Bowel ischaemia and cocaine consumption; case study and review of the literature.

BACKGROUND: Amongst others, cocaine consumption has a detrimental effect in the vascular supply to the mesenteric area causing abdominal ischemic changes. Early recognition of these changes and adequate treatment are essential to avoid serious complications and possible death of the patient from sepsis. CASE REPORT: In this case study, the subject is a 40-years-old gentleman presenting with acute abdominal pain due to multiple ischemic changes in both small bowel and sigmoid loops. The patient required emergency surgical intervention consisting of bowel resection and anastomosis. The pathologic analysis of the segment showed transmural necrosis and necrotizing phlebitis caused by the ingestion of drugs or toxic agents. The patient later confirmed the habitual consumption of cocaine. DISCUSSION: The increase in cocaine consumption and other recreational toxins substructed from erythroyilon coca alkaloids amongst young people have generated a large number of admissions to Hospital Accident and Emergency Departments with patients complaining of acute abdominal pain. In many of these cases, surgical intervention is required and in some cases patients will sadly die without a proper diagnosis. Some of the most common effects of cocaine and its compounds includes; hollow viscus perforation, gastro-intestinal bleed, and other vascular problems such as enteritis and ischemic colitis. It appears clear that there is a great need for an advance history taking of these patients and their habit to cocaine and other drugs together with a urine test for drug screening. These together with a suspicion of a non- occlusive ischemic bowel caused by the effects of cocaine in young adults with no cardiac risk factors will guide clinicians and establish, and plan the correct treatment for these categories of patients.

[Application of new technologies to the teaching of surgery in the school of medicine]. / Aplicación de las nuevas tecnologías en la enseñanza de la cirugía en la licenciatura de medicina.

INTRODUCTION: The new methods of teaching, based on new technologies, already available in other educational and professional fields are gradually being introduced in our Medical Schools. The aim of our study is to present our initial experience in the introduction of a subject on the principles of surgery in our university. MATERIAL AND METHODS: The subject was offered voluntary to undergraduate students, with a maximum of 65 students per course during two consecutive academic years, while maintaining the traditional teaching with a formal lecture program with a different lecturer. The subject was designed with 60% virtuality on a WebCT platform and later in Moodle. The virtual subject was structured into teaching units, academically directed activities and communication tools. The subject was assessed in a report prepared by Cadiz University Department of Evaluation and Quality. RESULTS: There were 32 students in the 2005-2006 course and 62 in the following course. The mean activity of the students was: 602 accesses, 13 subjects for discussion forums and 20 e-mails between students and teachers. The students who participated in the Virtual subject have remarked that virtualisation make it more attractive and is an aid in the acquisition of knowledge. The data obtained from the report showed better results than the mean obtained in other subjects of the Department, School of Medicine and Cadiz University. CONCLUSIONS: The virtual subject of principles of surgery has been well evaluated in our university campus. We believe that the provision of teaching tools and new communication models make an effective contribution to the teaching of surgery as a subject in the school of medicine curriculum.

[Retroperitoneal sarcomas. Report of five new cases and review of the current situation]. / Sarcomas retroperitoneales. Aportación de cinco nuevos casos y revisión de la situación actual.

INTRODUCTION: Soft-tissue sarcomas represent a heterogeneous group of rare tumors arising from the mesenchymal cells of the connective tissue. Approximately 15% of these tumors arise in the retroperitoneum. These neoplasms are locally aggressive and the only curative treatment is surgical resection "en-bloc". The main cause of mortality is locoregional recurrence. Five-year survival is 3-58%, depending on the histologic subtype and grade. PATIENTS AND METHOD: Over a 5-year period (2001 to 2006), we performed surgery in five patients with retroperitoneal sarcomas. The mean age was 59 years (range, 46-76) with a male-to-female ratio of 3:2. The most frequent signs were abdominal pain and the appearance of a mass. In 2 patients, an incidental diagnosis was made during the surgical intervention. RESULTS: Surgical resection was performed in 5 patients but was incomplete in two patients. We removed 2 liposarcomas, 1 leiomyosarcoma, 1 chondrosarcoma and 1 fusocellular sarcoma arising in the kidney. Locoregional recurrence occurred in four patients, requiring between 1 and 2 new relaparotomies (using the retroperitoneal approach in 2 patients). There was one death. CONCLUSIONS: Retroperitoneal sarcomas are a heterogeneous group of tumors, in which the only common factor is the anatomical location. New randomized, prospective, multicenter trials are required to apply different therapeutic options according to the subtype of retroperitoneal sarcoma.

Differences in polypropylene shrinkage depending on mesh position in an experimental study.

BACKGROUND: Polypropylene (PP) mesh is one of the most frequent materials used in hernia repair. We have experimentally evaluated the shrinkage of PP mesh depending on the place of implantation. METHODS: In 15 New Zealand rabbits a muscular defect measuring 3 x 3 cm was created in both pararectal sides of the abdominal wall. The defect was repaired using a PP mesh measuring 5 x 3.5 cm that was placed in the right side in the sublay location and in the left side in the onlay location. Five animals were killed on the 30th, 60th, and 90th postoperative days. Macroscopic measurement and microscopic study of the prosthesis-host tissue interfaces were performed. RESULTS: One rabbit was killed because of severe infection in the onlay mesh. Another 2 infections were tolerated in the onlay mesh side. All the prostheses were integrated in the host tissue at death. In the macroscopic evaluation the mesh areas were reduced by 25.92% on the 30th day, by 28.67% on the 60th day, and by 29.02% on the 90th day. The mesh shrinkage was greater in the onlay group than in the sublay group at the 3 time intervals. More inflammatory leukocyte and mononuclear responses also were seen in the onlay group. CONCLUSIONS: These observations support the theory of PP mesh shrinkage as a consequence of the incorporation of the biomaterial to the scarring tissue. This shrinkage is significantly more intense if the meshes are placed in the onlay position.

[Surveillance of shrinkage of polypropylene mesh used in the repair of ventral hernias]. / Seguimiento de la contracción de las mallas de polipropileno empleadas en la reparación de eventraciones.

INTRODUCTION: Polypropylene (PP) mesh is one of the most frequently used materials in the surgical repair of ventral hernias. Despite the widely recognized ability of PP to integrate into the host tissue, these meshes may shrink during the healing process in the patient. OBJECTIVE: To quantify polypropylene mesh shrinkage. PATIENTS AND METHOD: A radiological follow-up study was performed in 23 consecutive patients who underwent surgery for midline ventral hernias with diameters of at least 5 cm. PP meshes were marked with titanium clips at the ends of their longest transverse and longitudinal axes. X-rays were performed on the first postoperative day and at 1, 3, 6 and 12 months. The distances between clips were measured and the area of the mesh was calculated. RESULTS: Seventeen women and six men underwent surgery. In nine patients the mesh was placed on the prefascial space (onlay) and in 14 in the subfascial space (sublay). There were four seromas in patients with mesh placed with the onlay technique. The reduction in the calculated area was 12% at 1 month, 24% at 3 months, 29% at 6 months and 34% at 12 months. CONCLUSIONS: PP mesh provided excellent clinical results. Radiological surveillance revealed substantial shrinkage, mainly in the first 3 months after implantation.