ABSTRACT
La hidatidosis está causada por la familia Equinococcus, más frecuentemente E. granulosus. Su localización más común es en el hígado, seguida del pulmón. La localización muscular es extremadamente rara (< 1%). Presentamos el caso de una mujer cardiópata, en tratamiento anticoagulante que presenta tumoración dolorosa de crecimiento progresivo en pared abdominal, sospechando inicialmente hematoma en evolución y siendo estudiada por TAC, donde se aprecia tumoración parietal con comunicación intraperitoneal contactando con colon y mesocolon transverso. Se realiza exéresis quirúrgica sospechando intraoperatoriamente hidatidosis muscular, confirmada posteriormente según estudio anatomo-patológico. La hidatidosis forma parte del diagnóstico diferencial ante una masa de partes blandas en regiones endémicas. Su sintomatología varía en función de la localización. A nivel muscular, se presenta habitualmente con dolor y aumento de volumen. Es imprescindible la sospecha clínica, junto con las pruebas de imagen y serologías para su diagnóstico
Hydatid disease is caused by Equinococcus family, the most common is E. Granulosus. The most common location is the liver, follow the lung. Muscle tissue is extremely rare location(< 1%). We present a woman with cardiac disease and anticoagulant treatment who had a painful and progressive growth tumour in the abdominal wall. Our first idea it's a chronic hematoma and in the computed tomography we observed the tumour had intraperitoneal communication in contact with colon. Surgical resection was performed, intraoperatively suspecting muscle hydatidosis, which was confirmed later in patologic study. Hydatid disease is one of the differencial diagnosis in endemic areas. Symptoms depend on location, for example in the muscle being the pain and the increased in volumen the most usual. Clinical suspicion, combined with imaging and serology test, are essential for the diagnosis
Subject(s)
Humans , Female , Aged , Echinococcosis/surgery , Muscular Diseases/parasitology , Muscular Diseases/surgery , Abdominal Wall/parasitology , Abdominal Wall/surgery , Treatment Outcome , Peritoneal Cavity/parasitologyABSTRACT
The authors present a case of complete hydatidiform mole and coexisting fetus (CHMCF) in which mole gestation caused a placenta previa; with a posterior preterm premature rupture of membranes (PPROM) and ending in the 28h week of gestation due to acute chorioamnionitis, obtaining a live preterm newborn.
Subject(s)
Fetal Membranes, Premature Rupture/diagnostic imaging , Hydatidiform Mole/diagnostic imaging , Placenta Previa/diagnostic imaging , Pregnancy, Twin , Uterine Neoplasms/diagnostic imaging , Adult , Female , Fetus , Humans , Hydatidiform Mole/complications , Hydatidiform Mole/pathology , Infant, Newborn , Infant, Premature , Pregnancy , Uterine Neoplasms/complications , Uterine Neoplasms/pathologySubject(s)
Hematometra/etiology , Trachelectomy/adverse effects , Uterine Cervical Dysplasia/surgery , Uterine Cervical Neoplasms/surgery , Adult , Cesarean Section , Chorioamnionitis/etiology , Female , Fertility Preservation , Humans , Live Birth , Pregnancy , Trachelectomy/methods , Uterine Cervical Neoplasms/complications , Uterine Cervical Dysplasia/complicationsSubject(s)
Abnormalities, Multiple/diagnostic imaging , Arterio-Arterial Fistula/diagnostic imaging , Fetofetal Transfusion/diagnostic imaging , Placenta Diseases/diagnostic imaging , Adult , Female , Fetal Death , Fetal Heart/abnormalities , Humans , Live Birth , Pregnancy , Pregnancy, Twin , Remission, Spontaneous , UltrasonographyABSTRACT
OBJECTIVE: the accuracy of preoperative endorectal ultrasound in the status evaluation of lymph nodes is around 50-70%, with a lack of eco-morphological patterns of clinical use. Since, accurate local staging is of great value in prognosis and decision-making we decided to analyze the referenced eco-morphological parameters in a try to find a proper predictive tool of clinical help that could improve the accuracy of rectal ultrasound. MATERIAL AND METHOD: the resected specimens of 24 patients that were operated on by radical surgery because rectal cancer, without preoperative radiotherapy were suspended in warm water and ultrasound scanned (360º circular probe with a transducer of 10 Mhz). All suspicious nodes were recorded and marked for the definitive histological report. RESULTS: from the 24 specimens, 318 nodes were imaged(210 benign and 100 involved). All ultrasound parameters analysed were significant but only lobulation, echogenicity and hilar reflection were independent values. An score system was design with the addition of all parameters that showed a sensitivity of 98%and specificity of 99,1%. CONCLUSIONS: our study shows that a careful study of ultra-sound lymph node images can get a high level of accuracy and better help in tailoring the treatment of any particular case.
Subject(s)
Adenocarcinoma/diagnostic imaging , Lymphatic Metastasis/diagnostic imaging , Rectal Neoplasms/diagnostic imaging , Adenocarcinoma/surgery , Humans , In Vitro Techniques , Lymph Node Excision , Predictive Value of Tests , Rectal Neoplasms/surgery , Sensitivity and Specificity , UltrasonographyABSTRACT
El mucocele apendicular es una patología infrecuente y de difícil diagnóstico. Se presenta el caso de una paciente de 48 años con historia de dolor en fosa ilíaca derecha (FID), intervenida por un diagnóstico de sospecha de cistadenoma de ovario derecho, con diagnóstico intraoperatorio de mucocele apendicular (AU)
Appendiceal mucocele is a rare lesion that is difficult to diagnose. We report thecase of a 48-year-old woman with a history of right iliac fossa pain, who underwent surgerydue to a suspected diagnosis of right ovarian cystadenoma. The intraoperative diagnosis was appendiceal mucocele (AU)
Subject(s)
Humans , Female , Middle Aged , Mucocele/surgery , Appendix/pathology , Flank Pain/etiology , Diagnosis, Differential , Appendicitis/diagnosisABSTRACT
El embarazo ectópico sobre la cicatriz de una cesárea previa es una entidad muy poco frecuente y que se acompaña de complicaciones potencialmente muy graves. Sin embargo, debido a la baja frecuencia de su aparición, no existen unas pautas claras para su tratamiento, existiendo diferentes pautas de actuación tanto médicas como quirúrgicas. Presentamos un caso de una paciente con embarazo ectópico sobre cicatriz de cesárea previa diagnosticada mediante ecografía transvaginal y tratada mediante histerectomía total por vía abdominal, ya que la paciente no tenía deseo genésico (AU)
Ectopic cesarean scar pregnancy is a very rare process that has the potential forvery severe complications. However, due to the low frequency of this entity, there are no clearprotocols for its treatment and many different treatment plans, both medical and surgical, arecurrently applied.We report the case of a patient with an ectopic pregnancy in a previous cesarean scar, diagnosedby transvaginal ultrasound scan and treated by total abdominal hysterectomy, since thepatient did not wish to preserve her fertility (AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy, Ectopic/diagnosis , Hysterectomy , Cicatrix , Cesarean Section , Risk Factors , Ovarian Cysts/surgeryABSTRACT
Introducción. El derrame pleural fetal (DPF) es una entidad rara que puede amenazar la viabilidad fetal. El objetivo es revisar el DPF analizando su etiología, manejo y pronóstico.Métodos. Estudio retrospectivo de 16 casos de DPF de16.971 partos (0,094%) realizados en el Hospital Maternal La Fe en el período 2003-2006. Se valora la etiología, manejo, uso de técnicas invasivas, forma de parto y evolución neonatal.Resultados. La edad gestacional media del diagnósticofue 25±1 semanas (14-38), y la de finalización del embarazo fue 28±1 semanas (rango: 16-39). El DPF asoció hidrops en 8 casos (50%), ascitis en 14 casos (87,5%), cardiopatías 5 casos (31,25 %) y polihidramnios en 6 casos (37,5 %). La amniocentesis demostró aneuploidía en 3 casos (18,75%). El sexo fue varón en 12 casos, hembra en 3 y ambiguo en 1 (p<0,05). De las 16 gestaciones: 2 fueron abortos tardíos y 2 interrupciones voluntarias del embarazo (IVE). Sólo en 12 casos se controló la gestación, desapareciendo el DPF en 3 casos (25%). La finalización de la gestación fue: 7 cesáreas(58 %), y 5 partos vaginales (42 %). Solo en 5 casos (41%) hubo recién nacidos vivos, los 3 casos de desaparición y 2 casos sin desaparición. La tasa de mortalidad durante el embarazo fue del 58,3% y perinatal del 66,6%.Conclusiones. El derrame pleural fetal se asocia a unaalta morbimortalidad perinatal, siendo más frecuente en varones. Son factores de buen pronóstico la reabsorción durante la gestación y la finalización tardía
Introduction. Fetal pleural effusion (FPE) is an uncommoncondition that is life-threatening to the fetalviability. This study has aimed to review FPE, analyzingetiology, management and prognosis.Methods. Retrospective study (2003-2006) of 16 FPEfrom among 16,971 deliveries (0.094%) performed in theMaternity Hospital La Fe. Etiology, management, use ofinvasive techniques, delivery method and neonatal outcomewere studied.Results. Mean gestational age at diagnosis was 25±1(14-38) weeks, and gestational age at delivery was 28±1(16-39) weeks. FPE was associated to hydrops in 8 cases(50 %), ascitis 14 cases (87.5 %), heart disease 5 cases(31.25%), polyhydramnias 6 cases (37.5%). The amniocentesis showed aneuploidy in 3 cases (18.75%). Gender was male in 12 case, female in 3 and ambiguous in one (p<0.05). Among 16 pregnancies, 2 were late miscarriages and 2 Voluntary Termination of Pregnancy. The pregnancies were controlled in only 12 cases, the FPE disappearing in 3 cases (25%). The end of the pregnancy was by cesarean section in 7 (58%) and vaginal deliveries in 5 (42%). There were live newborns in only 5 cases (41%) (5/12), 3 cases of disappearance and 2 without disappearance. Mortality rate in pregnancy was 58.3% and perinatal mortality rate was 66.6%.Conclusions. Fetal pleural effusion is associated to ahigh perinatal morbidity-mortality, this being more frequent in males. Good prognostic factors are reabsorption during pregnancy of late birth
Subject(s)
Humans , Pleural Effusion/diagnosis , Prenatal Diagnosis/methods , Hydrothorax/diagnosis , Hydrops Fetalis/diagnosis , Sex Distribution , Pleural Effusion/epidemiology , Retrospective StudiesABSTRACT
Objective: To evaluate fetal deaths in the last 10 years by comparing two time periods and to analyze possible causes and variations of fetal mortality. Material and methods: We examined the fetal death rate between 1996 and 2005. Two groups were compared: group A included fetal deaths occurring in the period 1996-2000 and group B comprised those occurring in the period 2001-2005. Maternal, delivery and fetal characteristics were analyzed. Results: The fetal death rate at our hospital was 6.25 per 1000 births. Fetal death mainly occurred in Spanish mothers aged between 20 and 35 years old. Birth weight was between 500 and 1000 g in 53.4% of deaths and gestational age was less than 28 weeks in 32.5%. Mortality was higher in multiple pregnancies than in single pregnancies. Comparison of the two groups showed no significant differences in fetal death rate but a statistically significant increase (p <0.05) was found in patients aged less than 20 years old (1.2% vs. 6.9%) and foreigners (4.7% vs. 15.5%). There was a nonsignificant increase in fetal mortality in assisted reproductive pregnancies (5.8% vs. 9.2%). The cause of death was unexplained in 20.3% of fetal deaths. The most frequent causes registered were funicular abnormalities (13.3%), chorioamnionitis (8.7%), premature rupture of fetal membranes (8.4%), and abruptio (6.7%). Conclusion: The fetal death rate did not decrease during the periods studied and increased among young women and foreigners (AU)
Objetivo: Evaluar la mortalidad fetal en los últimos 10 años dividiéndola en 2 períodos, y analizar las posibles causas y variaciones de ésta. Material y métodos: Se estudia la tasa de mortalidad fetal (TMF) entre los años 1996 y 2005. Se comparan 2 grupos, el Grupo A con las muertes fetales entre 1996-2000 y el grupo B con los casos entre 2001-2005. Se estudian variables maternas, relacionadas con el parto, y fetales. Resultados: La TMF en nuestro medio fue del 6,25 recién nacidos. Principalmente se dio en madres españolas de entre 20 y 35 años. El peso fetal fue, en el 53,4% de los casos, de entre 500-1.500 g y el 32,5% era de edad gestacional < 28 semanas. La mortalidad está incrementada en las gestaciones múltiples respecto a las únicas. Al comparar los 2 grupos no ha habido diferencias significativas en la TMF, pero sí se evidencia un aumento estadísticamente significativo (p < 0,05) de pacientes < 20 años (el 1,2 frente al 6,9%) y extranjeras (el 4,7 frente al 15,5%). Sin embargo, aumenta la mortalidad en gestaciones de reproducción asistida (el 5,8 frente al 9,2%), sin alcanzar significación estadística. La causa de muerte fue, en el 20,3% de los casos, desconocida destacan como causas registradas la patología funicular (13,3%), la corioamnionitis (8,7%), la rotura prematura de membranas pretérmino (8,4%) y el desprendimiento prematuro de la placenta normoinserta (6,7%). Conclusión: No ha disminuido la TMF en los últimos años, aumentando entre gestantes extranjeras y jóvenes (AU)
Subject(s)
Humans , Female , Adult , Fetal Mortality , Hospitals, University/statistics & numerical data , Hospitals, University , Mortality/statistics & numerical data , Gestational Age , Fetal Death/epidemiology , Fetal Death/etiology , Mortality/trends , Perinatal Mortality , Perinatal Care/statistics & numerical data , Chorioamnionitis/complications , Chorioamnionitis/mortality , Abruptio Placentae/complications , Abruptio Placentae/mortalityABSTRACT
Se revisan en este capítulo la técnica e indicaciones de la histerectomía laparoscópica
Indications and technical procedure of laparoscopic hysterectomy are reviewed in this chapter
Subject(s)
Female , Humans , Hysterectomy/methods , Cervix Uteri/anatomy & histology , Uterine Prolapse/prevention & controlABSTRACT
INTRODUCTION: transanal endoscopic microsurgery (TEM) was developed in 1983 by Büess as a minimally invasive technique to manage rectal villous adenomas and early rectal adenocarcinomas. Many studies have been published worldwide about its excellent results in morbidity and recidive rate, but there are few studies addressing functional results. The objective of this study is to analyze the effect of this technique in the anal anatomy and compare with the manometric results. MATERIAL AND METHODS: we devised a prospective study of 40 patients. 39% female, 61% male. All of them filled an incontinence questionnaire (Pescatori scale) and endoanal ultrasonography and manometry was carried out preoperatively, third month postoperative and at sixth month only if incontinence appeared. RESULTS: 32 patients (80%) had villous adenomas and 8 patients (20%) had adenocarcinomas (uT1). Three patients complained of flatus incontinence at 3rd postoperative month that disappeared with normal continence at 6th month. Anorectal manometric values: mean anal resting pressure (ARP) decreased at 3rd month (from 87.2 mmHg to 70.1 mmHg), as it was for maximal squeeze pressure (MSP) from 152.5 mmHg preoperatively to 142.2 mmHg at 3rd month. Ultrasonography demonstrated internal anal sphincter (IAS) rupture in 3 patients, with a full integrity of the external anal sphincter in all patients. CONCLUSIONS: during TEM, a significant anal dilatation occurs, because of rectoscopy (40 mm wide), what can produce a rupture of IAS, with the consequent decreasing in ARP, and a dilatation without rupture of external sphincter what produces a decreasing of MSP. The fall of anal pressures had minima clinical repercussion when sphincter is intact, but when IAS is broken a temporal incontinence develops.
Subject(s)
Adenocarcinoma/surgery , Adenoma, Villous/surgery , Microsurgery/methods , Proctoscopy , Rectal Neoplasms/surgery , Aged , Anal Canal , Female , Humans , Male , Proctoscopy/methods , Prospective StudiesABSTRACT
Introducción: la microcirugía transanal endoscópica (TEM)fue desarrollada en 1983 por Büess como técnica mínimamenteinvasiva para el tratamiento de adenomas y adenocarcinomas enestadio precoz de recto. Son múltiples los estudios realizados entodo el mundo sobre sus resultados de morbimortalidad y tasa derecidiva, pero sin embargo son muy pocos los estudios publicadossobre los resultados funcionales. El objetivo de este estudio fueanalizar el efecto que esta cirugía provoca en la anatomía del canalanal y compararlo con los resultados funcionales.Material y métodos: realizamos un estudio descriptivo prospectivode 40 pacientes: 39% mujeres, 61% hombres. En todosellos se cumplimentó una encuesta de función esfinteriana (test dePescatori) y ecografía endoanal y manometría preoperatoria, al 3ermes postoperatorio, y al 6º sólo si apareció incontinenciaResultados: Treinta y dos pacientes (80%) fueron operados deadenomas y 8 pacientes (20%) de adenocarcinomas uT1. Tres pacientespresentaron incontinencia a gases al 3er mes postoperatorioque se normalizó al 6º mes. Valores de la manometría anorrectal: lapresión media en reposo (PMR) había disminuido a los 3 meses conrespecto al valor preoperatorio de 87,2 a 70,1 mmHg, al igual quela presión máxima de contracción (PMC) de 152,5 mmHg de formapreoperatoria a 142,2 mmHg. Ecográficamente se pudo demostrarrotura del esfínter anal interno en 3 pacientes, estando en todos lospacientes íntegro el esfínter externo.Conclusiones: durante el tiempo quirúrgico de la TEM y debidoal diámetro del rectoscopio (40 mm), existe una dilataciónmantenida del canal anal. Esto unido al hecho de que es frecuenteque haya que modificar la posición del mismo, se traduce, en algunoscasos, en un riesgo de rotura del EAI, con la consiguientecaída en la PMR. En definitiva la caída que se objetiva en las presionesendoanales tiene una mínima repercusión en la clínica amenos que exista una lesión esfinteriana lo que conlleva incontinencia,en cualquier caso siempre temporal
Introduction: transanal endoscopic microsurgey (TEM) wasdeveloped in 1983 by Büess as a minimally invasive technique tomanage rectal villous adenomas and early rectal adenocarcinomas.Many studies have been published worldwide about its excellentresults in morbidity and recidive rate, but there are few studiesaddressing functional results. The objective of this study is to analyzethe effect of this technique in the anal anatomy and comparewith the manometric results.Material and methods: we devised a prospective study of40 patients. 39% female, 61% male. All of them filled an incontinencequestionnaire (Pescatori scale) and endoanal ultrasonographyand manometry was carried out preoperatively, third monthpostoperative and at sixth month only if incontinence appeared.Results: 32 patients (80%) had villous adenomas and 8 patients(20%) had adenocarcinomas (uT1). Three patients complainedof flatus incontinence at 3rd postoperative month that disappearedwith normal continence at 6th month. Anorectalmanometric values: mean anal resting pressure (ARP) decreasedat 3rd month (from 87.2 mmHg to 70.1 mmHg), as it was formaximal squeeze pressure (MSP) from 152.5 mmHg preoperativelyto 142.2 mmHg at 3rd month. Ultrasonography demonstratedinternal anal sphincter (IAS) rupture in 3 patients, with a full integrityof the external anal sphincter in all patients.Conclusions: during TEM, a significant anal dilatation occurs,because of rectoscopy (40 mm wide), what can produce a ruptureof IAS, with the consequent decreasing in ARP, and a dilatationwithout rupture of external sphincter what produces a decreasingof MSP. The fall of anal pressures had minima clinical repercussionwhen sphincter is intact, but when IAS is broken a temporalincontinence develops
Subject(s)
Male , Female , Aged , Humans , Microsurgery/methods , Adenocarcinoma/surgery , Adenoma, Villous/surgery , Proctoscopy , Rectal Neoplasms/surgery , Prospective Studies , Anal CanalABSTRACT
INTRODUCTION: Proctalgia fugax (PF) is a benign, self-limiting disease characterized by episodes of intense anorectal pain at frequent intervals in the absence of organic proctological disease. Even though PF was described more than a century ago, its etiology remains unclear. Currently there is no information available. Few papers quoting many ways of management have been published. The aim of this study was to investigate patients complaining of this condition and to treat them with sequential therapy. PATIENTS AND METHODS: We devised a descriptive, prospective study of patients complaining of acute perianal pain--duration less than 30 minutes--without organic disease or previous perianal surgery since 1996 to 2002 in our Department. We treated these patients using a three-step treatment (1: information, hip bath, benzodiazepines; 2: sublingual nifedipine 10 mg, or topic 0.1% nitroglycerin on demand; 3: internal anal sphincterotomy if hypertrophy of the internal anal sphincter was demonstrated by anal ultrasonography and no improvement was confirmed with the previous steps of treatment). We defined remarkable improvement as a decrease in the number of episodes by half or in pain intensity by 50%. RESULTS: Fifteen patients with an average follow-up of 4 years. Anal endosonography confirmed a grossly thickened internal anal sphincter (IAS) in 5 cases. After the first step of treatment 7 patients improved and 1 patient was cured; after the second step of treatment 3 patients improved and 1 was cured; the third step was applied to 3 patients with a thickened IAS; 1 patient improved and 1 patient was cured. CONCLUSION: A total resolution of PF is not always possible, but we may improve symptoms and their frequency. Almost 50% of patients in our series improved with the first step of treatment; 30% of our patients had IAS hypertrophy. Anal endosonography can help in the diagnosis of organic diseases or IAS hypertrophy, for which we can perform an internal anal sphincter myectomy.
Subject(s)
Anal Canal , Anus Diseases/therapy , Acute Disease , Adult , Anal Canal/diagnostic imaging , Anal Canal/pathology , Anal Canal/surgery , Anti-Anxiety Agents/administration & dosage , Anti-Anxiety Agents/therapeutic use , Anus Diseases/diagnostic imaging , Anus Diseases/drug therapy , Anus Diseases/pathology , Anus Diseases/surgery , Baths , Benzodiazepines/administration & dosage , Benzodiazepines/therapeutic use , Endosonography , Female , Follow-Up Studies , Humans , Hypertrophy , Male , Middle Aged , Nifedipine/administration & dosage , Nifedipine/therapeutic use , Nitroglycerin/administration & dosage , Nitroglycerin/therapeutic use , Pain/drug therapy , Pain/etiology , Pain Management , Prospective Studies , Time Factors , Treatment Outcome , Vasodilator Agents/administration & dosage , Vasodilator Agents/therapeutic useABSTRACT
Introducción: la proctalgia fugaz (PF) es una patología benigna,autolimitada, caracterizada por dolor anorrectal intenso, a intervalosfrecuentes, sin causa orgánica aparente. Su etiología noestá clara, a pesar de ser conocida desde hace un siglo y existenpocos artículos publicados sobre esta patología, con escaso númerode pacientes, aplicando tratamientos variados con mayor o menorfortuna. El propósito de este trabajo ha sido estudiar a una seriede pacientes aquejados de esta patología y aplicar a todos ellosun tratamiento de manera secuencial en dependencia de su respuestaal mismo.Material y métodos: realizamos un estudio descriptivo prospectivode pacientes aquejados de dolor perianal brusco, < 30min de duración, sin lesión orgánica concomitante ni intervenciónprevia perianal desde 1996-2002 en nuestro Servicio, sometiéndolesa un tratamiento de manera secuencial, basado en 3 escalonesterapéuticos (1. información, baños de asiento, tranquilizantes;2. nifedipino 10 mg sublingual, o nitroglicerina tópica 0,1%en el momento de la crisis; y 3. esfinterotomía lateral interna si hipertrofiadel esfínter anal interno y no mejoría con los otros escalones).Definimos mejoría significativa cuando se producía un importantedistanciamiento de los episodios (disminución nº crisis ala mitad) y/o disminución del dolor en un 50%.Resultados: quince pacientes con un seguimiento medio de 4años. Mediante ecografía endoanal se pudo demostrar la existenciade hipertrofia del esfínter anal interno (EAI) en 5 casos. Tras laaplicación del escalón 1 mejoraron 7 pacientes y curó 1 paciente;con el escalón 2 mejoraron 3 pacientes y 1 curó, y se aplicó el escalón3 a 3 pacientes que presentaban hipertrofia del EAI mejorando1 y curando otro paciente.Conclusión: la curación de la PF no siempre es factible, perosí es posible aliviar los síntomas, así como su frecuencia. Casi el50% de los pacientes de nuestra serie mejoró con el escalón 1 deltratamiento. Un tercio de nuestros pacientes presentaban hipertrofiadel EAI. La ecografía endoanal ayudará tanto a descartar lesionesorgánicas concomitantes como a diagnosticar una hipertrofiadel EAI, que se beneficiaría de una esfinterotomía lateral interna
disease characterized by episodes of intense anorectal pain at frequentintervals in the absence of organic proctological disease.Even though PF was described more than a century ago, its etiologyremains unclear. Currently there is no information available.Few papers quoting many ways of management have been published.The aim of this study was to investigate patients complainingof this condition and to treat them with sequential therapy.Patients and methods: we devised a descriptive, prospectivestudy of patients complaining of acute perianal pain durationless than 30 minutes without organic disease or previous perianalsurgery since 1996 to 2002 in our Department. We treatedthese patients using a three-step treatment (1: information, hipbath, benzodiazepines; 2: sublingual nifedipine 10 mg, or topic0.1% nitroglycerin on demand; 3: internal anal sphincterotomy ifhypertrophy of the internal anal sphincter was demonstrated byanal ultrasonography and no improvement was confirmed withthe previous steps of treatment). We defined remarkable improvementas a decrease in the number of episodes by half or in painintensity by 50%.Results: Fifteen patients with an average follow-up of 4 years.Anal endosonography confirmed a grossly thickened internal analsphincter (IAS) in 5 cases. After the first step of treatment 7 patientsimproved and 1 patient was cured; after the second step oftreatment 3 patients improved and 1 was cured; the third stepwas applied to 3 patients with a thickened IAS; 1 patient improvedand 1 patient was cured.Conclusion: a total resolution of PF is not always possible,but we may improve symptoms and their frequency. Almost 50%of patients in our series improved with the first step of treatment;30% of our patients had IAS hypertrophy. Anal endosonographycan help in the diagnosis of organic diseases or IAS hypertrophy,for which we can perform an internal anal sphyncter myectomy
Subject(s)
Adult , Middle Aged , Humans , Anus Diseases/drug therapy , Anus Diseases/therapy , Anal Canal/pathology , Anal Canal/surgery , Anal Canal , Anti-Anxiety Agents/administration & dosage , Anti-Anxiety Agents/therapeutic use , Anus Diseases/surgery , Benzodiazepines/administration & dosage , Benzodiazepines/therapeutic use , Endosonography , Nitroglycerin/therapeutic use , Vasodilator Agents/administration & dosageABSTRACT
La estadificación quirúrgica del cáncer de cérvix no modificará la clasificación clínica, pero sí es un parámetro indispensable en la planificación del tratamiento adyuvante y en la determinación del pronóstico de la enfermedad. La diseminación del cáncer de cérvix es fundamentalmente local y es, precisamente, esta extensión la causa de la mortalidad en estas pacientes. (AU)
Subject(s)
Adult , Female , Middle Aged , Humans , Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Lymphography/methods , Neoplasm Staging/methods , Neoplasm Staging , Neoplasm Metastasis/physiopathology , Magnetic Resonance Spectroscopy , Magnetic Resonance Spectroscopy/methods , Uterine Cervical Neoplasms/classification , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/surgery , Tomography, Emission-Computed/methods , Tomography, Emission-Computed , Uterine Cervical Neoplasms , Uterine Cervical Neoplasms/pathologyABSTRACT
El presente estudio muestra nuestra experiencia en el tratamiento y estadiaje quirúrgico completo del adenocarcinoma de endometrio por vía laparoscópica, así como la correlación y utilidad de la resonancia magnética en el estadiaje prequirúrgico de estas pacientes. Un total de 25 pacientes con adenocarcinoma de endometrio fueron tratadas y estadiadas quirúrgicamente tras cirugía por vía laparoscópica reglada (histerectomía total laparoscópica, doble anexectomía y linfadenectomía pélvica).En todos ellos se realizó el estadiaje preoperatorio mediante resonancia magnética. Se concluye que la cirugía laparoscópica permite realizar un tratamiento quirúrgico adecuado y completo en este tipo de patología y que el estadiaje prequirúrgico con RM no se correlaciona adecuadamente con el estadiaje quirúrgico y anatomopatológico final (AU)
Subject(s)
Adult , Aged , Female , Middle Aged , Humans , Adenocarcinoma/diagnosis , Neoplasm Staging , Endometrial Neoplasms/diagnosis , Adenocarcinoma/surgery , Laparoscopy , Preoperative Care , Endometrial Neoplasms/surgery , Magnetic Resonance Spectroscopy , Hysterectomy/methods , Lymph Node Excision/methodsABSTRACT
We report one case of acute abdomen after the ingestion of raw or undercooked fish containing nematode larvae of the genus Anisakis. Early diagnosis is very important as it could prevent unnecessary surgical procedures since the symptoms of intestinal anisakiasis may mimic other illnesses such as appendicitis, ileitis or peritonitis. We suggest that anisakiasis should be considered in the differential diagnosis of patients with acute abdomen.
Subject(s)
Anisakiasis/diagnosis , Intestinal Obstruction/diagnosis , Abdominal Pain/diagnosis , Abdominal Pain/parasitology , Acute Disease , Adolescent , Ascites/diagnosis , Ascites/parasitology , Diagnosis, Differential , Humans , MaleABSTRACT
Se presenta el caso de una mujer de 51 años que, en el postoperatorio inmediato tras una histerectomía total y doble anexectomía por útero polimiomatoso, desarrolló un enfisema subcutáneo y neumomediastino debido a los vómitos (AU)
Subject(s)
Humans , Female , Middle Aged , Mediastinal Emphysema/complications , Subcutaneous Emphysema/complications , Hysterectomy/adverse effects , Postoperative Complications/diagnosis , Risk Factors , Drug Hypersensitivity/complicationsABSTRACT
Objetivo: Se comparan los resultados de la histerectomía laparoscópica y la histerectomía abdominal en pacientes con similares características e indicación quirúrgica. Pacientes y método: El grupo estudio está formado por una serie prospectiva de 68 histerectomías laparoscópicas que cumplían los siguientes criterios: útero # 14 semanas; cáncer de endometrio en estadio I; ausencia de cáncer de cérvix y de ovario, y ausencia de prolapso genital parcial o total. El grupo control está formado por una serie de 49 pacientes con los mismos criterios de inclusión, a las que se realizó una histerectomía abdominal durante 1998. Se analizan y comparan en los dos grupos el tiempo quirúrgico, la necesidad de analgesia, la estancia hospitalaria y las complicaciones intra y (..) (AU)
Subject(s)
Humans , Female , Hysterectomy/methods , Endoscopy/methods , Endometrial Neoplasms/surgery , Case-Control Studies , Intraoperative Complications/epidemiologyABSTRACT
Objetivo: Analizar los resultados operatorios y postoperatorios tras tratamiento laparoscópico de patología oncológica en pacientes obesas. Material y métodos: Se estudian 6 pacientes con índice de masa corporal (IMC) > 40 que fueron sometidas a laparoscopia. Se describen las características de las pacientes, los detalles de los procedimientos quirúrgicos y las complicaciones intra y postoperatorias. Resultados: La disminución del hematocrito fue del 6,7% (4,6-8,7). Los tiempos quirúrgicos presentaron una media de 114 min (95-150), la duración de la estancia hospitalaria fue de 36 h (48-96); no se observaron complicaciones mayores intra o postoperatorias. Conclusión: La laparoscopia quirúrgica es un método factible en mujeres con obesidad mórbida. La morbilidad y el tiempo de hospitalización fueron menores que los observados en la realización de laparotomías (AU)