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

Surgery requírements ín the treatment of herníatíon el t,he esophageal foramen ís analyzed; the importance of preventíng regurgitation backflow is pointed out. The approach may be either abdominal or thoracic and each case should be. analyzed accordíng to its pathology. ThePuthor states hís preference for the abdominal approach, employed in the last 37 operatíons, while ín earlier cases he had employed the thoracíc approach. The latter í .s reserved for cases involvíng seríous esophagítís or high acídíty values. The abdominal approach was used45 times ( 70 o/r¡ ) and the thoracíc 20 ( 30 % ) . Dífferent techníques are employed accordíng tho the círcumstances of ,;ach case. Favourable results have been obtaíned ín confrolled cases, whích range between 80 and 100 % . Results wíth dífferent procedures are símílar, but íj: ísbelíeved thís ís due to theír díscrímínate application in each sítuation. Favourable results amount to 85 % of controlled cases and 72 % of all patíents operated ín thís series. Morbílíty rate was 37 .5 % and death rate 1.5 % .

Our experience in the surgical treatment of colovesical fistulas resulting from complications of colonic (sigmoidea!) diverticular disease comprises a series of 10 operated cases in which death-rate and morbility were negligible. Their incidence is 3 % out of a casematerial comprising 230 cases of diverticular colopathy plus 4 non-hospital cases. Ages were between 42 and 79;8 were male and 2 female. Surgical tactics require resection of t°he colonic sector with complicated sigmoidea!colonic diverticular disease, including the fistula, with abscission of the fistulized vesical sector whenever such is the case. The addition of prior or concomitant right transverse colostomy (stepped surgery) is advisable. We favour insertion of Folley's catheter for operatory and even post-operatory management.

1) A gigantic front etmoidal bilateral osteoma of the eyesocket, with right predominance, slow evolution '.nd few functional disturbances, is described. 2) Total resection of the osteoma was made througb a special technique of broad transcraneal approach; eye structures were preserved with all their annexecs; visual and nasal functions were restored to normal. 3) The technique employed is described, with stresson the advantages of this broad transcraneal extradural approach.

The paper updates a surgical technique which is easy to apply and shoyld be included among the therapeutic weapons of all surgeons who have to deal with large gaps in the abdominal wall. Details of this technique, considered by the authors as highly valuable, are discussed.

The authors revise the subject, and stress its anatamopathologic, radiological and therapeutic aspects. In their opinion this disease is a mioglanduliform displasia, fundamentally localized, and thus disagree with the broad criteria sustained by authors such asJutras and Aguirre. The paper gives a detailed account of the radiological alterations which characterize this disease.When the patie.nt presents the typical biliary suffering, even in the absence )f associated litiasis, they propase a cholecystectomy. This therapy has shown very good results in the patients operated.

Hyperacute and chronic rejections in cases of kidney transplants are discussed ·n general. There are two distinct anatomopathological pictures in hyperacute rejections, though both respond to the same clinical type. Chronic rejection takes on a characteristic forro.

The experience obtainel through 10 aneurisms of ruptured abdominal aorta which were operated upon, is reviewed. Operatory death rate is as high as 50 % , which is in agreement with the majority of world statistics so far presented. From the clinical point of view the shock factor is the most important with respect to prognosis. Two different groups of patients with this disease are presented to the surgeon: the first is formed by those arriving to the operation in stabilized cardio-circulatory conditions, having had a generally intense but temporaryshock a few hours or days before surgery; the other group is formed by those patients with a picture of severe and persistent shock who have to be operated upon in this condition. Survivals consist almost exclusively of patients in the first group. Quick clamping of the supra-aneurismatic aorta, with blood replacement at that moment -and not befare-and the technique of "intra-sacular:• removal of aneurism, with its consequent saving of time and minimun disection, are factores which help to improve results in this extremely serious complication. Correct control of blood volume and adequate hydration, both in quantity and quality, are also important elements for prognosis. It is also fundamental that·the patient be watched for at least 48 hours in an intensive treatment centre. Preoperatory aligo-anuria, intra-peritoneal hemorrhage and advanced age, are ominous signs for prognosis. The paper pres. ents one extremely rare case of simultaneous rupture of the inferior vena cava and of the retroperitoneum, which was operated successfully.

It is analyzed in the simple radiography the radiological signs that provoke the retroperitoneal hematoma by the opening of aneurysms of the aorta and the signs that appear in the spontaneous hemaperitoneum. Afterwards it is described minutely the radiographical images that produce the mesentery intestinal infarct, according to the extension, localization, grade of haematic infiltration of the wall and different aetiologies of the same. These signs are clasified into two groups: 1) Specifics: a) changes of thickness and configurationof the mucous relief; b) gas in the intestinal wall sistem and the portal vein; c) segmentary tightness in the colon enlargment of the wall and defects of stuff at the leve! of the mucous..2) No specificss a) distribution and increasing of thethe intestinal gas; b) liquid levels in the small intestine. F'inally are studied the radiographics images angiographic obtaü1ed in the. various causes of the intestinal infarct mesentery: a) atheroma of the main mesentery; b) em bolism; c) stenosis by extrinsic causes; d) fibromuscular· hyperplasia; e) no occlude infarct;f) thrombosis of the ·veins.

The etiopathogenesis, pathophysiology and pathological anatomy of intestinal infarction are successively studied.

Diagnostica! and therapeutic problems are discussed since a better knowledge may aid in reducing the high deathrate of this disease. Its diagnosis is difficult (38 % )and is based on a high suspicion rate; its early stages require treatment. There are two stages in its clinical course and its symptomatology has 4 ethiopathogenicgroups: embolism, A. thrombosis, V thrombosis and non-occlusive disease. Its therapy, medico-surgical problems and drugs employed are discussed. Methodologyfar surgical exploration on its intestinal and vascular focus, is established, as well as resources and procedures of direct vascular surgery and risks of abruptrestoration of flow. The advantages of an early second look are discussed. The paper also contains a review of results and survival rate in national and foreign statistics.