Revista espanola de las enfermedades del aparato digestivo最新文献

We evaluated the echographic findings in gallbladder and bile duct disease in 300 patients. These findings were correlated with those obtained after surgery and post-mortem study. The literature was reviewed to compare our results with those of other authors. In some pathologies, mainly those involving distension of the choledochus, echography must be accompanied by other diagnostic techniques, endoscopy and conventional radiology, to determine the cause of the obstruction responsible for distension. Finally, we conclude that echography is very efficient in this kind of exploration because of its high diagnostic reliability, its innocuousness and the fact that barium contrast is not required.

Among the hematologic complications associated to cancer, microangiopathic hemolytic anemia and leukoerythroblastosis are rarely reported together. We present the case of a patient with gastric adenocarcinoma that presented clinically with microangiopathic hemolytic anemia and leukoerythroblastosis in peripheral blood as a result of metastatic invasion of the bone marrow. We discuss the probable etiopathogenic relation of these two entities with cancer, the therapeutic possibilities and the primary role of bone marrow biopsy and examination of the peripheral blood smear as more reliable diagnostic methods.

We present a case of extrahepatic biloma in a patient who was an emergency admission to the hospital and had a clinical pattern of obstructive jaundice secondary to choledocholithiasis. The diagnosis was made by echography and needle aspiration (PAAF). Due to the unfavorable evolution of the patient in the 48 hours after admission, she underwent surgery, which confirmed the diagnosis. Cholecystectomy was performed, with removal of the choledochal gallstone and side-to-side choledochoduodenostomy, and the postoperative evolution was satisfactory. We review the pathophysiologic characteristics of this entity and its etiology, symptomatology, diagnosis and treatment.

We reviewed retrospectively the septic postsplenectomy complications after splenic rupture from abdominal trauma in 53 patients treated in the last five years (1984-1988). We recorded a higher incidence of complications (pneumonia, subphrenic abscess) in these patients than in those who underwent clean surgery during the same period, but we did not demonstrate the same difference in other infectious processes (infection of the surgical wound). Infections had a higher incidence in patients with splenic rupture with associated lesions (54.10%) than in those with only a splenic lesion (37.50%) (SD p less than 0.05). The predominant agents usually isolated were aerobic Gram-positive. We remark the importance of open drainage systems (Penrose type) in the genesis of subphrenic abscesses.

In patients carrying a Kehr tube choledochostomy, the surgeon may observe, but rarely, important hypercholeresis, non-bile-acid dependent, in people with severe advanced chronic hepatic diseases or persistent cholestasis. The amount of bile flowing to the outside can reach two liters and more daily. We have seen this in two patients with compensated hepatic disorders and in another suffering from light cholestasis produced by choledocholithiasis. We have also found the same in three other people with liver and the main biliary extrahepatic tract completely normal. This hypercholeresis is continuous and subject to rapid increases relative to the ingestion of food. Such increases are related to gastrointestinal hormones, specially secretin, which is produced when portions of gastric chyme enters the duodenum.

We reviewed 680 cases of colorectal neoplasms with an incidence of 18 synchronous multiple carcinomas (2.7%). We describe the predominance in females (11/7), the late age of presentation (maximal incidence between 60 and 80 years) and the main symptoms of these patients. We remark the diagnostic difficulty of these tumors, despite all the methods used; the diagnosis of the second mass was intraoperative in 50% of the cases in our series. As treatment, we suggest partial colectomy, except when there is massive colonic affectation, in which we practice a total colectomy. The prognosis in these patients is similar to that of those who have a single carcinoma. We must carry out a rigorous follow-up of these patients to make an early diagnosis of any new metachronous tumors.

We present a case of cancer of a choledochal cyst in a patient with antecedents of cholecystectomy, who complained of pain in the right hypochondrium. Echography and CAT disclosed a cystic mass of biliary location, and the diagnosis was confirmed by intraoperative cholangiography and biopsy of the cyst margin. Cysto-jejunostomy on a Roux-en-Y loop was performed. The patient survived 11 months and died of tumoral dissemination. We reviewed 130 cases of cancer of a choledochal cyst published up until 1986 and possible etiopathogenic causes, and we discuss the diagnostic problems and related treatment.

We present the case of a 63-year-old female who with no previous history presented with episodes of self-limited diarrhea without fever, general repercussions, abnormal elements or tenesmus. Biochemistry: no abnormality. Parasite and feces culture: negative. Colonoscopy: at 20 to 40 cm from the anal margin were found polypoid lesions covered with normal mucosa. Barium enema confirmed the presence of multiple lacunar defects and possible parietal gas. Biopsy: submucous cysts with foreign body type giant cells. Mixed infiltrate. The differential diagnosis was made between intestinal enterogenous cyst, lymphangioma, retractable mesenteritis and deep cystic colitis, concluding with pneumatosis coli that evolved favorably.

We present our recent experience in the last ten cases of Spiegel's hernia, studying its form of presentation and clinical manifestations. We studied emergency cases because they presented intestinal obstruction and were handled as a surgical emergency. We remark the noninvasive diagnostic methods, mainly echography. The surgical treatment for repair of the hernial defect and the material used was the same in every case. The morbi-mortality of the series was null and there was no recurrence in the period in which we studied and followed-up the series.

In this study we review the mortality in Spain from liver cirrhosis between 1951 and 1983. There was a decrease in the general mortality due to this cause, while in the study of mortality by sexes there was only a tendency to decrease in males but not in females. When an analysis was made according to age groups, there was a tendency to rise in younger patients, while there was a lowering in older ones. We also studied comparatively the mortality data for the same cause in France.