[Endocrine tumors of the pancreas at a Mexican institution]. / Los tumores endocrinos del páncreas en una institución mexicana.

OBJECTIVE: To analyze characteristics of patients with endocrine tumors of the pancreas seen between 1960 and 1992 at the Instituto Nacional de la Nutrición. MATERIAL & METHODS: The clinical records of 38 patients with endocrine tumors of the pancreas were reviewed. Overall characteristics, diagnostic studies, intraoperative findings, treatment and outcome were analyzed. The archival histological specimens were revised and immunohistochemical stainings were performed in the non-functioning tumors. RESULTS: Twenty patients had hyperinsulinism, 10 non-functioning tumors, and eight a Zollinger-Ellison syndrome. The mean age of patients with hyperinsulinism was 38 years (8 males and 12 females); 18 were sporadic and two associated with MEN I syndrome. In 16 patients an insulinoma was removed: (6 in the head, 5 in the body, 5 in the tail of the pancreas). A cure was documented in 14 patients with sporadic tumors but not in the two cases associated with MEN I; 15 tumors were benign. Three patients with the Zollinger-Ellison syndrome were males and five females with a mean age of 41 years. Seven tumors were sporadic and one associated with the MEN I syndrome; 70% were located in the gastrinoma triangle. Local excision was performed in five and gastrectomy in three. The cure rate was 60% and malignancy was documented in 40%. Two males and eight females with a mean age of 30 years had non-functioning tumors (9 sporadic and one associated to MEN I). There was a positive immunohistochemistry in 60% of the tumors; 90% were malignant and the cure rate was 10%. CONCLUSIONS: Insulinoma is the most common endocrine tumor of the pancreas in our hospital. The cure rate for insulinomas, gastrinomas and non-functioning tumors was 90%, 60% and 10% and malignancy was documented in 5%, 40% and 90% respectively.

[Esophagocardiomyotomy or modified Heller technique, through the thorax, for the treatment of achalasia]. / Esofagocardiomiotomía o Heller moldificado por vía torácica, para el tratamiento de la acalasia.

BACKGROUND: Since 1913 surgical myotomy has been an effective method for patients with esophageal achalasia and until today there is controversy between pneumatic dilatation or surgery and between the abdominal or thoracic approach for Heller's procedure. AIMS: To find out the long-term results with thoracic short esophagomyotomy without an antireflux procedure for esophageal achalasia. METHODS: The charts of 31 patients with achalasia operated of thoracic Heller's myotomy between 1986 and 1995 were reviewed in retrospective fashion. RESULTS: Demographic and clinical data were similar to those reported in the English literature. Twenty five patients received medical or endoscopic treatment with poor results. Prior abdominal Heller's myotomy was performed in 5 patients, 25 per cent of patients developed postoperative complications, there was no operative mortality. The mean follow-up period was 4 years and 93.6 per cent of patients showed good to excellent results; in this group 3 patients (9.7 per cent) reported sporadic dysphagia. Two patients (6.4 per cent) had gastroesophageal reflux. CONCLUSIONS: The thoracic esophagomyotomy is a safe procedure for esophageal achalasia, it is easy to perform, there are several technical advantages over the abdominal approach, an antireflux procedure is not necessary and in the long-term follow-up a large number of good-to-excellent results may be obtained with both surgical approaches.

[Complex anal fistulas]. / Fístulas anales complejas.

BACKGROUND: Anorectal fistulas test the performance and experience of colon and rectal surgeons. PURPOSE: This review paper was performed to discuss the most recent advances in the diagnosis and treatment of complex anorectal fistulas. RESULTS: Failures to treatment of anorectal fistulas may be reduced only by fully knowledge of the anorectal anatomy, and all the possible routes that the fistulas could go through. Their complexity is directly related to their relationship with the anal sphincter, which should be considered by the surgeon in order to take care of the perfect identification and localization of their origin. Treatment should be individualized to each patient. CONCLUSIONS: The role of the diverse surgical alternatives will depend upon the characteristics and relationships of the fistulous tract and the sphincter.