Indicadores de calidad asistencial en cirugía mayor ambulatoria (2010-2012) / Indicators of healthcare quality in day surgery (2010-2012)

Introducción: La monitorización de indicadores de calidad en las unidades de Cirugía Mayor Ambulatoria es una herramienta fundamental para identificar los problemas, corregirlos y prevenirlos. Dado su gran número, es indispensable la selección de los más válidos. Objetivos: Mejora continuada de la calidad asistencial de la cirugía ambulatoria en nuestro centro mediante el seguimiento de parámetros de calidad selectivos, la información periódica de los resultados y la toma de medidas correctivas. Conseguir un porcentaje de pernoctas no planificadas y cancelaciones dentro de los estándares de calidad. Material y método: Estudio prospectivo, observacional y descriptivo de la cirugía ambulatoria realizada desde enero de 2010 a diciembre de 2012. Se seleccionaron y monitorizaron los ingresos imprevistos y las anulaciones el mismo día de la operación, y sus motivos. Los ingresos se clasificaron en selección inadecuada, complicaciones médico-quirúrgicas y otros. Los resultados se evaluaron anualmente y se analizaron estadísticamente con la prueba de χ2. Resultados: Durante estos 3 años, 8.300 pacientes fueron intervenidos en régimen de cirugía mayor ambulatoria. La cirugía ambulatoria y el índice de ambulatorización se incrementaron un 5,4 y 6,4%, respectivamente (p < 0,01). Los ingresos no previstos disminuyeron progresivamente, a expensas de un menor número de complicaciones (p < 0,01). Descendieron los debidos a tiempo prolongado en la recuperación de la anestesia locorregional (p < 0,01). Las náuseas y vómitos y el dolor mal controlado fueron mejor prevenidos. La proporción de ingresos de tarde se redujo significativamente (p < 0,01). Las anulaciones se incrementaron en el año 2011 (p < 0,01). Conclusiones: La monitorización de parámetros de calidad en cirugía mayor ambulatoria ha sido una herramienta útil en nuestra gestión clínica y de la calidad. Globalmente, los ingresos imprevistos y las anulaciones han estado dentro de los estándares de calidad y han mejorado muchos indicadores analizados (AU)

Introduction: Monitoring quality indicators in Ambulatory Surgery centers is fundamental in order to identify problems, correct them and prevent them. Given their large number, it is essential to select the most valid ones. Objectives: The objectives of the study are the continuous improvement in the quality of healthcare of day-case surgery in our center, by monitoring selective quality parameters, having periodic information on the results and taking corrective measures, as well as achieving a percentage of unplanned transfer and cancellations within quality standards. Material and method: Prospective, observational and descriptive study of the day-case surgery carried out from January 2010 to December 2012. Unplanned hospital admissions and cancellations on the same day of the operation were selected and monitored, along with their reasons. Hospital admissions were classified as: inappropriate selection, medical-surgical complications, and others. The results were evaluated each year and statistically analysed using 2 tests. Results: A total of 8,300 patients underwent day surgery during the 3 years studied. The daycase surgery and outpatient index increased by 5.4 and 6.4%, respectively (P < .01). Unexpected hospital admissions gradually decreased due to the lower number of complications (P < .01). Hospital admissions, due to an extended period of time in locoregional anaesthesia recovery, also decreased (P < .01). There was improved prevention of nausea and vomiting, and of poorly controlled pain. The proportion of afternoon admissions was significantly reduced (P < .01). The cancellations increased in 2011 (P < .01). Conclusions: The monitoring of quality parameters in day-case surgery has been a useful tool in our clinical and quality management. Globally, the unplanned transfer and cancellations have been within the quality standards and many of the indicators analysed have improved

Colecistectomía laparoscópica ambulatoria. Dificultades para su implementación y desarrollo: punto de vista del paciente / Outpatient laparoscopic cholecystectomy. Difficulties in its implementation and development: point of view of the patient

Introducción: El objetivo del estudio es saber las preocupaciones y expectativas del paciente en la colecistectomía laparoscópica ambulatoria (CLA) antes de su desarrollo e implementación en nuestro Hospital. Conocer la dificultades que van a presentarse. Diseñar las medidas que deben introducirse para transmitirle seguridad, disminuir su temor y lograr su confianza y aceptación. Material y método: Estudio prospectivo iniciado en abril de 2012 y finalizado en marzo de 2013, observacional y descriptivo de los pacientes intervenidos consecutivamente de colecistectomía laparoscópica electiva con hospitalización. Participaron voluntariamente en una encuesta realizada antes y después de la operación que hacía referencia a su conocimiento y opinión de la CLA y de su predisposición a su aceptación. Resultados: Se examinaron 114 casos. Preoperatoriamente, el 46 % habrían aceptado la CLA. Este porcentaje se incrementó al 60 % en los pacientes que cumplieron criterios de selección preoperatorios de CLA (p < 0,05). Esta opinión favorable estuvo relacionada con el nivel de estudios (primarios, secundarios y universitarios: 41, 42 y 100 %, respectivamente [p < 0,01-]).Tras la intervención, solo el 18 % la hubieran preferido (p < 0,01). El único factor que contribuyó a elegir esta decisión fue el cirujano que practicó la operación que varió entre O y 43 % (p < 0,05). La causa principal del rechazo fue el temor a las posibles complicaciones. Conclusiones: La opinión del paciente es mayoritariamente desfavorable a la CLA. El cirujano deberá realizar un sobreesfuerzo informativo y docente para eliminar los prejuicios previos. Selección adecuada, estudios superiores y el cirujano apropiado pueden facilitar la aceptación de CLA (AU)

Introduction: The aim of our study is to understand the worries and expectations from the patients in ambulatory laparoscopic cholecystectomy (ALC) before the development of ALC in our Hospital. Knowing what difficulties can occur. Designing measures to be introduced to convey safety and reduce fear to the patient and allow achieve his confidence and acceptance. Material and method: Prospective study started in April 2012 and completed in March 2013, observational and descriptive of patients undergoing consecutively elective inpatient laparoscopic cholecystectomy. Voluntarily participated in a survey before and after the operation referring to their knowledge and opinion about the ALC and their predisposition to acceptance. Results: 114 cases were examined. Before the operation, 46 % would have accepted outpatient surgery option. This percentage increased to 60 % in patients who had preoperative selection criteria of ALC (p < 0.05). This favourable opinion was related to the study's level (primary, secondary and university: 41, 42 and 100 %, respectively, [p < 0.01]). Only 18 % would have accepter after the operation (p < 0.01). The only factor that contributed to choosing this decision was the surgeon who performed the operation, ranged from O to 43 % (p < 0.05). The main reason for rejection was the fear of possible complications. Conclusions: The opinion of the patient is mostly unfavourable to the ALC. The surgeon should strive to provide information and teaching to eliminate the previous prejudices of the patient. Proper selection, higher education and the appropriate surgeon may facilitate the acceptance of CLA (AU)

[Indicators of healthcare quality in day surgery (2010-2012)]. / Indicadores de calidad asistencial en cirugía mayor ambulatoria (2010-2012).

INTRODUCTION: Monitoring quality indicators in Ambulatory Surgery centers is fundamental in order to identify problems, correct them and prevent them. Given their large number, it is essential to select the most valid ones. OBJECTIVES: The objectives of the study are the continuous improvement in the quality of healthcare of day-case surgery in our center, by monitoring selective quality parameters, having periodic information on the results and taking corrective measures, as well as achieving a percentage of unplanned transfer and cancellations within quality standards. MATERIAL AND METHOD: Prospective, observational and descriptive study of the day-case surgery carried out from January 2010 to December 2012. Unplanned hospital admissions and cancellations on the same day of the operation were selected and monitored, along with their reasons. Hospital admissions were classified as: inappropriate selection, medical-surgical complications, and others. The results were evaluated each year and statistically analysed using χ(2) tests. RESULTS: A total of 8,300 patients underwent day surgery during the 3 years studied. The day-case surgery and outpatient index increased by 5.4 and 6.4%, respectively (P<.01). Unexpected hospital admissions gradually decreased due to the lower number of complications (P<.01). Hospital admissions, due to an extended period of time in locoregional anaesthesia recovery, also decreased (P<.01). There was improved prevention of nausea and vomiting, and of poorly controlled pain. The proportion of afternoon admissions was significantly reduced (P<.01). The cancellations increased in 2011 (P<.01). CONCLUSIONS: The monitoring of quality parameters in day-case surgery has been a useful tool in our clinical and quality management. Globally, the unplanned transfer and cancellations have been within the quality standards and many of the indicators analysed have improved.

Guía en DVD en la Cirugía Mayor Ambulatoria. Análisis de los resultados iniciales / Ambulatory surgery DVD guide. Analysis of the initial results

Introducción: Con la intención de mejorar la calidad asistencial se ha producido colateralmente una mayor complejidad en los circuitos peroperatorios. Así, en nuestro centro hemos asistido en los últimos años a un incremento de los pasos que deben realizar los pacientes desde que son derivados al cirujano para ser valorado un posible tratamiento quirúrgico hasta la fecha de la operación. Todo ello puede ocasionar confusión y angustia al paciente, a pesar del soporte y de la información oral y escrita que recibe de los diferentes profesionales sanitarios que visita. Objetivos: Para paliar esta situación se realizó un DVD que es entregado al paciente en la primera visita del especialista. Dicho DVD da a conocer una visión general del circuito de la CMA de nuestro centro y detalla cada paso que deberá realizar. De esta forma, el paciente puede verlo en su domicilio todas las veces que considere oportunas. Su observación familiariza al paciente con nuestras instalaciones y el ambiente hospitalario, complementa las explicaciones orales y escritas entregadas para clarificar las dudas que todavía pudieran persistir y creemos ayuda a disminuir la ansiedad del enfermo ante este acontecimiento. Material y método: Voluntariamente, el paciente realiza na encuesta de satisfacción que es remitida varias semanas tras el alta. Los resultados se comparan con los de un grupo de control que han visualizado el DVD. Resultados: Actualmente el estudio no está finalizado. Se han recibido 35 encuestas de las entregadas a los pacientes de cirugía general, de las cuales solo a 13 pacientes se le había entregado el DVD. El 31% de los pacientes a los que se entregó el DVD no tuvieron interés en verlo, los que lo consultaron refieren que la información fue útil en el 100% de los casos. Comparando los que reciben DVD de los que no, referente a sus preferencias de ingreso, el 11% hubieran preferido ingresar en comparación al 14% del grupo a los que no se les entregó. El grado de satisfacción fue elevado en ambos grupos, 8,8 puntos sobre 10. Conclusiones: La información perioperatoria puede ser mejorada con la entrega de material audiovisual complementario. Esta herramienta sintetiza y aclara todas las etapas que debe realizar el paciente. Incrementa el grado de satisfacción y la calidad asistencial percibida del paciente de la CMA realizada en nuestro hospital (AU)

Introduction: Nowadays there is more complexity in the per-operative circuits as a collateral consequence of trying to improve the health care quality. In the last years, we have seen an increase in steps that patients should be at our hospital since they are derived to the surgeon to be valued a possible surgical treatment until the date of the operation. All this can cause confusion and distress to the patient, despite the support and the oral and written information received from different specialists visited. Objective: A DVD was made to remedy this situation that is delivered to the patient in the first surgeon's visit. This DVD gives a general vision of the circuit of the ambulatory surgery of our center and details of each step. In this way the patient can see it at his home every time he deems appropriate. Its observation familiarizes him with our facilities and the hospitable atmosphere, clarifies the doubts that could still persist and we believe helps to decrease his anxiety before this event. Material and method: The patient performs a satisfaction questionnaire and he returns it several weeks after discharge from hospital. The results are compared with those of a control group that not viewed the DVD. Results: Currently the study is not complete. There have been 35 surveys delivered to the general surgery patients, of which only 13 patients had been given the DVD. 31% of patients who gave the DVD had no interest in seeing it, those who report that looked at the information was useful in 100% of cases. Comparing those who received the DVD not concerning their preferences for income, 11% would have preferred to enter compared to 14% of the group to which they were not given. The degree of satisfaction was high in both groups, 8.8 ut of 10. Conclusions: The preoperative information can be improved with the delivery of additional audiovisual material. This tool summarizes and clarifies all the stages that the patient should perform, increases the degree of satisfaction and the perceived quality in the care of ambulatory surgery patient in our hospital (AU)

Analysis of image quality parameter of conventional and dental radiographic digital images.

The image quality obtained by a radiographic equipment is very useful to characterize the physical properties of the image radiographic chain, in a quality control of the radiographic equipment. In the radiographic technique it is necessary that the evaluation of the image can guarantee the constancy of its quality to carry out a suitable diagnosis. In this work we have designed some radiographic phantoms for different radiographic digital devices, as dental, conventional, equipments with computed radiography (phosphor plate) and direct radiography (sensor) technology. Additionally, we have developed a software to analyse the image obtained by the radiographic equipment with digital processing techniques, as edge detector, morphological operators, statistical test for the detected combinations‥ The design of these phantoms let the evaluation of a wide range of operating conditions of voltage, current and time of the digital equipments. Moreover, the image quality analysis by the automatic software, let study it with objective parameters.

Epigenetic events in normal colonic mucosa surrounding colorectal cancer lesions.

Gene inactivation by promoter hypermethylation has been demonstrated in the colonic mucosa of colorectal cancer (CRC) patients. However, current data do not prove direct involvement of this epigenetic modification in the early stages of CRC. Promoter methylation profiles of E-cadherin, hMLH1, MGMT, p16(INK4a), p15(INK4b) and p14(ARF); mutations of K-ras, B-raf and TP53 and microsatellite instability (MSI) were examined in normal and cancerous colonic mucosal tissue in 82 CRC patients using methylation-specific PCR assays. Methylation of hMLH1 and MGMT in normal mucosa correlated significantly with MSI and K-ras activation in neighbouring cancerous mucosal tissues. Similarly, poorly differentiated tumours were associated with methylated p16(INK4a) and E-cadherin in neighbouring normal colonic tissues (NCTs). Our results indicate that epigenetic changes in mucosa surrounding colorectal neoplastic lesions may describe a 'field cancerisation' phenomenon that may occur previous to genetic alterations in early stages of carcinogenesis.

Case management method applied to older adults in the primary care centres in Burjassot (Valencian Region, Spain).

This research determines if the case management for health primary care means changes in: (a) frequency of use of social and health care resources, (b) number of patients visiting a doctor or social worker in the primary care centre, and visits that these professionals receive, (c) number of drugs consumed, (d) urgent hospital admittances which did not need significant intervention and (e) patients' and caregivers' satisfaction towards the social and health care resources received. The data were gathered with a questionnaire elaborated by the Administration and supervised by researchers. One hundred and fifty-two older dependent patients receiving home care in 2004, in a health department of the Valencia Region (Spain) collaborated. Results show: (a) Increase in the use of combined health and social resources in the intervention group; (b) number of patients visiting a practitioner or a social worker is lower in the intervention group, with a significant difference in both cases;

Analysis of digital image quality indexes for CIRS SP01 and CDMAM 3.4 mammographic phantoms.

Mammographic phantom images are usually used to study the quality of images obtained by determined mammographic equipment. The digital image treatment techniques allow carrying out an automatic analysis of the phantom image. Nowadays, the digital radiographic equipments are replacing the traditional film-screen equipments and it is necessary to update the parameters to guarantee the quality of the process. In this work we apply some techniques of digital image processing to compute a specific image quality indexes for mammographic phantoms, namely CIRS SP01 and CDMAM 3.4. to study the evolution of this parameter with different varying conditions of the mammographic equipment. The indexes are calculated from a scoring system based on a designed algorithm which analyses the phantom image by means of an automatic detection of the test objects in each phantom.

Study of digital mammographic equipments by phantom image quality.

Nowadays, the digital radiographic equipments are replacing the traditional film-screen equipments and it is necessary to update the parameters to guarantee the quality of the process. Contrast-detail phantoms are applied to digital radiography to study the threshold contrast-detail sensitivity at operation conditions of the equipment. The phantom that is studied in this work is CDMAM 3.4. One of the most extended indexes to measure the image quality in an objective way is the image quality figure (IQF). The aim of this work is to study the image quality of different images contrast-detail phantom CDMAM 3.4, carrying out the automatic detection of the contrast-detail combination and to establish a parameter which characterize in an objective way the mammographic image quality. This is useful to compare images obtained at different digital mammographic equipments to study the functioning of the equipments that facilitates the evaluation of image contrast and detail resolution.

Diffusion equations with negentropy applied to denoise mammographic images.

Mammography is a radiographic technique used for the detection of breast lesions. The analysis of the digital image normally requires a previous application of filters as a preprocessing step to reduce the noise level of the image, while preserving important details to carry out a suitable diagnostic. In the literature, there are a large amount of denoising techniques applied to different medical images. In this work we have studied the performance of a diffusive filter with a stopping condition based on the statistical concept of negentropy, applied to denoise mammographic images. The negentropy has been succesfully prove with other denoising methods as independent component analysis by the authors in [1]. We have evaluated the final image quality obtained, measuring a root mean squared error between the noise-free initial image and the final restored image and compared the results obtained by this diffusive filter with those obtained by an adaptative non-linear Wiener filter.

Nonlinear diffusion, negentropy and restoration of mammographic images.

Diffusive iterative filtering may be used to restore mammographic noisy images. Assuming that images are corrupted by additive gaussian noise, the negentropy as a statistical measure of the nongaussianity, can be used to estimate the amount of noise removed from noisy images. In particular, the evolution of the negentropy with the iterations is used to introduce a stopping criterion to end the diffusive filtering process. Because of computational complexity of the negentropy function, it is estimated by using an approximation of the negentropy introduced by Hyvärinen in the context of independent component analysis.

A comparative study of computer assisted assessment of image quality index for mammographic phantom images.

Mammographic phantom images are usually used to study the quality of images obtained by dedicated mammographic equipment. The digital image treatment techniques allow us to carry out an automatic analysis of the phantom image. In this work, some techniques of digital image processing are applied to compute a specific image quality index (IQI) for a mammographic phantom, namely CIRS model 11A version SP01. The algorithm designed analyses the phantom image by means of automatic detection of the number of microcalcifications, and the image resolution as the number of line pairs per millimetre. Then, the IQI is calculated from a scoring system. The manner in which the functioning conditions (kV and mAs) of the mammographic equipment and the preprocessing denoising method of the digital image affect the results for the IQI are also studied.

Automatic evaluation of the image quality of a mammographic phantom.

In this work a method has been developed to analyse the digital image quality of a mammographic phantom by means of automatic process techniques. The techniques used for the digital image treatment are standard techniques as the image thresholding to detect objects, the regional growing for pixels pooling and the morphological operator application to determine the objects shape and size, etc. This study allows the obtention of information about the phantom characteristics, that due to its small size and lowly contrast can be obtained very difficultly by direct observation. The final aim of this work is to obtain one or more parameters to characterize the reference phantom quality image in an objective way. These parameters will serve to compare images obtained at different mammographic centers and also, to study the temporal evolution of the image quality produced by determined mammographic equipment.

Comparing methods to denoise mammographic images.

Digital mammographic image processing often requires a previous application of filters to reduce the noise level of the image while preserving important details. This may improve the quality of digital mammographic images and contribute to an accurate diagnosis. In the literature, one can find a large amount of denoising techniques available for different kinds of images. We have adapted some of the existing denoising algorithms to mammographic images. We compare the effect of different denoising filters acting on digitized mammograms. The considered filters are: a local Wiener filter, a wavelet filter, a filter based on independent component analysis, and finally, a filter based on the diffusion equation. The noise reduction is measured by the mean squared error.

Care needs among the dependent population in Spain: an empirical approach.

The objective of the present paper was to identify the profile and needs of social and healthcare users in Spain who required long-term care. To achieve this goal, an extensive empirical study was carried out in 2001 of a typical southern European region: the Valencia Autonomous Region in Spain. The method used was a questionnaire-based survey. The data collection instrument was a questionnaire comprising 119 questions grouped into seven sections: social and demographic data; clinical diagnosis and treatment; living environment; degree of dependence in activities of daily living (ADLs); cognitive state; social support; and the social, demographic and attendance data of the carer, if available. The sampling was carried out in two strata, i.e. social and healthcare: first, the authors randomly selected the centres and services as sampling points, and then they randomly selected the subjects. A total of 1265 people were interviewed. The results show different care profiles: users aged under 65 years were mostly mentally ill and/or drug users requiring short- and medium-term care from the health services, while those aged over 65 years had chronic illnesses for which they were actively receiving treatment, were functionally dependent for ADLs, and were normally receiving social care that basically provided company and resolved functional limitations.

Preperitoneal repair for recurrent inguinal hernia: laparoscopic and open approach.

BACKGROUND: The aim of this study was to investigate the outcome of preperitoneal repair using laparoscopic (TEP) and open (OPM) approach in recurrent inguinal hernia. METHODS: We performed a prospective controlled nonrandomized clinical study in 188 patients with 207 recurrent inguinal hernias over a period of 5 years. TEP repair was employed for 86 repairs, and OPM was used in 121 procedures. The main outcome measurements were: recurrence rate, operating time, hospital stay, and postoperative complications. RESULTS: There were three recurrences (1.7%). Two in the OPM group (1.8%) and one (1.3%) in the TEP group [ P=NS (not significant)]. The TEP procedure was faster than OPM for unilateral repair (40.8 vs 46.3 min) (P<0.001). Postoperative complications were more frequent in the OPM group (23.9%) than the TEP group (13.9%) ( P=NS). Hospital stay was significantly shorter in the TEP group (1.2 vs 3.9 days) (P<0.001). CONCLUSIONS: Preperitoneal approach (open or laparoscopic) seems to be a good option in recurrent inguinal hernia when these procedures are done by experienced surgeons.

[Camptocormia: an infrequent muscular disease]. / Camptocormia: una enfermedad muscular infrecuente.

The camptocormia is an entity characterized by a kyphosis lumbar reductible in supine decubitus, associated to dysfunctions in computed tomography scans and histologics in the paravertebrals muscles of the lumbar segment. We contribute a new case corresponding to a 70 year-old woman with chronic lumbar pain and kyphosis dorsolumbar reductible, in who the on-line tomography showed compatible images with fatty degeneration and atrophy of the lumbar musculature, discoveries that were confirmed in the histologic study.

Tumor estromal extragastrointestinal. Peculiaridades en su semiología y terapéutica clínica / Extragastrointestinal stromal tumor. Semiology and clinical therapy peculiarities

Los tumores estromales gastrointestinales con localización extragastrointestinal son muy infrecuentes. Suelen diagnosticarse cuando presentan un gran tamaño. Su naturaleza benigna o maligna es difícil de determinar. Los mejores parámetros histológicos para evaluar su pronóstico son: un alto grado de celularidad, la presencia de necrosis tumoral y poseer más de dos mitosis por cincuenta campos. Presentamos el caso de una paciente asintomática que, por un control ecográfico rutinario por hepatopatía crónica por virus C, fue diagnosticada de un tumor mesentérico. La enferma fue tratada quirúrgicamente. El estudio inmunohistológico de la tumoración confirmó un tumor estromal gastrointestinal. El análisis del caso presentado y la bibliografía consultada sugieren unos hallazgos clínicos propios de esta entidad. Se revisa y actualiza la histogénesis de estas neoplasias y se destaca la utilidad de nuevos fármacos para el control de la progresión tumoral (AU)

Camptocormia: una enfermedad muscular infrecuente / Camptocormia: a infrequent muscular disease

La camptocormia es una entidad caracterizada por una cifosis lumbar reductible en decúbito supino, asociada trastornos tomodensitométricos e histológicos en los músculos paravertebrales del segmento lumbar. Aportamos un nuevo caso correspondiente a una mujer de 70 años con dolor lumbar crónico y cifosis dorsolumbar reductible, en quien la tomografia computarizada mostró imágenes compatibles con degeneración grasa y atrofia de la musculatura lumbar, hallazgos que se confirmaron en el estudio histológico (AU)

The camptocormia is an entity characterized by a kyphosis lumbar reductible in supine decubitus, associated to dysfunctions in computed tomography scans and histologics in the paravertebrals muscles of the lumbar segment. We contribute a new case corresponding to a 70 year-old woman with chronic lumbar pain and kyphosis dorsolumbar reductible, in who the on-line tomography showed compatible images with fatty degeneration and atrophy of the lumbar musculature, discoveries that were confirmed in the histologic study (AU)

Extra-gastrointestinal stromal tumour--semiology and clinical therapy peculiarities.

The gastrointestinal stromal tumor with extragastrointestinal location are very infrequent. We often diagnose them when they show a big size. Their bening or malignant nature is difficult to fix. The best histological parameters to evaluate their prognosis are a high cellularity, the tumor-like necrosis presence and having more than two mitosis per fifty high-power fields. We introduce an asyntomatic patient's case by a routine echographical control for chronic hepatitis by C virus, that has been diagnosed of a mesentery tumor. The patient has been treated surgically. The inmunohistological study of the tumor had confirmed a stromal gastrointestinal tumor. The showed case's analysis and the considered bibliography suggest some clinical discoveries characteristic of this entity. The histogenesis of these neoplasias are examined and made up to date and the usefulness of the new medication to control check the tumor-like progress is emphasized.