Francisca León G

Pólipos vesiculares: correlación entre hallazgos ecográficos e histopatológicos

BACKGROUND Gallbladder polyps are becoming a common finding. The management of these polyps is complicated considering that they can bear malignant lesions. AIM To analyze the ultrasonographic and histopathologic findings of patients operated due to gallbladder polyps. PATIENTS AND METHODS The records of patients with ultrasonographic diagnosis of gallbladder polyp and that underwent cholecystectomy in a thirteen years period were reviewed, collecting their demographic, ultrasonographic and histopathological data. RESULTS One hundred and twenty three patients were operated. The mean age was 44+/-13 years, and 69% were women. The mean size of polyps in ultrasonography was 7.3+/-5 mm. Histopathology confirmed the presence of polyps in 79% of patients, with a mean size and number of lesions of 5.1+/-3.8 mm and 2.1+/-2, respectively. Nine percent of polyps were greater than 10 mm, and single polyps were significantly larger than the multiple ones (p =0.003). Four cases of adenoma (3.2%) were diagnosed; one of them had in situ carcinoma. All were single and larger than 10 mm. We found a significant correlation between ultrasonographic and histopathological polyp size determination (r =0.47; p =0.002). Polyp size was also a predictor of the presence of adenoma (p =0.043; confidence intervals: 1.006-1.424). CONCLUSIONS There is a good correlation between the size of the gallbladder polyp in ultrasonography and the size in the histopathology report. Gallbladder adenoma is uncommon and it correlates with the size of the polyp. In this series, size was the only predictor of the presence of adenoma.

Cáncer colorrectal hereditario: análisis molecular de los genes APC y MLH1

Two FAP andone HNPCC families were studied. The APC gene (for FAP patients) and the MLH1 gene (forHNPCC patients), were screened for mutations on genomic DNA. The molecular analysis wasperformed through polymerase chain reaction, Single Strand Conformer Polymorphism (SSCP)and DNA sequencing. Mutations were defined as changes in the DNA sequence leading into a stopcodon and a truncated protein.

Hernioplastia inguinal con técnica Prolene hernia system: Evaluación de los resultados a largo plazo

Introduccion: En multiples trabajos se han evaluado los resultados a corto y mediano plazo de la reparacion de la hernia inguinal con la tecnica prolene hernia system PHS). Sin embargo, en pocos estudios se han reportado resultados a largo plazo. Objetivos: Evaluar los resultados a largo plazo de la reparacion de la hernia inguinal con la tecnica PHS. Material y metodo: Se realizo un estudio prospectivo de 62 enfermos operados con la tecnica PHS entre 2001 y 2002. Las complicaciones inmediatas y el dolor fueron evaluadas en todos los enfermos. Se completaron 4 anos de seguimiento en 53 pacientes que se analizan en este trabajo (90,1%). Se evaluo la recurrencia hemiaria, la presencia de dolor cronico (en reposo y en actividad), el rechazo de la malla y la satisfaccion con la operacion. Resultados: El grupo esta formado por 50 hombres (94%) y 3 mujeres (6%), con una edad de 53,2 + 8,5 anos. En 52 enfermos (98%) la hernia inguinal fue asintomatica. Se repararon 58 hernias en 53 enfermos. Dos enfermos (2,5%) presentaron complicaciones inmediatas. En el seguimiento a largo plazo, no se ha observado recurrencia, dolor cronico, rechazo de la malla y todos los enfermos estan satisfechos con los resultados obtenidos. Conclusiones: La hernioplastia inguinal con tecnica PHS presenta buenos resultados en el seguimiento a largo plazo, sin recidiva ni dolor cronico. Los pacientes se encuentran satisfechos con los resultados obtenidos

Poliposis familiar: Alternativas terapéuticas y estudio de los familiares

Background: To reduce the mortality associated to Familial Adenomatous Polyposis (FAP), screening of close relatives of patients with the disease is crucial. Aim: To analyze the results of the surgical treatment of patients with FAP, and to evaluate the family screening. Patients and Methods: Clinical records of patients operated in our institution since 1977, were reviewed analyzing surgical and pathological results, and follow up. In their family members, we evaluated and analyzed the performance of screening tests, former surgeries, history of disease-related cancer and mortality, all due to FAP. Results: Between January 1977 and August 2002, 15 patients were operated on. Of these, only 33% consulted on the setting of a familial screening. A proctocolectomy and terminal ileostomy was performed in 27% of patients; 20% had a proctocolectomy and ileal pouch, and 53% underwent a total colectomy with ileo-rectal anastomosis. Morbidity and mortality were 7% and 0%, respectively. Twenty percent had a colorectal cancer. During a median of 68 months follow-up, the disease-related survival was 92%; no cancer of the rectal stump was detected. Of the 122 family members identified, only 33% with clear indication of screening underwent a colonoscopy. Twenty-nine percent had a confirmed FAP and were operated: in 61% of them a colorectal cancer was found, and 91% of these died. Conclusions: The results of the surgical treatment of FAP are satisfactory. Nevertheless, family screening should be improved to reduce the high rates of mortality revealed in the study of other family members (Rev Med Chile 2005; 133: 1043-50).

RECONSTRUCCIÓN PERINEAL INMEDIATA EN EXTENSA RESECCIÓN ABDOMINOPERINEAL RECTAL

Introduccion: El tumor de Buschke-Lowenstein es una lesion cutanea benigna, secundaria a la infeccion por virus papiloma humano, usualmente se presenta como una gran masa exofitica genitoanal y tiene riesgo de evolucionar a carcinoma espinocelular. Dentro de su tratamiento existen varias alternativas, desde menos agresivas como quimio-radioterapia e inmunoterapia, que suelen tener alta tasa de recidiva, hasta la cirugia radical. Caso clinico: Presentamos el caso de un paciente masculino, con una lesion perianal de 15 anos de evolucion, inicialmente se sometio a terapias locales conservadoras y quimiorradioterapia y posteriormente recidivo con transformacion maligna. Habiendose confirmado histologicamente la presencia de carcinoma espinocelular, debio abordarse mediante una reseccion abdominoperineal rectal. Dicha cirugia determino un gran defecto de cobertura perianal y perineal que fue reparado mediante colgajos musculo-cutaneos de gracilis y fasciocutaneos de muslo. Discusion: Si bien se han descrito algunos metodos de reseccion local, solo la cirugia radical permite su eliminacion completa disminuyendo el riesgo de recurrencia. Ello genera un defecto perianal de dificil manejo, para el cual existen varias opciones reconstructivas: injertos, colgajos locales y regionales, y, con menor frecuencia, colgajos libres. Se debe considerar que en aquellos defectos de gran tamano, con gran perdida de tejido, las opciones de reconstruccion del defecto con volumen y cobertura cutanea adecuada son limitadas. Presentamos nuestra experiencia con algunas de estas tecnicas, entre las que destaca el colgajo de musculo gracilis, con los multiples beneficios que posee.