[Colitis cystica profunda. A case report]. / Colitis quística profunda. Informe de un caso.

OBJECTIVE: To present a pathology not previously informed in national literature. BACKGROUND: Colitis cystica profunda (CCP) is a rare benign entity and with an unknown etiology. There are 148 cases documented in world literature at the present time. Histologically it is defined as the obliteration of lamina propria by fibroblasts and the presence of submucous cysts. It comes in localized, segmental or diffuse forms and associated to other entities as solitary rectal ulcer, rectal prolapse, alterations in the pelvic floor, etc. Treatment can be medical or surgical according to severity of its manifestations. METHOD: A case of CCP is revised as well as the treatment effectuated. RESULTS: A case of patient with the diagnosis of CCP of localized type is presented, which principal symptom was transanal mucous secretion; on physical exploration a sessile mucous polypoid formation at 8 cm from anal verge was found and was treated with surgical resection with a satisfactory outcome. CONCLUSIONS: In a patient with alterations in pelvic floor or puborectal bundle contraction and sigmoidorectal intussusception CCP must be suspected. Treatment can be medical with a high percentage of failure being optimal treatment the surgical one.

[Hereditary nonpolyposis colorectal cancer. Lynch syndrome]. / Cáncer colorrectal hereditario sin poliposis. Síndrome de Lynch.

BACKGROUND: Hereditary non-polyposis colorectal cancer represent 5% of the colorectal cancer population. It's characterized by an autosomal dominant inheritance; there are two variants: Lynch syndrome I is characterized by predisposition to early onset colorectal cancer, with predominance for proximal location to the splenic flexure and synchronous and/or metachronous colorectal cancers. Lynch syndrome II shares the same features, but shows association with extracolonic cancers, particularly carcinomas of endometrium, ovary and stomach. However, this syndrome is not easily recognized, due to the lack of phenotypical expression as familiar adenomatous polyposis. OBJECTIVE: The purpose of this report is to review the natural history, diagnosis, treatment, surveillance of the probands and their families, and to update recent research on the genotypic risk biomarkers located in chromosomes 2, 3 and 7. METHODS: We analyzed the available literature to discuss the clinical characteristics, pathology, genetics, management, and surveillance of hereditary non-polyposis colorectal cancer. CONCLUSIONS: The diagnosis of hereditary non-polyposis colorectal carcinoma is not a rare event. It requires the demonstration of vertical transmission, therefore, the past history of colorectal cancer in the proband and his family should be carefully taken; including the anatomic site, histology and age at diagnosis.

[The mechanisms of the dissemination and the treatment of ovarian metastases in colonic adenocarcinoma]. / Mecanismos de diseminación y tratamiento de las metástasis ováricas de adenocarcinoma de colon.

OBJECTIVE: The aims of this study are: 1) To known the frequency of ovarian metastasis, 2) to define the role of the surgical therapy and 3) to establish the mechanism of spread of colorectal cancer to the ovaries. MATERIAL AND METHODS: Between 1989 and 1993 624 patients with colorectal adenocarcinoma; were treated, 19 (7.7%) had ovarian metastasis; they were divided in 2 groups according to the diagnostic time: A) synchronous; B) metachronous. In most patients a peritoneal lavage were performed; the primary tumor was resected. RESULTS: The median age was 41.4 years. In group A: there were 9 patients; in 3 of them underwent elective surgery and in 6 an exploratory celiotomy due to colonic obstruction or perforation. The primary tumor was located in the sigmoid in 8 patients and in cecum in 1; the stage of the primary tumor was follows: B1, 2; B2, 3; C2, 4. The ovarian metastasis were located in the left ovary in 6; right, 2, and bilateral 1. The peritoneal lavage was positive in 6, and negative in 3. In group B: there were 10 patients; one underwent elective surgery and 9 exploratory celiotomy. The primary tumor was located in the sigmoid in 9, caecum in 1. The stage of the primary tumors were: B2, 4; C2 4; D, 2. The ovarian metastasis were located: left, 5; right, 1; bilateral, 4. The peritoneal lavage was positive in 6, negative in 2. The 5-year survival in group A was 16% in group B, 0%. CONCLUSION: Ovarian metastasis were associated with advanced metastatic diseases. The treatment of synchronous ovarian metastasis is the resection of primary tumor plus bilateral oophorectomy, and in metachronous metastasis it is palliative. The mechanism of spread to the ovaries is by direct implantation and hematogenous.

[Incidence of post-dural puncture headache using the 24G "pencil tip" needle. Prospective study in 100 young patients]. / Incidencia de cefalea pospunción dural con la utilización de la aguja "punta de lápiz" 24G. Estudio prospectivo en 100 pacientes jóvenes.

We studied the incidence of headache after dural punction using a "pencil-tip" 24G needle in 100 patients aged 15 to 55 years (mean 31.4 years) undergoing surgical interventions that allowed early physical activity. The study variables were age, sex, anesthetic agent, and previous history of headache. All patients received 1,500 ml of Ringer lactate during the peroperative period and after 48 hours the presence of headache was investigated. Headache was not observed in any case. We conclude that the pencil-tip 24G needle has been effective in the prevention of headache after dural punction particularly in young patients, who are traditionally considered to be at risk.

[Epidural perfusion with fentanyl in the treatment of postoperative pain]. / Perfusión epidural de fentanilo en el tratamiento del dolor postoperatorio.

In 40 patients with high abdominal surgery the analgesia achieved with continuous epidural phentanyl infusion was evaluated. Treatment was started when the patients had pain, with the injection of 150 micrograms of phentanyl in 18 ml of saline and going on with the infusion. The patients were divided in 4 groups. Each received a different infusion dose. The variables pain, alertness, pO2, pCO2 and hemodynamic status at the beginning of infusion and after 6, 18 and 24 hours were evaluated. All patients had an adequate postoperative analgesia. In the statistical analysis the only significant difference was an increase in pCO2 after 24 h in the patients who received the highest doses. The incidence of nausea and vomiting was 10%, with 13.04% of urinary retention Clinical respiratory depression was not observed. We think that administration of 150 micrograms of epidural phentanyl followed by a continuous epidural infusion of the drug (0.5 microgram/kg/hour in 5 ml of saline) is an adequate technique of postoperative analgesia.