Bacteriology of the anal wound after open hemorrhoidectomy. Qualitative and quantitative analysis.

The purpose of this study is to analyze the size of the bacterial colonies in anal wounds after open hemorrhoidectomy. Twenty patients were studied during predetermined postoperative time periods. Material was collected from the surface and from within the tissue of each patient's three open wounds, intraoperatively, on the 6th, 13th and 20th postoperative days for bacteriologic examination in aerobic, microaerophilic, and anaerobic media. The bacterium most commonly identified was Escherichia coli, followed by Staphylococcus aureus and Staphylococcus epidermidis. Pseudomonas aeruginosa, Enterococcus faecalis, Klebsiella pneumoniae, Proteus vulgaris, and Proteus mirabilis were also identified. Critical indexes of colonization were present since the intraoperative stage (greater than 10(5) bacteria/g of tissue and greater than 10(6) bacteria/ml); obligate anaerobic bacteria were not identified; neither the species nor the number of bacteria, even when critical indexes were present, prevented proper healing. The same bacteria were not necessarily present on the surface and in the tissue; the bacterial load observed among the three wounds (left lateral, right posterior, and right anterior), was the same.

[Chilaiditi syndrome associated the volvulus of the transverse colon]. / Síndrome de Chilaiditi associada a volvo do colo transverso.

The hepatodiaphragmatic interposition of the colon (Chilaiditi's Syndrome) and associated volvulus of the transverse colon is a rare cause of mechanical intestinal obstruction. The preoperative diagnosis is extremely difficult. We report a 26-year-old- male case, symptomatic since childhood, whose diagnosis by barium enema was confirmed surgically in Hospital Universitário de Taubaté. He underwent a transversectomy, and presented an intestinal obstruction in the post-operative period. Two reoperations were required. He has remained well, with outpatient supervision.

[Cystadenoma of the pancreas. Various aspects of the diagnosis and surgical management adopted in 3 cases]. / Cistoadenoma do pâncreas. Aspectos do diagnóstico e da conduta cirúrgica adotados em três casos.

The authors report three cases of cystadenoma of the pancreas. Two cases were serouscystadenoma and one case was mucouscystadenoma. The best diagnostic procedures were computed axial tomography and ultrasonography. Decisions regarding operation depend on three factors: the patient's general conditions, site of the tumor and hystologic pattern. In the first case the elderly patient had the tumor in the head of the pancreas which had led to biliary obstruction. To establish satisfactory biliary drainage a biliodigestive anastomosis was used. The other two cases were younger patients with large protruding abdominal mass in the epigastrium and mesogastrium by a tumor of the body and tail of the pancreas. In these cases we opted for body pancreatectomy and splenectomy. Since the serouscystadenoma doesn't have the malignant potential that the mucouscystadenoma has, the surgical procedure can be different from the surgical resection used for the treatment of pancreatic cystadenoma.