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OBJECTIVE: Gastric carcinoma can be divided into two main histological and clinical types: diffuse and intestinal. The aim of this study was to investigate the expression of neu/c-erbB-2 oncoprotein, epidermal growth factor receptor (EGFR), cathepsin D (catD), progesterone receptor (PR) and tumor-associated glycoprotein-72 (TAG-72) in gastric carcinoma of these histological types. METHOD: In this randomized, prospective study we analyzed 85 biopsy samples from patients with gastric adenocarcinoma. The control group consisted of 40 specimens from normal gastric mucosa. Neu oncoprotein and PR were determined by ELISA. CatD and TAG-72 were quantified with immunoradiometric (IRMA) methods, and EGFR were studied by radioimmunoassay (RIA). RESULTS: Neu, EGFR, catD and TAG-72 concentrations were higher in the tumoral group (p = 0.02, p = 0.00001, p = 0.002 and p = 0.007, respectively). In diffuse adenocarcinomas, catD and PR expression was increased (p = 0.01 and p = 0.04 respectively), whereas TAG-72 concentration, which correlated with neu (r = 0.57), was higher in the intestinal type (p = 0.04). No significant differences in EGFR and neu concentrations were seen between the two histological types. CONCLUSIONS: The higher PR and catD concentrations in diffuse adenocarcinomas, and the overexpression of TAG-72 in the intestinal type, support the existence of two modes of gastric carcinogenesis.

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We report a series of 37 patients with upper gastrointestinal fistulas, from a total of 90 postoperative fistulas, treated in our Department over a period of five years (1987-1991). 46% of these originated after peptic ulcer surgery. Most patients (54%) required surgical intervention mainly due to the presence of major intraabdominal sepsis, and only 12 (32.4%) had spontaneous fistula closure. Morbidity (59.4%) and mortality rates (32.4%) were high.

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A case of biliary ascaridiasis is presented in which biliary obstruction and pancreatitis were diagnosed. Recovery followed surgical removal of the worms. The literature is reviewed.

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Between January 1985 and December 1989, 583 patients with carcinoma of the colon and rectum have been studied. In 85 with synchronous liver metastases discovered at laparotomy and followed-up, median survival time has been 5.8 months and 1 and 3 year survival 23 and 6 percent respectively. Favorable factors for survival were rectosigmoid location, single metastasis in the right hepatic lobe, normal values of alkaline phosphatase, resection of the tumor as well as stage II of Duke's classification.

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We report a patient with mesenteric fibromatosis, a rare entity in our environment resulting in rectal stenosis which required resection and a Hartman operation. The features of this disease are reviewed.

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We have reviewed our experience with 2,430 cases of lithiasis of the biliary tract, 500 of them located in the common bile duct and 104 corresponding to residual lithiasis. We have made a general reflexion on the problems aroused by this very common al condition, which has an imprevisible, some times severe, outcome. The recent acquisition of new conservative methods, as disolvents and lithotrix, and the diagnostic and therapeutic role of endoscopy have revolutionated the state of the art and have introduced controversial points still unsolved. As it is common in clinical practice, biliary lithiasis should be approached in a multidisciplinary fashion, employing the most convenient diagnostic procedure for the clinical situation of the patient; a priori no accredited procedure should be disregarded.

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We reviewed retrospectively the septic postsplenectomy complications after splenic rupture from abdominal trauma in 53 patients treated in the last five years (1984-1988). We recorded a higher incidence of complications (pneumonia, subphrenic abscess) in these patients than in those who underwent clean surgery during the same period, but we did not demonstrate the same difference in other infectious processes (infection of the surgical wound). Infections had a higher incidence in patients with splenic rupture with associated lesions (54.10%) than in those with only a splenic lesion (37.50%) (SD p less than 0.05). The predominant agents usually isolated were aerobic Gram-positive. We remark the importance of open drainage systems (Penrose type) in the genesis of subphrenic abscesses.

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A case is presented of acute gastric volvulus associated with paraesophageal hernia. Gastric volvulus is an infrequent clinical entity that generally appears in chronic form secondary to diaphragmatic pathology. Pathogenesis rests on two factors, relaxation of the supporting ligaments and neighboring associated pathology that acts to trigger gastric distension. Early diagnosis and treatment of acute forms and prophylactic surgery of chronic forms would lead to practically null mortality figures. The surgical technique, aside from devolvulation, includes hiatal repair in cases associated with paraesophageal hernia, gastropexy being sufficient for other forms.

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