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Damos a conocer el hallazgo de una adenopatía axilar pigmentada durante la realización de una mastectomía bilateral profiláctica en una paciente de 35 años. El estudio anatomopatológico reveló pigmento compatible con tinta en el interior del ganglio. Esto, junto con la presencia de un tatuaje próximo a la axila de la paciente, permitió identificar el tatuaje como causa de la coloración de la adenopatía. Discutimos el diagnóstico diferencial a realizar en casos similares. Hasta un tercio de la población joven en España se ha realizado algún tatuaje, y las series de autopsias muestran la alta incidencia de presencia de pigmento en ganglios próximos a esos tatuajes. Creemos necesario realizar un correcto diagnóstico diferencial con melanoma y otras etiologías en pacientes tatuados para llevar a cabo una adecuada indicación quirúrgica (AU)

We report the finding of an axillary pigmented adenopathy during a bilateral profilactic mastectomy in a 35- year-old patient. The anatomopathologycal analysis revealed pigmentation compatible with ink inside the lymphatic node. The presence of a tattoo close to the axillary region of the patient made us identify the tattoo as the cause of the adenopathy coloration. We discuss the differential diagnosis to be considered in this cases. Around one third of the spanish population wears a tattoo, and series of autopsies show an elevated incidence of the presence of pigment in nodes adjacent to tattoos. The correct differential diagnosis with melanoma and other etiologies in tattooed patients is necessary to establish an adequate surgical indication (AU)

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El uso de tejido abdominal representa una de las primeras líneas de actuación en reconstrucción mamaria con tejido autólogo. En aquellas pacientes en las que no está disponible, el colgajo miocutáneo transverso de gracilis (TMG) representa una opción válida para la creación de una nueva mama. Presentamos una serie de 10 casos de reconstrucción mamaria con TMG con el objetivo de evaluar esta opción quirúrgica. Para ello, administramos a las pacientes intervenidas un cuestionario sobre calidad de la reconstrucción y de la zona donante y valoramos además: la duración promedio de la intervención, el periodo promedio de ingreso hospitalario, las complicaciones sufridas en el área donante y en la mama reconstruida. Para poder comparar los resultados obtenidos con esta técnica, recogimos también los mismos datos en las pacientes sometidas a reconstrucción mamaria con colgajo de músculo dorsal ancho, una alternativa a la reconstrucción con tejido abdominal ampliamente extendida. Exponemos los resultados de la comparación, que obtuvieron resultados superiores en los ítems referentes al aspecto de la mama reconstruida con el colgajo TMG (AU)

The use of abdominal tissue is one the first options in breast reconstruction with autologous tissue. In case of contraindication for this technique, the transverse myocutaneous gracilis flap (TMG) is a valid option for breast reconstruction. We present a series of 10 breast reconstructions with TMG flap. In order to evaluate this surgical option, we gave the patients a questionnaire about the quality of the reconstructed breast and of the donor site, and we also evaluated: the mean duration of the intervention, the average hospitalization time, the complications in the donor site and in the reconstructed breast. To compare our outcomes, we repeated the same process with patients reconstructed with a latissimus dorsi flap, another alternative to breast reconstruction with abdominal tissue. We present our comparative results, with better results in the ítems about breast appearance in TMG group (AU)

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La fascitis necrosante es una rara infección de tejidos blandos con una alta tasa de morbi-mortalidad. Presentamos el caso de una paciente de 44 años diagnosticada defascitis necrosante por E. coli en el contexto clínico de inmunosupresión por trasplante renal. Logramos un tratamiento exitoso mediante la asociación de desbridamiento quirúrgico, antibioticoterapia intravenosa y curas con terapia de presión negativa (VAC ®), seguido de injertos autólogos de piel parcial. Remarcamos las ventajas clínicas de la terapia de presión negativa en el manejo y curación de heridas complejas (AU)

Necrotizing fasciitis is a rare soft tissue infection which presents a high rate of morbi- mortality. We describe the case of a 44 years old patient diagnosed with necrotizing fasciitis caused by E. coli, in the context of immunosuppression due to renal transplantation. Successful treatment was achieved by combining surgical debridement, intravenous antibiotic treatment and vacuum assisted closure therapy (VAC ®) completed by autologous split skin grafts. We stress the clinical benefits of subatmospheric pressure therapy in the management and healing of complex wounds (AU)

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Las complicaciones cutáneas secundarias a artrodesis raquídea son un problema frecuente que requiere la colaboración de los Servicios de Cirugía Plástica y en cuyo tratamiento la terapia de presión negativa puede resultar útil. En este artículo presentamos el caso de un paciente afectado por metástasis vertebrales de adenocarcinoma gástrico que requirió artrodesis raquídea y desarrolló posteriormente una úlcera por presión dorsal debido al material implantado. El sistema VAC® permitió la limpieza y disminución de tamaño de la lesión, siendo posible la cobertura posterior de la misma con un colgajo miocutáneo de dorsal ancho. En este artículo discutimos la utilidad de la terapia depresión negativa en este tipo de lesiones (AU)

Cutaneous complications secondary to spinal fusionare a common problem that requires the collaboration of the Department of Plastic Surgery and in which negative pressure therapy treatment may be useful. In this paper we present the case of a patient with spinal metastases secondary to gastric adenocarcinoma that required spinal fusion and developed a dorsal pressure ulcer secondary to the implanted material. VAC® therapy system allowed cleaning the wound and decreasing the size of the injury,thus making it possible subsequently to cover it with alatissimus dorsi myocutaneous flap. In this paper we discuss the usefulness of negative pressure therapy in this type of injury (AU)

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La fascitis necrosante es una rara infección de tejidos blandos con una alta tasa de morbi-mortalidad. Presentamos el caso de una paciente de 44 años diagnosticada defascitis necrosante por E. coli en el contexto clínico de inmunosupresión por trasplante renal. Logramos un tratamiento exitoso mediante la asociación de desbridamiento quirúrgico, antibioticoterapia intravenosa y curas con terapia de presión negativa (VAC ®), seguido de injertos autólogos de piel parcial. Remarcamos las ventajas clínicas de la terapia de presión negativa en el manejo y curación de heridas complejas (AU)

Necrotizing fasciitis is a rare soft tissue infection which presents a high rate of morbi- mortality. We describe the case of a 44 years old patient diagnosed with necrotizing fasciitis caused by E. coli, in the context of immunosuppression due to renal transplantation. Successful treatment was achieved by combining surgical debridement, intravenous antibiotic treatment and vacuum assisted closure therapy (VAC ®) completed by autologous split skin grafts. We stress the clinical benefits of subatmospheric pressure therapy in the management and healing of complex wounds (AU)

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Ebastine is H1 receptor antagonist, powerful and selective for histamine. Its efficacy has been evaluated in control of symptoms of persistent rhinitis, appearance of secondary effects and tolerance of the drug, in 30 children who were suffering from persistent rhinitis, of which the diagnosis included:- clinical history, skin tests (prick test) nasal and conjunctival provocation tests, total and specific IgE. All the children had treatment for 30 days. The parameters followed were:- clinical score, skin tests, nasal and conjunctival provocations and evaluation of secondary effects, of the start and 10 days after the end of treatment. The results obtained were a disappearance or reduction of the weals from histamine and specific antigens, disappearance or reduction of the response in nasal and conjunctival provocation with carbachol or specific antigens, clear clinical improvement in 22 patients, in 2 small improvement and no response in 6 patients. We conclude that Ebastine improved the clinical symptoms in persistent rhinitis, the skin test is inhibited and sensitivity of the shock organ is reduced. No secondary effects were seen on the Central Nervous System (SNC) and the tolerance of the drug was very good.

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One hundred and twenty-one transrectal ultrasound examinations of the prostate were performed between August and October of 1987. Indications included screening in 41 patients, evaluation of bladder outlet obstruction in 63 patients, evaluation of palpable nodules in 6 patients, and evaluation after transurethral resection of the prostate in 11 patients. A total of five patients were discovered to have prostate cancer after biopsy of a hypoechoic lesion in a normal feeling prostate by digital rectal examination. One patient was from the screening group, two patients with bladder outlet obstruction and two patients from the postransurethral resection group. All six patients with palpable nodules were diagnosed as having a cancer: Stage B2 on the rectal examination and two of the six patients were upstaged to Stage C by ultrasound criteria. In our hands transrectal ultrasound of the prostate is a valuable adjunct in the urological armamentarium with clear application in the diagnosis and staging of prostate cancer.

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Ninety-one children that were subjected to transabdominal radical nephrectomy are reviewed. The patients' ages ranged from 20 days to 10 years. Forty cases had a right side tumor and 44 a left side tumor; bilateral tumor incidence was 7.70% (7 cases). The tumor weight incidence was 75% for greater than or equal to 500 g and 37.5% for greater than or equal to 1,000 g. Incidence of local extension of the disease was 21.98%. Intraoperative complications were 12 ruptures of the kidney capsule, 1 laceration of the cecum, 1 opening of the pleura, 1 section of the superior mesenteric artery, and 1 section of the right common iliac artery. The mortality rate in unilateral surgery, because of intraoperative massive hemorrhage, was 3/83 (3.61%). One patient with bilateral tumor died because of acute renal insufficiency and sepsis. One patient with caval thrombus which extended up to the right atrium died because of intraoperative massive pulmonary embolism.

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Twenty-nine patients with squamous cell carcinoma of the penis underwent bilateral ilioinguinal groin dissection 6 weeks after removal of the primary penile lesion. Eighty percent of the patients were alive and without evidence of disease at 5 years when the dissected lymph nodes were negative. When positive nodes were found, 62.5% of the patients were alive and without evidence of disease at 5 years: two of these patients had one iliac deep node positive each. The mortality rate at 5 years because of progression of disease was 6.6% when the dissected lymph nodes were negative, as compared to 37.5% when the dissected lymph nodes were positive.

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Thirty seven patients with Stage I yolk sac tumor of the testis were registered at the Instituto Nacional de Enfermedades Neoplasicas (I.N.E.N.), Lima-Peru from 1962 through 1980. Eighteen patients underwent retroperitoneal Lymph node dissection. The age incidence was 5 to 29 months except for two patients 50 and 84 months of age each. Bilateral retroperitoneal lymph node dissection was performed in seventeen patients; unilateral dissection was performed in one patient. In two patients both had one positive node at lymphadenectomy (2/18: 11%). Eleven patients (61.11%) are alive and with no evidence of disease in between 7 to 26 years post lymphadenectomy. Seven patients (38.89%) died: 4/18 (22.22%) because of progression of the disease and three patients because of no neoplastic cause. Nineteen patients did not have retroperitoneal lymph node dissection: seven patients (36.84%) are alive with no evidence of disease and 12 patients (63.16%) died: 8/19 (42.10%) because of progression of the disease and 4/19 (21%) with no neoplastic disease. In conclusion, patients with localized disease (Clinical Stage I) benefit from retroperitoneal lymph node dissection when compared to a similar group of patients not submitted to lymphadenectomy.

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Thirty patients with adenocarcinoma of the prostate, Grade III-V, Stage IV, 80 years of age or more have been studied. Survival rate at 12 months was 19/30 (63.3%). Survival rate at 3 years was 18/30 (60%). The results of this study show that in spite of being a selected group of patients with high grade, high stage tumors, the survival rate at three years was even better when compared to a heterogeneous group of patients ten years younger (57.75%).

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Fifty six patients with yolk sac tumor are registered in the "Instituto Nacional de Enfermedades Neoplásicas" (Lima-Peru), from 1952-1980: 48.22% were less than 2 years of age; 51.78% were beyond that age.- Seventeen patients survived 3 years post diagnosis: 44% when patients less than 2 years of age and 17.2% when over two years of age. 25.9% of the patients less than 2 years of age were found to have metastases whereas 48.5% when over 2 years of age. 21/56 already had metastases when first seen. All tumors were greater than or equal to 3 cm. in diameter when first seen. Metastases were found in 38% of cases when tumors were less than or equal to 6 cm., compared to 61.9% of cases in which tumors exceeded 6 cm. 51.8% of clinical stage I survived 3 years without evidence of disease; 14.3% when stage II while none survived at clinical stage IV. It is to be expected that young patients who survive 3 years after diagnosis and treatment will not suffer a recurrence of the disease.

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Eighteen patients with T1 transitional cell carcinoma of the urinary bladder were submitted to transurethral resection of the tumor, followed by Cobalt therapy (5,500 rads to the pelvis and 6,500 rads to the bladder in six weeks). The recurrence rate at three years follow-up was 33% (6/18). Recurrence of transitional cell carcinoma of the urinary bladder is a well known condition in stage O and A, even when low grade is present. Recurrence rates at one year as high as 84% (Loening et al., 1983) are reported in the current literature. In recent years many studies have been performed which were oriented to the use of intravesical chemotherapy in order to reduce the recurrence rate (Adolphs and Bastian, 1983; Huland, 1983; Loening et al., 1983; National Bladder Cancer Collaborative Group A, 1977; Rodriguez and Caserta, 1983; Zincke et al., 1983) of this tumor. We started a protocol on treatment of the transitional cell carcinoma of the urinary bladder in 1963. The protocol calls for transurethral resection of the tumor followed by Cobalt therapy. This is an interim report on stage T1 (stage A) with such a treatment.

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The surgical technique for a new alternative to urinary diversion is described. The biocarbon conduit is an inert device implanted in the abdominal wall. Its inner end is anastomosed to the distal ureter, and the outlet is over the abdominal skin and connected to a collector tube into a urinary bag. Twenty implants were performed between March, 1980, and July, 1981. Seventeen patients had carcinoma of the uterine cervix, and 3 had carcinoma of the urinary bladder (age range 34 to 79 years). All had severe urinary tract infection, retrodilation, and were in poor general physical condition. Eight fistulas developed in the 20 implants.

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The progressive proportion of 25-50 and 75% of undifferentiated cells in the Wilms' tumor mass generate three grading categories: well differentiated (WD); the moderate differentiated (MD) and the poorly differentiated (PD). The Urology Department of the Instituto Nacional de Enfermedades Neoplásicas (Lima, Peru) has studied 60 selected cases registered at its Biostatistics Department. Only 6.9% were well differentiated; 69% were of the poorly differentiated type. In 58 patients our survival rate at two years after diagnosis is higher (39.53%) when the patients are over 2 years of age; while under 2 years of age this survival rate is 26.67%. In a group of 46 patients, the survival rate at two years after initial diagnosis is 44% with a tumor size between 10-14 cm; the survival rate drops to 39.3% when the tumor size is over 15 cm in diameter. There is a linear increasing scale of survival rate for the well differentiated (25%), moderate differentiated (27.3%) and for the patients bearing poorly differentiated types of tumors (48.4%). Further studies are encouraged in order to learn the reasons for this correlation.

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Between 1952 and 1976 192 consecutive cases of penile epidermoid carcinoma were seen at the Instituto Nacional de Enfermedades Neoplascias of Lima, Peru. The mean age when the disease developed was 60.5 years, with a peak incidence between 60 and 64 years (32 patients). No correlation was observed between extensive lesions of the shaft of the penis to high pathological staging. Clinical examination of the inguino-crural nodes is not a good criterion for staging. We wait six weeks after eradication of primary lesion before lymphadenectomy. No correlation exists between grade and pathological stage. When no lymph node was positive, the overall survival rate over five years was 90.69%; when lymph nodes were metastasized there was an overall survival rate over five years of only 9.39 percent. The coefficient of cancer versus noncancer cause of death was 1.25 for pathological stage I, 3.09 for pathological stage II, 4.83 for pathological stage III, and 10.000 for pathological stage IV. Our patients did have advanced disease, as 57.14% of deaths occurred at two years and 25.21% more at five years.

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