We present the case of a 29 year-old cholecystectomized woman with hepatic hydatid cysts who was admitted for acute pancreatitis. Echography and abdominal CAT revealed three thydatid cysts-the one in the right liver lobe being complicated-as well as pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed the suspected diagnosis of intrabiliary hydatid cyst rupture. An endoscopic sphincterotomy was performed, posterior evolution being asymptomatic, thus permitting the postponing of surgery.
61 patients with postoperative enterocutaneous fistulas of the small intestine, were admitted to the Intensive Care Unit from 1983 to 1989 and divided in two groups. Group A (n = 46) was treated with Total Parenteral Nutrition (TPN), while B (n = 15) received a combination of TPN and Somatostatin. The reduction of fistula output was significantly greater in group B. Spontaneous closure was observed in 30.4% of the cases in group A and in 53.3% in group B. A significant difference in the time taken to close the fistula between group A and B (29.7 +/- 18 versus 11.1 +/- 1.6 days) was observed.
Three cases are presented of traumatic diaphragmatic hernia which represent different stages in the evolution of this pathology, illustrating the different clinical presentation, course, diagnostic methods and surgical solutions. Emphasis is placed on the importance of early diagnosis to reduce the mobi-mortality of this important disease. A bibliographic review is made.
One of the main drawbacks attributed to azygoportal disconnection operations in the surgical treatment of bleeding esophageal varices is recurrence of hemorrhage. The present paper reviews the results obtained as regards hemorrhage recurrence in 4,975 patients who underwent azygoportal disconnection in 41 series published in the western literature in recent years. An analysis is also made of the factors that, according to different authors, could be related to the failure of these procedures to prevent eventual variceal hemorrhage.
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.
Recent studies of in vitro evolution of DNA via protein binding indicate that the evolution behavior is qualitatively different in different parameter regimes. I here present a general theory that is valid for a wide range of parameters, and which reproduces and extends previous results. Specifically, the mean-field theory of a general translation-invariant model can be reduced to the basic diffusion equation with a dynamic boundary condition. The simple analytical form yields both quantitatively accurate predictions and valuable insight into the principles involved.
Surgery of the distal half of the rectum has changed considerably in the last decades; new technical procedures have made possible the conservation of the sphincters in a considerable number of patients. We present the most significant factors of this change in surgical approach. The supporting pilars of the change have been the possibility of automatic sutures (staplers), the reduction of the distal margin and the fact that the rate of complications is similar to that of the abdomino-perineal resection. We review the complications of the surgical treatment (stenosis and fistulas) and the advantages and disadvantages of the instrumental sutures and new surgical procedures.
An extensive review is made of the prognostic variables that can affect the survival of patients with cancer of the colon and rectum. The prognosis is considered in the light of findings of the clinical history, physical examination, radiology, endoscopy and anatomopathologic results. The prognosis of different types of colonorectal cancer is also examined.
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.
We present the case of an asymptomatic male in whom bilateral hilar and right paratracheal lymph node enlargement was a casual finding. An esophagogram was performed to evaluate possible mediastinal nodes and an esophagobronchial fistula was discovered. In view of the coexistence of lymph node enlargement and esophagobronchial fistula, the case was presumed to be tuberculosis, as was confirmed by sputum culture positive for Mycobacterium tuberculosis. After tuberculostatic treatment, the course was favorable. Closure of the fistula was confirmed in a later follow-up.
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.
Boerhaave's syndrome, or spontaneous esophageal perforation, is an infrequent entity with an elevated morbidity and mortality. Its clinical manifestations are such that an extensive differential diagnosis with other entities in necessary, but diagnostic delay worsens the prognosis. We present a new case of Boerhaave's syndrome, that debuted as a picture of acute abdomen which led to the realization of an exploratory laparotomy that failed to evidence the esophageal perforation.
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.
