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

Presented at session 14th August 1963

Tribute to the death of a doctor

Presented at session 14th August 1963

Four cases of acute- pancreatitis which present troubles in order to perform a diagnosis are exposed. The real positive value of urinary amylase dosages produce errors when theirmarks are taken into consideration to state or refuse the diagnosis of acute pancreatitis. W e have found examples of false-positive dosage in bowel strangulation; false. negative dosage in an acute necrotizing haemorragic pancreatitis, and a questionable one in a developed acute pancreatitis. It is difficult to perform a diagnosis in acute pancreatitis and biliar-peritonitis connected, specially in bilio pancreatic and pancreatic-biliar peritonitis, as they were called by Tejerina Fotheringham. At last, we can emphasize that the study of pancreatitis is harmless, when it is positive, in order to perform the difinitive diagnosis. Therefore, the author analyses: 1) the physical characteristics of peritoneal fluid; 2) the hígher persistentnucleous .f amylase in this fluid than in seru and urine, and 3) other chemical an citobacteriological studies that help to p form the diagnosis of acute pancreatitis.

1) A case of bilobated liver with permeable scissure is reported. According to the anatomical criteria it would be the fourth case in the medical literature due to persistence of sagital scissure or the first one due to persistence of left scissure. . 2) There was a short choledochus and a cancer of the gall bladder which perforated the common duct and formeda neoplastic bilio-biliary fistula. This condition is very uncommon. 3) J aundice was produced by a canalicular haemorrage, which obstructed the biliary duct and produced also a digestive haemorrage.  4) Only four previous observations of biliary obstruction due to neoplastic haemobilia have been published, and only once, like in this case, the diagnosis wasperformed finding neoplastic cells in the clots. 5) An haemorragic syndrome generat. ed an hemoperitoneum in aqdition to the haemobilia. 6) The p atient died eleven days afteroperation from acute páncreatitis and a pseudo-membranous necrotizing colitis.

a) Transversal inc1s10ns for oclusive problems of the newly born are advised. b) Slating incisions can only be performed when you have a right diagnosis, because its range is limited.) If we are forced to perform vertical incitions, the skin incision must not coincide with that of the deeper layers, being these in "Y" or in "Z".  d) According to our criteria these principles are absolute for newly born and lactants of less than one year, and they are advisable in first infancy. e) We advise to take into consideration these principles and apply them in metabolic disturbances, catabolizing diseases, cortisone medication or possibility of bowel ileum in se·cond infancy, according to the surgical possibilities of _these ages. We don't object the performance of paramedial incisions to normal grown-up children spécially when the have traumatic disturbances. 

A series of 35 children with Wilm's 'tumours is presented. 28 of these cases have a follow-up of more than two years. 7 patients had no evidence of disease 2 to 10 years after treatment. preoperative irradiation of Wilm's tumours is advised, as a 60 % cure-rate in 5 patients was obtained with this technic. It is recognized that the group of patients with pr.eoperativeirradiaion is very s?iall. A series of 14 children wih proved abdominal neuroblastoma is presented. Only 6 cases were able to be treated by radiotherapy, and only one is living with noevidence of disease 2 years and a half later.

14 cases of post-operative pancreatitis in biliary surgery are analyzed. Etio-pathogeny is studied. The most important clinical characteristics and the results of post-operativecontrols of pancreatic enzymes in blood and uriné are emphasized. The acute hyghly lethal condition is stressed. The importance of profilaxy of this disease is· bring out, and the conservative medical treatment based specially on the of Trasylol anti-enzymes is advised.

Two cases of spontaneous disappearance of gall stones are reported. This is such an exceptional phenomenon that we are interested in let in know. W e don't have elements enough to know why gall stones have dísappeáred.

1) A case of gall stone intestinal obstruction is reported. Biliary pneumatosis was the clue for a corre.et pre-operative diagnosis. 2) During surgical exploration division of colecystoduodenal adhesions demonstrate a duodenal fistula. 3) Duodenal surgical suture -in two layers- was satisfactory.