Traumatismos colorrectales por cuerpos extraños introducidos por prácticas sexuales: actitud diagnóstico-terapéutica / Colorectal trauma caused by foreign bodies introduced during sexual activity: diagnosis and management

Objetivo: este trabajo trata de exponer la experiencia de 17 casos de cuerpos extraños colorrectales introducidos por prácticas sexuales, los cuales han sido recogidos por los autores a lo largo de veinte años (1980-2000), y establecer las pautas diagnósticas y terapéuticas ante estas situaciones. Material y métodos: un total de 17 pacientes fueron tratados de traumatismos rectales por introducción de cuerpos extraños, por prácticas sexuales no habituales. La extracción del cuerpo extraño del recto se consiguió en 10 casos por vía anal mediante diversas técnicas (pinzas ginecológicas, sondas de Foley, etc.), y 7 pacientes requirieron intervención quirúrgica, siendo necesaria una colostomía de protección en 5 pacientes, y sutura de la lesión rectal en los 2 restantes. Resultados: mortalidad nula. Postoperatorio sin complicaciones. Cierre de la colostomía en todos los casos a los 3-6 meses de la intervención. No hubo ningún caso de incontinencia anal. Conclusiones: es fundamental realizar una correcta anamnesis y exploración física del paciente, a parte de todas las exploraciones complementarias que sean necesarias, para un correcto diagnóstico y tratamiento de las lesiones. Habrá que tomar grandes precauciones en la extracción del cuerpo extraño para que no se produzca la rotura de éste en el recto, convirtiendo un problema relativamente simple en uno más complejo (AU)

Colorectal trauma caused by foreign bodies introduced during sexual activity: diagnosis and management.

PURPOSE: The aim of this study is to describe 17 cases of colorectal foreign bodies introduced during sexual activity, gathered by the authors over the past twenty years (1980-2000), and to establish diagnostic and therapeutic guidelines for these situations. MATERIAL AND METHODS: A total of 17 patients were treated for rectal trauma caused by foreign bodies due to unusual sexual practice. The extraction of the foreign body was possible through the canal anal in 10 cases using different techniques (gynecological forceps, Foley catheters, etc.), whereas 7 patients required surgical treatment; in five patients a protective colostomy was needed, and in the other two a simple suture of the rectal lesion was performed. RESULTS: There were no deaths and no post-operative complications. In all cases the colostomy was closed 3-6 months after surgery. There were no cases of anal incontinence. CONCLUSIONS: A detailed clinical history and physical examination are essential for the diagnosis and management of these lesions, in addition to any other diagnostic techniques that might be necessary. Great care should be taken when extracting the foreign body so as to avoid its breakage inside the rectum, which would complicate a rather simple problem.

Estadificación laparoscópica del cáncer digestivo / Laparoscopic staging of gastrointestinal cancer

Introducción. Establecer el estadio de los tumores digestivos es de gran importancia a la hora de plantear su tratamiento. La estadificación laparoscópica y la ecografía por laparoscopia, como método para explorar la cavidad abdominal, se han introducido de forma progresiva en los algoritmos diagnóstico-terapéuticos de estos pacientes. Resultados. En la experiencia de los autores, la estadificación laparoscópica en el cáncer gástrico evita la laparotomía innecesaria en el 40 por ciento de los casos, con una exactitud en la resecabilidad tumoral del 98 por ciento. En el cáncer de cardias y esófago, así como en el cáncer colorrectal, ofrece importante información en cuanto a la existencia de diseminación a distancia o metástasis hepáticas, especialmente con la ayuda de la ecografía por laparoscopia. En cirugía hepatobiliopancreática es donde se manifiesta especialmente la utilidad de la ecografía por laparoscopia, permitiendo modificar el estadio tumoral establecido preoperatoriamente y evitar un 25 por ciento de laparotomías en tumores hepáticos. En el cáncer de páncreas, la estadificación y ecografía por laparoscopia modifica la actitud inicial en el 35 por ciento de los casos y evita una laparotomía innecesaria en el 20 por ciento. Conclusión. La estadificación laparoscópica es de gran utilidad para establecer el estadio intraoperatorio de los tumores digestivos y puede ayudar a la hora de tomar decisiones intraoperatorias. En el caso de los tumores hepatobiliopancreáticos, la información adicional ofrecida por la ecografía laparoscópica permite disminuir la incidencia de laparotomías innecesarias y debe plantearse como paso previo a la cirugía (AU)

Laparoscopic evaluation of the risk of locoregional recurrence after radical surgery for gastric cancer.

OBJECTIVE: we studied the diagnostic utility of laparoscopy in patients who underwent absolute radical surgery (R0) for gastric adenocarcinoma and who were at risk for locoregional recurrence. Risk was considered to exist in patients with T3-T4 stage tumors (IUAC TNM classification) that invaded the serosa or affect nearby organs. These patients are candidates for clinical trials involving multimodal therapies, especially with neoadjuvant or intraperitoneal chemotherapy. METHOD: ninety consecutive patients with gastric adenocarcinoma diagnosed by endoscopic biopsy were studied. The tumors were considered to be operable and potentially resectable depending on the preoperative evaluation of spread. The gold standard was the pathology report, based on the resected piece or specific biopsies. RESULTS: in T3-T4 tumors, laparoscopy had a sensitivity of 81% and a specificity of 100%, whereas for an 80% prevalence the positive predictive value was 100%, the negative predictive value was 56%, and diagnostic accuracy was 84%. CONCLUSIONS: in global terms, laparoscopy is very useful in detecting and confirming malignant invasion of the serosa or neighboring organs. In this sense it is similar to other diagnostic staging techniques such as endoscopic echography, with the added advantages of requiring less operator skill and being available in any center where such tumors are treated.

[Subcutaneous injection chambers for central venous access: a multicenter clinical trial. The Interhospital Group of Valencia (GIHV)]. / Cámaras de inyección subcutánea para acceso venoso central: un ensayo clínico multicéntrico. Grupo Interhospitalario Valenciano (GIHV).

UNLABELLED: A multicentric clinical trial was performed to evaluate two routes of access for implantable subcutaneous central venous devices: by way of the subclavian vein (group A) and peripheral access by way of the veins of the flexion side of the elbow (group B). The indications for implantation were: antineoplastic treatment of solid tumors, myelo- and lymphoproliferative syndromes, antiviral treatment, and parenteral nutrition at home. The study was composed of 87 patients, 48 men and 39 women, with a mean age of 57.1 years (SD = 12.6). Group A was made up of 48 patients, and group B of 39. RESULTS: Implantation failure was 8.3% in group A and 5.1% in group B (p = n.s.). Complications of implantation were 23.4% in group A and 15.4% in group B (p = n.s.). The complications of permanence were diagnosed at 27.6% in group A and at 15.4% in group B (p = n.s.). CONCLUSIONS: We have not been able to find significant differences between the two groups, probably due to the fact that the series is still short. Nevertheless, the manageability, comfort for the nursing staff and for the patients, appears to be greater with the devices implanted in the infraclavicular region, by means of a subclavian vein puncture.

Laparoscopic access to the lesser sac in gastric cancer staging.

A new technique to access the lesser sac in gastric cancer staging by laparoscopy is described. The posterior surface of the stomach is approached through the gastrocolic ligament after lifting the stomach by means of a transparietal suture.

Endoscopic enhancement of the healing of high-risk colon anastomoses by low-power helium-neon laser. An experimental study.

Recent studies suggest that helium-neon (He-Ne) lasers at low energy can enhance wound healing in intestinal anastomoses. In this experimental study, we tested the strength and collagen concentration of high-risk anastomoses of the rat colon after endoscopic irradiation by helium-neon laser. Our results show that repeated helium-neon laser irradiation (1.9 J/cm2) increases the bursting strength of the anastomoses by almost 100% on the fourth postoperative day. This effect is not observed by increasing the radiation dose (6.4 J/cm2). Differences in collagen (hydroxyproline) concentration did not reach statistical significance.

Histological effects of He:Ne laser on the healing of experimental colon anastomoses in the rat.

Despite technical advances, the incidence of anastomotic leaks in elective colorectal surgery remains around 14%. Recent studies suggest that the use of low-energy lasers may enhance wound healing in different tissues in a selective, nondestructive manner. Based on these findings we have attempted to provide experimental background on the histological effects of He:Ne laser during the early stages of healing in 70 colonic anastomoses performed on rats. The irradiation of the anastomoses by two doses of 3.6 J/cm2 produces an increase in the populations of round cells and fibroblasts of the scar tissue, an increase in new vessel formation, and a significant improvement in epithelialization. This suggests that the irradiation of colonic wounds with He:Ne lasers can result in an enhancement of healing.

[Surgical treatment of cancer of the colon: a review of 175 cases]. / Tratamiento quirúrgico del cáncer de colon: revisión de 175 casos.

We present a review of 175 cases of carcinoma of the colon out of 270 cases of colorectal cancer operated in our service during the period 1980-1986. It is noteworthy that 46.8% of the patients underwent emergency surgery for occlusion and/or diastasic tumoral perforation, and that they presented an advanced average age (48.5% were over 70 years). In emergency surgery there was a predominance of bypass operations (73%) versus tumoral resection (27%). In programmed surgery the index of resectability was 83%. The global operative mortality was 12.5%, but separately it was greater for emergency surgery (18%) than for elective surgery (7.5%). Wound infection occurred in 35% of emergency operations and in 11.8% of programmed operations. An anastomotic fistula appeared in 6.9% of cases, with a similar incidence for mechanical and manual anastomoses. It is concluded that early detection of the disease is necessary to reduce the percentage of urgent operations, and consequently the rates of operative morbi-mortality, and improve long-term survival.

Stimulation of the healing of experimental colon anastomoses by low-power lasers.

Anastomotic leakage following colorectal surgery remains a complication with high mortality and morbidity. Recent studies suggest that helium-neon (He-Ne) lasers at specific energy densities can be used to enhance wound healing in different tissues. In this experimental study we have tested the strength of end-to-end anastomosis of the rat colon irradiated by He-Ne laser by measuring bursting pressures and bursting wall tensions at 2, 4 and 7 days after operation. The study shows that He-Ne laser radiation induces a significant increase in colonic strength at the anastomosis. The laser does not cause the luminal narrowing observed in non-irradiated specimens.