Sacral nerve stimulation for constipation: long-term outcomes.

BACKGROUND: There has been some controversy regarding the efficacy of sacral nerve stimulation (SNS) for the treatment of chronic constipation, due to less positive outcomes and concerns about cost-effectiveness in the long term. The aim of the present study was to evaluate the long-term outcomes of SNS in patients with chronic constipation. METHODS: A retrospective study was conducted on patients who had SNS for chronic constipation in 2008-2017 at our institution. Clinical factors, profile of constipation, physiology studies, and patient satisfaction with SNS therapy were investigated during a follow-up period up to 10 years after the implantation. RESULTS: Twenty-nine patients [86% female, median age 49 years (range 17-86)] were tested for SNS, and 24 received implants after a positive test phase [median 47 days (range 21-56 days)]. There were 27 bilateral and 2 unilateral implants, in S3 or S4 depending on best response. Mean follow-up was 59 months. Efficacy was considered as a score > 5 (on a scale of 1-10) in general symptom improvement. Nine (37.9%) implanted patients had a satisfaction score > 5. In 6 cases (25%), patient satisfaction was higher than 9. Due to the small sample size, there were no statistically significant variables considered as predictors of response. CONCLUSIONS: Our results agree with current studies which describe around a 30% response of SNS for refractory constipation. However, there is a small group of patients highly satisfied with SNS therapy. More studies are needed to better understand this profile and optimize outcomes.

Caroli's disease: study of six cases, including one with epithelial dysplasia.

Six cases of Caroli's Disease are reviewed. Three of the patients had an associated form of the disease, one of which had a congenital hepatic fibrosis, another a cystic dilatation of extrahepatic bile duct and the last one suffered both the above mentioned associated anomalies. Three patients presented with the simple form which was initially described by Caroli. The distribution of the biliary lesions was a bilobar one in four cases and monolobar in two. One patient presented areas of biliary ectasia partially lined by dysplastic epithelium. Surgical treatment was used in four cases, a left hepatectomy being carried out in two of them and an internal biliary drainage by Roux-Y hepaticojejunostomy in the other two. This is a rare disease, frequently associated with congenital hepatic fibrosis, possibly pre-malignant and whose treatment of choice is hepatic resection.

[Primary gallbladder carcinoma. A review of 41 cases]. / Carcinoma primario de vesícula biliar. Revisión de 41 casos.

We present a retrospective study of primary carcinoma of the gallbladder with a total of 41 cases over a period of 11 years. In the majority of cases the clinical presentation (cholelithiasis, choledocholithiasis); there were only 7 cases of suspected diagnosis, mainly through the use of new diagnostic techniques (echography, computerized tomography). The classification used is that described by Nevin (1976) of affection of gallbladder wall and adjacent tissues. The conclusions of our study are as follows: a) primary neoplasias of the gallbladder are aggressive tumours carrying a poor prognosis aggravated usually late diagnosis due to the scarce symptomatology, b) given the high incidence of cholelithiasis, it is advisable to perform routine cholecystectomy, c) survival is related to the histological grading of the tissues.

Effect of povidone iodine and chlorhexidine on the mortality and bacterial clearance in the abdominal cavity of peritonitis rats.

Peritonitis was induced in Wistar rats by intraperitoneal inoculation of pure Escherichia coli. The mortality rate in the untreated control group was 36% (18/50). Rats in which 2 ml 1% povidone iodine had been injected intraperitoneally 5 min after the bacterial challenge, had a significantly increased mortality rate (43/50, 86%) (p less than 0.01). When the same experiment was done with 2 ml of 0.05% chlorhexidine the mortality rate decreased significantly to 16% (8/50) (p less than 0.05). Povidone iodine did not have any bactericidal effect; on the contrary, the number of colonies of bacteria had increased in all the animals 12 and 24 hours after challenge. Chlorhexidine, on the other hand, had sufficient bactericidal effect to cause a progressive decrease in the concentration of intraperitoneal bacteria.

[Cystic mucinous tumor of the pancreas . A new case]. / Tumores quísticos mucinosos de páncreas. Un nuevo caso.

The case of a woman with a mucinous cystadenoma of the pancreas is presented. Caudal pancreatectomy was performed. Post-operative course was uneventful.

[Ogilvie syndrome treated with endoscopic decompression]. / Síndrome de Ogilvie tratado mediante descompresión endoscópica.

An elderly woman with multiple myeloma was admitted to the hospital because of colonic obstruction due to Ogilvie's syndrome. Successful decompression was obtained by colonoscopy.