Role of Peritoneal Cytology in Patients with Early Stage Colorectal Cancer.

The main objective of this study was to investigate the incidence of free tumour cells in peritoneal lavage cytology performed using a standard method before and after the resection of the tumour, and to assess the usefulness of this technique in scheduled interventions on colorectal cancer patients. Peritoneal lavage cytology was performed on a homogeneous sample of 188 patients undergoing colorectal cancer curative resection before and after the resection of the tumour. The procedure was performed systematically in all cases. Malignant cells were detected in the peritoneal lavage cytology performed before the resection of the tumour in three patients. Lymph node affection was the variable most associated with the prognosis of these colorectal cancer patients. Peritoneal lavage cytology can provide additional information for a small group of patients who need to be closely monitored and studied to decide on the most effective type of chemotherapy.

Influence of intestinal resections on biliary composition and liver ultrastructure.

BACKGROUND & AIMS: Among the multiple factors that can influence bile acid (BA) metabolism and biliary poles, intestinal resections could do so directly (through absorption alterations) and/or indirectly (bacterial translocation, alterations of the hepato-intestinal hormonal axis). Our aim was to study the influence of partial intestinal resections on bile metabolism and biliary structure in an animal model. METHODS: Dunkin Hartley guinea pigs were used: Group A with only jejunum resection, Group B with only ileum resection, and Group CtrG, the control group. They were monitored for 21 days, with oral nutrition. At the end of this period, samples of the bile were taken from the hepatic duct and vena cava. After liver perfusion, samples of hepatic tissue were taken for optical and electron microscopy. RESULTS: There was a significant decrease in serum cholesterol in both GA & GB. The levels of biliary phospholipids (Ph) and cholic acid decreased only in Group B, but not ketolithocholic acid nor total conjugated BA. Slight liver macrosteatosis was observed in GB, but there were no changes in the biliary poles or canaliculi in the electron microscopy samples. CONCLUSIONS: Ileum resections affect the biliary Ph and BA composition, which could increase bile lithogenicity but do not seem to affect biliary duct anatomy.

[A possible case of superior mesenteric artery syndrome of congenital origin]. / Un posible caso de origen congénito de síndrome de la arteria mesentérica superior (SAMS).

We describe a case of a 10 yr old boy, who suffered from gastroesophageal reflux in the neonatal period and from recurrent abdominal pain, epigastric distension and vomiting since birth, but with an increase in this clinic in the last two years, especially in the last five months, without suffering weight loss, having operations or other illnesses. After the diagnosis of superior mesenteric artery syndrome was confirmed by a superior barium series and a CT-scan, a laparotomy was performed, carrying out the Koecher manoeuvre, cutting the Treitz ligament near of the 4th part of the duodenum until descend that and freeing the aorto-mesenteric space. The follow up after 5 years showed an excellent clinical evolution. In our opinion, this case should be considered to be of congenital origin, but without other associated abdominal anomalies. The possible different interventions are also discussed.

Cholestasis induced by total parenteral nutrition.

Parenteral nutrition is a life-saving treatment for patients who have acute and chronic intestinal failure. Severe cholestasis induced by total parental nutrition (TPN-IC) is characterized by bile duct regeneration, portal inflammation, and fibrosis. Its progression could be very rapid, and in some patients liver cirrhosis may develop in few months. This article describes the definition, incidence, hepatic changes, histopathologic findings, risk factors, pathogenesis, and clinical implications of TPN-IC. The goal is to improve hospital and home management, quality of life, and prognosis of patients requiring parenteral nutrition.

Anomalies of intestinal rotation and fixation: consequences of late diagnosis beyond two years of age.

The malrotation and no well fixation anomalies of the digestive tract is also frequent in older child, young and adult, with characteristic and specific clinical presentation. Actually, the diagnostic and treatment seem to be late, after suffering prolonged symptoms and/or in emergency. We present nine cases of anomalies in the embryonic development of the digestive tract which were diagnosed and treated in infants or young, all above 2 years old. Eight cases were of more or less complete intestinal malrotation; one of them was a complete malrotation with an intrinsic duodenal stenosis associated (no bands of Ladd) and another one was a right paramesocolic hernia, always accompanied by malrotation. The association with other extra-digestive anomalies, especially urological, was 70%. The predominant symptom was intermittent abdominal pain (IAP)-80%-sometimes accompanied by vomiting (35%) and episodes of diarrhoea (25%). In all the cases, while the clinical background was early, diagnosis was late. Indeed, in 60% of the cases diagnosis was made intra-operatively in emergency surgical interventions. The imaging procedures employed were scanning and Doppler ultrasound, CT scan, and contrast gastrointestinal series (GIS). Up to 30% of errors in interpretation occurred, although they were eventually corrected with other tests. The most reliable diagnostic procedures were GIS and CT scan with contrast, although partial interpretation errors occurred with the latter procedure. Surgery was essential in 80% of the pre-operative cases, and in another two it was required as a preventative measure. Post-operatively, there was notable persistence of SBS in the cases of intestinal necrosis, and of other lesser symptoms in the rest. We conclude that: intestinal malrotations and malfixations are still being diagnosed very late, with serious systemic consequences such as intestinal obstructions or necroses, and prolonged clinical suffering. This could all be avoided if more attention were paid to the digestive symptoms associated with IAP, and to subocclusion or other abdominal phenomena (distension,...), together with, in the case of doubt about the findings with the previous procedures, the opportune imaging tests (e.g., abdominal Doppler ultrasound, CT scan with contrast, and barium GIS). Unlike other authors, we consider that the morbidity/mortality associated with cases of late diagnosis of these anomalies is high, and calls for earlier surgical treatment.