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We present 28 patients who underwent surgery after failed procedures due to gastroesophageal reflux with an asymptomatic period over 2.6 years. The most frequent complications resulted in recurrent reflux (86%) and peptic strictures (36%). An abdominal approach was used on all the patients. Reoperation, using the Collis-Nissen gastroplasty (19 cases), Nissen 360 degrees (3 cases), duodenal diversion with Roux-en-Y (3 cases) and Angelchick prothesis (3 cases) gave excellent or good results in 84% of the patients and poor in 4 cases. There was one operative death. All patients were referred for 24 hour pH-monitoring. Sphincter pressure and length of the distal esophageal sphincter were significantly increased over the preoperative values. Our results suggest that the Collis Nissen procedure is a suitable form of treatment for complicated forms of peptic esophagitis after the failed antireflux operations.

Objective: This is a retrospective study to evaluate our results in the treatment of abdominal trauma., Design: We have analysed the incidence, the clinical characteristics, the diagnosis, the indications for laparotomy, the therapeutic methods and the morbidity-mortality. During the last 14 years we have operated on 29 hollow viscus injuries. They were divided into two groups: Eleven with penetrating or open trauma and 18 with blunt or closed traumatism., Results: In the cases of blunt trauma 36.8% of injuries were located in the proximal jejunum, 21% in the terminal ileum, 15% in the colon. In the cases of penetrating trauma, small intestinal perforation predominated (46.9%). In 23.5% of the cases the colon was affected. Morbidity in blunt trauma was 38.8% and 0% in penetrating trauma. The mortality in the two groups has been zero., Conclusions: The most common surgical procedure practised for injuries to the small intestine was simple suture, and for injuries to the colon, colostomy. The most usual surgical procedures in penetrating trauma were simple suture in all small intestine injuries and for colonic lesions half had primary closure and half suture plus colostomy.

We present three cases of polymicrobian endocarditis (PE), two of them in parenterally drug addicts (PDA) and the other one in a central catheter carrier. In all these three cases, the form of clinical presentation was similar to the monomicrobian endocarditis and the valve affected was the tricuspid one, as it occurs in most of the described PE. PE must be suspect in PDA or central catheter carriers if a rare germ is isolated (commensal of skin, oropharynx or gastrointestinal tract) or if there is a poor response to the antibiotic treatment, as it is the case in the patients described here.

Idiopathic sclerosing peritonitis (I.S.P.) is a rare disease, in which the small bowel is encased in a fibrous capsule, with symptoms and signs of intestinal obstruction. A new case of I.S.P. in a 42-year-old man who underwent laparotomy and was reoperated for intestinal obstruction is presented. A jejunal fistula with a favorable outcome occurred in this case. The literature about this entity is reviewed, and 16 cases are collected. This condition is being reported more and more commonly and requires further research to elucidate its unknown mechanism.

Two patients with neurogenic gastrointestinal tumors are reported. One of them was a gangliocytic paraganglioma of the duodenum. The second one, a jejunal tumors in a patient with Von Recklinghausen's disease (ganglioneuroma). The neural crest origin of these tumours is discussed.

We present a case of thrombocytopenic purpura associated to acquired immunodeficiency; this disease is very infrequently associated to AIDS; the clinical characteristics are similar to the classical Idiopathic Thrombocytopenic Purpura, including the response to splenectomy. We discuss the therapeutic approach of this condition and review the literature, adding this new case of a patient with AIDS, Walter and Reed's stage II, who responded to splenectomy.