[Bioethics in the face of death]. / La bioética ante la muerte.

We review death, thanatology and bioethics concepts and precepts, the value scale and hierarchization; the changes in death vision according to culture, religion and hierarchy, changes in perception of, according to culture, religion and mores in different communities and times, as well with scientific and technological advances. We analyzed patient's reactions to death, and the reactions of people close to them. We describe and analyze the principal bioethical dilemmas associated with death: therapeutic overkill or dysthanasia, passive and active euthanasia, assisted suicide, orthothanasia, and organ transplants. We discuss the relationship between death and science, bioethics and thanatology, as a necessary discipline today.

[The surgical patient in critical state. Progress in the diagnostic-therapeutic process]. / El paciente quirúrgico en estado crítico. Avances en el proceso diagnóstico terapéutico.

Bases on advances in scientific knowledge, we have reviewed the circumstances under which patients recommended for surgery may enter a critical state pre, trans, and post-operatory period and the physiopathological changes that these patients undergo: hypovolemia; systemic inflammatory response syndrome; infection; sepsis; septic shock; and multiple organic failure. We have analyzed the utility of advantages in diagnostic procedures, with emphasis on non-invasive methods, the dosage of inflammation intermediaries, and the use of prognostic indices. We have also looked into effective circulation volume replenishment, organ function failure, the rational application of vasoactive amines, antibiotics, and monoclonal antibodies, as well as surgery with septic focus elimination, and pre- and post-operation nutritional support.

[Monoclonal antibodies. Their usefulness in the diagnosis of malignant tumors of the digestive system]. / Anticuerpos monoclonales. Su utilidad en el diagnóstico de tumores malignos del aparato digestivo.

Lately, there is a lot of interest in tumor markers, monoclonal antibodies and immunoscanning in the diagnosis and follow-up of certain cancers. The main objective of this study is to report our initial experience with the detection of specific antibodies and with the obtention of scan images. In 85.7% of patients with cancer and in 40% of patients with benign conditions, above normal values of CEA were obtained. In 85.7% of patients with cancer and in 60% of patients with benign disease, above normal values of CA 19-9 were noted. Positive scans were obtained in 83.4% of cancer patients and 13.3% negative scans; it was not useful in one case. In benign conditions 40% of the scans were positive and 60% negative. I-131 was capable of detecting tumors very clearly. The statistical analysis employed was the exact test of Fisher and the correlation was evaluated with contingency coefficients.

Influence of D-Trp-6-LH-RH on the survival time in patients with advanced pancreatic cancer.

Carcinoma of the exocrine pancreas seems to be sex-hormone sensitive. Administration of agonistic analogs of luteinizing hormone--releasing hormone (LH-RH) creates a state of sex-hormone deficiency. Therapy with D-Trp-6-LH-RH was evaluated in 17 patients with unresectable and biopsy-proven adenocarcinoma of the pancreas (stage IV). Nine patients were male and 8 female, and the median age at diagnosis was 60 years. The majority of patients underwent a gastro-intestinal and biliary bypass. The therapy with D-Trp-6-LH-RH was started 3-31 days after bypass surgery. The analog was given at the dose of 1 mg/day subcutaneously for the first 7 days. Subsequently, the dose was reduced to 100 micrograms/day. One month after the start of the therapy the gonadotropin levels were in subnormal range. This therapy led to clinical improvement, better quality of life and an increase in survival time. The median survival time for all the groups was 7.2 months (men 7.4 months and women 6.9 months). LH-RH agonists appear to decrease pancreatic cancer growth by eliminating the stimulatory effect of sex steroids, and by direct effects on tumors. Further improvement in the clinical response in patients with inoperable pancreatic carcinoma might be possibly obtained by the combination of LH--RH agonists with modern somatostatin analogs.

[Pancreatic abscess. Extraperitoneal drainage]. / Absceso pancreático, drenaje por vía extraperitoneal.

The pancreatic abscess occurs in two to six per cent of patients with acute pancreatitis and in 40 to 50 per cent of whom develop the severe form of the disease. The postoperative morbidity rate is 85 to 90 per cent and the mortality rate is 30 to 50 per cent due to persistence or recurrence of infection. The anatomical location and dissemination of the pancreatic abscess allows an extraperitoneal approach. Twelve patients with pancreatic abscess are reported. Seven males and five females, with an average age of 36 years. Fever, abdominal pain, cutaneous hypersensitivity and palpable abdominal mass were the most frequent clinical signs. Most of them developed multiple organic failure, leukocytosis, hyperglycemia, increasing L.D.H. and alkaline phosphatase levels. The CAT scan was most useful to localize the abscess. About 83 per cent of patients had been operated on previously. The extraperitoneal surgical approach was anterior in 10 patients and posterior in two patients. Ten patients developed complications that resolved with conservative measures. Two patients (17%) died. Extraperitoneal drainage is a valid alternative to prevent peritoneal contamination and some other serious postoperative complications in the management of pancreatic abscess.

Neoplasias del aparato digestivo. Revision de 70,055 casos de material quirurgico y necropsias. / Digestive system neoplasms.Review of 70,055 cases of surgical specimens and necropsies

El cancer del aparato digestivo es una causa frecuente de mortalidad, sin embargo su prevalencia en nuestro medio se desconece. En este trabajo se informan los resultados obtenidos en un analisis retrospectivo de 70,055 estudios histopatologicos; 61,533 correspondieron a material quirurgico-biopsia o pieza operatoria - de cinco anos (1975-1980), de ellos 673 (1.09%) presentaban proceso neoplasico maligno del aparato digestivo; los restantes 8, 522 correspondieron o protocolos de necropsia de 20 anos (1960-1980) en los que 352 (4.13%) presentaban igual patologia.Tanto en piezas operatorias como en necropsias la variedad histologica mas frecuente fue el carcinoma 82.6% y 92.8% respectivamente, seguida del linfoma. Por lo que hace a la localizacion del proceso los resultados varian igualmente segun el material motivo de estudio; en piezas operatorias los carcinomas mas frecuentes fueron: estomago (37.95%), vesicula y vias biliares (24.29%), colon (19.25%); mientras que al estudiar el material de necropsias la frecuencia fue: vesiculas y vias biliares (35.47%) pancreas (22.62%) y estomago (18.45%).Se senalan aspectos epidemiologicos, clinicos y terapeuticos de las neoplasias mas frecuentes informadas en esta revision