Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

The paper presents the result of observations in three patients suffering from cancer of the esophagus. An artificial esophagus was made utilizing a subcutaneous peristaltic gastric tube. One of the patients died a month after the operation, and two survive. One is under treatment due to a fistulous relapse in the neck and 'ecent metastasis; the otherpatient, is clínica] well two years later, with good functional result of the gastric tube. The observations on the vascularization of gastric tubes and the length and ascentachieved, is presented. An important suture defect was observed in the inmediate postoperatory period, involving anastomotic tension and distension of the gastric tube, but did not require decompressive gastrostomy.  There is a repeated tendency to fistulization of the anastomosis due to the ramming effect of swallowing in the "Angle Area"; this however, is susceptible of repair as can be seen in the case of the first patient. lt is for this reason that au artificial esophagus with stomach should not be utilized as a first choice in a patiente incolon esophageal resection is possible. The presternal peristaltic gastric tube, due to the limitations in the ascent, should not be employed in thecase of high esophageal lesions when the esophagostoma is located high we in the neck. The obtention of a large tube should be considered in the first period, in cases when gastrostomy is to be performed in the highest possible location. The procedure should be limited to cancers of the middle esophagus so as to maintain a proximal stomach and feeding gastrostomy which protects the cervical esophagogastr.c anastomosis. For this same reason, in the case of a small stomach where the is difficulty in leaving an upper gastric sector with its gastrostomy, another method of esophagoplastia should be employed. These cases form part of an inicial series, and we believe that as we acquire experience we shall be able to eliminate sone of the mentioned problems.

This communication refers to the case, which is perhaps unique in literature, of a cirsoid aneurism of the left branch of the cystic · artery. Clinically it is believed to be the probable cause of the hepatic colics presented by the patient. Radiologically it appeared in the cholecystogram fixed repletion defect of the gall bladder, !acunar un aspect. It was treated by a complete resection involving a cholecystectomy. The infrequent but varied pathology of the cystic artery is analized. The paper includes a discussion of presumptive diagnosis and the conduct to be applied when cholecystographic studies show repletion defects of the gall bladder.

In view of the importance in the circulation of the lower limb, of the deep femoral artery, we removed their obstruction, simultaneously with the iliac and commonfemoral in the extensive obstructions of all the arteries of the same limb. Even though the superficial femoral artery is not patent the patient improves. The method utilizedwas an angioplasty with a flap of the superficial femoral artery after the femoroiliac thromboendoarteriectomy.

The paper presents a case of . tráumatic hemobilia in a patient in whom the extrahepatic development of a post-traumatic pseudo cyst resulted in a compression of  the main hepatic hile duct and the portal vein causing its thrombosis. Therapy involved drainage of the cavity and l igation of the right branch of the hepatic artery. The treatment to be followed in casessuch as this, is discussed.

The author presents the clinical symptoms of sorne patients with direct inguinal hernia: 1) protrusion of the.pubic region; 2) a somewhat reduced penis, emergingfrom a subpubic fold; 3)• hypoplasic scrotum, which always coincides with hyperplasia of the subcutaneous cell tissue, weaknes of the posterior wall of the inguinalcanal, direct diverticular hernia and hipertrophy of the Retzius fat. Among the factors which act in the manner of a ram on the abdominal wall, we find the treatment of the Retzius celltissue, and great significance is attached to the umbilical artery.

Digestive hemorrhages are discussed as an unusual complication of the hydatid cyst in the spleen, the knowledge whereof is of importance in its surgical solution. Hemorrhages are explained by 3 mechanisms: 1) the most important one, is by compression of the spleen vein by retro or subpedicle cysts which leave gastrosplenic anatomosis free; 2) by hypersplenism; 3) by perforation of the cyst in the stomach.

Nine cases of miolinfangioplastia with latissimus dorsi, performed in an attempt to prevent postoperatory edema of the upper limb on the same side as the mammaryresection, are presented. Distant results obtained by the use of this teclinique can be considered good, and we advise their application in radical mastectomy.

Two observations of biliary lithiasis by thread are presented. Considerations as to their frequency, production mechanisms and means of preventing them, are also included.

The paper presents the result of the observation of volvulus or acute twisting of the gall bladder; this is a very rare case and only two such appear in national bibliography.

A method for the treatment of malignant melanomas of the extremities is shown: the perfusion with Alkeran with extracorporeal circulation of the isolated limb. The technique used in 16 perfusions performed on 14 patients is described, 8 of the patients remain without evidence of cancerous disease at the present time. Pathological studies performed on tumors excised after the perfusion revealed decreasing in size dissecation and wrinkling of tumors and 'tendency to healing. Microscopical findings were atrophy, necrosis,cellular lisis and liberation of pigment that was phagocited by macrophages. The drug action was larger on pigmented tumor than on amelanic ones. Complications of the procedure were slight or moderate: fibrinolisis, hematuria, infected hematoma and brachial paralysis. The more constant one was slight edema. There was no mortality with this procedure.We believe it is feasible with this procedure to act upon the tumor, the metastases and circulating cells, avoiding in that way mutilating surgery on the affected limb.