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

The 4th. case of spontaneous rupture of the esophagus reported in Uruguay is presented. This is the first patient with an early diagnosis, 7 hours after the onset of theclinical symptomatology. This surgery was rendered possible within what is classically regarded as the useful 12 hours span ( this patient was operated on within 7 hours).Conventional positive diagnosis was substantiated by a good anamnesis, phisical examination and above all, a chest X ray which, toghther with the thoracocentesis,confirmed the condition. From the above, the following conclusions are inferable: in the presence of a patient with an acute abdominal or retrosternal picture, accompanied by a state of severe, persistent collapse, unamenable to medication, serial X ray studies of the abdomen and chest (front, profile and oblique) are necessary in arder to detect the early signs of this most severe condiction.

Seven personal cases of surgically treated heart wounds, are reported upon. In two of then the clinical diagnosis of cardio-pericardiac wound was ascertained; in one, it was suspected while in the remaining 4 it was borne out by exploratory thoracotomy. The bases underlying diagnosis and treatment of this dramatic situation, are dealt with. The author advocates the use of a pericardium strip as a major contribution in the case of difficult sutures as weU as the performance of the maneuver required prior to the suture and the adjustment of the movement of the surgeon's hand to the myocardial rate.

1) A report is made of a case of Gardner's syndrome marked by overdevelopment and prevalence of intra- abdominal and parietal desmoid fibromatosis entiling distinct limitations in the treatment. The above results iri a poor prognosis owing to an intrinsic, unchecked course involved in the transformation of the polyposis which was not amenable to resection.2) The various features of the condition are dealt with in the hyght of the available literature.

The location of malignant tumors in the thoracoabdominal walls, whether they are primitive or secondary, requires very extensive resections, which sometimes pose difficult problems for the surgeon ...

Regional antineoplastic chemotherapy through the hepatic artery has already been discussed by us in this Society  and in the 1965 Uruguayan Congress of Surgery . Now we want to discuss the possibility of doing this therapy via the adult umbilical vein ...

The adequate treatment of traumatic . ruptures of the liver calls for: 1) replacement of blood loss; 2) removal of the devitalized hepatic parenchyma; 3) brain duct drainage at the thoraco-abdominal region.

Clinical case

Patients who were operated of cholesystopancreatitis and pancreatitis with papillitis, presented Oddian radiological images which revealed mechanisms in the choledochopancreatic- duodenal dynamics which hadnot yet been described. The Oddi sphyncter clases the Oddian channel progressively from botton to top(first ampulla of Vater, choledochus and then Wirsung's terminal) and opens it from top to bottom.The duodenum has a double action: a) clases like a guillotine the high segment ( mural and extraduodenal) ; and b) compresses and expresses the low submucuous segment. In cases of papillitis, the Oddi sphyncter-as a result of the distention- does not evaquate the distended ampulla of Vater, whilst the duodenum -due to the double mechanisms of the high guillotine and the loy expression- empties, either partially of totally, the distended ampulla of Vater and submucuous segment, which the Oddi sphyncter does not evaquate.The filiform image of the contracted duodenum, together with that of the submucous segment, form the "two parallel intraduodenal columns", and are placed within the pathological forms of the submucuoussegment. 

The paper refers to the author's experience during the last three years with 21 cases of pilonidal sinus treated by resection and primary closure using Swinton's technique. The author points out the need for agood selection of patients, a careful operatory technique and a severe post-operatory control. In this manner excellent results are obtained.

The authors present the observation of a case of primitive gastric tuberculosis, diagnosed through the histological study of two ganglia by biopsy during surgery, in a 21-year-old patient, operated on byreasori of a pyloric syndrome which had not improved through medical treatment.The patient, treated by triple medication, was totally cured, and his clinical, radiologicaland laboratory controls are normal. The authors, furthermore, point out sone details of the pathology and clinic of this rare form of tuberculosis.