Revista espanola de las enfermedades del aparato digestivo最新文献

In 7 dogs with fecal peritonitis, induced by incision of the cecum, and in the same number of control animals the thoracic duct was cannulized at the neck level together with a femoral vein for the purpose of sequential study of the routes of bacterial dissemination. The findings show: a) rapid appearance of germs in lymph and then in blood in animals with peritonitis, b) a progressive increase in the number of species isolated in each sample, and c) that the lymphatic flow and drainage of bacterias lasted throughout the 12 hours that the experiment lasted. The microbes isolated in lymph and blood were related to the flora of the intestinal segment where the infection originated, with development of a large number of anaerobic species.

Choledocus cyst is a rare anomaly which affects the intramural segment of the common bile duct. The presenting clinical symptoms are recurrent abdominal pain, episodes of jaundice, with fever, and increased levels of serum amylase. Although the diagnosis may be obtained by conventional clinical and radiologic methods, the anatomy of the ducts is best demonstrated by endoscopic retrograde cholangiopancreatography; moreover, this technique enables some therapeutic manoeuvres. We present a young girl with a choledocus cyst and some other ductal abnormalities with the results of the previously mentioned technique.

We present a retrospective study on 506 patients with acute pancreatitis (AP), admitted in our hospital in the last five years (1984-1988). The goal of the paper is to establish a possible correlation between the severity and the etiology of the AP. Depending on the severity of the acute attack, and according to the Ranson's prognostic signs and the findings of the abdominal CAT, we have classified AP in three grades: mild, moderate and severe. 52% of AP were of biliary etiology, 25.7% alcoholic, and in 17.0% of the cases the responsible agent was not demonstrated. In relation with severity, the distribution was as follows: mild, 184 (36.4%), moderate, 254 (50.2%) and severe, 68 (13.4%). Among the cases of biliary and alcoholic etiology, 14.7% and 9.2%, respectively, were severe. Postoperative AP were severe in 71.4% of the cases. Systemic complications were more frequent in the severe forms, particularly of biliary etiology. Pancreatic abscesses and fistulas were also more frequent in biliary pancreatitis; on the other hand, pseudocysts and ascites were more common in alcoholic pancreatitis. Overall mortality was 2.8% (14 patients). Mortality was 19.1% in the severe forms. In relation to etiology the mortality was as follows: 3.7% in biliary AP; 0.8% in alcoholic AP; 14.3% in postoperative AP; and 2.3% in the idiopathic AP.

In view of the lack of studies on the percentage of atypical forms of duodenal ulcer, we made one based on our cases, analyzing separately the location, hours and time periods. We personally studied 3,120 duodenal ulcers, considering as atypical those that diverged form the norm in any of the 3 variables. The epigastrium was considered to be the characteristic location, extending from the infraxiphoid zone to the navel, although there can be simultaneous pain in other abdominal zones, the breast or back. The hour was found to be more than an hour after the feeding. Time intervals of more than 2 months without discomfort were established and the pain intervals lasted from 10 days to 2 months. Complicated ulcers were not considered. Atypical duodenal ulcers represent more than a fourth, 27.37%. Of the three variants, one the most common and three were less frequent. The absence of pain during determined time periods in more than two thirds is emphasized, while those without a pattern of hours and of atypical location are more or less equal. We note that the absence of determined time periods represents 80% of atypical duodenal ulcers and a fifth of all duodenal ulcers.

An analysis was made of the results obtained in terms of postoperative complications, mortality and the 5-year survival rate in a series of 23 patients diagnosed as adenocarcinoma of the cardias who underwent total gastrectomy with distal esophagectomy via left thoracophrenolaparotomy, with esophagojejunostomy on a Roux-en-Y loop. We consider the results as favorable and conclude that this procedure has an application in adequately selected patients.

We present eleven patients diagnosed of giant hepatic hemangioma in the last 20 years. The diagnosis was confirmed in all the cases during laparoscopy or laparotomy. The mean age of the patients was 44.9 +/- 8.99; nine of them were women. Only two of the patients complained of abdominal pain. Five patients showed abnormal liver function tests; the most common finding was increased levels of alkaline phosphatase. We have reviewed the diagnostic tools employed: isotopic study of the liver with 99Tc, and labeled erythrocytes, abdominal ultrasonography, CAT, hepatic arteriography, laparoscopy, laparotomy and liver biopsy. Usually we employed more than one of these diagnostic methods. In the last years there has been a shift to employ less invasive procedures.

We present a retrospective study of 208 colorectal cancers, 131 of them followed during more than 5 years. Overall survival was 38%. We have tried to correlate clinical findings with prognosis and survival. The analyzed parameters have been the following: age, sex, site and size of the tumor, time and cause of surgical treatment, stage of the lesion, cytologic grade of differentiation of the tumor, delay between the presenting symptom and surgery, surgical procedure, local invasion and number of positive lymph nodes. The results show that the main factors related to prognosis are local extension through the intestinal wall and the presence of positive lymph nodes (particularly if more than 4) and, of course, distant metastases.

Angiodysplasia of the colon is a vascular lesion which involves the arterioles, venules and small venous vessels; usually it is a lesion of the aged and presents with rectorrhagia, melena or chronic anemia due to chronic blood loss. We present two cases of angiodysplasia of the colon in two female patients in the eighth decade of their lives, treated in the Servicio de Cirugía del Hospital Universitario Virgen Macarena de Sevilla. We emphasize the value of the angiographic study for the diagnosis of this lesion, and also the usefulness of isotopic study with labeled erythrocytes for the localization. The treatment of choice is surgical resection of the affected area. It was performed in both patients. One of them died.