Outpatient surgical unit: critical review after the first year of operation.

Introduction: Outpatient surgery has been quickly accepted by many hospitals, showing a lot of advantages, both in the quality of health care and also in hospital management. Following this trend, our Hospital started operating an Outpatient Surgical Unit in May 1997. Objectives: Once we had reached our 'cruising speed', we thought it wise to make a critical review of our experience. Material and methods: We have reviewed 331 patients who underwent surgery during the first year of operation, with special attention to the acceptance of this type of surgery by the population in general, and to the changes in pre-operative and post-operative protocols that this process has caused. Results: The rate of admission was 3.02%, and all of them occurred after 24 h. We found 57 minor complications (spotty dressing, mild inflammatory signs) on the first day assessment, but only 16 patients had refered complications. 91.5% of the questionnaires sent back by the patients qualify the experience as good or excellent. Conclusions: Outpatient Surgery is a good solution for many surgical pathologies, as it is well accepted by the general population. Inclusion and exclusion parameters regarding age, architectural obstacles and post-operative care can become selectively more lax.

[Spermatic cord lipoma]. / Lipoma de cordón espermático.

In spite of being the most frequent tumour in this location, together with adenomatoid tumours, the spermatic cord lipoma is a very rare entity (30-35% each). The etiology is unknown but linked to a constitutional factors, obesity, an its presentation is more frequent in the fifth or sixth decade of life. It progresses always as an asymptomatic tumour, usually unilateral, showing a swift growth to masses larger than 10 cm. Diagnosis is reached by ultrasound and CAT when doubtful, and the histology is confirmed during scrotomy. Tumour resection is the choice treatment. In the case reported here there had been two earlier resections, so relapses and pseudo-relapses should be taken into account. Although rare, a few cases of lipoma degeneration to liposarcoma have been reported.

[Parameatal cysts of the penis]. / Quistes parameatales del pene.

Parameatal cysts of the penis are highly infrequent, benign cysts of varied sizes usually unilateral. Contribution of two cases of parameatal cysts of the penis, one and epidermoid inclusion, allegedly post hypospadias surgery, while the other one is similar to the middle raphe cysts and appears to derive from the endodermal debris following a defective closure of the urogenital folds. Treatment is by surgical excision; simple aspiration or marsupialization may result in relapse and unsatisfactory cosmetic results.

Upper extremity deep venous thrombosis in cancer patients with venous access devices--prophylaxis with a low molecular weight heparin (Fragmin).

Central venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism. We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested. On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% CI: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 +/- 145 vs 207 +/- 81 x 10(9)/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.

[Severe obesity: its surgical treatment in 120 patients. The results and a prospective focus]. / Obesidad severa: tratamiento quirúrgico en 120 pacientes. Resultados y enfoque prospectivo.

Severe or morbid obesity (M.O.) is a pathological state which is very difficult to treat by non-surgical means. It is defined internationally on the basis of anthropometric measurements when a body mass index (BMI) of 40 kg/m2 is exceeded. In such cases, the pathological increase in body fat influences patient mortality and morbidity. The present state of bariatric surgery is reviewed in the series presented. The guidelines are submitted which are currently used as an approach to surgery, and the reasons are set out used by the authors, on the base of 5 years' experience and more than 110 patients operated on (ringed vertical gastroplasty-RVG, inflatable silicone gastric band, Salmon's technique) in a prospective approach to new surgical projects. The series presented is divided into two groups. It is shown that not all the severely obese (SMO) (BMI > 50 kg/m2) respond adequately to a simple restrictive technique (RVG) notwithstanding very considerable weight loss. Other techniques are currently under consideration for this group. It is concluded that bariatric surgery demonstrates effective and permanent results if the right technique is used on the patient selected.

[Advanced double gastric neoplasm]. / Doble neoplasia gástrica avanzada.

Gastric cancer, shows a 14% incidence of multiplicity when stomachs obtained from gastrectomies are studied carefully. That's explained by the fact that near all multiple gastric neoplasias are early cancers, and a lot of them aren't diagnosed preoperatively. We present a rare case of multiple gastric cancer where both tumors were advanced and represented different types of neoplasia under Lauren's classification. Both tumors where diagnosed preoperatively.