[Carcinoid tumors of the common bile duct: report of a case]

The authors discuss an uncommon case in the literature of a carcinoid tumor of in the bifurcation of common hepatic duct. The tumor was surgically resected and the duct was reconstructed by Y of Roux's technic. The patient had a good evolution and no tumoral lesion was found in post operative exams during the last six months. The authors present a literature review and discuss diagnosis, treatment and prognosis.

[Results of the surgical treatment of non-complicated pilonidal disease]

In spite of the high incidence of pilonidal disease at young population and prolonged disabling period that it demands, colorectal surgeons have not reached consensus about etiology or best treatment for this condition. The authors intend to analyse results from 154 cases operated on at HCFMUSP through a retrospective chart analysis regarding patients' sex, age and race, operative technique, complications and recurrence. Half patients were male. Eighty-three percent were between 11 and 30 yr-old. Incision and curettage was offered to 74.7% of the patients. Excision technique was used in 25.3%. In patients who underwent excision technique, there were no recurrences and a cicatrization defect was diagnosed in 2 (5.1%) patients. For patients who underwent incision and curettage, recurrence was 3.5% and cicatrization defect was seen in 1 (0.9%) case. Excision or incision plus curettage techniques seem to be both effective for treatment of chronic pilonidal disease although the former may produce healing defect more commonly. Patients who present with complex lesions may benefit from excisional techniques associated to skin or myocutaneous flaps in a first attempt instead of conservative approaches.

[Chronic anal fissure: results of the surgical treatment of 220 patients]

Since results from non-surgical procedures designed for treatment of chronic anal fissure are still controversial, sphincterotomy remain as the "state of the art" therapy for this condition. In a retrospective basis, the authors intend to review results from treatment of chronic anal fissure in 220 patients who underwent surgical procedure between 1984 and 1995. Data from chart review included age, sex, location of the lesion at the canal anal, associated anorectal disease, delivered surgical technique and complications. Seventy per cent of the patients were male. Mean age was 37.1 years. Fissure was located at the posterior midline in 86.1%. Associated anorectal conditions occurred in 41.4%. Fissurectomy plus posterior sphincterotomy was the treatment of choice in 84.1%. Complications occurred in 5 (2.3%) cases. There were no incontinent patients. Mean follow-up was 2.6 years. The authors conclude that partial internal anal sphincter section produces excellent results in treatment of chronic anal fissure. Posterior sphincterotomy may persist effective and safe since continence impairment was not identified in the present study.

[Surgical treatment outcome of hemorrhoidal in 475 patients]

Despite feared by patients and reserved for the minority of patients suffering from hemorrohoids, hemorrhoidectomy remains as the most effective approach to this condition. To analyse results from 475 hemorrhoidectomies performed at University of São Paulo Hospital das Clínicas between 1984 and 1995, a retrospective chart review regarding gender, age, associated anorectal conditions, surgical technique, complications and their management and follow-up was addressed. Two hundred and seven (43.6%) were male. Age between fourth and sixth decades were observed for 70.8%. Associated anorectal conditions were diagnosed in 18.9%. Chronic anal fissure was the commonest one. Milligan-Morgan operation was performed in the majority of patients (91.2%) and Ferguson technique in 6.7%. There were no intraoperative complications postoperative complications occurred in 38 (8%) patients regardless of employed surgical technique. Urinary retention was the commonest postoperative complication. Mean follow-up was 5.8 years for 70% of patients. Surgical hemorrhoidectomy remains as a treatment with excellent results in the management of hemorrhoid disease for selected patients. Produces erradications of the disease in all cases in spite of low morbidity.

[Colonoscopy: diagnostic and treatment methods]

The author presents the historical and technical development of the colonoscopy showing the advantages provided by the employment of the method, specially with the use of new equipment. He discusses different pre-colonoscopy bowel cleansing methods, and particularly the use of mannitol 10%.

[The importance of colonoscopy in the early detection of colorectal cancer]

The rates of surveillance for patients with colorectal cancer have been steady in the decades. Aspects regarding the importance of the early detection of the colorectal cancer were focussed, as well as the outstanding difference observed in relation to the surveillance of patients when the detection of the disease is achieved early. It was emphasized the use of colonoscopy as a diagnostic and therapeutic method which brings beneficial results to an effective raising in the rates of detection of patients with colorectal cancer. It was also demonstrated that colonoscopy having a higher accuracy in the diagnosis of the large bowel polyps and in the performance of polypectomies, has much contributed to put to an end to the cycle described by Morson: the evolution of adenomatous polyp to cancer.

[Colonoscopy and digital cytometry in the clinical assessment of prolonged non-specific ulcerative rectocolitis]

Twenty-one patients having ulcerative colitis (U.C.) for a period of seven or more years, and considered as being in the risk group for developing large bowel neoplasia, were studied according to the following procedures: 1) colonoscopic examination for macroscopic identification of mucosal alterations and obtainment of multiple biopsies; 2) histologic examination of mucosal biopsies; 3) quantification of mucosal-cell DNA using digital cytometry. The duration of disease in these patients ranged from seven to 33 years, with an average of 14 years. In three patients colonoscopic images showed vegetant lesions suggestive of malignancy. The association of UC with cancer occurred in 14% of cases. Colonoscopy was efficient in providing accurate diagnosis in all cases and also allowed a successful endoscopic resection of an aneuploid neoplastic lesion. Digital cytometry revealed diploid DNA histogram in all phases of U.C. and aneuploid in cases with association of UC and neoplastic development.

CONCLUSION

these three methods together should be utilized in the follow-up of patients with long standing ulcerative colitis.

[Colon injuries: treatment study in 313 patients]

The author presents a retrospective descriptive study of 313 colon injuries treated surgically. The lesions were caused by fire arms and knife wounds, impalement and closed abdominal trauma. Results were analysed considering factors directly involved with the outcome in terms of morbidity and mortality. They were age, sex, ethnic group, span of time between traumatic event and surgery, type and anatomical location of colonic lesions and associated injuries, degree of contamination of the abdominal cavity, surgical procedure, intraabdominal and surgical wound, post-operative complications, systemic complications, evolution and results of post-mortem examinations in cases of death. The results of observations can be summarized as follows: 1. Mortality rate was 10.22% (32 patients). 2. The majority of cases with lethal outcome (90.62% or 29 patients) had severe associated or missed injuries, pulmonary embolism and anesthetic complication. 3. There was a 43.75% (14 patients) mortality rate during the first 48 hours. 4. Mortality due directly to poor performance of the surgical procedure was found to be lower than 1%. 5. Primary closure of colon wounds was performed in 60.70% of cases and no deaths could be attributed to this procedure. 6. Different types of colostomy were performed in 109 patients (34.82%). In this group 94.5% of the cases had no complications. 7. Morbidity (31.4%) was mostly consequent to surgical wound complications (16.30%).