Laparoscopic surgery in the management of traumatic hemoperitoneum in stable patients.

Unnecessary laparotomies in patients with abdominal traumatism (AT) who present hemoperitoneum with stable hemodynamics may be avoided if a diagnostic/therapeutic laparoscopy is performed. Between July 1992 and December 1994, 24 patients with AT and hemoperitoneum underwent this exploration: 5 were found to have a large retroperitoneal hematoma; 2, a tear in the intestinal mesenterium; 4, hepatic injuries; and 13, splenic lesions. Of the 24 patients, 9 needed conversion to open exploration: 8 during the laparoscopy and 1 shortly after operation. Mean hospital stay was 7 days (5-9). There was no morbidity or mortality in the series. Diagnostic/therapeutic laparoscopy is a method that is efficient and economical and can easily be undertaken by surgeons with experience in laparoscopy; it may be a valid alternative to conservative treatment or laparotomy in AT and hemoperitoneum patients who are hemodynamically stable.

[Angiodysplasia of the colon and Crohn's disease. A study with vascular resin casts]. / Angiodisplasia de colon y enfermedad de Crohn. Estudio con moldes vasculares de resina.

All the previous studies which have associated arteriovenous malformations of the colon with chronic inflammatory disease have always been performed on a diseased intestine. This study, which uses the intravascular injection of resin, shows morphological evidence that angiodysplasia of the colon and intestinal inflammatory disease can coexist independently. This fact suggests that in cases of severe hemorrhage in a patient with inflammatory disease of the small intestine, it cannot simply be assumed that it originates in the macroscopically abnormal intestine, and that angiographic examination is a wise measure to rule out the possibility of arteriovenous malformations in the "normal" intestine.

[Effects of urologic surgery on lymphocyte blastogenic response to phytohemagglutinin]. / Efectos de la cirugía urológica sobre la respuesta blastogénica linfocitaria a la PHA.

In order to study the effect of urological surgery on the defence system, we have evaluated the postoperative evolution of the lymphocyte blastogenic response to phytohemagglutinin (PHA) in 45 patients. 25 of them were subjected to a transurethral resection (TUR) of a vesical tumour, 10 to a transvesical prostatectomy, 6 to a pyelolithotomy and 4 to a nephrectomy due to renal atrophy secondary to lithiasis. We verified a significant drop in the lymphocyte blastogenic response to PHA at 2-4 hours of transvesical prostatectomy (p less than 0.001) and of pyelolithotomy and nephrectomy (p less than 0.001) which was sustained until the fourth and second day after operation respectively, with subsequent return to normal. However, lymphocyte blastogenic response to PHA did not vary significantly during the postoperative of patients subjected to a TUR of vesical tumours. On the whole, the degree and duration of postoperative immunodepression was dependent on the intensity of the surgical traumatism.

[Effects of urologic surgery on lymphocyte subpopulations]. / Efectos de la cirugía urológica sobre las subpoblaciones linfocitarias.

We studied the postoperative development of lymphocytes, T cells and lymphocyte subpopulations, in peripheral blood in 45 patients. Twenty-five of them were subjected to a TUR of a bladder tumor, 10 to a transvesical prostatectomy, 6 to a pyelolithotomy and 4 to a nephrectomy for renal atrophy secondary to lithiasis. We confirm a significant postoperative drop in the lymphocyte count and in the percentages of OKT 3+ (total T cells), OKT 4+ (helper T cells) and OKT 8+ cells (cytotoxic/suppressor T cells) 2-4 hours after the operation. Its duration varies according to the type of operation carried out. Despite the slight differences observed in the postoperative development of the lymphocyte subpopulations, at no time in the study did we report significant postoperative variations in the OKT 4+/OKT 8+ quotient.