Preservación del esfinter anal en lesiones rectales bajas / Preservation of the anal sphincter in low rectal lesions

We have discussed the surgical options to save the anorectal sphincter in lesions within the lower 2/3 of the rectum. We presented four clinical cases: two villous adenomas, one adenocarcinoma and one benign tumor, probably of embryonic origin. We discussed the surgical options in order to avoid a permanent colostomy. There is not a single surgical procedure that we can count on to preserve the anal sphincter, either in benign or malignant lesions. The surgeons treating this pathology should consider all options and be able to select the most adequate, the less complicated and yet be able to preserve continence. The surgeons should remember that in treating malignant lesions [quot]a curative resection is worth a colostomy[quot]

Tuberculosis abdominal / Abdominal tuberculosis

The authors studied the symptoms, signs and diagnostic procedures in 9 cases of abdominal tuberculosis, six in women, three in men, 17 to 84 and average of 43 years old, who were treated in the Social Security Arnulfo Arias Madrid Hospital Complex in Panama City. In 8 cases the diagnosis was confirmed by biopsy with laparotomy, in 5 with laparoscopy in 1 case because by concomitant lung tuberculosis and improvement with antituberculosis drugs. They present the clinical histories of 2 patients in order to discuss the presenting complaints in abdominal tuberculosis, review the pathology and arouse interest in the study of this entity precisely now that since the initiation of the AIDS epidemic in Panama in 1984 until July 1992 there have been a total of 369 confirmed cases of which 18% had tuberculosis as the first or second opportunistic infection

Cáncer colorectal: un estudio de 133 casos quirúrgicos / Colorectal cancer: a study of 133 surgical cases

The author studied the medical records of 133 patients who underwent surgery for adenocarcinoma of the colon or rectum in the Metropolitan Hospital Complex Arnulfo Arias Madrid from June 1972 to July 1992. In 9 (6.7%) the tumor was staged as Dukes A, in 49 (36.8%) as Dukes B; in 60 (43.1%) as Dukes C and in 10 (16.7%) as Dukes D. The anatomical location of the tumor was the cecum in 9 (6.7%), the ascending colon in 3 (2.3%), the sigmoid colon in 44 (33%) and the rectum in 41 (31.6%). Of the rectal carcinomas 24 (58.5%) were in the inferior one third, 10 (24.3) were in the middle and 7 (17%) in the superior third. It is evident that nearly two thirds of the tumors were within reach of the digital rectal examination of the sigmoidoscopic examination. The parents ranged from 21 to 89 years of age and their median age was 63 years. 73 patients were women and 60 were men. 60.5% of the women and 39.5% of the men had carcinoma of the colon. The sexual prevalence of carcinoma of the rectum was different: 5% were in men and 43% were in women. 2.2% of the tumors were synchronous and 4% were metachronous. The author discusses the number, type and indications for the surgical procedures used. There were no perioperative deaths. The 5 year survival for adenocarcinomas of the colon was 100% for those patients with tumors staged as Dukes A, 78.5% for the Dukes B, 61.1% for the Dukes C and 0% for those staged as Dukes D. For the rectal adenocarcinomas the 5 year survival was 100% for those patients with tumors in Stage Dukes A, 57.1%, for those in Dukes B, 33.3 for those in Dukes C and 0% in those in Dukes D. These results indicate that these patients are seen in an advanced stage and point to the urgent need to make the diagnosis in early, curable stages. The low incidence of tumors in stage Dukes A indicates an indifference of the patients and/or the doctors to the symptoms and signs of this disease. The most frequent symptoms, in descending order were: bleeding on defecation (all types), change in bowel habits (diarrhea or constipation), abdominal pains, tenesmus and anemia (with its different clinical manifestations). Other symptoms were a palapable abdominal mass, feces with bloody mucus and rectal prolapse on defecation