Estudio Delphi de la Sociedad Valenciana de Cirugía: tratamiento quirúrgico del cáncer gástrico / A Delphi study by the Surgical Society of Valencia, Spain: surgical treatment of gastric cancer

Se presentan los resultados del primer estudio de consenso auspiciado por la Sociedad Valenciana de Cirugía sobre el tratamiento quirúrgico del cáncer gástrico. Se trata de un esudio tipo Delphi, con la participación de 31 expertos pertenecientes a la mayoría de hospitales de la Comunidad Valenciana. Los temas consensuados han versado sobre los siguientes aspectos: nutrición artificial, métodos de estadificación preoperatoria, tipo de resección y de linfadenectomía, técnicas de reconstrucción, criterios de resecabilidad y temas de organización (AU)

[Treatment of gastroesophageal reflux by pexis to the round ligament. Report of 100 operated patients followed-up for 16 to 23 years]. / Le traitement du reflux gastro-oesophagien par pexie avec le ligament rond. A propos de 100 opérés suivis entre 16 et 23 années.

In a study of 1,491 patients operated with ligament cardiopexy from 1,694 onwards, which we published in 1986, we reviewed 100 consecutive cases operated 15 years earlier or more. The review was based on a radioclinical (100), fiberscopic (53) and manometric (71) study, as well as on a measurement of the pH in doubtful cases (22). The results were distributed into categories A (normal), B (occasional disorders), C (functional disorders without recurrence) and R (recurrence), as follows: A + B 81%, C 12% and R 6%. This recent study confirms the conclusions we drew in 1981: a 15-minute operation that cures 94% of the patients without recurrence after 15 years and more is an appropriate procedure.

[Supraselective or proximal gastric vagotomy. Report of 1,250 surgical cases. 777 special cases with objective follow-up for over 10 years]. / La vagotomie suprasélective ou gastrique proximale. A propos de 1,250 opérés. Spécialement 777 cas suivis objectivement plus de 10 années.

From August, 1970 to February, 1989, we performed 1,105 elective and 145 emergency PGVs (proximal gastric vagotomy). The emergent cases included 118 perforations and 27 bleeding lesions. Since September, 1973, we have been able to measure the pH of the mucosa using a GR282C transesophageal electrode. Two cases of exitus (0.2%) were noted. With an intraoperative test (pH) or the systematic section of the gastroepiploic nerve (n.ge) (randomized with 269 cases followed up over 57 months) the rate of recurrence does not exceed 2%. Without these "tools", it is as high as 10%. Since this rate is still a cause of confusion in this 20th year of PGV, we analyse 684 "stabilized" (excluding the first 10 patients of each surgeon). PGVs followed up (88% of 777 PGVs) over 10 to 17 years. The study was clinical and radiological in 100% of cases, based on acid secretion in 2/3, and fiberscopic in 47%. Between 5 and 17 years, 318 patients had a fiberscopic study and 325 an analysis of the basal and stimulated acid secretion (76% were already evaluated preoperatively). Two types of recurrence were defined: those due to failure of the surgeon or technique (gastroepiploic nerve in 1/5 of cases) involving acidity--this being the "persistent" ulcer (3/4 of cases during the first years); and disorders in gastric evacuation (?) with a very low acidity level, also causing more delayed gastric ulcers. The non-cumulative probability of R in successive years stays around 0.2 to 0.1% after the 3rd or 4th year following the PGV, and the total rate after 10 years or more is about 10%. If performed by experienced surgeons and with the intraoperative test (or systematic section of the n.ge), PGV should have only a low rate of failure, these cases being more amenable to treatment than an anastomotic mouth ulcer following resection, for instance.

[Hernial strangulation of Meckel's diverticulum: Littre's hernia. Apropos of 4 cases]. / Estrangulación herniaria del divertículo de Meckel: hernia de Littré. A propósito de cuatro casos.

Hernial strangulation of Meckel's diverticulum (Littre's hernia) is a rare anatomoclinical form. It represents 10% of all complications of Meckel's diverticulum (8.8% of our cases), and complications like hemorrhage, perforation and diverticulitis are fairly frequent. Four cases of Littre's hernia are presented: two males and two females, with an average age of 67 years (range 50-83 years), representing 0.08% of all the inguinal-crural hernias operated in the department. The clinical manifestations were those of intestinal obstruction because a mixed type Littre's hernia was involved, with compromise of the diverticulum and its intestinal loop. Preoperative diagnosis is unlikely in strangulation without disturbances in the intestinal transit and, in fact, is even less likely if it is accompanied by obstruction. The diagnosis is thus almost always intraoperative. The correct treatment is surgery after restoring the patient's hemodynamic equilibrium. Simple and/or loop diverticulectomy via herniotomy, herniolaparotomy or laparotomy are debated. We think that this disorder can generally be resolved using the inguinal approach, as in any strangled hernia, with the technical option of using a larger, more comfortable and safer approach in cases of important obesity and/or deterioration of the loop (necrosis, perforation). In elderly patients with uncomplicated Littre's hernia and Meckel's diverticulum, abstention from diverticular exeresis may be justifiable. Of the four patients, the first two died from cardiogenic shock and pulmonary embolism, respectively; the last two evolved well (except for a wound abscess).

The influcence of ziznc sulphte on gastric blood flow in rats

A reduçäo do fluxo sanguíneo gástrico é apontada como um dos fatores responsáveis pelas lesöes ulcerativas observadas no estômago e no duodeno. Esta deficiência de irrigaçäo reduz o suprimento de energia, oxigênio e outros fatores responsáveis pela manutençäo da integridade tissular contra os efeitos autolesivos do HCl e da pepsina da secreçäo gástrica. É reconhecida a relaçäo entre fluxo sangüíneo da mucosa e a secreçäo cloridro-péptica. Em doentes com úlcera duodenal, o fluxo sangüíneo é mais lento e a secreçäo ácida mais elevada do que em voluntários säo. Na patologia digestiva há muitas doenças associadas à reduçäo considerável dos níveis séricos de zinco (acrodermatite enteropática, doença celíaca, doença de Crohn, úlcera gástrica, etc.). A maior parte delas apresenta lesöes ulcerativas em diferentes partes do organismo. Neste trabalho, estudou-se o efeito do sulfato de zinco no fluxo sangüíneo gástrico, em condiçöes experimentais de estresse induzido por noradrenalina. Utilizando-se o tritio marcado, estudou-se o fluxo sangüíneo da mucosa gástrica em ratos tratados com sulfato de zinco e num grupo controle. Nesses dois grupos, avaliou-se a m,odificaçäo do fluxo snagüíneo apósa adminsitraçäo intraperitoneal de noradrenalina. No grupo controle observou-se uma reduçäo significante (p < 0,05) do fluxo 20 minutos após a injeçäo de noradrenalina. No grupo tratado com sulfato de zinco, näo houve modificaçäo significante, indicando que o zinco iônico exerce um efeito protetor da mucosa gástrica do rato, preservando seu fluxo sangüíneo contra o estresse

[Antiulcerogenic properties of bran rice oil in rats]. / Estudio de las propiedades antiulcógenas del aceite de salvado de arroz (ASA) en la rata.

A study was made of the effect of rice chaff oil (ASA) on gastroduodenal ulcer (UGD) induced by different techniques: cysteaminium chloride, indomethacin, artificial gastric juices and stress (acidity, histamine, pepsin and volume of gastric juice were evaluated). For each technique the same protocol was followed: four days before the experiment 20 Wistar rats (180-220 g) were divided into a control group (0.2 ml/day of saline solution per os) and a treated group (0.2 ml/day of oral rice chaff oil). After quantitation of the ulcers and statistical analysis of the data, the ulcer index was found to be smaller in the treated group than in controls, both for stress ulcers (p less than 0.01) and for those induced by indomethacin (p less than 0.001) and artificial gastric juice (p less than 0.001). As for the cysteaminium chloride technique, an evaluation was made of the ulcer per se and the inflammatory halo; in both cases there were significant differences (p less than 0.05 and p less than 0.01 respectively) between the treated group and controls. No significant differences were found on comparing the values off histamine, pepsin and the volume of gastric juices, but there were differences in hydrogen ion concentration (p less than 0.05). An analysis is made of the physiologic aspects studied in each technique, emphasizing the possible implication of prostaglandins (PG) and alpha-tocopherol after treatment with rice chaff oil.

A statistical approach to an individualized prognostic index (IPI) for breast cancer survivability.

The authors present 611 and 262 case histories of patients with breast cancer, studied 5 and 10 years after mastectomy, respectively; 27 clinical and 10 histologic parameters were considered for the statistical evaluation, in order to define an Individualized Prognostic Index (IPI) for breast cancer survivability. The probability of survival was estimated by a Bayesian formula using selected prognostic parameters, these parameters were placed in order of discriminant resolution and, for the calculation of the IPI, were selected according to their importance, as it follows: 5 years after surgery: percent affected nodules, dermal infiltration, TNM phase, Scarff-Bloom index and evolutive outbreak (PEV); 10 years after surgery: TNM phase, dermal infiltration, percent affected nodules and Scarff-Bloom index. The current information considers that out of several parameters, the selected prognostic parameters used for the IPI are sufficient to establish probability tests and a reliable estimation of life expectancy following breast cancer surgery.