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

This is a case. of a bullet wound in the abdomen, with multivisceral lesions including the hepatic pedicle, kidney, duodenum and liver, its treatment and evolution.

One case of primitive pancreatic cancer in a síxyear old girl is described. World literature on the subject  is revised and the clínica! and pathological evoIutionestablished.

This is a report of the results obtained in the treatment of 14 cases of non-tumoral disease of the biliary tract with bilio-digestive anastomosis on diverticular loops. Eleven cases of main biliary tract lesions after cholecystectomie, s were treated: 1 delayed postoperatory choledoco-duodenal fistula, 1 post-gastrectomy stenosis and one oriental-type intrahepatic lithiasis. In two cases termino terminal hepatoduodenostomies were performe.d on the duodenal stump after gastrectomies Billroth II. In 11 cases termino lateral hepatojejunostomies were performed. In one (intrahepatic lithiasis) two hepatojejunostomies were performed on the same loop, using the common and left hepatic duct.In ali cases anastomosis were calibrated by means of transanastomotic tu bes: Through the hepatic duct in two cases in which a healthy fragment thereof was left; in Witzel's manner in the case of double anastomosis; with transhepatic tubes in the remaining patients. The latter technique has been perfected by the authors and is the one. which offers least risk. The 14 patients did well, although only three underwent the first reoperation by the authors. The majority of them had already been reoperated by other surgeonsprevioosly, once, twice, three or even four times. One patient had suffered from stenosis of the common bile duct for 20 years and had biliary cirrhosis with portal hoypertension, so additional spleno-renal anastomosis was performed.

First of all, we must thank the authorities of the 209 Uruguayan Congress of Surgery for having granted us the honor of coordinating a Round Tableabout this theme. We will try to do our best although it is a difficult problem, old in some respects and new in others, in thewhich we consider that the coordination between the internist's activity and that of the surgeon is essential.

It is impossible to judge on the results of a treatment without knowing the natural history of hepatic metastases. A study was done on 60 out of the 921 patients who were discharged from the Clínicas Hospital, Montevideo, with such diagnosis. The median survival time of those patients was 48 days. Survival is longer in the patients who have the primary tumor in colon than in those who have it in the stomachor the biliary tree. Jaundice and ascitis decrease the survival time of the patients with metastatic liver cancer. The method of intrarterial liver infusions with chemotherapeutic agents is described. Results of the procedure are discussed. Good palliation was obtained in 38 % of the cases, as well as an increasing in survival time.

The existence of brain, lung or liver tumor metastases conditions an almost always fatal prognosis, but in a long termvariable, which is dependent on numerous factors related to the patient, the primary tumor and the characteristics of these metastases.

The directives followed in the Institute of the Thorax will be exposed here. A correctly conducted surgical act can be ruined in its results due to the appearance of complications derived from a poorly placed or poorly monitored pleural drain.

When, in the course of a Laparotomy, a presumed or clearly neoplastic ascites is found, following a serous diffusion of an abdominal neoplasm, the event poses some behavioral problems for the surgeon, which we are going to analyze.

The therapy of metastatic processes of the brain can be considered in two different situations: A) presumably single metastasis; B) multiple metastases.

Thoracofrenolaparotomies are approach incisions of the right and left thoracoabdominal region and lower thorax, pleura and mediastinum, that give a wide light to deep organs: proximal stomach, 3 lower esophagus, spleen, adrenals, kidney, liver, pedicle hepatic,...