Giant sigmoid diverticulum: case report and review of the literature.

Giant colonic diverticulum is a rare entity first described in 1946 by Bonvin and Bonte. It may be congenital or acquired and the average age of presentation is 65. There are less than 150 reported cases in the literature. A large abdominal mass was detected during a routine physical examination in an 82-year-old man. CT scan showed a large air-filled mass, barium enema showed multiple sigmoid diverticula, but no communication with the mass was found. A diagnosis of giant sigmoid diverticulum was made, elective sigmoidectomy and resection of the diverticulum was performed with no complications. The clinical picture may be different, varying from asymptomatic to acute abdomen, intestinal perforation or fistula. It can be diagnosed with abdominal X-ray, CT scan, barium enema or MRI, but colonoscopy is not effective. There are two accepted theories of the pathophysiology of this entity: first, a congenital origin and second, that inflammatory diverticula are caused by a perforation with a ball-valve that allows gas to enter, but not to leave the cyst, thus, enlarging the false diverticulum, and progressively destroying the bowel layers, causing secondary fibrosis. Elective treatment is a segmental resection of the affected colon with the diverticulum and in cases of acute abdomen two-stage bowel resection is preferred.

[Gastric carcinoma in patients under 35 years]. / Carcinoma gástrico en pacientes menores de 35 años.

OBJECTIVE: To address the frequency, type of clinical presentation, treatment modalities and survival of gastric carcinoma in young Mexicans. PLACE: Hospital de Especialidades, Centro Medico Nacional Siglo XXI, IMSS, Mexico City. METHODS: A retrospective review of all charts of patients 35 years old or younger, with a diagnosis of gastric carcinoma treated at the department of surgery, from July 1986 to January 1990 was performed. Follow up was conducted at the surgery clinic until death or up to January 1998. RESULTS: Eleven patients under 35 years of age were identified, they represent 13.7% of 80 patients treated during that time period. Women were affected more frequently (1.7:1). Ten patients presented with advanced disease, and only one patient had Stage II. Five gastric resections were performed, one patient had a bypass only, three underwent surgical explorations and two were not operated. Ten had diffuse type lesions and only one intestinal adenocarcinoma. Median survival was 15.3 months and only one patient is alive and well. CONCLUSIONS: In our series, gastric carcinoma is frequent, it is diagnosed in advanced stages, and this is the reason for a very poor prognosis.

[Squamous cell carcinoma of the liver]. / Carcinoma escamoso primario de hígado.

A case of primary squamous cell carcinoma of the liver in a 38-year-old male patient is informed. We could only find 13 cases reported in the literature, all of them in male patients; in the Mexican literature this histologic type of hepatic neoplasia has not been reported. The prognosis of these lesions are extremely poor, and no case has survived over six months.

[Management of pancreatic fistula with terbutaline. Report of a case]. / Manejo de fístula pancreática con terbutalina. Informe de un caso.

External pancreatic fistulas are secondary to trauma or surgery. Their treatment consists of scrupulous skin care, fluid and electrolyte replacement and nutritional support. Usually they are associated to significant morbidity and mortality as well as long hospital stay. In 1981 Joehl described the inhibitory effect on pancreatic secretion caused by the beta agonist terbutaline, in 1985 he used it successfully in a patient with an external pancreatic fistula following an episode of pancreatitis. We report the case of a 21 year old patient who presented with a 26 day posttraumatic pancreatic fistula that closed five days after the administration of terbutaline. To our knowledge this is the second case reported in the literature. We believe that use of terbutaline, due to its pancreatic inhibitory effect as well as its minimal side effects, might be useful in these patients.

Zinc and copper abnormalities in fasting patients undergoing total parenteral nutrition.

Low serum levels of zinc and copper have recently been reported in association with TPN and the fasting state. A prospective study during May 1977 through November 1978 was performed in 28 patients undergoing TPN. Serum and urinary Zn and Cu levels were detected; the patient population was divided in septic and non septic groups and each was subdivided according to plasma administration. In both groups low serum Zn and Cu levels were detected. The urinary losses were greater in the group with sepsis. Three patients had clinical manifestations of Zn deficiency, in two it was reversible with the administration of diet or oral Zn. The third one died of sepsis. The low serum levels found in our patients suggested that plasma administration might be insufficient to cover the daily requirements of such elements. This requirement is augmented by the increased urinary losses seen in septic postoperative stages.