[Synchronous neoplasias in colorectal cancer]. / Neoplasias sincrónicas en cáncer colorrectal.

OBJECTIVE: The aim of this study was to show the incidence of synchronous lesions in colorectal cancer patients treated surgical at our service. SUMMARY BACKGROUND DATA: Many studies have shown different incidences of synchronous lesions in colorectal cancer, mainly due to variations in the accuracy of the diagnostic methods used and the intentional search for associated lesucosal. METHOD: Fifty-eight clinical records of patients operated on for colorectal cancer were retrospectively reviewed from August 1995 to March 1999. The synchronous lesions were classified as benign or malignant lesions based on its histological classification. Statistical analysis was carried out by the Spearman coefficient correlation. RESULTS: Fifteen patients (25.8%) had 28 synchronous lesions, nine were male (60%), and six females (20%). The average age was 63.2 years with a range of 26 to 83 years. The endoscopic diagnosis of synchronous lesions was performed preoperatively in 12 patients (80%). The most frequent localization's of primary tumor was the sigmoid colon in six patients (40%). The more frequent localization of synchronous lesions was the rectum (35.7%). Benign lesions were most commonly found in synchronous lesions (89.3%). CONCLUSIONS: The patient with colorectal cancer has an unstable epithelium and an uncommon predisposition to develop several mucosal alterations. This predisposition is prone to grow benign or malignant lesions. For this reason, we advise all that patient with colorectal cancer be fully studied endoscopically.

[Anorectal surgery in patients infected with human immunodeficiency virus]. / Cirugía anorrectal en pacientes infectados por el virus de la inmunodeficiencia humana.

OBJECTIVE: The aim of this study was to describe the clinical characteristics of the patients infected with the human immunodeficiency virus (HIV), who were submitted to anorectal surgery with emphasis on healing time and complications. METHODS: The patients were evaluated prospectively from July 1998 to July 1999; there was a total of 23 patients HIV (+) (Group 1). They were compared to a control group of randomly chosen HIV (-) patients (Group II) to establish the characteristics of each group, the morbidity, and the time of healing. The statistical analysis was performed with the student T test. RESULTS: In Group I, the diagnosis were fistula in the anus, anal fissure, anal abscess, condylomata acuminata, anal ulcer, and cutaneous flaps. Seven patients had a fistulotomy, a drainage of abscess in one, resection of different skin lesions in 12, electrofulguration of condylomata in two, fisturectomy in three and solely biopsy in three. The average healing time was 26.087 days for Group I and 23.21 days for Group II. A comparison between healing time and complications in these two groups was carried out to determine a whether significant difference exists in these parameters. There was no significant difference between these groups, but there were unequal rates of healing (26.087, DE +/- 10.778 days vs 23.21 DE +/- 6.259 days; p = not significant) and complications for the similar procedures. CONCLUSIONS: The healing in time HIV (+) patients submitted to anorectal surgery may not vary important when compared with HIV (-) patients.

[Morbidity and mortality in surgery for gastric cancer]. / Morbilidad y mortalidad en cirugía por cáncer gástrico.

BACKGROUND DATA: Surgery stays as the only effective therapy against gastric cancer. Several factors have been postulated to influence morbidity and mortality risk in gastric cancer surgery. OBJECTIVE: Determine morbidity and mortality of gastric cancer surgery and establish risk factors. METHOD: We reviewed the charts of patients who underwent surgery for gastric adenocarcinoma. Morbidity and mortality is reported. Demographic factors, preoperative physical evaluation, biochemical parameters, surgical technique and tumor biology were analyzed as risk factors for morbidity and mortality. RESULTS: During a seven year period, 120 patients were operated for gastric cancer. Median age was 58.07 years. Subtotal gastrectomy was the most common surgical procedure in 51 patients (42.5%). Morbidity was 26.66% (n = 32). Medical most common complication was renal failure (n = 6, 14.63%) and surgical most common complication was wound infection (n = 7, 17.07%). Mortality was 13.33% (n = 16). Statistically significant risk factors for morbidity were age, ECOG status, Goldman Cardiac Risk Index and a total lymphocyte count. Statistically significant risk factors for mortality were Goldman Cardiac Risk Index, albumin, creatinine, and total lymphocyte count. CONCLUSIONS: Morbidity and mortality after gastric cancer surgery is influenced by preoperative conditions of patients.

[Spontaneous postpartum coronary dissection]. / Disección coronaria espontánea posparto.

We report a case of spontaneous dissection of right coronary artery diagnosed in a 31-year-old woman in the postpartum period, presenting with prolonged angina and ST segment elevation in the ECG, a rare manifestation of this extremely uncommon anatomico-clinic entity. We described the clinical presentation, the findings derived from transthoracic echocardiography and coronary arteriography, and the clinical course with medical therapy.