Revista espanola de las enfermedades del aparato digestivo最新文献

We have reviewed our experience with 2,430 cases of lithiasis of the biliary tract, 500 of them located in the common bile duct and 104 corresponding to residual lithiasis. We have made a general reflexion on the problems aroused by this very common al condition, which has an imprevisible, some times severe, outcome. The recent acquisition of new conservative methods, as disolvents and lithotrix, and the diagnostic and therapeutic role of endoscopy have revolutionated the state of the art and have introduced controversial points still unsolved. As it is common in clinical practice, biliary lithiasis should be approached in a multidisciplinary fashion, employing the most convenient diagnostic procedure for the clinical situation of the patient; a priori no accredited procedure should be disregarded.

The clinical characteristics of 100 patients diagnosed of congestive hepatomegaly have been reviewed in order to analyze some of the clinical and analytical parameters. The protocol for the study consisted of ten variables: sex, age, quality and size of the hepatomegaly, presence of hepatojugular reflux, jugular engorgement, ankle edema, abdominal ultrasonography, laboratory data and any other pertinent exploration. The mean age of the patients was 69 (31%). 65% of the cases had ankle edema. Prothrombin time was abnormal in 12% of the total series and in 27.9% of those with abnormal laboratory data. The most common ECG finding was atrial fibrillation (26%). The second most common was complete bundle block (21%).

To evaluate the incidence of ulcer recurrence, mortality and morbidity derived from the surgical technique, we made a prospective and randomized study in patients with perforated duodenal peptic ulcer, within 10 hours after the acute episode and without intercurrent serious diseases. In a total of 180 patients, oxyntic cell vagotomy (VCO) with simple closure or simple closure alone were performed alternatively in the period from 1971 to 1977. Periodic controls were established that included clinical, radiographic and gastroduodenoscopic evaluation. Twelve years after operation, 115 of the patients could be evaluated. Recurrence was defined as endoscopic or surgical evidence of the ulcerous lesion. The endoscopic results after 12 years showed 1.56% of relapses in the group that underwent oxyntic cell vagotomy with simple closure, and 54.9% in the group that only had simple closure (p less than 0.0005). There were also significant differences in the clinical and radiographic controls, and in the degree of comfort achieved with the technique. Mortality was null in both groups and there were no differences between the two techniques as regards morbidity. The results obtained in this study show that oxyntic cell vagotomy with simple closure of the perforation may be the technique of choice in the treatment of perforated duodenal peptic ulcer, which is why we think is should be more extensively used in emergency services.

We have made a comparative cross study of 30 patients with chronic pancreatitis and steatorrhea. The aim of the study has been to compare the effectiveness of a new galenic form of pancreatin, in pellets, with the common galenic presentation, in tablets. In all the cases the cause of pancreatic failure was alcoholism. In both groups the treatment was administered during seven days, after a period of wash out. We evaluated steatorrhea and clinical symptoms, including the typical abdominal pain. (The doses administrated were 12 tablets/day or 9 pellets/day.) Statistically there was a significant decrease of steatorrhea p less than 0.01.

We present our experience on pancreato-duodenal trauma surgically treated; we have studied the etiopathogenesis of the lesions and the severity of the condition, which is related to their anatomical relationships and to the difficulties of the early diagnosis. We emphasize the value of non invasive diagnostic methods, particularly immediate ultrasonography, CAT and exceptionally RECP. Abdominocentesis with peritoneal lavage and the insertion of a catheter through a minimal jejunostomy, for the nutritional support of the patient and to prevent complications merits special mention.

In five patients, three male and two female (average age 74 years), with complete rectal prolapse, Delorme's operation was performed, realizing resection of the entire prolapsed rectal mucosa and the suturing the plicature of the rectal muscular layer, which permits its invagination into the muscular funnel formed by the outer sphincter. This technique, which also tenses the longitudinal muscle of the rectum that is lax in every total prolapse, partially remedies the dislocation of the hiatal ligament and improves the function of the elevator muscle, which is disordered in these patients. The five patients were followed-up for 3 to 36 months. There was no postoperative morbi-mortality in patients of advanced age or high risk had to be operated for rectal prolapse.

A case of glomus tumor of the stomach occurring in a patient of 59 year old founded during a cholecystectomy is described. Clinicopathological and immunohistochemical findings are commented.

A study performed on acute hepatitis affected subjects (patients) caused by virus B, is presented. Seventeen patients separated in two groups were treated for same: A) (10) positiveness of reply marker in serum, and negative for spittle. B) (7) positiveness of reply marker in serum and spittle. Above said was determined throughout DNA molecular hybrid of VHB in serum and spittle. For group B patients, detecting this marker positiveness of 71.5% patients in serum and none in spittle.

We face a case of duodenal ulcer perforation a nine year old child who's diagnosis was not detected before operating. This is an unusual case and it is not normally observed in the differential diagnosis of the acute abdominal pain in the infancy. The lack of the radiological signs of perforation contributed to the diagnosis mistake before operating.