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Introduction and Objectives: Despite the criticisms from prestigious expert committees, a high percentage of surgeons continue to use, as the technique-of-choice, Hartmann's procedure for acute malignant intestinal obstruction of the distal colon and rectum, without faecal peritonitis. We have reviewed our results with this technique and compared them with other series of patients in the literature undergoing one-stage surgery (resection with primary anastomosis or sub-total colectomy)., Material and Methods: A retrospective and descriptive study using clinical histories and, from which, the variables studied were: median hospitalisation stay, morbido-mortality and reconstruction index., Results: Included in the analysis were 44 patients (24 male; 20 female) with an age range between 37 and 87 years (median age: 67.04 years). The median hospitalisation stay was 15.59 days (range: 8-39). In the 10 patients undergoing reconstruction this was 12.8 days (range: 10-17). The overall stay, therefore, was 28.39 days. The median stay in the series of patients having one-stage surgery was 13.9 days. The morbidity using Hartmann's procedure was 43.18% (19/44) and, in the patients with reconstruction, 40% (4/10). The morbidity in the literature series with one-stage surgery was 22.53%. Mortality in our study was 0%. The mortality in the 16 cases from the literature was close to 5%, although in 3 of the studies this was also 0%. The percentage undergoing reconstruction was 22.72% (10 cases). The median age in the non-reconstructed patients was 71.42 years (range: 46-87) compared to a median age of 52.6 (range 37-67) in the group with reconstruction (p < 0.001). The percentages undergoing reconstruction, according to tumour stage, were Dukes B: 36.84%; Dukes C: 23.07%; Dukes D: 0% (p < 0.001). The median waiting-time for a reconstruction was 15.73 months (range: 8-33)., Conclusions: Comparisons of our results with the outcomes in the series of patients in the literature with one-stage surgery indicate that "one-stage surgery" is the more suitable but, however, with two conditions: a sufficient command of the technique so as to minimise complications and a strict patient selection, with the Hartmann's procedure being retained for patients with high anaesthesia risk.

The sane authors of the work titled "Treaty of Pathology and Surgical Clinic" of the Editorial McGraw-Hill Iberoamericana written in three volumes, of those that have been carried out several reprints and a second edition with changes in the structure and contents, that it has been accepted by studious of the surgery in spain and other countries, have the mission of writing this book whose extension constitutes approximately the third part of the Treaty os Surgery mentioned. The object of this work that contains the whole General Surgery and their specialities, as it corresponds to the effective university programs, it is to define the extension of matters at the postgraduates' level, instead of being also good for postgraduates and incipient specialist with the purpose of that the students are not overflowed when facing at the same time with other disciplines in each course. The spirit of this book has much of the one that feeds the persons that write, all of them Professors of Pathology and Surgical Clinic that believe in General Surgery and they exercise it, naturally with personal preferences toward the different sectors of the same one, as it is done in almost all countries.

Sepsis and septic shock continue being a topic of enormous interest for their high frequency, and for not existing a decrease in the figures of mortality in spite of the new acquired knowledges relation with their physiopathology and the advances arisen in the diverse applied treatments. The purpose of the present study is to update the present notions in the specialized literature, trying to summarize the complex existent interaction among different mediators of double character: exogenous and endogenous, and to enunciate the possible causes for those that the novel treatments applied in the sepsis continue not to be very promising.

A case is reported of segmental portal hypertension secondary to compression of the splenic vein by an aneurysm of the distal splenic artery. Splenectomy was used to treat the aneurysm and segmental portal hypertension, as well as the hypersplenism existent. Collateral circulation through the short gastric veins originated grade V gastroesophageal varices, which makes this mechanism of production equivalent to that described in cases of thrombosis of the splenic vein.

The immunosuppressive and nephrotoxic effects of cyclosporine A (CsA) have been ascribed to a calcium-dependent mechanism of action. However, verapamil, a slow-calcium-channel blocking agent, enhances the immunosuppressive action of CsA and reduces its nephrotoxicity. The present experimental study performed in Wistar rats demonstrates that 0.1 mg..24 h.-1 IM verapamil prevents reduction of liver weight caused by treatment with 20 mg..kg.-1..24 h.-1 IM, as well as a rise in SGOT, SGPT, serum LDH and creatinine. The nephro-protective effects of verapamil in rats treated with CsA could be ascribable to the increased plasma clearance of the immunosuppressive agent.

Histologic study of the body and tail of the pancreas in a patient in whom total duodenopancreatectomy was carried out for ductal adenocarcinoma of the head (ADC) demonstrates the existence of dysplasia of the pancreatic duct in its entire length associated with intente parenchymal atrophy. It is considered that cephalic duodenopancreatectomy in ductal adenocarcinoma of the head of the pancreas should be based on an adequate anatomic, histologic and functional evaluation of the residual pancreas.