[Toxic megacolon secondary to pseudomembranous colitis]. / Megacolon tóxico secundario a colitis pseudomembranosa.

BACKGROUND: Toxic megacolon is a rare complication of pseudomembranous colitis. OBJECTIVE: The aim of this paper is to present a rare case of toxic megacolon secondary to pseudomembranous colitis. METHODS: The chart of a 75-year-old male, who developed a toxic megacolon secondary to pseudomembranous colitis no was reviewed. RESULTS: The clinical features and outcome of a 75-year-old male with pseudomembranous colitis are depicted. The main symptoms were no ever, abdominal distention, bloody and diarrhea; the man suddenly developed a toxic megacolon and taken was to surgery. Total colectomy with proximal rectal closure was performed. The patient died within 24 hours of the abdominal procedure. CONCLUSIONS: Toxic megacolon is a rare complication of pseudomembranous colitis. Its presence should be suspected when these patients develop no colonic dilatation with associated systemic toxicity. Aggressive surgical intervention is indicated.

Medical applications of resurfacing lasers.

The medical applications of resurfacing lasers are expanding every year. They are formidable instruments for removing the unwanted top layers of the skin. We must keep the following question in mind when facing a challenging dermatologic entity: would it benefit from elimination of the epidermis and upper dermis? If the answer is yes, we know we might just have the perfect tool.

[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.

[Anorectal surgery in patients infected with human immunodeficiency virus]. / Cirugía anorrectal en pacientes infectados por el virus de la inmunodeficiencia humana.

OBJECTIVE: The aim of this study was to describe the clinical characteristics of the patients infected with the human immunodeficiency virus (HIV), who were submitted to anorectal surgery with emphasis on healing time and complications. METHODS: The patients were evaluated prospectively from July 1998 to July 1999; there was a total of 23 patients HIV (+) (Group 1). They were compared to a control group of randomly chosen HIV (-) patients (Group II) to establish the characteristics of each group, the morbidity, and the time of healing. The statistical analysis was performed with the student T test. RESULTS: In Group I, the diagnosis were fistula in the anus, anal fissure, anal abscess, condylomata acuminata, anal ulcer, and cutaneous flaps. Seven patients had a fistulotomy, a drainage of abscess in one, resection of different skin lesions in 12, electrofulguration of condylomata in two, fisturectomy in three and solely biopsy in three. The average healing time was 26.087 days for Group I and 23.21 days for Group II. A comparison between healing time and complications in these two groups was carried out to determine a whether significant difference exists in these parameters. There was no significant difference between these groups, but there were unequal rates of healing (26.087, DE +/- 10.778 days vs 23.21 DE +/- 6.259 days; p = not significant) and complications for the similar procedures. CONCLUSIONS: The healing in time HIV (+) patients submitted to anorectal surgery may not vary important when compared with HIV (-) patients.

[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.

Clinical response of psoriasis to low-energy irradiance with the Nd:YAG laser at 1320 nm report of an observation in three cases.

BACKGROUND: Psoriasis is a perplexing disease for which we have no definitive therapy. many types of lesions and clinical forms exist, from the small, localized indolent papule, to the persistent intractable plaque, to the disabling palmo-plantar involvement to the erythrodermic form. This wide variety of clinical manifestations has made it difficult to apply therapies such as lasers, which can reportedly produce an improvement. Although they have been shown to work, the carbon dioxide laser needs local injection for anesthesia along with healing by second intention, lasting for 3 to 6 weeks, while the flashlamp-pumped dye laser needs to be delivered in individual pulses of 5 to 10 mm in diameter each and repetition rates of only 1 to 2 pulses per second (1-2 Hz). These factors have made both lasers impractical for widespread use given the extensive skin involvement, which is often present. OBJECTIVE: To report on the beneficial effects of this new apparatus in some psoriatic lesions as observed in 3 out of 3 individuals tested. METHODS: Three patients who had lesions ranging from the small indolent papule to the persistent plaque, resistant to conventional treatment, to plantar involvement, underwent focal treatment with low-energy continuous emission of laser light below the threshold of pain for a total of 4 treatments in a span of 2 weeks. RESULTS: A clinical response was observed in all 3 cases. Improvement was noticed at a 4-week follow-up visit and continued for 3 months. Early recurrence in 1 case was noted at the end of this period. Partial response in a case of plantar involvement was seen. CONCLUSIONS: These findings are not only encouraging to undertake a study in a larger number of patients, with several different fluences and treatment frequencies, but are also intriguing regarding the possible mechanism or mechanisms of action.

Long-term effects of one general pass laser resurfacing. A look at dermal tightening and skin quality.

BACKGROUND: Laser resurfacing with high-energy, short-pulsed lasers is generally a safe and cosmetically rewarding procedure. Nevertheless, the aggressive use of these instruments has the potential for unpredictable, undesirable complications. It has long been held that multiple passes are needed to achieve dermal tightening (collagen shrinkage), which will result in a cosmetically desirable appearance. The observation of skin tightening after one general pass has not been previously reported. OBJECTIVE: To look at the long-term results after only one general pass and of focal multiple passes over lines, with particular attention to the degree of tightening and quality of the skin. METHODS: Fifteen patients with varying degrees of photodamage and resulting skin laxity, and with at least eighteen months follow-up, were evaluated. High quality photographic records were compared between pre- and postoperative pictures at three different angles on each. RESULTS: Cosmetically significant dermal tightening was observed in all of these patients. This was noted in some patients after six months and continued for several months after. All patients were pleased with the cosmetic improvement obtained. Of note were fast healing and the absence of significant complications in these patients. CONCLUSIONS: The appearance of dermal tightening as a late occurrence in the postoperative course after one single general pass has not been previously reported. When numerous general passes are done, dermal tightening is quite impressive and appears much sooner; however, much of this result is due to edema and the resulting skin quality in these patients is different. A more natural look is achieved if only one pass is done. The procedure is safer and has a faster recovery period.

A pictorial diary of complete healing in 6 days after UltraPulse laser skin resurfacing.

Minimizing mechanical trauma during laser skin resurfacing leads to faster healing times. Selective ablation with multiple passes of wrinkled areas renders satisfactory results with important visual improvement and a happier patient who can return to work sooner. Erythema and pain after the procedure are also significantly reduced. Pre- and postoperative management is discussed.

Erythema after laser skin resurfacing.

Erythema after laser skin resurfacing is seen by many as a necessary evil in order to get good results from the procedure. A critical review of widely accepted concepts may lead to diminishing the length of postoperative erythema in patients undergoing laser resurfacing. The authors report on two previously unrecognized factors in the causation of this problem.

UltraPulse laser skin resurfacing in Hispanic patients. A prospective study of 36 individuals.

BACKGROUND: The main question in the mind of a physician about to treat a Hispanic patient for facial cosmetic improvement using laser resurfacing is: How safely can I predict an even pigmentation after the procedure? Specific studies in Hispanic patients to establish the safety of laser skin resurfacing with the UltraPulse carbon dioxide laser do not exist. OBJECTIVE: To establish the degree of safety for this procedure in this patient population. METHODS: Thirty-six volunteer patients were treated for facial rhytides and acne scars. A Coherent UltraPulse 5000c carbon dioxide laser was used. The guidelines for the minimal mechanical trauma technique were followed. Monthly follow-up for 6 months was done, except in three patients. RESULTS: Cosmetic improvement was achieved in the vast majority of patients. No cases of persisting erythema, hyperpigmentation, or hypopigmentation were seen at 90 days or at the completion of the study. CONCLUSION: This appears to be a safe procedure for this patient group following the criteria of minimizing mechanical trans-operative trauma and close follow-up as described in this paper.

UltraPulse laser skin resurfacing of the hands.

A 74-year-old woman underwent UltraPulse laser skin resurfacing of the dorsal aspect of both hands. The procedure was done to improve chronic actinic changes for cosmetic reasons. A satisfactory cosmetic results was obtained without untoward complications. Persistent erythema was seen at the last follow-up evaluation in the hand that had two passes. Cosmetic improvement was similar in both hands. The details of the treatment laser parameters and postoperative management are the subject of this report.

Wound care after laser skin resurfacing. A combination of open and closed methods using a new polyethylene mask.

A new mask (N-Terface Mask) for interpositional placement in a layered dressing was evaluated. The dressings were applied to 46 patients following facial skin resurfacing with the UltraPulse carbon dioxide laser. Remarkably low postoperative pain, rapid healing, absence of crust formation, painless removal of dressing, and excellent visualization of wound bed were observed in all patients. This dressing affords the best of both open and closed wound management after laser skin resurfacing, because the mask is removed 48 hours later. Early visualization of the wound takes place allowing the surgeon to detect potential problems early enough while taking advantage of reduced pain and increased patient comfort postoperatively typical of closed wound care.

[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.

Fast healing after laser skin resurfacing. The minimal mechanical trauma technique.

BACKGROUND: Laser resurfacing is rapidly becoming a widely used method of skin ablation for cosmetic improvement. The technique with which the instrument is used can make the difference between obtaining the desired result with a benign postoperative period and one with unnecessary complications. OBJECTIVE: This paper describes a technique that maximizes the benefits while minimizes the risks in using this highly advanced instrument. METHODS: We have limited the areas where multiple passes are done to areas that have rhytides; for the rest of the skin a single pass is done and the final carbonized eschar is not removed. RESULTS: Faster healing and less complications. Shorter operative and anesthesia times. Greater patient acceptance and satisfactory cosmetic results. CONCLUSIONS: This technique provides a safer, faster, and satisfactory cosmetic results with a much smaller possibility of the complications seen with conventional methods.

[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.