Elastofibroma Dorsi

Se realiza un estudio clínico-patológico de dos casos, mujeres de 57 y 45 años, de "elastofibroma dorsi" intervenidos quirúrgicamente. En una enferma apareció como una tumoracion asintomática y en otra asociada a dolor en el hombro irradiado a miembro superior derecho. Se describen las particularizadas clínicas, las exploraciones complementarias, los hallazgos quirúrgicos y las características histológicas de estos tumores de partes blandas cuyo origen debe referirse a una alteración del tejido fibroelástico. Se confronta nuestra experiencia con los casos anteriormente publicados confirmándose su aparición en mujeres adultas o añosas dedicadas a trabajos manuales rutinarios, que parecen estar implicados en la patogenia del elastofibroma dorsi. En uno de los casos, aunque localizado en el espacio anatómico escápulo-torácico, su situación era supraescapular frente a la típicamente infraescapular del elastofibroma dorsi, y la consideramos la primera observación de la literatura.A clinical-pathological study of two cases of elastofibroma dorsi was carried out. Both patients were female, 57 and 45 years old, and underwent surgical operation. One patients was sympton-free, while the other complained of pain in the shoulder which spread to the upper right arm. The autors describe the clinical details, the diagnostic methods employed, the results of surgery and the histopathological features of these tumours which must have originated in a modification of conective tissue, especially in elastic fibres. We compare our findings with those of previously published cases and can confirm the appearence of these tumours in adults or middle-aged women who carry out rutinary manual work, which seems to be connected with the pathogeny of the elastofibroma dorsi. These are normally found adjacent to the vertebral border of the escapula at its inferior angle, but in one case ot was located in the supra-escapular region and we believe this is the first evidence of this kind in the literature

Comparison of the application of low concentration and 80% phenol solution in pilonidal sinus disease

Objectives Many conservative methods have been applied in the treatment of pilonidal sinus disease (PSD). The most commonly used conservative treatment is 80% phenol solution. Our observations demonstrated that 80% phenol solution caused much destruction in the sacrococcygeal region. Design In this study low concentrations of phenol were used with the aim of reducing the unwanted side-effects of high-concentration phenol without reducing the therapeutic effects. Participants We treated 112 patients (18 women, 94 men) with PSD using phenol solution. Patients were divided into two groups: Group A was treated with a 40% solution of phenol solution, and Group B was treated with an 80% solution of phenol solution. Setting All patients were treated on an outpatient basis. One mL of low (40%) or high (80%) concentration phenol solution was injected into the main sinus orifice. During the check it was observed and noted whether there was skin necrosis, fatty tissue necrosis or abscesses. Main outcome measures The mean age was 27.4 years (6–44). The median length of symptoms was seven months (0.5–132). In the 2.8 years (1–6) of mean follow-up period, the disease recurred in 13 (11.6%) patients. Results This treatment procedure was well-tolerated by all the patients except for those who had unwanted results. No patients in group A had skin necrosis, and only one had abscesses. In group B two patients had abscesses, and three had skin necrosis. Fatty tissue necrosis was seen in one patient in Group A and in five patients in Group B. Recurrence rates were four (7.4%) cases in Group A and nine (15.5%) cases in Group B. Conclusions It is possible to treat patients in a shorter time with a considerably smaller loss of working time, since the destruction of peripilonidal adipose tissue and skin is less. Therefore, the use of low-concentration phenol solution is an option to be considered in the treatment of PSD.PubMe

The evolution of postoperative ileus after laparoscopic cholecystectomy. A comparative study with conventional cholecystectomy and sympathetic blockade treatment. Surg Endosc

Summary. Our study is prompted by the arrival of laparoscopic cholecystectomy in connection with the evolution of postoperative ileus (PI) and by its avoidance of the intraabdominal handling implied in conventional cholecystectomy. With this aim a prospective, controlled, randomized, and blind clinical trial was designed using 100 patients divided into five groups (n = 20): I, conventional cholecystectomy (CC); II, CC + injection of 20 ml bupivacaine 0.5% into the mesentery root; III, CC + 7.5 mg propanolol i.v. and 0.5 mg neostigmine s.c., postoperatively until the first defecation; IV, II + III; and V, laparoscopic cholecystectomy. The shortest period of PI was observed in group V. This period increases notably in group IV (53 h), group II (72 h), and group III (84 h) relative to the control group with (89 h). This reduction in PI time runs parallel with an improvement in the patient's general state of well-being. We concluded that after laparoscopic cholecystectomy PI is nonexistent. Furthermore, this study confirms the correlation between the avoidance of intraabdominal manipulation and the evolution of postoperative ileus. Key words: Postoperative ileus -Laparoscopic cholecystectomy -Sympathetic blockade During the last two decades a considerable number of studies have emerged, each with the aim of identifying a clear pathophysiology of postoperative paralytic ileus Offprint requests to: C. Vara-Thorbeck Nevertheless, the majority of the authors agree that the disorder is brought about by the triggering of sympathetic inhibitory reflexes originating from receptors in the intestinal wall and in the parietal and visceral layers of the peritoneum The introduction of laparoscopic surgery, and specifically its most widespread application in general surgery --cholecystectomy --has made it possible to avoid the opening and manipulation of the abdominal cavity, which, as we have indicated above, appears to be the cause of this pathology. Our group, which has for some time been studying postoperative ileus Material and methods A hundred patients were included in the study after passing the exclusion criteria (see A routine preoperative study was carried out on all the patients as well as an ultrasonic study of the bile duct. Those patients who were to undergo laparoscopy were submitted to an intravenous cholangiotomography 24 h prior to the operation in order to ensure against choledocholithiasis. Anesthesia was induced with Pentothal (3-5 mg/kg), athracurium, to prevent fasciculations, and maintained with N20 and 02 and a bolus dose of 0.1 mg of fentanyl followed by a standardized dose of 0.003 mg/kg/h. At the conclusion of surgery, 0.5 mg of atropine followed by 1 mg of neostigmine was administered to reverse the neuromuscular blockade. The patients were randomly allocated into the following five groups (n = 20), each being differentiated by the specific postoperative ileus treatment applied

Linfangioma cístico do mesentério: uma rara apresentação de abdômen agudo

Mesenteric cyst is a rare intra abdominal pathology. The incidence ranges from 1/100,000 to 1/250,000 hospital admissions. The authors present a case of a female patient, 20 years old, with abdominal pain for four months which three days had an acute onset of abdominal pain, and ultrasound revealed a cyst of mesentery within a dense fluid. The patient had been submitted to a laparotomy, and resection of the cyst. We emphasized the clinical symptoms, diagnostic evaluation and the therapeutic of this condition