Revista espanola de las enfermedades del aparato digestivo最新文献

We have determined hepatitis B virus markers to 107 nursing personnel (90 women and 17 men) of a general hospital. The prevalence was 15.88% (17 persons). Two persons (1.86%) presented HBs-Ag. The prevalence was more low what the prevalences found by other authors of our country. The difference between the two sexes not was significative. The highest prevalences were found in the personnel of outpatient clinics and in the personnel in contact with blood and its derivates. The prevalence more low was found en the nursing personal rooms. The collective of midwives presented the prevalence more height: 37.5%. The prevalence increased generally with age and years in occupation. We associated the low indexes of prevalence found for us with the high percentages of young personnel (39.25%) are more low of 30 years age) and with short years occupation in the hospital (19.62% are more low of 4 years).

Total gastrectomy due, principally, to malignant diseases, has two aims: a) to carry out an adequate oncological operation, and b) to perform a simple reconstruction of the digestive tract which must avoid biliary esophageal reflux. All other functional disturbances may be controlled by adequate diet. Pseudogastric jejunal pouches are, at present, being abandoned. The reduced intestinal malabsorption--favored by the loss of the stomach and the bacterial proliferation--is kept under control, it seemed, by the function of the "ileal brake", which, when certain fat acids and other substances reach the ileum, produce hypomotility of the jejunum with slowing up of the intestinal flow. In such patients, an important catabolism prolongs for some weeks after the operation, and lose also weight due to poor appetite and not eating enough. In view of this, it is considered justified the application of an enterostomy tube during the operation, in order to provide a supplement of food by direct intestinal way, which should begin to be used only after the first postoperative days (five-six).

We have studied the epidemiology of colorectal cancer in Asturias. We have collected 850 cases of colonic and rectal cancer, diagnosed from 1977 to 1981 (470 males and 380 females). The incidence was 17.13 per 100,000 for males and 13.08 per 100,000 for females. The incidence adjusted for the age was 12.32 (males) and 7.95 (females). The average age was 63.68 and 64.06, for females and males, respectively. The more frequent localization were rectum, sigmoid colon and cecum. Two hundred and sixty two patients lived in rural areas and 588 in urban areas. In 57.9% of the cases of blood group was A. The most common presenting symptoms were abdominal pain and blood in the feces. 69.9% of the tumors were Dukes' type C. The treatment was elective surgery in 693 cases. Five years after surgery the survival rates were 44.1% for tumors type C, and 68.5% for tumors type B. During the period of present study underlines the importance of the programs directed to the early diagnosis of high risk groups, as an efficient secondary prevention of the colorectal carcinoma.

We present two patients with mucinous cystadenoma and mucinous cystadenocarcinoma of the appendix, respectively. These are very uncommon lesions in that localization. We point out the lack of specificity of the term "mucocele" and also the need of strict criteria to define this type of lesions in order to establish the adequate treatment. Usually the diagnosis is not possible before surgery. The treatment consists of simple appendectomy for the benign lesions and right hemicolectomy for mucinous carcinoma.

Proximal gastric vagotomy controlled by intraoperative testing, preferred for locating the zone of denervation (or "enlarged" to section of the gastroepiploic nerve, as these tests show), not only is the technique that has the lowest morbimortality but also a small number of recurrences, about 1%. In this study we prospectively and objectively evaluated (endoscopy, basal study, stimulated acid secretion and pH measurement) 88% of 777 vagotomies performed between 1971 and 1980 (10-17 years earlier) to demonstrate that the results are maintained and that after the fourth year the probability of recurrence is 2 per thousand. Acid secretion rises in a nonsignificant way, without reaching safety levels, during the first 5-9 years, remaining stabilized for at least 17 years except for duodenal recurrences that are due to incomplete denervation of the acid secretion zone, which continue to produce increased acid production. Out of 318 endoscopies, we only saw 3 "new gastric ulcers" in asymptomatic operated patients. As for the decline in the number of elective indications, this is more of less due to the occurrence of graver complications that must be urgently operated, and are accompanied by mortality. H2 or proton transport blockers heal the ulcer, but it remains to be demonstrated that after 10 years more than 95% will remain healed without grave complications, as occurs with surgery. The elective indication of efficient and safe surgery can be prophylactic against serious complications in the ulcer patient, which are responsible for mortality, a mortality that is not decreasing in the world population.

As a result of the occurrence of a case of esophageal leiomyoma with intra-abdominal growth, we made a detailed study of it and a summary of the topic of benign muscular tumors of the esophagus.

We have reviewed 1,725 cases of RGE-HH, corresponding to the period between February 1967 to July 1989; the total number of clinical histories in that period of time was 17,553. Of this series, 1,594 (92.OFF were sliding hernias; 214 (12.4%) were operated. In order to prevent recurrences, in 146 cases (68.2%) of sliding hernia, which we expose in the present paper, we have employed different surgical techniques, associated to the pexia of the round ligament. Presently, the surgical technique of our preference is the anterior SemiNissen or Dor's hemivalve, with closure of the His' angle, the hiatus and the pillars of the diaphragm, when indicated, and pexia of the round ligament. There has not been mortality and the results have been excellent in 81.6% of the cases; good in 10.3%; fair in 4.5%, and poor or recurrence in 3.4%.

A review was made of the differences between 21 cases of Crohn's disease and 40 cases of ulcerative colitis, diagnosed in the same 10-year period. In terms of sex, age, symptoms, location, complications and evolution, the findings were similar to those obtained in England and northern Europe.