[Is mucinous colorectal adenocarcinoma a distinct entity?]

INTRODUCTION

Several publications have demonstrated that mucinous carcinomas of the colon and rectum are associated with certain clinicopathological and genetic peculiarities that distinguish them from non-mucinous carcinomas. The principal aim of this study was to evaluate whether the biological behavior of mucinous carcinomas differs from that of intestinal carcinomas in patients undergoing surgery for colorectal cancer.

PATIENTS

Between January 1993 and December 2000, 215 patients. underwent surgery in our hospital for colorectal cancer. The patients were divided into two groups according to histological type: tumors were intestinal in 169 patients (82%) and mucinous in 36 (17.6%). Patients undergoing non-resective surgery and those with tumors of other histological types (n = 10) were excluded.

RESULTS

The percentage of patients aged less than 50 years in the group with mucinous carcinoma was 19% (7/36) compared with 4% (7/169) in the non-mucinous group (p = 0.001). Regarding presenting symptoms, anemia was more frequent in patients with mucinous carcinoma (18.2% [n = 6] vs 5.7% [n = 8]) and a change in bowel habits was less frequent (15% [n = 5] vs 34.3% [n = 48]; p < 0.05). A total of 63.9% of mucinous carcinomas (n = 23) were located in the proximal colon (cecum, ascending and transverse colon) compared with 21.3% (n = 36) of non-mucinous carcinomas (p < 0.001). Surgical intention was palliative in 41.7% (n = 23.7) of mucinous carcinomas and in 23.7% (n = 40) of non-mucinous carcinomas (p < 0.05). The mean tumoral size was 6.2 2.5 cm in mucinous carcinomas and 4.7 2 in non-mucinous carcinomas (p = 0.001). Patients with mucinous carcinoma presented a higher percentage of nodal and distant metastases and a lower percentage of early stage tumors (p < 0.05). However, no differences were found in survival between the two histological types.

CONCLUSION

Mucinous tumors were more frequently located in the right colon and in patients less than 50 years old and were more likely to be in more advanced stages than non-mucinous tumors but no differences were found in survival according to tumor type.

'Hybrid' Bariatric Surgery: Bilio-pancreatic Diversion and Duodenal Switch- Preliminary Experience

BACKGROUND: Hybrid, combined or mixed bariatric surgery is the combination of a degree of 'malabsorption' (as achieved by the intestinal bypass) with a 'restriction' (as achieved by gastric bypass or gastroplasty), thereby simultaneously reducing the absorption of fats in the small bowel and decreasing the intake of food. METHODS: A modification of the bilio-pancreatic diversion (BPD) with a duodenal switch procedure, vertical lineal gastrectomy and preservation of the pylorus, has been used in 23 patients. The antropyloric pump and 4 cm of the duodenum are left intact to preserve physiologic gastric emptying and to prevent anastomotic ulcer. The use of staplers and continuous running sutures reduces surgical risks and operative time. RESULTS: One patient, converted from a vertical gastroplasty, had an intrathoracic esophageal perforation and died of multi-systemic organ failure, a mortality rate of 4.5%. One patient had a partial dehiscence of the laparotomy wound. Three patients developed subcutaneous seromas. Mean weight losses during the first 4 months were 13, 11, 6 and 5 kg, with a loss of 70% of excess weight in patients approaching 1 year. No patient needs treatment for diarrhea. No serious secondary side-effects have been detected. CONCLUSION: This operation appears to result in very satisfactory weight loss, improved quality of life, and a low incidence of complications.

[A new method of studying gastric emptying in gastrectomized patients]

OBJECTIVE

We present a new method of assessment of gastric emptying in gastrectomized patients.

PATIENTS AND METHODS

The gastric emptying of non digestible solids were studied in two groups of gastrectomized patients, the Billroth II (n = 25) and the Roux-en-Y (n = 36) to relate the gastric emptying with the postgastrectomy symptoms.

RESULTS

The food retained in the gastric stump is related with significance with the presence (p = 0.01) and the absence (p = 0.02) of markers. The patients operated on with the Billroth II technique present a higher frequency of markers in the gastric stump (40% over 19.4% with the Roux-en-Y). The markers in the gastric stump are more common with the symptoms of pyrosis, nausea, bilious vomit, diarrhea and the postoperative gastritis of alkaline reflux.

CONCLUSIONS

The method of gastric emptying of non digestible solids is a valid and reliable study of the gastric emptying and should be carried out in all candidates for endoscopy because it is harmless and easy to perform and evaluate.

[Value of endoscopy in the diagnosis of postoperative gastritis caused by alkaline reflux]

OBJECTIVE

A long term retrospective study comparing endoscopic lesions and their relationship with symptoms and histological lesions of postoperative Alkaline Reflux Gastritis (ARG) between partial gastrectomy Billroth II (n = 25) and the Roux-en-Y (n = 36) is presented.

PATIENTS AND METHODS

In patients operated on with both techniques the clinical, endoscopic and histological aspects are studied.

RESULTS

The patients operated on with the Billroth II technique present a higher frequency of bile in the gastric remnant and mucosal lesions in the endoscopic study (p < 0.001) compared with the Roux-en-Y group. Bile and mucosal lesions on the gastric stump are more common with symptoms and histological lesions of postoperative ARG.

CONCLUSIONS

The endoscopic evaluation is a valid and reliable examination in the diagnosis and follow up of postoperative ARG.

[Corynebacterium pseudotuberculosis adenitis in a shepherd]

Corynebacterium pseudotuberculosis causes suppurative lymphadenitis in sheep and other domestic animals. Human infection has been reported in few instances. We report on a case of Corynebacterium pseudotuberculosis lymphadenitis in a human being. A 34-years old previously healthy shepherd was attended for presenting a painful lymph node in right groin with one year of evolution. Cultures of an aspirate and ganglionar tissue yielded growth of Corynebacterium pseudotuberculosis in pure culture. Histological examination of the excised lymph node showed a suppurative granulomatous lymphadenitis with areas of necrosis in which there were clusters of bacillary organisms. After surgical excision and administration of erythromycin clinical signs disappeared without complications. We have carried out a review of the literature and we have found no case reported in Spain. Corynebacterium pseudotuberculosis lymphadenitis in human beings is a rare entity that principally affects persons in contact with animals, principally sheep. Most cases have been reported in Australia. In accordance with the reviewed literature this is the first time this disease is reported in Spain. Corynebacterium pseudotuberculosis infection should be considered in the differential diagnosis of localized granulomatous lymphadenitis.

[Aneurysm of the abdominal aorta]

OBJECTIVE

Three clinical cases of Aneurysm in the abdominal Aorta are presented, in order to make a clinical review of aneurysms in the abdominal Aorta (AAA) and underline the importance of their early diagnosis in Primary Care, given the risk factors.

DESIGN

A retrospective, descriptive analysis of three cases of AAA from 1991. SITE. The patients studied had attended the hospital emergency department in the Alcoy Health area.

MAIN MEASUREMENTS AND RESULTS

Case 1: A patient, who attended because of three days of bilateral lumbar pain of a colic type spreading to the mesogastrium, which did not respond to treatment for nephritic colic. The patient died in a few hours, with the diagnosis of hypovolaemic shock caused by a burst AAA. Case 2: A patient with generalised continuous abdominal pain, which over 12 hours had been located in the lower right hemiabdomen, who was admitted with the provisional diagnosis of acute pyelonephritis. Case 3: A patient who, after an emergency surgical intervention where the diagnosis of AAA was confirmed, presented after a month a clinical picture consistent with a cerebral vascular accident and died afterwards because of renal failure.

CONCLUSION

Given the present increase of patients diagnosed in hospital as suffering AAA in our Health Area, we urge that special attention be paid to the early diagnosis of this pathology. It is important to look actively for this pathology in patients with chronic pathologies of high prevalence and include it in Primary Care preventive programmes.