[Synchronous neoplasias in colorectal cancer]. / Neoplasias sincrónicas en cáncer colorrectal.

OBJECTIVE: The aim of this study was to show the incidence of synchronous lesions in colorectal cancer patients treated surgical at our service. SUMMARY BACKGROUND DATA: Many studies have shown different incidences of synchronous lesions in colorectal cancer, mainly due to variations in the accuracy of the diagnostic methods used and the intentional search for associated lesucosal. METHOD: Fifty-eight clinical records of patients operated on for colorectal cancer were retrospectively reviewed from August 1995 to March 1999. The synchronous lesions were classified as benign or malignant lesions based on its histological classification. Statistical analysis was carried out by the Spearman coefficient correlation. RESULTS: Fifteen patients (25.8%) had 28 synchronous lesions, nine were male (60%), and six females (20%). The average age was 63.2 years with a range of 26 to 83 years. The endoscopic diagnosis of synchronous lesions was performed preoperatively in 12 patients (80%). The most frequent localization's of primary tumor was the sigmoid colon in six patients (40%). The more frequent localization of synchronous lesions was the rectum (35.7%). Benign lesions were most commonly found in synchronous lesions (89.3%). CONCLUSIONS: The patient with colorectal cancer has an unstable epithelium and an uncommon predisposition to develop several mucosal alterations. This predisposition is prone to grow benign or malignant lesions. For this reason, we advise all that patient with colorectal cancer be fully studied endoscopically.

[Colonoscopy. Analysis of 2,000 procedures]. / La colonoscopia. Análisis de 2,000 procedimientos.

BACKGROUND: During the last 3 decades, colonoscopy has become the diagnostic study with greatest sensitivity and acuity in colonic pathology. AIMS: To know the most frequent diagnostic and colonoscopic disorders, and the pathology found, to establish certainty of the colonoscopic procedure. METHOD: Between 1987 and 1997, a descriptive, transversal, retrospective and observational study of the 2,000 colonoscopies that were carried out at on service was done, making a registry of the endoscopic search in colorectal pathology and their characteristics in on patients. RESULTS: Colonoscopies were done in 967 men (47.3%) and 1,053 women (52.6%) with a median age of 55.8 years (10 range (-) 93 years). In 1,780 of them (89.%), it was possible to arrive to cecum; 1,150 (57.5%) were pathologic. The most frequent finding was hemorrhage of the lower digestive tube in 525 (26.2%) patients; in addition cancer in 402 (20.1%), suspicion of intestinal inflammatory disease 292 (14.6%) and colorectal polyps 199 (10%) were found. The most frequent endoscopic diagnosis was colorectal polyps in 405 (35.7%) patients; in additions diverticular disease was found in 404 (35.1%) patients intestinal inflammatory disease in 185 (16%), colorectal cancer in 85 (7.4%), and vascular ectasias in 52 (4.5%) patients. There were four complicated cases (0.25%), three by resolved therapeutic colonoscopy and one diagnostically. CONCLUSION: The most frequent colonoscopic were findings hemorrhage of the lower digestive tube and the finding of cancer. The most frequent diagnoses were colorectal polyps and diverticular disease. Colonoscopy is a safe diagnostic and therapeutic procedure.

[Malignant stromal tumor of the transverse colon. Case report]. / Tumor estromal maligno de colon transverso. Informe de un caso.

OBJECTIVE: Case report of a malignant stromal tumor of the transverse colon. BACKGROUND: Colon sarcomas are rare; the most frequent presentation is the leiomyosarcoma. Forty five cases of malignant stromal tumor have been reported in the international literature. The histogenesis of these mesenchymatous neoplasms is determined by ultrastructural analysis and immunohistochemical stains, nevertheless when special techniques are negative and there is uncertainty related to the cellular differentiation line (smooth muscle, neural or undifferentiated) it is preferable to call them stromal tumors of gastrointestinal tract. METHOD: A 46 year old patient with the diagnosis of malignant stromal tumor of transverse colon and the prescribed treatment was reported. RESULTS: A case of a patient with the diagnosis of malignant stromal tumor in transverse colon is presented, who had as the main clinical features abdominal pain, transanal hemorrhage and finally intestinal occlusion. He was submitted to exploratory laparotomy finding a transverse colon intussusception, which was treated with an extended right hemicolectomy and a post surgical satisfactory recovery. Follow-up to three years hasn't found tumoral activity. CONCLUSIONS: Stromal tumors are rare in colon, treatment is a wide surgical resection with curative or palliative purposes.

[Anorectal diseases in HIV-positive patients. A prospective study]. / Patologías anorrectales en pacientes VIH positivo. Estudio prospectivo.

BACKGROUND: The acquired immunodeficiency syndrome (AIDS) has transformed in a illness pandemic and it is thought that 120 million of people will be infected by the year 2000. About thirty five percent of HIV positive patients will have rectal manifestations during their illness, and from these the most important anorectal manifestation are perianal sepsis, anal condyloma, hemorrhoidal disease, chronic diarrhea syndrome, anal ulcer and anorectal tumors. PURPOSE: To determinate in our medical environment which anorectal manifestation have the most frequency in HIV positive patients. PATIENTS AND METHOD: We developed a linear prospective, comparative and observational trial between December 1993 and December 1994, which included 83 patients distributed in 4 groups: 1) HIV homosexual patients with AIDS, 2) positive HIV homosexual patients without AIDS, 3) negative HIV homosexual patients, 4) negative HIV heterosexual patients. The statistical analysis was done through a chi 2 (Chi square) test. RESULTS: In homosexual HIV patients with the disease, the most common lesion was the anal ulcer (55%). In positive HIV homosexual patients without disease and negative HIV homosexual patients the most frequent lesion is Condyloma acuminata (48 y 84%). In negative HIV heterosexual patients the most frequent disease was anal fistula (40%) and hemorrhoidal disease (36%). CONCLUSION: In negative HIV patients and positive HIV patients without disease the most frequent anorectal lesion is condyloma acuminata; when immunosuppression begins by AIDS, anal ulcer appears and is transformed in the most frequent anorectal disease in AIDS patients.

[Surgical treatment of colonic diverticulitis]. / Tratamiento quirúrgico de la diverticulitis colónica.

BACKGROUND: Colonic diverticulitis is a serious disease that may require surgical treatment. Early diagnosis and management are necessary to reduce the rates of morbidity-mortality. PURPOSE: This review article was performed in order to discuss the most recent advances in the diagnosis and management of colonic diverticulitis. RESULTS: Patients with acute diverticulitis should be categorized based upon the presence or absence of complications. Patients with complicated diverticulitis should be further categorized into I) pericolonic abscess, II) distant abscess (retroperitoneum or pelvis), III) purulent peritonitis, and IV) fecal peritonitis. In the absence of complications, elective treatment is mainly indicated in patients with recurrent episodes of diverticulitis. In complicated diverticulitis, the surgical alternatives will depend upon the clinical category. The current tendency is to attempt a percutaneous drainage of the abscess, followed by a semi-elective resection. In patients operated upon on emergency basis, resection with a diverting colostomy, with or without anastomosis, is the most widely used procedure. CONCLUSIONS: Surgical treatment for acute diverticulitis should be based upon the presence of complications and their clinical category.