[Buschke-Lowenstein Tumor associated to nasopharyngeal condillomatosis]. / Tumor de Buschke-Lowenstein asociado a condilomatosis nasofaríngea.

Giant Acuminata Condyloma or Buschke-Lowenstein Tumor (BLT) is a rare disease characterized typically by its perineal location, local aggressiveness and its cauliflower-like aspect. BLT is associated with Human Papilloma Virus (HPV) infection. Because malignant transformation of BLT is high, radical local excision and histopathological examination are needed. We report a 26-year-old male, seropositive for HIV with giant verrucous lesions in the inguinal, perineal, suprapubic and genital area. Rectosismoidoscopy revealed anal canal involvement. Oropharyngeal papillomatosis was also found. Wide local excision was performed, including inguinoperineal and oropharyngeal lesions. Pathology studies show papillomatosis with koilocytes and no evidence of malignant transformation.

[Preservation of the bladder in rectal cancer with prostatic invasion]. / Preservación de la vejiga en el cáncer de recto con invasión de la próstata.

Colorectal cancer in the 2nd commonest cancer in Europe. In 5-10% of cases there is infiltration of urological organs. When infiltration affects the bladder or the prostate, anterior pelvic exenteration is the treatment that achieves the largest percentage of tumor free margins and the best 5-year survival. In very select cases of prostatic infiltration, the bladder can be preserved and prostatectomy and abdominoperineal block resection are carried out fulfilling oncological surgical requirements and producing an important improvement in the patient's quality of life. Owing to the very scarce published literature (two articles with three cases) we contribute our experience of 2 patients who received cytoreducing preoperative radiochemotherapy, prostatectomy and block abdominoperineal amputation and intraoperative radiotherapy. We describe the surgical technique used, which is substantially different from standard prostatectomy and requires good coordination between surgeons and urologists.

Preservación de la vejiga en el cáncer de recto con invasión de la próstata / Preservation of the bladder in rectal cancer with prostatic invasion

El cáncer colo-rectal es el 2º tumor en frecuencia en Europa. En el 5-10% de los casos existe infiltración de órganos urológicos. Cuando la infiltración afecta a la vejiga o a la próstata, la exenteración pelviana anterior es el tratamiento con el que se consiguen mayor porcentaje de márgenes quirúrgicos libres de tumor y mayores probabilidades de supervivencia a los 5 años. En casos muy seleccionados de infiltración prostática es posible preservar la vejiga, realizando una prostatectomía y amputación abdominoperineal en bloque cumpliendo con los requisitos quirúrgicos oncológicos y mejorando de forma importante la calidad de vida del paciente. Debido a la escasa bibliografía existente (dos artículos con 3 casos) presentamos nuestra experiencia en 2 pacientes a los que se les realizó radioquimioterapia preoperatoria citoreductora, prostatectomía y amputación abdominoperineal en bloque y radioterapia intraoperatoria. Describimos la técnica quirúrgica utilizada, que presenta diferencias sustanciales con la prostatectomía estándar y precisa de una buena coordinación entre el equipo de cirujanos y el de urólogos

Colorectal cancer in the 2nd commonest cancer in Europe. In 5-10% of cases there is infiltrationof urological organs. When infiltration affects the bladder or the prostate, anterior pelvic exenterationis the treatment that achieves the largest percentage of tumor free margins and the best 5-yearsurvival. In very select cases of prostatic infiltration, the bladder can be preserved and prostatectomyand abdominoperineal block resection are carried out fulfilling oncological surgical requirementsand producing an important improvement in the patient’s quality of life.Owing to the very scarse published literature (two articles with three cases) we contribute ourexperience of 2 patients who received cytoreducing preoperative radiochemotherapy, prostatectomyand block abdominoperineal amputation and intraoperative radiotherapy. We describe the surgicaltechnique used, which is substantially different from standard prostatectomy and requires goodcoordination between surgeons and urologists

[Low gastrointestinal bleeding due to ectopic varices as a result of adhesions]. / Hemorragia digestiva baja por varices ectópicas sobre bridas.

Portal hypertension frequently causes the appearance of porto-systemic shunts, such as esophageal varices and also, but with much less frequency, other atypical shunts known as ectopic varices. Despite their infrequency/rarity, ectopic varices can cause serious gastrointestinal bleeding. Intraabdominal adhesions, especially post-operative ones, promote their appearance. The therapeutic management of ectopic varices is initially the same as that for esophageal varices but surgical treatment is usually necessary as a diagnostic and therapeutic procedure.

Transanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon.

BACKGROUND: Palliative colostomy is still unavoidable in many patients with malignant obstruction of the left colon. This report describes an initial experience and follow-up in a small series of patients with left-sided colon obstruction in whom transanal self-expanding metal stent (SEMS) placement was attempted for palliative purposes. METHODS: Palliative transanal SEMS placement was attempted in 11 patients with malignant obstruction of the rectosigmoid region. The selection criteria included patients with advanced pelvic disease, peritoneal carcinomatosis and/or multiple parenchymatous metastatic disease. Wallstent oesophageal endoprostheses were used, and the technique was carried out by interventional radiologists. RESULTS: The technique succeeded in relieving the obstruction in seven patients, and surgical intervention was prevented in six. Five of these six patients died with an unobstructed colon from 26 days to 7 months after SEMS placement. The technique failed in four patients, three of whom underwent emergency colostomy. CONCLUSION: Transanal SEMS placement is an appealing method for the relief of obstruction in selected patients, obviating the need for palliative colostomy.

Early resolution of Ogilvie's syndrome with intravenous neostigmine: a simple, effective treatment.

PURPOSE: Our aim was to assess the value of a parasympathomimetic drug (neostigmine) in the early resolution of acute colonic pseudo-obstruction (Ogilvie's syndrome). METHODS: A prospective study was undertaken in 18 consecutive patients (mean age, 76 (range, 31-87) years) with acute colonic pseudo-obstruction. After a varying period of conservative treatment in all cases, 16 patients with persistent, massive abdominal distention were given intravenous neostigmine. RESULTS: A rapid and satisfactory clinical and radiologic decompression of the large bowel was obtained in 12 patients (75 percent) after a single dose of the drug; another patient had complete resolution after a second dose, and the other 3 patients had only partial resolution, in one of them after a second dose of the drug. No patient required surgical decompression of the bowel. CONCLUSION: These results give support to the theory of excessive parasympathetic suppression in most cases of Ogilvie's syndrome. The treatment with intravenous neostigmine has proved very effective, preventing in many cases prolonged periods of uncomfortable and potentially hazardous conventional conservative management and avoiding surgical treatment in a consecutive series of patients.

[Acute obstruction of the colon secondary to biliary lithiasis]. / Obstrucción aguda de colon secundaria a litiasis biliar.

Gallstone ileus is an unusual cause of mechanical obstruction of the gastrointestinal tract; but obstruction of the colon by a gallstone is an even more rare event, and there are few references in the literature. We describe the cases of two elderly women who were admitted to the Emergency Service with a mechanical obstruction of the colon and air in the biliary tract. A barium-enema examination showed the presence of a foreign body in the sigmoid colon; this was found to be a gallstone in a subsequent colonoscopy in one of the patients; a precise preoperative diagnosis was not possible in the other. In both cases the obstruction was caused by a gallstone impacted in the sigmoid colon and a cholecystocolonic fistula was evident in a postoperative barium enema examination. Correction of the obstruction is the main objective of initial treatment. The repair of the fistula can be performed at the same time or at a later date.

[Idiopathic granulomatous appendicitis or Crohn's disease confined to the appendix?]. / Apendicitis granulomatosa idiopática o enfermedad de Crohn limitada al apéndice?

Crohn's disease limited to the appendix is uncommon. When Crohn's disease affects the appendix it typically has a longer clinical course than most cases of acute appendicitis. The diagnosis is histological. Appendiceal Crohn's disease has a benign course after surgery, and that's why some authors believe that it could be a different entity which should be better addressed to as "Idiopathic Granulomatosus Appendicitis". We present three new cases of Crohn's disease limited to the appendix.

Squamous cell carcinoma complicating perianal hidradenitis suppurativa.

Hidradenitis suppurativa or Verneuil's disease is usually a chronic, recurrent, suppurative and cicatricial disorder. It most often affects the skin of the axillae, groins and perineum, and less commonly the buttocks and upper thighs. A squamous cell carcinoma located in the hidradenitis-affected area is a rare complication. We present a review of the twenty-six published cases adding one of our own.