[Permanent venous access through a +portacath reservoir in patients receiving prolonged chemotherapy]. / Acceso venoso permanente mediante reservorio portacath en pacientes que reciben quimioterapia prolongada.

A significant number of oncology patients need intravenous chemotherapy. Peripheral venous access is generally difficult, frequently requiring central venous access. This study reviews the Author's experience with permanent venous portals. A total of 66 patients records, from January 1992 to April 1994, were reviewed. The central venous portals remained in place an average of 272 days. An average of 8 courses of chemotherapy were given through each port. There was no significant difference in the rate of complications secondary to the portal site. The Authors conclude that the placement of permanent venous portals is a safe and reliable chronic venous access in patients with cancer who require intravenous therapy. The rate of serious complication was 3% which is relatively low for these immunosuppressed patients. All venous portals, except one (98.5%) remained functional.

Acceso venoso permanente mediante reservorio portacath en pacientes que reciben quimioterapia prolongada / Permanent venous access through a +portacath reservoir in patients receiving prolonged chemotherapy

A significant number of oncology patients need intravenous chemotherapy. Peripheral venous access is generally difficult, frequently requiring central venous access. This study reviews the Author's experience with permanent venous portals. A total of 66 patients records, from January 1992 to April 1994, were reviewed. The central venous portals remained in place an average of 272 days. An average of 8 courses of chemotherapy were given through each port. There was no significant difference in the rate of complications secondary to the portal site. The Authors conclude that the placement of permanent venous portals is a safe and reliable chronic venous access in patients with cancer who require intravenous therapy. The rate of serious complication was 3% which is relatively low for these immunosuppressed patients. All venous portals, except one (98.5%) remained functional

[The outpatient management of internal hemorrhoids by infrared photocoagulation]. / El manejo ambulatorio de la hemorroide interna con fotocoagulación infrarroja.

Infrared photocoagulation is a new ambulatory therapy for 1st, 2nd and 3rd degree internal hemorrhoids. It is an effective method, comparable to others such as sclerotherapy or rubber band ligature. It is necessary to use multiple applications in several sessions in order to obtain good results. Patients with hemorrhoids grade IV are candidates for hemorrhoidectomy. The author did not observe minor nor serious complications with this new therapeutic modality. It is fast and easy to use by a single operator. The equipment is portable, easy to handle and long lasting, needing little maintenance. The anatomical results suggest that the progression of hemorrhoids and also, probably, surgery are prevented. Long-term follow up is necessary.

El manejo ambulatorio de la hemorroide interna con fotocoagulación infrarroja / The outpatient management of internal hemorrhoids by infrared photocoagulation

Infrared photocoagulation is a new ambulatory therapy for 1st, 2nd and 3rd degree internal hemorrhoids. It is an effective method, comparable to others such as sclerotherapy or rubber band ligature. It is necessary to use multiple applications in several sessions in order to obtain good results. Patients with hemorrhoids grade IV are candidates for hemorrhoidectomy. The author did not observe minor nor serious complications with this new therapeutic modality. It is fast and easy to use by a single operator. The equipment is portable, easy to handle and long lasting, needing little maintenance. The anatomical results suggest that the progression of hemorrhoids and also, probably, surgery are prevented. Long-term follow up is necessary

[Medical treatment of epidermoid carcinoma of the anus]. / Tratamiento médico del carcinoma epidermoide del ano.

From January 1987 to May 1988 11 patients with epidermoid carcinoma of the anus were treated with Chemotherapy and Radiotherapy, six female and five males, between 46 and 90 years and a medium of 66. Five patients had recurrent disease to a previous treatment of surgery, radiotherapy or both. Chemotherapy treatment consisted of Mitomicine C 15 mg/m2 on day 1 and 5--FU 1 g/m2/d IV by 96 hours infusion. In the last six patients Mitomycin C was changed to Cisplatin to a dose of 80-100 mg/m2 on day 1. Radiotherapy to the pelvis was started on the first day of QT, with the exception of two patients with disseminated disease. The total response rate was 90.8% (6 CR and 4 PR). Those patients that did not receive previous treatment, had a complete response in 83.3% of the cases. The three patients that received Cisplatin as initial treatment have a complete response. All patients that received the treatment with curative intention and had an initial complete response are without evidence of disease after 33 to 47 months of follow up.

An attempt to reduce the side effects of mannitol bowel preparation by intravenous infusion.

The authors compared two groups of patients receiving oral 5% mannitol for bowel preparation to see whether the volume of rectal effluent and quantity of bowel preparation could be maintained by a smaller oral mannitol intake supplemented by an intravenous infusion. Nineteen patients drank 2--3 1 5% mannitol, supplemented by an intravenous infusion of N/saline (intravenous Group) and 19 patients drank 4--5 1 5% mannitol (oral group). The volume of rectal effluent and the quality of bowel preparation was the same in both groups. The loss of sodium in the oral group was corrected by the intravenous infusion, but the infusion resulted in greater water retention. There was no reduction in the incidence of vomiting between the two groups.

Treatment of anal fissure by lateral subcutaneous sphincterotomy should be under general anaesthesia.

Seventy-one consecutive patients with acute anal fissure were randomly allocated to treatment by lateral subcutaneous sphincterotomy under either local anaesthesia (n = 34) or general anaesthesia (n = 37). Four months after treatment there were 18 patients with a recurrent or persistent anal fissure, 17 had had local anaesthesia (50 per cent) and only one had a recurrent fissure after general anaesthesia (3 per cent). These results indicate that if lateral subcutaneous sphincterotomy is used for treatment of anal fissure the operation should be performed under a general anaesthetic.

Value of an anal dilator after anal stretch for haemorrhoids.

A prospective randomized trial compared anal stretch with or without continued dilatation for three months in 89 consecutive patients with haemorrhoids. Complications of therapy occurred in only 4 patients, 3 of whom had transient incontinence of flatus. When patients were reviewed four months after treatment, only 4 of 44 patients (9%) who used a dilator had not been improved and required additional therapy, compared with 15 of 42 patients (36%) who had anal stretch alone (P less than 0.02). It is concluded that the use of an anal dilator improves the results of anal stretch.

A randomized trial to compare rubber band ligation with phenol injection for treatment of haemorrhoids.

A prospective randomized trial has compared rubber band ligation with phenol injection in 82 patients with symptomatic haemorrhoids. The symptomatic results in all patients 12 months after treatment were indistinguishable, 64 per cent being improved after rubber band ligation, compared with 70 per cent after injection. Complications of treatment were recorded in 5 patients after rubber band ligation, 3 of whom required hospital admission compared with one minor complication after infection. However, repeated treatment was necessary in 13 patients after phenol injection compared with only 4 following rubber band ligation (P less than 0.05). Additional treatment was necessary in 6 patients from each group. Two-thirds of patients with third-degree piles required additional therapy. It is concluded that rubber band ligation and injection provide similar results, but rubber band ligation is more liable to complications with inexperienced operators.