary tolerance and necessity of nutritional supplements.

Bypass gástrico en el tratamiento de la obesidad mórbida y la superobesidad: estudio comparativo / Gastric bypass in the surgical treatment of the mobid obesity and super obesity: comparative study

Introducción: El Bypass Gástrico (BG) constituye en la actualidad el tratamiento quirúrgico de elección de la obesidad mórbida (IMC 50). Objetivo: El objetivo de éste trabajo es el de analizar los resultados de pérdida de peso de los primeros 52 Bypass Gástricos abiertos consecutivos de nuestra serie y comparar las pérdidas de peso en obesos mórbidos (OM) y superobesos (SO), para determinar si los pacientes superobesos pierden suficiente peso con nuestra técnica o por el contrario sería más recomendable otra técnica más malaobsortiva, como recomiendan algunos autores. Materiales y método: Estudio retrospectivo de los primeros 52 pacientes intervenidos de BG por vía abierta. Se comparan las pérdidas de peso de 32 pacientes con OM y 20 con SO a 60 meses de seguimiento. Los parámetros analizados son edad, sexo, talla, peso inicial, peso actual, IMC inicial, IMC actual, % del IMC perdido, % del sobrepeso perdido (% SPP), incidencia de hernia incisional, tolerancia alimentaría y alteraciones metabólicas. El componente malabsortivo asociado a los pacientes SO era una Y de Roux de 150 a 200 cm de pie de asa y en los pacientes con OM el pie de asa estaba entre 100 y 150 cm. Los resultados se comparan mediante el test estadístico del chi2 para porcentajes y la U de Mann Whitney para medias numéricas. Resultados: Los grupos son homogéneos en cuanto a edad media, sexo y talla. En el grupo de OM el peso inicial es de 121,5 kg, IMC inicial 45, IMC actual 28,9, la pérdida media de peso a 5 años es de 48 kg; la pérdida porcentual del exceso de IMC es del 80% y la pérdida porcentual del exceso de peso es del 74,6%. En el grupo de SO el peso inicial es de 142,7 kg, IMC inicial 54,9, IMC actual 34,9, la pérdida media de peso a 5 años es de 54 kg; la pérdida porcentual del exceso de IMC es del 65,3% y la pérdida porcentual del exceso de peso es del 63,2%. Las diferencias en cuanto a resultados ponderales resultan estadísticamente significativas en los dos grupos (P < 0,05), sin embargo la tasa de éxitos, según el parámetro clásico de pérdida de más del 50% del exceso de peso, es superior al 90% en ambos grupos. Los resultados del estudio sobre la presencia de hernia incisional postoperatoria, tolerancia alimentaria y alteraciones metabólicas, indican que no existen diferencias estadísticamente significativas entre los dos grupos. Conclusiones: El BG es una técnica eficaz en el tratamiento quirúrgico de la obesidad tanto en el paciente con obesidad mórbida, como en el paciente con superobesidad, siempre que se aplique en estos últimos un mayor grado de malabsorción. No existe diferencia en la morbilidad, mejoría de la enfermedad asociada, tolerancia a la ingesta y en la necesidad de suplementos nutricionales entre los grupos

Introduction: Gastric Bypass (GB) constitutes the surgical treatment of election of morbid obesity (BMI 50). Objective: The purpose of this work is one of to analyze the results of loss of weight of the first 52 open GB of our series, and to compare the losses of weight in morbid obesity (MO) and super obesity (SO), to determine if the superobese patient looses enough weight with this technique or if it would be more indicated another technique more malabsorptive, like some authors recommend. Materials and method: Retrospective study of the first 52 patients operated of open GB pathway. The weight loss of 32 patients’ with MO are compared with the weight loss of 20 patients with super obesity after five year follow-up. The parameters analyzed are: age, sex, height, initial weight, current weight, initial BMI, current BMI, % BMI lost, % overweight lost, incidence of incisional hernia, acceptable oral tolerance and metabolic alterations. The mal absorptive procedure associated in patients with super obesity was a 200 cm Roux-en-Y and a patients with BMI between 40 and 50 was a 150 cm Roux-en-Y. The results are compared by means of the X2 and Mann Whitney statistical test. Results: The age, the sex and the stature are homogeneous in the two groups. In the group of MO the initial weight was of 121,5 kg; initial BMI, 45; current BMI; 28,9, the median loss of weight in 5 years was of 48 kg; the percentage loss of the excess of BMI is of 80% and the percentage loss of the excess of weight is of 74,6%. In the group of SO the initial weight was of 142,7 kg; initial BMI, 54,9; current BMI, 34,9; the median loss of weight in 5 years was of 54 kg; the percentage loss of the excess of BMI was of 65,3% and the percentage loss of the excess of weight was of 63,2%.The analysis of the results ponders shows that it exists statistically significant differences (P < 0,05) among the two groups, however the rate of success, according to the classic parameter of loss of more than 50% of the excess of weight, was superior to 90% in both groups. The results of the study about the presence of incisional postoperative hernia, alimentary tolerance and metabolic alterations, indicate that it doesn’t exist differences statistically significant between both groups. Conclusions: GB is an effective surgical technique in patients with morbid obesity and with super obesity, provided that in these patients is realized a procedure more malabsorptive. There are not differences between both groups, in morbidity, improvement in the associate disease, alimentary tolerance and necessity of nutritional supplements

Colovesical fistula complicating diverticular disease: one-stage resection.

Colonic diverticular disease is common in developed countries, and its prevalence increases with age. Most affected individuals remain asymptomatic throughout their lives, and relatively few patients require surgical intervention for obstructive or inflammatory complications. Colovesical fistula is the most common type (65%) of fistula associated with colonic diverticular disease. Primary resection of sigmoid colon with colorectal anastomosis performed as a one-stage procedure is its definitive treatment and can be performed safely--as simple closure, using an omental flap, or through resection and closure of bladder defect--in 90% of the patients. We report our experience with four patients suffering from colovesical fistula who were treated with primary resection of sigmoid colon and colorectal anastomosis performed as a one-step procedure. In our experience, diverting colostomy or Hartmann intervention is not recommended because of the lack of fistula definitive resolution and the possibility of additional complications.

Inclusión de la anilla en el reservorio tras bypass gástrico: diagnóstico y tratamiento / Inclusion of the ring into the stomach pouch after gastric bypass: diagnosis and treatment

El Bypass Gástrico (BG), es en la actualidad el procedimientoquirúrgico más frecuentemente realizado, en el tratamientode la obesidad mórbida. Algunos cirujanos añadenal reservorio gástrico una anilla de diversos materiales, conel propósito de mantener en el tiempo el porcentaje delsobrepeso perdido, sin embargo; además de añadir unamayor complejidad a la técnica, puede generar una mayormorbilidad. La inclusión de la anilla en el reservorio es unacomplicación infrecuente. Publicamos el caso de unapaciente de 35 años de edad, que presentó inclusión de laanilla en el reservorio gástrico tras el BG por obesidad patológica.El cuadro clínico debutó como una oclusión intestinal.El diagnóstico se confirmó tras realizar tránsito intestinalcon contraste y endoscopia. La paciente requirió cirugíatras fracasar el intento endoscópico

At present the Gastric Bypass (GB), is the surgical techniquemore frequently realized, for treatment of the morbidobesity. Some surgeons add to the gastric pouch aring of different materials, with the purpose of maintainingthe rate of the lost overweight, for longer period oftime. However; besides adding a higher complexity tothe technique, it can generate a higher morbidity. Theinclusion of the ring in the pouch is an uncommon complication.We report a 35 year-old woman who developedinclusion of ring into the stomach pouch. The patientpresented picture clinic of the intestinal occlusion. Thediagnosis was made by endoscope. The patient requiredsurgery for resolution of symptoms after failure of theendoscopic treatment

Condiloma acuminado gigante inguinal y perineal: cuadro clínico, diagnóstico y tratamiento / Inguinal and perianal giant condyloma acuminata: clinical aspect, diagnosis and treatment

La incidencia de condilomas y de otras enfermedades de transmisión sexual, han mostrado un comportamiento ascendente en la últimas décadas, debido a conductas sexuales sin protección adecuada. El agente etiológico es el virus del papiloma humano (VPH) y puede afectar piel y mucosas. Las manifestaciones clínicas pueden ser variadas y con gran tendencia a recurrir. Son enfermedades frecuentes en la práctica clínica, sin embargo el condiloma acuminado gigante es excepcional. Presentamos un caso de condiloma acuminado gigante inguinal y perineal, en un paciente varón de 46 años de edad, de carácter asintomático y de ocho años de evolución. Tras la resección quirúrgica de la lesión en dos tiempos, con bisturí ultrasónico, el paciente está libre de recidiva seis meses después

The incidente of the acuminata condylomas and other sexual transmission diseases, has showed an ascending behaviour in the last decades, due to sexual conducts without suitable protection. The etiological agent is the virus of the human papilloma. They can affect mucosal and skin. The clinical manifestations can be varied with a great trend to the recurrence. They are frequent diseases in the clinical practice, nevertheless the giantcondyloma is exceptional. We present a asymptomatic case of giant acuminata condyloma inguinal and perineal, in a 46-year-old male of eight years evolution. After the surgical resection ultrasonic scalpel, the patient is free of recurrence six months later

Linfadenitis axilar primaria de etiología tuberculosa: importancia clínica y diagnóstico diferencial / Primary axillary lymphadenitis of tubercular aetiology: clinical importance and differential diagnosis

La linfadenitis axilar primaria de etiología tuberculosa,sin otra patología asociada, es una entidad francamente rara;sin embargo, debido al aumento en nuestro país de la incidenciade la enfermedad tuberculosa, puede verse incrementadasu frecuencia. Se presenta un caso de linfadenitisaxilar aislada de origen tuberculoso en una paciente de 33años de edad, que debutó como una tumoración de carácterasintomático, sin afectación mamaria y sin otra enfermedadasociada. La prueba de tuberculina resultó ser positivay el estudio anatomopatológico de la pieza de resecciónquirúrgica fue compatible con una linfadenitis tuberculosa.Tras seis meses de tratamiento antituberculoso la pacientese encuentra libre de enfermedad

Primary axillary lymphadenitis of tuberculous aetiology, without another associate pathology, is quite uncommon. However, an increased frequency is waited for the next years largely due to the increase of tuberculosis in our country. We present a case of isolated axillary lymphadenitis, in a 33-year-old woman, initially manifested as an asymtomatic tumour, without mammary or extrammary associate disease. Tuberculin reaction and microscopically the appearance was consistent with tuberculous lymphadenitis. The patient is free of disease after a cycle of six months of anti-tuberculosis treatment

[Bochdalek's hernia in an adult with stomach volvulus and extrapulmonary sequestration]. / Hernia de Bochdalek del adulto con volvulación gástrica y secuestro extrapulmonar.

We report a case of Bochdalek's hernia with volvulus of the stomach and extrapulmonary sequestration in an adult. A 27-year-old woman presented acute respiratory failure, pain in the left side of the chest and recurrent vomiting of sudden onset. Upon examination there was pain in the left hypochondrium that was not tolerated in decubitus position. A chest film showed an "arch" at the base on the left side and an upper gastrointestinal series revealed volvulus of the stomach. After a left thoracotomy, the stomach, spleen and greater omentum were found displaced into the thoracic cavity. After the viscera were confined to the abdomen, the hernia was repaired and the pulmonary sequestration was removed. Two years later, the patient was asymptomatic and a chest film was normal.