Pascual Parrilla Paricio

Intestinal perforation by foreign bodies

OBJECTIVE: To present our experience of patients who presented with intestinal perforation by foreign bodies to our hospital between 1980 and 1998. DESIGN: Retrospective study. SETTING: University hospital, Spain. SUBJECTS: 21 patients who presented with intestinal perforation by foreign bodies. MAIN OUTCOME MEASURES: Size of perforations, nature of foreign bodies, clinical symptoms, radiological findings, treatment and outcome. RESULTS: The most common location was the terminal ileum (n = 11), followed by the rectosigmoid junction (n = 5). The objects were mainly bone fragments and toothpicks. The diagnosis was generally made at operation, and only 4 of the 21 patients had signs of pneumoperitoneum on the preoperative abdominal film. The most common treatment was simple suture of the defect. CONCLUSIONS: Intestinal perforation by a foreign body is uncommon, and normally affects the ileocaecal and rectosigmoid regions, in which it is unusual to find pneumoperitoneum preoperatively. It must be considered in the differential diagnosis of such conditions as acute appendicitis and diverticulitis.

Non-neoplastic mediastinal cysts

OBJECTIVE The non-neoplastic mediastinal cysts (NNMCs) form a group of uncommon benign lesions of a congenital origin. The significant controversy regarding these cysts is whether to manage with observation or surgical resection. The aim of this study is to analyse the utility of thoracic computed axial tomography (CT) in imaging diagnosis of the NNMCs and the results of surgery in these lesions. PATIENTS AND METHODS Twenty NNMCs underwent surgery between 1980 and 2000. The preoperative study of mediastinal cystic masses includes a complete blood test, chest radiography (CR) and, for the last 15 years, a thoracic CT and/or nuclear magnetic resonance. All the patients underwent surgery in our thoracic surgery department and were reviewed in outpatients at 1 month, 6 months, 1 year and biannually thereafter. The form of manifestation, clinical features, imaging techniques, surgical operation, morbidity, mortality and follow-up are analysed. RESULTS Ten corresponded to bronchogenic cysts, the most common symptom of which was chest pain. CR showed a mass in the anterior-superior mediastinum in nine cases, and CT (five cases) revealed a cystic tumour in the anterior mediastinum. All were removed surgically, with three patients presenting with mild complications. Seven corresponded to pleuro-pericardial cysts, four being asymptomatic. CR showed a right paracardial mediastinal tumour, which was confirmed by CT (four cases). All were removed surgically, with two patients presenting with mild complications. Three corresponded to enteric cysts. CR showed a tumour in the posterior mediastinum, with CT confirming its cystic nature (two cases). Excision of the cyst was done in all cases, which corresponded to duplication cysts: two oesophageal and one gastric. All the patients are asymptomatic and recurrence-free after a follow-up of 11 +/- 10 years. CONCLUSIONS NNMCs are benign lesions in which the lesions in which the surgery can be done with a low morbidity and mortality rate, enables us to rule out malignancy and offers a definitive cure. Actually the thoracic CT permit a correct diagnosis pre-surgery in function of the radiologic characterisation and topography.

Biopsia selectiva del ganglio centinela en el melanoma mediante localización con linfogammagrafía preoperatoria y sonda de detección gamma intraoperatoria

Fundamentos Se refiere la experiencia para la deteccion del ganglio centinela en el melanoma utilizando unicamente la linfogammagrafia preoperatoria y trazador radiactivo con sonda de deteccion de radiacion gamma intraoperatoria. Pacientes y metodo Se estudio a 60 pacientes con melanoma en estadios I-II, a quienes se realizo biopsia selectiva del ganglio centinela mediante su localizacion con sulfuro coloidal marcado con Tc-99m. A todos se les efectuo una gammagrafia preoperatoria y se trato de localizar el ganglio centinela con una sonda de deteccion de radiacion gamma. Se han estudiado los resultados de la gammagrafia preoperatoria, la eficacia tecnica en la localizacion intraoperatoria, asi como los resultados anatomopatologicos y del seguimiento de los pacientes. Resultados La tasa de deteccion preoperatoria fue del 98,3%, con una media de 1,17 drenajes por lesion, siendo multiples especialmente en los melanomas de tronco. La localizacion intraoperatoria (eficacia tecnica) fue del 98,48%, con dificultades para su localizacion en la region parotidea. En el estudio histopatologico fueron fundamentales las tecnicas de inmunohistoquimica con HMB45, resultando positivos un 10%, por lo que se evito la linfadenectomia en el 90% de los casos. No se observaron recidivas y las metastasis se dieron en casos inabordables. La morbilidad de la tecnica fue significativamente menor que la de la linfadenectomia. Conclusiones La linfogammagrafia preoperatoria y el uso de sonda de deteccion de radiacion gamma, como tecnica de localizacion del ganglio centinela en el melanoma, tienen una elevada eficacia tecnica, permiten detectar drenajes multiples y posibilitan un abordaje muy selectivo y con diseccion minima.

Carcinoma epidermoide primario de mama

Primary squamous cell carcinoma of the breast is an infrequent tumour, that requires to rule out a tumor from other location to be diagnosed. Several characteristics as big size, and necrosis or cyst presence, have been associated rather than adenocarcinoma, although clinic and radiological squamous cell carcinoma non-specific characteristics are difficult to distinguish from adenocarcinomas. We present a woman with a 4-cm primary squamus cell carcinoma of the breast. Pathogenic, diagnostic, and therapeutic aspects in accordance with medical literature, are discussed.