Splenectomy complications in hematological diseases.

The postoperative complications observed in a group of 27 patients with hematological diseases that underwent splenectomy are reported: 21 patients had a non-malignant hematological condition, whereas the rest had a hematological malignancy. Seven complications presented in 6 patients (two wound infections, two severe post-operative hemorrhages, one incisional hernia, one sepsis by capsulated bacteria and one fatal hemophagocytic syndrome). The overall complication rate was 27%, whereas the fatal complication rate was 3%. The complication rate in patients with malignant diseases was 83%, whereas that in benign conditions was 9%. The size of the spleen was related with the complication rate (median weight of patients with complications was 990 g versus 132 g in those without complications; p < 0.01). The two patients that underwent splenectomy before age six months had complications, in one case related to parental negligence. In splenectomies performed for hematological disease the benefits must be balanced carefully against the risks.

[Experience and complications in the management of parenteral nutrition]. / Experiencia y problemas en el manejo de la nutrición parenteral.

We inform the experience of the Parenteral Alimentation Service of the Hospital de Especialidades of the Instituto Mexicano del Serguro Social in Puebla, México, between February lst., 1980 and Marc, 31, 1981 is summarized. There were 124 patients in whom parenteral nutrition treatments were performed, 73 were males and 53 females. The majority was in the decade of the sixties. A catheter was placed in a central vein through a cut dawn of the cefalic vein in the shoulder in 104 and the rest had an internal jugular or subclavian veins punctured. The most frequent indication for parenteral nutrition was the presence of an external intestinal fistula. The most frequent complication was hyperglycemia (15.3%) and catheter sepsis (6%). Mortality was 33.3%, but of this only in one (0.75%) was the death caused directly by the procedure of parenteral Nutrition. The authors insist that the procedure is very usefull and with an acceptable risk if it is done with strict rules and protocols.

Experiencia y problemas en el manejo de la nutricion parenteral. / Experience and problems in management of parenteral nutrition

Se informa sobre la experiencia en el Servicio de Alimentacion Parenteral del Hospital de Especialidades del Instituto Mexicano del Seguro Social de la Ciudad de Puebla, en el lapso que comprende del 1o de febrero de 1980 al 31 de marzo de 1981.Se manejaron 124 pacientes en los que se realizaron 132 procedimientos de nutricion parenteral, de los cuales 71 correspondieron al sexo masculino y 53 al femenino. El mayor numero de pacientes se encontraba en la sexta decada de la vida. Se les coloco cateter en vena central mediante diseccion de la vena cefalica a 104 pacientes y a los restantes se les aplico por puncion de la vena subclavia o de la yugular interna. La indicacion mas frecuente para el suministro de nutricion parenteral fue la existencia de fistula enterocutanea. Se analizan las complicaciones siendo la mas frecuente en el grupo estudiado la hiperglucemia (15,3%) y la contaminacion del cateter (6%). La mortalidad fue del 33.3%. Solo en un caso (0.75%), el fallecimiento fue atribuible al procedimiento de nutricion parenteral. Se hace hincapie en que el procedimiento es util y con riesgo aceptable cuando se maneja adecuadamente y se realiza con apego estricto a un protocolo

[Spontaneous rupture of the esophagogastric junction. Report of a case]. / Ruptura espontánea de la unión cardio-esofágica Presentación de un caso.

It is presented a case of spontaneous rupture of the union cardioesophageal consecutive on ingestion of bicarbonate in an old patient with strangulated hiatal hernia. It is analyzed the phisiopathological factors of such complication and the surgical treatment employed.

[Surgical treatment of amebic liver abscess]. / Tratamiento quirúrgico del absceso hepático amibiano.

The charts of 50 patients with hepatic amebic abscesses diagnosed during 1976 in the Hospital de Especialidades del Instituto Mexicano del Seguro Social and in the Unidad Hospitalaria La Paz in the city of Puebla, were reviewed: 39 were men and 11 women, with an age range between the third and sixth decade. It was necessary to resort to surgical treatment in 25 (50%) of the patients for one or various of the following reasons: failure of medical treatment, imminent perforation, septicemia, perforation or the occurrence of an extremely large abscess. The total mortality was 2%. In all cases medical treatment was administered in the pre- and postoperative period. The surgical technique as well as its frequency is described and compared with the results of other groups. The mortality in our study was very low probably because the patients with large abscesses or sepsis were operated on an early stage of their evolution.