[Acute cholecystitis: is it a laparoscopic procedure?]. / Colecistitis aguda: es un procedimiento laparoscópico?

One-hundred and twenty-seven consecutive patients with acute cholecystitis were operated using laparoscopic technique. Average Surgical operating time was 113 minutes with an average of 127 minutes if operative cholangiogram was performed and 96 minutes when cholangiogram was not done. Technical difficulties related to gallbladder edema and hyperemia was seen in all cases (100%), also poor exposure and difficulty in grasping the gallbladder in 87%. The most common post operative complication was the wound infection of the entry trocar port, mainly at the umbilicus. One patient with gangrenous cholecystitis and multiple organ failure died after endoscopic attempt and converted to open technique. The total number conversions was 3%. In 28% of the patients a ERCP was done with ten positive for common duct stones. Operative cholangiogram was attempted in all cases with 83% success rate and 5% where positive for common duct stones. In cases where ERCP was done postoperatively for suspicious stones, seven cases were positive. Hospital stay averaged 1.6 days. Acute cholecystitis does not contraindicate laparoscopic technique and chances of having concomitant common duct stone is 16%, for that reason radiologic studies are mandatory.

[Cholecystectomy by video laparoscopy in acute cholecystitis: report of 25 cases]. / Colecistectomía por video laparoscopia en colecistitis aguda. Reporte de 25 casos.

The cholecystectomy by video laparoscopy has made a big revolution in biliary surgery during de last three or four years. We present the first 25 cases with acute cholecystitis operated on by this technique with very low morbidity a convalescence period and hospitalization time inferior to the one expected for open cholecystectomy and a conversion to open laparotomy in a relatively low percentage of the cases. In order to perform this procedures a basic training in surgery and laparoscopy is necessary groups of surgeons that work coordinated with adequate instrumentation as well as experience in laparoscopic cholecystectomy in non acute cases is always necessary.

[Cholecystectomy by video laparoscopy: 100 consecutive cases]. / Colecistectomía por video laparoscopia. 100 casos consecutivos.

The cholecystectomy by video-laparoscopy has made a revolution in biliary surgery. We present the first 100 cases operated with this technique in acute and chronic cholecystitis. Eighty five percent (85%) with admissions of less than 24 hours, a low morbidity and convalescence period of less than seven days. To perform this procedure is necessary basic training in surgery and endoscopy, the appropriate equipment and team of surgeons.

[Carcinoma of the colon metastatic to the cervix uteri. Review of unusual metastases and report of one case]. / Carcinoma de colon metastásico a cuello uterino. Revisión de metástasis inusuales y presentación de un caso.

Metastases from colon and rectal carcinoma are by direct extension, lymph node infiltration, haematogenous, perineural, intraluminal or by superficial spread. Diagnosis is based on carcinoembryogenic antigen levels, chest x-rays ultrasound, bone scan, laparoscopy or computerized axial tomography. Target organs are liver, lung, ovaries, brain, bone and muscles; other sites are rather uncommon and seldom reported. No other case of cervix metastases has been reported in the English or Spanish literature in the last 10 years.

[Analysis of current surgery of gastric cancer in Venezuela]. / Análisis de la cirugía contemporánea del cáncer gástrico en Venezuela.

Gastric cancer in Venezuela is a public health problem occupying the first place as a cause of death due to cancer. The experience of the University Hospital of Caracas during the 1976-86 decade is reviewed. Surgical morbidity and mortality is adequate and relates with other local literature reviewed. The difference is that our patients are seen when lesions are very advanced and all therapeutic measures do not get five years survivals. When diagnosis is early and appropriate surgery is performed, survival is similar to other statistics. It is important to emphasize early diagnosis, massive exams, and public campaigns associated with aggressive surgical treatment that will improve the prognosis of this fatal disease.

Dermatofibrosarcoma non-protuberans: description and report of five cases of a morpheaform variant of dermatofibrosarcoma.

Five cases of dermatofibrosarcoma are reported. All showed features typical of dermatofibrosarcoma protuberans except that in four cases, and a portion of the fifth case, no protusion of the tumor was noted clinically despite the rather advanced stage of growth of the tumor. These lesions resembled morphea or a morpheaform basal cell carcinoma clinically but could be recognized as "dermatofibrosarcoma non-protuberans" by physicians who had observed a previous case.

A vest for ambulatory patients receiving hyperalimentation.

There have been no significant complications related to the use of this ambulatory hyperalimentation vest. The potential positive impact that increased use of this vest at home might have upon hospital stay and cost containment is obvious. It is further anticipated that, as advances are made in the technology of plastic bags, tubing, miniature pumps and microprocessors, ambulatory or home hyperalimentation delivery systems exemplified by this vest will achieve a much higher degree of sophistication, practical application, economy and favorable clinical results.

Parenteral nutrition techniques in cancer patients.

If a patient is expected to respond optimally to one or more forms of oncologic therapy, he should simultaneously be in the best possible nutritional and metabolic condition. When the alimentary tract cannot be used effectively for feeding cancer patients, parenteral nutrition can be lifesaving. Moreover, patients who are poor candidates or noncandidates for any antineoplastic therapy because of their debility or cachexia can be converted to reasonable candidates following a course of i.v. hyperalimentation. This i.v. hyperalimentation can significantly reduce the morbidity and mortality of cancer patients without stimulating tumor growth when applied conscientiously according to the established principles and techniques and when integrated with specific tumor therapy. With the use of ambulatory or home hyperalimentation techniques, normal nutritional status can be restored or maintained during prolonged periods of antineoplastic therapy on a practical and relatively economical outpatient basis. It is anticipated that specific nutrient substrate formulas and parenteral therapy techniques will be developed to maintain optimal host nutrition while adversely affecting the neoplasm.