Influence of psychopathological changes on quality of life after laparoscopic fundoplication for the treatment of gastroesophageal reflux.

There are references in medical literature to the influence of psychopathological changes and their negative impact on the results of laparoscopic fundoplication. The objective of this study is to analyze the influence of psychological changes, as assessed by the General Health Questionnaire-28 (GHQ-28), on patients undergoing surgery for gastroesophageal reflux. This is a prospective study in a series of 103 consecutive patients (62 males and 41 females with a mean age of 40 years) undergoing laparoscopic fundoplication. In addition to functional studies, patients completed the SF-36, Gastrointestinal Quality of Life Index, and GHQ-28 before surgery. Functional tests and questionnaires were repeated 6 months after surgery. Patients were also questioned about their degree of satisfaction. Postoperative results of patients with a normal GHQ-28 and patients showing psychopathological changes as defined by the GHQ-28 questionnaire before surgery were compared. Overall, all patients experienced an improvement in their quality of life. Forty-one patients showed a pathological result in the preoperative GHQ-28 questionnaire. No differences were found in functional results and degree of satisfaction with surgery between patients with normal and pathological results in the preoperative GHQ-28 questionnaire. However, patients with a pathological result in the preoperative GHQ-28 had poorer results in all domains of the postoperative Gastrointestinal Quality of Life Index and SF36 quality of life questionnaires as compared to patients with a normal preoperative GHQ-28 questionnaire. Patients with pathological results in the preoperative GHQ-28 had poorer results in terms of postoperative quality of life despite having normal postoperative physiological studies; this decreased quality of life did not have an impact on the degree of satisfaction with surgery performed. The GHQ-28 does not therefore appear to serve as a predictor of postoperative satisfaction.

Hepatectomía derecha tras extirpación de tumor de la ampolla de Vater / Right hepatectomy after excision of a carcinoma of the ampulla of Vater: report of one case

Occasionally hepatectomy for metastases of ampulla of Vater carcinoma can result in a better survival and quality of life of patients. We report a 67 years old male subjected to a duodenopancreatectomy for a carcinoma of the ampulla of Vater that required afterwards a right hepatectomy for metastases. Twenty one months after the second operation and 42 months after the first operation, that patient is asymptomatic and without evidences of relapse.

El tratamiento quirúrgico del carcinoma de ampolla de Vater presenta mejores resultados oncológicos que los del resto de los tumores periampulares. En casos seleccionados, la resección hepática por metástasis de carcinoma de ampolla de Vater extirpado previamente, puede proporcionar supervivencias prolongadas y con buena calidad de vida. Presentamos un paciente de 67 años tratado con duodenopancreatectomía por cáncer de la ampolla de Vater y posteriormente con hepatectomía derecha por metástasis. A los 42 y 21 meses de la primera y segunda intervención respectivamente, permanece asintomático y sin evidencia de enfermedad.

Distrofia muscular oculofaríngea: tratamiento quirúrgico / Surgical treatment of oculopharyngeal muscular dystrophy: report of two cases

Oculopharyngeal muscular dystrophy (OPMD) is a rare myopathy that is characterized by ocular and pharyngeal muscle involvement. OPMD typically presents with ptosis, dysarthria, and dysphagia. It can also be associated with proximal and distal extremity weakness. We report two patients with the disease. A 79 years old female presenting with ptosis, dysphagia and a history of three aspiration pneumonias. The patient was subjected to a myotomy of the cricopharyngeal muscle of 4.5 cm of length. The patient had a symptomatic improvement and is in good conditions five months after the operation. A 75 years old male presenting with dysphagia and ptosis. He was operated, performing a myotomy of the cricopharyngeal muscle of 3.5 cm of length. Two and a half months after operation the patient is devoid of dysphagia.

La distrofia muscular oculofaríngea (DMOF) es una enfermedad de carácter hereditario, que cursa con disfagia, ptosis palpebral y debilidad proximal de las extremidades. Para su valoración la realización de manometría y estudio radiológico contrastado pueden ser de gran utilidad a pesar de que el diagnóstico de seguridad se obtiene por el estudio genético del gen PABPN1 del cromosoma 14. La enfermedad se desarrolla al sufrir este gen pequeñas expansiones en el triplete (GCG)7-13. Presentamos dos pacientes diagnosticados genéticamente de DMOF, uno de herencia autosómica dominante y otro de herencia autosómica recesiva, ambos tratados mediante miotomía del cricofaringeo debido a la intensidad de la disfagia. En ambos casos se obtuvo una mejoría clínica evidente después de la intervención.

Results of R0 surgery with D2 lymphadenectomy for the treatment of localised gastric cancer.

INTRODUCTION: Surgical excision is the best therapeutic option for gastric cancer, provided it is performed with curative intent as R0 surgery. And, according to many authors, D2 lymphadenectomy may be performed with acceptable morbidity and mortality rates. MATERIALS AND METHODS: A prospective study was conducted on a series of 126 consecutive cases of gastric cancer treated with gastrectomy and D2 lymphadenectomy. A R0 resection was done in 99 cases (78.6%). RESULTS: Total gastrectomy was performed in 70 patients and subtotal gastrectomy in 29. The mean number of lymph nodes removed was 32.5 per patient. Suture dehiscence occurred in 3 patients (in one of them in the esophago-jejunal anastomosis). Hospital mortality was 2%. Twenty-six recurrences were detected after a median follow-up of 73.6 months. Five-year actuarial survival was 65%. Five-year survival of patients with positive lymph nodes at the N2 level was 26.5%. CONCLUSIONS: Gastrectomy with D2 lymphadenectomy may be performed with low morbidity and mortality. R0 resection allows acceptable survival rates to be achieved. There is even a group of patients with invaded lymph nodes at the N2 level surviving at 5 years. It appears to be very important that this surgery is performed by specialised surgeons.

Results of R0 surgery with D2 lymphadenectomy for the treatment of localised gastric cancer

INTRODUCTION: Surgical excision is the best therapeutic option for gastric cancer, provided it is performed with curative intent as R0 surgery. And, according to many authors, D2 lymphadenectomy may be performed with acceptable morbidity and mortality rates. MATERIALS AND METHODS: A prospective study was conducted on a series of 126 consecutive cases of gastric cancer treated with gastrectomy and D2 lymphadenectomy. A R0 resection was done in 99 cases (78.6%). RESULTS: Total gastrectomy was performed in 70 patients and subtotal gastrectomy in 29. The mean number of lymph nodes removed was 32.5 per patient. Suture dehiscence occurred in 3 patients (in one of them in the esophago-jejunal anastomosis). Hospital mortality was 2%. Twenty-six recurrences were detected after a median follow-up of 73.6 months. Five-year actuarial survival was 65%. Five-year survival of patients with positive lymph nodes at the N2 level was 26.5%. CONCLUSIONS: Gastrectomy with D2 lymphadenectomy may be performed with low morbidity and mortality. R0 resection allows acceptable survival rates to be achieved. There is even a group of patients with invaded lymph nodes at the N2 level surviving at 5 years. It appears to be very important that this surgery is performed by specialised surgeons (AU)

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Tratamiento quirúrgico de la achalasia de esófago en estadio avanzado / Esophagectomy in advanced achalasia: report of four cases

Introducción: El tratamiento del estadio avanzado de la achalasia es un tema controvertido. Cuando el esófago adopta una morfología "sigmoidea" se ha preconizado la resección esofágica como tratamiento de elección. A la luz de los resultados recientes publicados de la cirugía laparoscópica dicha conducta debe ser revisada. Material y Método: Durante un período de 11 años se estudian los pacientes en estadio avanzado, correspondientes a nuestra serie de casos operados de achalasia de esófago, tratados con esofagectomía. Resultados: Cuatro casos intervenidos con resección esofágica, plastia gástrica, y anastomosis cervical. En tres casos por vía transhiatal y el cuarto precisó toracotomía. Edad promedio de los pacientes 63 años. Tiempo medio de duración de la sintomatología clínica 37,7 años. Morbilidad: Derrame pleural en dos casos, disfonía transitoria en dos casos, una eventración. Tras un seguimiento medio de 66 meses todos están actualmente asintomáticos.

Esophageal excisión is recommended in advanced stages of achalasia, when the esophagus acquires a sigmoid morphology. We report four patients with achalasia aged 59, 60, 66 and 67 years (two males) that were treated with esophagectomy, gastroplasty and cervical anastomosis. Three were operated using a trasnhiatal approach and one required a thoracotomy. In the postoperative period, two patients had a pleural effusion, two had transient dysphonia and one had an eventration. After a follow up ranging from two to 11 years, all are asymptomatic.

Intrahepatic mucinous biliary cystadenoma.

Mucinous biliary cystadenoma (MBC) is a very rare cystic tumour of the liver usually occurring in middleaged women. This condition is difficult to diagnose before surgery; differential diagnosis with hydatid disease of the liver has to be done and is difficult to distinguish from mucinous biliary cystadenocarcinoma. We report two diagnosed and treated cases of intrahepatic MBC.

Simultaneous presentation of oesophageal and renal cancer.

Oesophageal cancer has been documented to be often associated with other primary tumours. However, concurrent oesophageal and renal cell carcinoma is extremely uncommon. We report a case of synchronous oesophageal and kidney cancer that was successfully treated at our hospital by a one-stage surgical procedure. The patient is doing well and without recurrence 54 months after the operation.

Simultaneous presentation of oesophageal and renal cancer

Oesophageal cancer has been documented to be often associated with other primary tumours. However, concurrent oesophageal and renal cell carcinoma is extremely uncommon. We report a case of synchronous oesophageal and kidney cancer that was successfully treated at our hospital by a one-stage surgical procedure. The patient is doing well and without recurrence 54 months after the operation (AU)

Intra-abdominal follicular dendritic cell sarcoma

Follicular dendritic cell (FDC) sarcoma is a very rare condition. We report here an intra-abdominal FDC sarcoma occurring as a mass, dependent on the celiac and left gastric lymph chains, that was completely excised. Eighteen months after surgery a recurrence at the liver pedicle was detected by a CT-scan and fully resected; in order to prevent another disease relapse postoperative radiotherapy was given (AU)

Gastroesophageal reflux: prevalence of psychopathological disorders and quality of life implications.

There is evidence in the literature that psychosocial aspects affect the symptoms and results of surgery for gastroesophageal reflux. The purpose of this study was to estimate the prevalence of psychopathological disorders measured using the General Health Questionnaire (GHQ-28) in a sample of patients with gastroesophageal reflux, and to assess the influence of such disorders on their quality of life. A prospective study was conducted in 74 consecutive patients before gastroesophageal reflux surgery; patients answered the GHQ-28, the health questionnaire SF-36, and the Gastrointestinal Quality of Life Index (GIQLI). The convergent validity of the GHQ-28 questionnaire as compared to the other two questionnaires and preoperative quality of life was tested. A pathological result of the GHQ-28 questionnaire was found in 38.3% of patients. A correlation was seen between the results of the GHQ-28 questionnaire and all categories of the SF-36 and GIQLI questionnaires. Patients with pathological results in the GHQ-28 questionnaire had poorer results in all dimensions of the SF-36 and GIQLI quality of life questionnaires as compared to patients with a normal result in the GHQ-28 questionnaire. In conclusion, 38.3% of patients with gastroesophageal reflux showed psychopathological disorders when administered the GHQ-28 questionnaire. These patients also had poorer results in quality of life studies.

Impact of surgical procedure for gastric cancer on quality of life.

BACKGROUND: The aim was to assess quality of life in a group of patients who had a curative resection for gastric cancer. METHODS: The European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire with a gastric cancer-specific module was used in patients who had undergone R0 gastrectomy between 1992 and 1999, and who had no disease at the last check-up. A response was obtained from 54 patients, 36 men and 18 women, of mean age 67 years. Of these, 24 patients had total gastrectomy and 26 D2 lymphadenectomy. RESULTS: Significant differences were found only in the social domain of quality of life in patients aged over 70 years (P = 0.036); there was no impact of operation type on overall quality of life. CONCLUSION: The quality of life of patients undergoing curative surgery for gastric cancer, regardless of age, was not significantly influenced by the type of gastrectomy, or whether lymphadenectomy was performed.

The value of D1 lymphadenectomy as prognostic marker in gastric cancer.

BACKGROUND/AIMS: To assess if the study on the involvement of perigastric lymph nodes, the only ones resected in D1 lymphadenectomy, is a valid prognostic marker in patients undergoing curative resection for gastric cancer. METHODOLOGY: A retrospective study was performed in 101 patients with gastric cancer, 34 women and 67 men, with a mean age of 61 years, undergoing curative resection by gastrectomy and D1 lymphadenectomy. Tumor size, the depth of tumoral invasion of the wall, nodal involvement and 5-year survival were assessed. RESULTS: Both tumor size and the depth of tumoral invasion of the wall were significantly related to metastatic involvement of perigastric lymph nodes. Similarly, tumoral involvement of the first-level lymph nodes was significantly associated with survival. CONCLUSIONS: D1 lymphadenectomy can provide adequate prognostic information in patients with gastric cancer undergoing curative resection.

Cáncer de muñón gástrico: resultados del tratamiento quirúrgico / Gastric stump cancer: results of surgical treatment

Introducción. El pronóstico de cáncer de muñón gástrico, en general, es peor que el de cáncer gástrico primario. Métodos. Un total de 33 pacientes con cáncer de muñón tratados en nuestro servicio desde 1984 a 1999, 31 varones y 2 mujeres, con una edad media de 69,6 años. La primera intervención fue por úlcera gástrica en 14 casos, y duodenal o pilórica en 19. Presentaban gastrectomía Billroth II 22 pacientes y Billroth I 11 pacientes. El intervalo medio entre la primera operación y el diagnóstico del tumor fue de 30,6 años. Resultados. Fueron operados 27 pacientes; el índice de resecabilidad fue del 66,6 por ciento. Se realizaron 16 gastrectomías totales, 6 de ellas ampliadas y 2 casi totales. Predominó el adenocarcinoma tipo intestinal (22 casos); 4 pacientes presentaban tumores precoces (early) y en 13 (72,2 por ciento) existía afección de la serosa (pT3-pT4). La supervivencia actuarial global a los 5 años es del 22 por ciento, un 41,4 por ciento en los pacientes resecados (p < 0,001). Fue significativa la supervivencia de los casos resecados según el tamaño del tumor (p < 0,05).Conclusiones. En los pacientes gastrectomizados parece aconsejable el control endoscópico a partir de los 15 años para mejorar la resecabilidad y la supervivencia mediante un diagnóstico más precoz. La supervivencia obtenida en los casos tratados con gastrectomía total justifica este tratamiento quirúrgico agresivo. Hubo diferencias significativas en la supervivencia según el tamaño del tumor (AU)

Congenital esophageal cysts--two cases in adult patients.

Esophageal cysts are a rare clinicopathological condition. They usually cause respiratory symptoms in children, while they are often asymptomatic in adults. Two cases of esophageal cysts in adults, recently diagnosed and treated in our department, are reported. In the 1st case (a 52 year-old woman) dysphagia was the main symptom. In the 2nd one (a 39 year-old woman) the patient was asymptomatic. Both were surgically excised by enucleation, with no post-operative complications. The histological study showed both cysts to be lined with ciliated cylindrical epithelium, and they were therefore considered to be congenital. Smooth muscle was only seen in the cyst wall in the 2nd case, but it was not organized in 2 layers, as is typical of duplication cysts. Cartilage or respiratory glands, the pathognomonic features of bronchogenic cysts, were not identified in either of them. Therefore, the diagnosis was inclusion cysts in both cases.

Albendazole plus praziquantel versus albendazole alone as a pre-operative treatment in intra-abdominal hydatisosis caused by Echinococcus granulosus.

OBJECTIVE: To compare the effects of a combined medication of albendazole (10 mg/kg/day) plus praziquantel (25 mg/kg/day) to those of albendazole alone at different doses (10 and 20 mg/kg/day). METHOD: The protoscoleces' viability was studied in a consecutive series of patients affected by intra-abdominal hydatidosis caused by Echinococcus granulosus. In all cases the drugs were given during the month prior to surgery. RESULTS: A significant increase of patients with nonviable protoscoleces was observed in the group treated with the scolicides combination compared to those treated with albendazole alone, both at a dose of 10 mg/kg/day (P = 0.004) and at a dose of 20 mg/kg/day (P = 0.03). Albendazole sulphoxide levels in serum and in cyst fluid were higher in patients given the combined therapy than in those who received only albendazole (10 mg/kg/day: P = 0.016; 20 mg/kg/day: P = 0.034). Levels in the cysts were not significantly different probably due to the sample size; nevertheless a lineal relation between the values obtained in serum and inside the cysts could be discerned in the patients treated with the combined medication. CONCLUSION: Albendazole plus praziquantel is more effective than monotherapy with albendazole in the preoperative treatment of intra-abdominal hydatidosis.

[A patient with Mirizzi's syndrome. The diagnostic and therapeutic considerations]. / Paciente con síndrome de Mirizzi. Consideraciones diagnósticas y terapéuticas.

A 35-year-old woman presented with a 4-month history of jaundice and pruritus. Endoscopic retrograde cholangiography (ERC) showed a partially obstructed common hepatic duct with a smooth and curved laterally based compression defect having the appearance of being secondary to an impacted gallbladder stone. Gallbladder filled with contrast medium but the cystic duct was not visualized, thus suggesting cholecystobiliary fistula formation. According to these radiologic findings, the diagnosis of Mirizzi syndrome was made. We discuss differential diagnosis, therapeutic aspects and the importance of preoperative diagnosis.

[Retroperitoneal lipoma (with areas of myxoid degeneration)]. / Lipoma retroperitoneal (con áreas de degeneración mixoide).

Retroperitoneal tumors of lipomatous origin are usually liposarcomas. Only a minority of adipose tumors of the retroperitoneum show histological criteria of benignity. We present the case of a 52-year-old woman, diagnosed of a retroperitoneal lipoma with areas of myxoid degeneration. The tumor involved the left kidney and was resected completely.

[Hepatic trauma (90 consecutive cases treated in 9 years]. / Traumatismos hepáticos (90 casos consecutivos tratados en nueve años).

90 consecutive hepatic traumatisms at the Hospital de Navarra are presented over a period of 9 years, excluding those which did not overcome the initial reanimation phase and those diagnosed as necropsy. The etiology is presented (76 closed and 14 open), the degree of lesion, associated intra and extra-abdominal lesions plus the results (12.2% mortality) and causes of death related to the degree of lesion and associated lesion. Finally, our casuistics and results are compared with those appearing in the existing bibliography on the subject.