Revista espanola de las enfermedades del aparato digestivo最新文献

A patient is presented who was operated for an intestinal obstruction and developed in the immediate postoperative period Boerhaave's syndrome. Subtotal esophagectomy with bipolar exclusion was performed. We discuss the advantages of radical surgery, even in advanced cases, if the size of the lesion justifies it, as compared to more conservative therapeutic attitudes.

We present a patient with acute pancreatitis that was specially persistent from a biochemical viewpoint, derived from a duodenal sarcomatous tumor of immunoblastic type that narrowed the second duodenal segment for a length of about 8 centimeters. We discuss the possible role of tumoral neoformations in the production of pancreatitis due to increased intraluminal pressure distal to the Vater ampulla, or to occlusion of the Oddi sphincter or the Wirsung duct. We review the existent literature.

We review the incidence, etiopathogenesis, clinical manifestations and treatment of lower esophageal or Schatzki's rings. In patients with dysphagia caused by this ring, medical and dietetic treatment is the first step, and dilatation should be reserved for cases of failure of this treatment. Surgery is rarely needed, being indicated only in cases of recurrence or failure of dilatation treatment. In these cases, complete excision of the ring and end-to-end anastomosis of the gastric and esophageal mucosa through a gastrostomy is recommended before antireflux surgery is considered.

It seems logical to think that the longer the interval between the patient's first symptom of colorrectal cancer and operation, the greater the tumoral extension found by the surgeon will be, and the lower the postoperative survival. Nevertheless, there is much evidence to indicate that this may not always be true. We've analyzed the problem in 307 patients operated of colorectal cancer in our service from January 1979 to December 1984 and followed-up until now. We investigated the time interval from the first clinical symptom until operation, and survival. These variables were related to the Duke grade. As regards the preoperative interval, the average (in months) for Duke's grade A was 7.41 (sigma = 16.88), for D it was 7.41 (sigma = 9.47) and for C, 5.13 (sigma = 8.41). There were no statistically significant differences. As for survival, after four years all the grade A patients, 64% of the grade B patients and 35% of the grade C patients followed-up survived. We've found no relation between diagnostic delay and postoperative survival. These results suggest that it is not true that the longer the symptomatic period, the greater the tumoral spread. As such, diagnostic delay is not a good prognostic indicator for predecting tumoral spread or survival.

Leiomyosarcoma of the small intestine is a rare neoplasm that has a difficult, and normally late, diagnosis. We present two cases operated in our service and discuss the different forms of clinical presentation, the surgical strategy and the controversial aspects of benignity and malignancy aspects. The survival is emphasized.

In our center solitary ulcer of the rectum has a low incidence. There has been only one case in more than 13,000 distal endoscopic studies performed in the last ten years. Its rarity, and its possible confusion with other pathologies of the distal colon motivated our interest in this disease. The clinical and diagnostic features and therapeutic attitude in solitary rectal ulcer are remarked.

A case of gastric metastasis of renal carcinomas is described. The patient had been nephrectomized 22 months ago, and she had yet presented another in appearance solitary metastasis in lung and brain, which had been resected. This is a very unusual localization in the spread of a renal tumor, and two cases alone exist in the literature up to date which had been diagnosed during life. In despite of surgical treatment, a short free interval after nephrectomy and the tumor aggressivity, with three foci of spread at less than a year, have been the pivotal factors determining a relatively short survival of 26 months after resection of primary tumor.

Insulinomas are rare tumors whose difficult diagnosis is usually delayed with respect to appearance of the first symptoms. The Whipple triad (symptoms of hypoglycemia, low blood glucose and rapid alleviation of symptoms after glucose administration) associated with an increase in plasma immunoreactive insulin (IRI) and low blood glucose levels constitute the diagnostic basis of insulinoma as the cause of organic hypoglycemia. Curative treatment entails surgery and its success will depend on the location of the tumor. Selective arteriography and, more recently, percutaneous transhepatic insulin determination (IRI) in the splenoportal axis have a diagnostic rate of 90%. Nevertheless, none of these topographic diagnostic methods replaces meticulous intraoperative exploration of the pancreas, which in our case was definitive for cure.

Angiodysplasias of the colon are small vascular lesions that probably affect 25% of the population over 50 years. As a result of selective arteriography the number of diagnoses of lower gastrointestinal hemorrhage (HDB) caused by a colonic angiodysplasia (CA) has increased considerably. Seven new cases of colonic angiodysplasia (6 cecal and 1 rectal) are presented, all diagnosed by arteriography. In 6, treatment was surgical and in one, medical. The postoperative bleeding recurrence was 33.3%.