This study assesses the proportion of patients presenting with nonvisceral chronic abdominal pain who have thoracic disk herniation as a possible cause. We designed a descriptive transversal study of patients attending our offices between February 2009 and October 2010, with a complaint of chronic abdominal pain of suspected abdominal wall source (positive Carnett sign). Nuclear magnetic resonance (NMR) of the spinal column was performed on all patients. When the NMR showed thoracic disk herniation the patients were treated according to their etiology. We also evaluated the symptoms in patients with thoracic disk herniation and their response to the applied treatment. Twenty-seven patients with chronic abdominal pain were evaluated. The NMR results in 18 of these 27 patients (66.66%) showed evidence of disk herniation. We report on the results of these 18 patients, emphasizing that the symptoms are florid and varied. Many patients had been previously diagnosed with irritable bowel syndrome. Thoracic disk herniation may account for chronic abdominal pain in many patients who remain undiagnosed or are diagnosed with irritable bowel syndrome. Thus, this possibility needs to be taken into account to achieve a correct diagnosis and a suitable mode of treatment.

No abstract

Surgical treatment of high perianal fistulas, which affect a significant proportion of the sphincter apparatus, is difficult and associated with considerable risk of impaired anal continence. The diversity of approaches proposed for the treatment of complex perianal fistulas reflects the fact that no method has yet been shown to be fully satisfactory. We believe the successful treatment of this condition is directly proportional to the amount of fibrous tissue that can be removed. We used a kit of small curettes, of different thicknesses and sizes, incorporating spicules that enable the physician to remove fibrous tissue from the fistula tract. The small size and varying thicknesses of the curettes enable them to mold to the curves of the fistula tract and to remove tissue by de-roofing from the shallowest to the deepest layers, thus excising the entire fibrous tract. The tract is then sealed using autologous fibrin, applied through a catheter, with the help of a monitor indicating the amount of product remaining at all times. Finally, the internal orifice is closed by simple suturing.

Outpatient treatment of perianal fistula is totally innocuous. It is a very low cost procedure and the results obtained are highly acceptable (similar to those of the surgical insertion of a plug, with traditional curettage). Therefore, we believe this approach should be considered a valid initial treatment for perianal fistula, reserving surgical treatment (curettage and sealing using a cylindrical-curette kit) for cases in which this initial method is unsuccessful. This would avoid many complications and achieve considerable financial savings for the health system.

Introduction: Conventionally, thoracic disc herniation has been viewed as a very rare pathology, and the few cases considered were considered to have a very low frequency of symptoms. However, new imaging methods show that the frequency of this pathology is quite high and also that its symptoms are encountered much more frequently than expected (since previously only neurological symptoms were taken into account). In view of these considerations, we conducted an anatomical descriptive study of this circumstance. Methods: A retrospective study was conducted to review all the nuclear magnetic resonance examinations made of the vertebral column at our hospital between October 2009 and October 2013. For this purpose, we selected the cases that presented herniated thoracic disc (HDT) and studied the social factors involved, the anatomical locations and the effects produced on nerve structures. Results: The sample consisted of 165 subjects, 95 men and 70 women, who presented a total of 337 HDT, with an average of 2.042 injuries per patient. We describe the most frequent locations, effects, and relationship to sex and age. Conclusions: We believe it is of interest to determine the anatomical details of this type of herniation, in view of recent knowledge obtained concerning its high frequency and the clinical significance of this information.