Excision and V-Y plasty reconstruction for giant condyloma acuminatum.

BACKGROUND: Condyloma acuminata is the most common anorectal lesion in patients infected with human immunodeficiency virus (HIV). Surgical treatment can be challenging in cases where the size and extension into the anal canal make individual excision impossible. These patients require large resections and reconstruction using grafts or local flaps. METHODS: Six patients were treated for giant perianal condylomas between 1999 and 2001. Four patients were HIV-positive, and were selected for surgical intervention after achieving a T4 count >350 and low viral replication. In 5 cases, the lesions were circularly resected up to the pectinate line and the defect was reconstructed using a bilateral V-Y plasty. In the remaining case, fulguration was possible on one side and a unilateral V-Y plasty was performed. RESULTS: There were no infections or healing delays in this series, and the functional and aesthetic results are satisfactory. CONCLUSION: V-Y plasties are a valid method for perianal reconstruction after resection of giant anal condyloma, with good results in selected patients with HIV infection.

Asociación de tumor carcinoide y endometriosis en el apéndice junto a endometriosis de íleon terminal / The relationship between carcinoid tumour and endometriosis of the appendix and also endometriosis of the terminal ileum

Presentamos el caso clínico de una mujer de 29 años, nuligesta, que consultó por dolor en el hipogastrio y fiebre, con leucocitosis y masa compleja en la ecografía. Se estableció el diagnóstico de peritonitis pélvica de origen no claro y se practicó laparoscopia y laparotomía. Se encontró una tumoración inflamatoria que afectaba al aparato genital, íleon y sigma. Se extirpó un pequeño tumor en el íleon, con anastomosis termino-terminal y apendicectomía. Se dejaron drenajes pélvicos. El diagnóstico definitivo fue de tumor carcinoide en el apéndice asociado a endometriosis apendicular. El tumor ileal también era un endometrioma aislado. Todo ello se produjo en un contexto de endometriosis del aparato genital. Se revisan estas asociaciones (AU)

Estudio Delphi de la Sociedad Valenciana de Cirugía: tratamiento quirúrgico del cáncer gástrico / A Delphi study by the Surgical Society of Valencia, Spain: surgical treatment of gastric cancer

Se presentan los resultados del primer estudio de consenso auspiciado por la Sociedad Valenciana de Cirugía sobre el tratamiento quirúrgico del cáncer gástrico. Se trata de un esudio tipo Delphi, con la participación de 31 expertos pertenecientes a la mayoría de hospitales de la Comunidad Valenciana. Los temas consensuados han versado sobre los siguientes aspectos: nutrición artificial, métodos de estadificación preoperatoria, tipo de resección y de linfadenectomía, técnicas de reconstrucción, criterios de resecabilidad y temas de organización (AU)

Video-laparoscopic staging of gastric cancer. A prospective multicenter comparison with noninvasive techniques.

BACKGROUND: The high proportion of gastric carcinomas present in an unresectable stage, together with the emergence of multimodal treatments, increases the usefulness of objective staging methods that avoid unnecessary laparotomies. METHODS: A prospective evaluation of the accuracy of laparoscopy in the staging of 71 patients with gastric adenocarcinoma is presented. Serosal infiltration, retroperitoneal fixation, metastasis to lymph nodes, peritoneal and liver metastasis, and ascites were determined in the staging workup. Sensitivity, specificity, and predictive values were calculated and compared with those obtained with ultrasonography (US) and computed tomography (CT). RESULTS: The diagnostic accuracy of laparoscopy in the determination of resectability was 98.6%. Consequently, over 40% of patients were spared unnecessary laparotomies. Laparoscopy yielded diagnostic indices superior to US and CT for all the tumoral attributes studied. Our technique permits accurate assessment and pathologic verification of liver and the peritoneal and retroperitoneal extent of tumor invasion in the majority of patients. CONCLUSIONS: Laparoscopy in gastric adenocarcinoma is a reliable technique that provides accurate assessment of resectability and stage, thus avoiding unnecessary laparotomies in patients in whom surgical palliation is not indicated. A stepwise diagnostic workup combining imaging and minimally invasive techniques is proposed.

[Size of breast cancer at the time of initial diagnosis]. / Extensión del cáncer de mama en el momento del diagnóstico inicial.

BACKGROUND: To observe whether patients with breast cancer of an epithelial strain consult physician with a less advanced disease, the patients attended by the Valencian Interhospital Group were studied between January 1981 and December 1990. METHODS: The same diagnosis of disease spread (anamnesis, physical examination, blood analysis and imaging techniques of the thorax, bones and liver) was carried out in all cases. Surgical techniques and histopathologic criteria were homogenous throughout the study. The classification used was that of the International Union Against Cancer of 1987. Histopathologic correlations were studied. RESULTS: Seven hundred seventy-nine patients with a mean age of 57.3 years (range: 24-85) were studied. A statistically significant (S) progressive reduction in the size of the tumor was observed (p less than 0.003) with the percentage of stage II progressively increasing and stage IIIa (more advanced disease than stage II) parallelly diminishing (p less than 0.0019) (S). In patients over the age of 55 this diminution was not observed. To the contrary, more advanced stages (stage IIIb--locally advanced, and stage IV--metastatic disease) were presented than in younger women (p = 0.000) (S). There is a direct correlation between the size of the tumor, the degree of tumoral differentiation and lymphatic metastases. CONCLUSIONS: Patients under the age of 55 spontaneously and progressively consult the physician with a less advanced breast cancer. This is expected to have beneficial effects on survival. It is suggested that primary medicine may play a fundamental role in making women more aware of breast cancer, particularly those over 55 years of age regardless of early detection campaigns.

120-hour 5-fluorouracil (5-FU) continuous infusion (CI) plus BCNU in advanced colorectal cancer.

Seventy-five previously untreated patients with measurable advanced colorectal cancer were treated with 5 fluorouracil 1,000 mg/m2 as a 24-hour intravenous (i.v.) continuous infusion during days 1-5 and 28-32 every cycle, plus 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU), 200 mg/m2 i.v. bolus on day 1, all given every 8 weeks up to 6 cycles. Median Karnofsky performance status (KPS) was 100. Sites of disease at entry were mainly the abdomen (45%) and liver (33%). All patients were evaluable for response and survival. There were two complete responses and seven partial responses (PR) for an overall response rate of 12% (95% confidence limits: 5-20%). Four out of 25 patients with liver metastases alone had PR. Stabilization was seen in 40 patients (53%). Median time to progression was 9.3 months and overall median survival was 12.5 months, whereas median survival for patients with liver metastases alone was 16 months. Toxicity was mild except for 8% with WHO grade 4 mucositis. Only KPS had statistical significance in the multivariate analysis of prognostic factors. It is concluded that this regimen is relatively active and well tolerated in patients with advanced colorectal cancer.