Caracterización clínica y epidemiológica de los pacientes con cáncer de colon / Clinical and epidemiological characterization of patients with colon cancer

INTRODUCCIÓN. El cáncer de colon es una neoplasia del tubo digestivo considerada una de las más frecuentes en ambos sexos y que predomina en adultos mayores. OBJETIVO. Describir las características clínicas y epidemiológicas de los pacientes con cáncer de colon. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, retrospectivo. Población de 1 601 y muestra de 210 datos de Historias Clínicas Electrónicas de pacientes diagnosticados con cáncer de colon, atendidos por la Unidad de Oncología del Hospital de Especialidades Carlos Andrade Marín de la ciudad de Quito en el periodo enero de 2016 a diciembre de 2019. Criterios de inclusión: diagnóstico confirmado de Cáncer de Colon, edad igual o mayor a 18 años, y disponer de todos los datos clínicos requeridos en el estudio. Se utilizó el método de muestreo probabilístico con lo que se estimó una proporción para el estudio con un intervalo de confianza del 95%, un margen de error del 5% y una frecuencia esperada del 3%, de donde se obtuvo una muestra ajustada al 10% de pérdidas. El procesamiento de datos se realizó en los programas Microsoft Excel versión 16 y el Statistical Package for Social Sciences versión 24. RESULTADOS. La mayor presentación fue en adultos mayores de 50 años, con una relación 1:1 en cuanto a sexo, y en la procedencia, se ubicó mayoritariamente en la población de la región Sierra; las personas con una actividad económica de tipo profesional fueron las más afectadas; en lo que se refiere a los antecedentes se encontró mayor relación en los personales y dentro de estos los pólipos; no hubo relación con los antecedentes quirúrgicos ni familiares. El síntoma de debut más prevalente fue el dolor abdominal; la mayoría fueron sometidos a colonoscopia; predominó la lateralidad derecha y el tipo histológico principalmente identificado fue el adenocarcinoma. CONCLUSIÓN. No se observó relación estadísticamente significante entre estadíos, evolución y tratamientos instaurados, lo que pudo estar influenciado por el muestreo al azar; y que el 53,30% de los pacientes aún se encuentra en controles.

INTRODUCTION. Colon cancer is a neoplasm of the digestive tract considered one of the most frequent in both sexes and predominantly in older adults. OBJECTIVE. To describe the clinical and epidemiological characteristics of patients with colon cancer. MATERIALS AND METHODS. Observational, descriptive, retrospective study. Population of 1 601 and sample of 210 data from Electronic Medical Records of patients diagnosed with colon cancer, attended by the Oncology Unit of the Hospital de Especialidades Carlos Andrade Marín of the city of Quito in the period January 2016 to December 2019. Inclusion criteria: confirmed diagnosis of Colon Cancer, age equal to or older than 18 years, and having all the clinical data required in the study. The probability sampling method was used with which a proportion was estimated for the study with a confidence interval of 95%, a margin of error of 5% and an expected frequency of 3%, from which a 10% loss adjusted sample was obtained. Data processing was performed in Microsoft Excel version 16 and Statistical Package for Social Sciences version 24. The greatest presentation was in adults over 50 years of age, with a 1:1 ratio in terms of sex, and in terms of origin, it was mainly located in the population of the Sierra region; people with a professional economic activity were the most affected; in terms of history, a greater relationship was found in personal history and within these, polyps; there was no relationship with surgical or family history. The most prevalent debut symptom was abdominal pain; the majority underwent colonoscopy; right laterality predominated and the histological type mainly identified was adestatistically significant relationship was observed between stages, evolution and treatment, which could be influenced by random sampling; and that 53,30% of the patients are still in controls.

Simultaneous resection for colon cancer and synchronous liver metastases: case series with follow-up / Resección simultánea por cáncer de colon y metástasis hepáticas sincrónicas: serie de casos con seguimiento

SUMMARY: Treatment of colonic cancer (CC) and synchronic liver metastasis (SLM) is still controversial in relation to how to act. The aim of this study was to analyze initial single center experience in simultaneous surgical approach of patients with CC and SLM, in terms of overall survival (OS) and disease-free survival (DFS). Retrospective case series of patients with CC and SLM undergoing simultaneous surgery, consecutively, at Clínica RedSalud Mayor Temuco, between 2007 and 2021. Outcome variables were OS and DFS. Other variables of interest were postoperative morbidity (POM), surgical time, hospital stay and mortality. Descriptive statistics was used (measures of central tendency and dispersion), and survival analysis was estimated applying Kaplan Meier curves. Sixteen patients (10 female and 6 male) were operated, with a median age of 61 years. The most frequent localization was cecum and right colon (37.5 %). In all patients some type of liver resection was added (parenchymal-sparing hepatectomy or anatomical resection). Median surgical time and hospital stay were 150 min and 5 days respectively. POM was 31.2 % (5 cases), mainly Clavien & Dindo I and II (12.5 % of patients required a re-intervention). With a median follow-up of 52 months 1, 3 and 5-year OS were 100 %, 62.5 %, and 50.0 % respectively. On the other hand, DFS rates of 1, 3 and 5-year were 75.0 %, 43.8 %, and 25.0 % respectively. The series had no mortality. OS, DFS, POM and mortality, were like other series. Simultaneous resection of CC and SLM is an aggressive approach, but not compromise oncological outcomes.

RESUMEN: El tratamiento del cáncer de colon (CC) con metástasis hepática sincrónica (MHS), tiene un tratamiento controvertido aún. El objetivo de este estudio fue analizar la experiencia unicéntrica en el tratamiento de pacientes con CC y MHS simultáneo, en términos de supervivencia global (SG) y supervivencia libre de enfermedad (SLE). Serie de casos retrospectiva consecutiva, de pacientes con CC y MHS sometidos a cirugía simultánea, en Clínica RedSalud Mayor Temuco, entre 2007 y 2021. Las variables de resultado fueron SG y SLE. Otras variables de interés fueron la morbilidad postoperatoria (MPO), tiempo quirúrgico, estancia hospitalaria y mortalidad. Se utilizó estadística descriptiva (medidas de tendencia central y dispersión) y se estimó supervivencia aplicando curvas de Kaplan Meier. Se operaron 16 pacientes (10 mujeres y 6 hombres), con mediana de edad de 61 años. La localización más frecuente fue ciego-colon derecho (37,5 %). En todos los casos se practicó algún tipo de resección hepática (hepatectomía conservadora o resección anatómica). La mediana del tiempo quirúrgico y la estancia hospitalaria fueron de 150 min y 5 días respectivamente. La MPO fue del 31,2 % (5 casos), principalmente Clavien & Dindo I y II (hubo 12,5 % de reintervenciones). Con una mediana de seguimiento de 52 meses. La SG a 1, 3 y 5 años fue 100 %, 62,5 % y 50,0 %, respectivamente. Por otro lado, la SLE a 1, 3 y 5 años fue 75,0 %, 43,8 % y 25,0 %, respectivamente. La serie no tuvo mortalidad. La SG, SLE, MPO y la mortalidad fueron similares a otras series. La resección simultánea de CC y SLM es agresiva, pero no compromete los resultados oncológicos.

Results of surgical treatment of uncomplicated colon cancer: case series with follow-up / Resultados del tratamiento quirúrgico del cáncer de colon no complicado: serie de casos con seguimiento

SUMMARY: The standard treatment of colonic cancer (CC) continues to be the radical resection of the intestinal segment compromised with free margins, associated or not with adjuvant therapies. The aim of this study was to determine postoperative morbidity (POM) and 5-year overall survival (OS) in patients with uncomplicated colon cancer surgically treated. Retrospective case series of patients with uncomplicated CC undergoing colectomy and lymphadenectomy, consecutively, at Clínica Red Salud Mayor Temuco, between 2007 and 2019. The outcomes variable were POM and 5-years OS. Other variables of interest were surgical time, number of resected lymph nodes, hospital stay and recurrence. Descriptive statistics was used (measures of central tendency and dispersion), and OS analysis was applying Kaplan Meier curves. In this study, 52 patients (53.8 % men) were intervened, with a median age of 68 years. The most frequent localization and stages were right colon (42.3 %); IIIA and IIIB respectively (78.9 %). Median surgical time, number of resected lymph nodes and hospital stay were 98 min, 34 and 4.5 days respectively. POM was 17.3 % (9 cases). With a median follow- up of 58 months, a recurrence of 19.2 % was verified, and the 5-year OS for stages IIA, IIIA, IIIB and IVA was 83.3 %, 73.6 %, 68.2 % and 40.0 % respectively. The results, in terms of POM, mortality and 5-year OS, were similar to national and international series.

RESUMEN: El tratamiento estándar del cáncer de colon (CC), continua siendo la resección radical del segmento intestinal comprometido con márgenes libres (al menos 5 cm por encima y debajo del tumor), pudiendo asociarse o no a terapias complementarias. El objetivo de este estudio fue determinar morbilidad postoperatoria (MPO) y supervivencia actuarial global (SVAG) a 5 años en pacientes resecados por CC no complicado. Serie de casos con seguimiento, de pacientes con CC no complicado, sometidos a colectomía subtotal y linfadenectomía, de forma consecutiva, en Clínica Red Salud Mayor Temuco, entre 2007 y 2019. Las variables resultado fueron MPO y SV actuarial global (SVAG) a 5 años. Otras variables de interés fueron: tiempo quirúrgico, número de linfonodos resecados, estancia hospitalaria y recurrencia. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión; y análisis de SV con curvas de Kaplan Meier. Se intervinieron 52 pacientes (53,8 % hombres), con una mediana de edad de 68 años. La localización y estadios más frecuentes fueron colon derecho (42,3 %); IIIA y IIIB respectivamente (78,9 %). La resecabilidad de la serie fue 100 %. La medianas del tiempo quirúrgico, del número de linfonodos resecados y de estancia hospitalaria; fueron de 98 min, 34 y 4.5 días respectivamente. La MPO fue 17,3 % (9 casos). Con una mediana de seguimiento de 58 meses, se verificó una recurrencia de 19,2 %; y una SVAG a 5 años para los estadios IIA, IIIA, IIIB y IVA; de 83,3 %; 73,6 %; 68,2 % y 40,0 % respectivamente. Los resultados obtenidos, en términos de MPO, mortalidad y SVAG a 5 años, fueron similares a series de nacionales e internacionales.

Linfangioma quístico de recto-sigmoides en un hospital público de Lima, Perú: reporte de caso / Cystic lymphangioma of the rectum-sigmoid in a public hospital in Lima-Peru: case report

RESUMEN Los linfangiomas son lesiones benignas que se deben a una malformación del desarrollo en el sistema linfático que ocurre durante la etapa embrionaria. Son más frecuentes en niños. Pueden encontrarse en cavidad abdominal, siendo la afectación del tracto gastrointestinal en forma ocasional. La presentación clínica es variada, dependiendo de la localización de los linfangiomas, pudiendo tener formas asintomáticas y, en ocasiones, presentarse con dolor abdominal, alteraciones del hábito defecatorio, rectorragia, etc. El diagnóstico se realiza por endoscopía, imágenes auxiliares y se confirma por medio de histología. Presentamos un caso de linfangioma quístico de recto-sigmoides que tuvimos en nuestro hospital; la paciente se presentó con proctalgia, alternancia evacuatoria y rectorragia intermitente. Examen físico sin alteraciones significativas. Durante la colonoscopía, a nivel de recto y sigmoides, se encontró múltiples lesiones protruidas, a modo de protuberancias, cuya superficie era lisa, trasluciente y de coloración azulada, con algunos orificios pseudodiverticulares, a predominio de recto. En la ultrasonografía endoscópica se observó, a nivel del recto, engrosamiento de la submucosa con múltiples imágenes anecoicas, microquísticas, algunas de ellas con tabiques finos. El diagnóstico definitivo se realizó mediante histopatología, que describe conductos linfáticos dilatados, rodeados de células endoteliales, hallazgos consistentes con linfangioma quístico de recto-sigmoides.

ABSTRACT Lymphangiomas are benign lesions due to a developmental malformation in the lymphatic system that occurs during the embryonic stage. They are more frequent in children. They can be found in the abdominal cavity, being the involvement of the gastrointestinal tract occasionally. The clinical presentation is varied, depending on the location of the lymphangiomas, and may have asymptomatic forms and, occasionally, present with abdominal pain, changes in defecation, rectal bleeding, etc. The diagnosis is made by endoscopy, auxiliary images and is confirmed by histology. We present a case of cystic rectal-sigmoid lymphangioma that we had in our hospital; the patient presented with proctalgia, alternating evacuation and intermittent rectal bleeding. Physical examination was without significant alterations. During the colonoscopy, at the level of the rectum and sigmoids, multiple protruded lesions were found, whose surface was smooth, translucent and bluish in color, with some pseudodiverticular holes, predominantly of the rectum. Endoscopic ultrasound revealed thickening of the submucosa at the level of the rectum with multiple anechoic, microcystic images, some of them with fine septa. The definitive diagnosis was made by histopathology, which describes dilated lymphatic ducts, surrounded by endothelial cells, findings consistent with cystic rectal-sigmoid lymphangioma.

Trombosis segmentaria sigmoidea consecuente a neoplasia maligna de colon. A propósito de un caso interesante / Sigmoid segmental thrombosis consequent to colon malignant neoplasia. On the purpose of a case

RESUMEN Se presentó un caso de una paciente de 78 años de edad, procedente del municipio de Calimete, con antecedentes patológicos personales de infarto agudo miocárdico sin elevación del segmento ST e hipertensión arterial. Llegó a la Unidad de Cuidados Intensivos de Emergencia, de Colón con un estado toxico infeccioso severo. Fue intervenida quirúrgicamente con el diagnóstico presuntivo de una trombosis mesentérica. Se constató dicho diagnóstico complementario a una neoplasia maligna de colon sigmoides. Falleció producto a un shock séptico refractario a aminas. En la necropsia se reportaron hallazgos de interés.

ABSTRACT The authors present the case of a 78-years-old female patient from the municipality of Calimete, with personal pathological antecedents of acute myocardial infarct without ST segment elevation and arterial hypertension. She arrived to the Emergency Intensive Care Unit of Colon with a severe toxic-infectious status. She underwent a surgery with a presumptive mesenteric thrombosis. It was stated that diagnosis, complementary to a sigmoid colon malignant neoplasia. She died as a product of an amine-refractory septic shock. The autopsy showed findings of interest.

Resultados de la cirugía resectiva de pacientes con Cáncer de Colon no complicado en un centro privado y regional de salud / Results of resective surgery in patients with non-complicated Colon Cancer in a private and regional health establishment

El tratamiento estándar del cáncer de colon (CC), continúa siendo la resección radical del segmento intestinal comprometido con márgenes libres (al menos 5 cm por encima y debajo del tumor), pudiendo o no asociarse a terapias complementarias. El objetivo de este estudio fue determinar morbilidad postoperatoria (MPO) y supervivencia actuarial global (SVAG) a 5 años en pacientes resecados por CC no complicado. La metodología usada fue serie de casos retrospectiva de pacientes con CC no complicado, sometidos a colectomía subtotal y linfadenectomía, de forma consecutiva, en Clínica RedSalud Mayor Temuco, entre 2007 y 2017. La variable resultado fue SV actuarial global (SVAG) a 5 años. Otras variables de interés fueron: tiempo quirúrgico, número de linfonodos resecados, estancia hospitalaria, MPO, y recurrencia. Los pacientes fueron seguidos de forma clínica. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión; y análisis de SV con curvas de Kaplan Meier. Se intervinieron 43 pacientes (58,1 % hombres), con una mediana de edad de 66 años. La localización y estadios más frecuentes fueron colon derecho (18 casos, 41,9 %); y IIIA, IIIB, respectivamente. La resecabilidad de la serie fue 100 %. La medianas del tiempo quirúrgico, del número de linfonodos resecados y de estancia hospitalaria; fueron de 100 minutos, 30 y 5 días, respectivamente. La MPO fue 30,2 % (13 casos). Con una mediana de seguimiento de 55 meses, se verificó una recurrencia de 13,9 %; y SVAG a 5 años de 69,8 % para la totalidad de la serie. Los resultados obtenidos, en términos de MPO, mortalidad y SVAG a 5 años, fueron similares a series de nacionales e internacionales.

The standard treatment of colonic cancer (CC) continues to be the radical resection of the intestinal segment compromised with free margins, associated or not with adjuvant therapies. The aim of this study was to determine postoperative morbidity (POM) and 5-year overall survival (OS) in patients resected by non-complicated CC. The methodology used was a series of cases in retrospective of patients with non-complicated CC undergoing colectomy and lymphadenectomy, consecutively, at RedSalud Mayor Temuco Clinic, between 2007 and 2017. The outcome variable was 5-years OS. Other variables of interest were: surgical time, the number of resected lymph nodes, hospital stay, POM, and recurrence. Patients were followed clinically. Descriptive statistics were used (measures of central tendency and dispersion), and OS analysis was applying Kaplan Meier curves. 43 patients (58.1% men) were intervened, with a median age of 66 years. The most frequent localization and stages were the right colon (18 cases, 41.9%); and IIIA, IIIB respectively. Median surgical time, the number of resected lymph nodes and hospital stay were 100 min, 30 and 5 days respectively. MPO was 30.2% (13 cases). With a median follow-up of 55 months, a recurrence of 13.9% was verified, and a 5-year OS of 69.8% was observed. The results, in terms of POM, mortality and 5-year OS, were similar to the national and international series.

Mobilização da flexura esplênica nas ressecções dos tumores de reto e sigmoide: meta-análise dos resultados cirúrgicos / Splenic flexure mobilization in sigmoid and rectal cancer resections: a meta-analysis of surgical outcomes

RESUMO Objetivo: avaliar a influência da mobilização da flexura esplênica nos principais resultados cirúrgicos de pacientes submetidos à ressecção de câncer do cólon sigmoide ou reto. Métodos: os bancos de dados MEDLINE, Cochrane Central Register de Ensaios Controlados e LILACS foram pesquisados usando os termos "mobilização da flexura esplênica", "cirurgia colorretal", "câncer retal", "ressecção anterior", "câncer de cólon sigmoide", "ressecção de sigmoide". O desfecho principal foi a deiscência da anastomose. Outros desfechos analisados foram mortalidade, sangramento, infecção e complicações gerais. Os tamanhos dos efeitos foram estimados por meio do agrupamento dos dados de seis estudos de caso-controle (1.433 pacientes) publicados até janeiro de 2018. Resultados: nossa meta-análise revelou que pacientes submetidos à mobilização completa da flexura esplênica tinham um risco maior de deiscência anastomótica (RR=2,27, IC95%: 1,22-4,23) em comparação àqueles não submetidos a esse procedimento. Nenhuma diferença pôde ser demonstrada entre os grupos em termos de mortalidade, sangramento, infecção e complicações gerais. Conclusão: a mobilização da flexura esplênica está associada a um maior risco de deiscência anastomótica nas ressecções de câncer de reto ou cólon sigmoide. Esta manobra cirúrgica deve ser utilizada com cautela no manejo cirúrgico dos tumores colorretais.

ABSTRACT Objective: to evaluate the influence of the splenic flexure mobilization for the main surgical outcomes of patients submitted to resection of sigmoid and rectal cancer. Methods: we searched the MEDLINE, Cochrane Central Register of Controlled Trials and LILACS, using the terms "splenic flexure mobilization", "colorectal surgery", "rectal cancer", "anterior resection", "sigmoid colon cancer", and "sigmoid resection". The main outcome was anastomotic dehiscence. Other outcomes analyzed were mortality, bleeding, infection and general complications. We estimated the effect sizes by grouping data from six case-control studies (1,433 patients) published until January 2018. Results: our meta-analysis showed that patients undergoing complete mobilization of the splenic flexure had a higher risk of anastomotic dehiscence (RR=2.27, 95%CI: 1.22-4.23) compared with those not submitted to this procedure. There was no difference between the groups in terms of mortality, bleeding, infection and general complications. Conclusion: splenic flexure mobilization is associated with a higher risk of anastomotic dehiscence in resections of sigmoid and rectal cancer. This surgical maneuver should be used with caution in the surgical management of sigmoid or rectal cancers.

An elderly man with gastric cancer, Saint's triad and Heyde's syndrome / Un anciano con cáncer gástrico, tríada de Saint y síndrome de Heyde

This case study describes a 71-year-old man with signet-ring cell gastric adenocarcinoma and malignant sigmoidal polyp; and typical features of Saint's triad and Heyde syndrome. He had digestive bleeding, two types of hernia, diverticulosis, arterial hypertension, malignant polyp, and antecedent of smoking, lung tuberculosis, and surgical correction of aortic valve stenosis. There is a hypothetical inverse relationship between herniosis and development of malignancy; however, the patient herein described presented gastric and sigmoidal cancers. Gastrointestinal malignancies are sometimes associated with paraneoplastic entities, isolated or manifested as syndromes, but neither Saint's triad or Heyde syndrome have been included. This patient persisted clinically stable during the preoperative period, but suddenly died; Trousseau's syndrome would be the most probable mechanism of sudden death in this setting. Case reports can stimulate further studies to get additional knowledge about unusual entities.

Este estudio de caso describe un hombre de 71 años de edad, con adenocarcinoma gástrico con células en anillo de sello y un pólipo maligno sigmoideo; y características típicas de la tríada de Saint y del síndrome de Heyde. Tuvo una hemorragia digestiva, dos tipos de hernias, divertículos, hipertensión arterial, y pólipo maligno; con antecedente de tabaquismo, tuberculosis pulmonar, y corrección quirúrgica de estenosis de la válvula aórtica. Hay una hipotética relación inversa entre hernioses y el desarrollo de malignidades; sin embargo, el paciente que se describe en el presente documento presentó cánceres gástrico y sigmoideo. Neoplasias gastrointestinales se asocian a veces con entidades para neoplásicas aisladas o manifiestan síndromes, pero ni la tríada de Saint ni el síndrome de Heyde se ha incluido. Este paciente persistió clínicamente estable durante el período preoperatorio, pero de repente murió; síndrome de Trousseau sería el mecanismo más probable de muerte súbita en esta situación. Los informes de casos pueden estimular más estudios para obtener un conocimiento adicional sobre esas entidades inusuales.

Prevalencia de adenomas y adenocarcinomas de recto-sigma en pacientes menores de 50 años que consultan por proctorragia / [Prevalence of rectosigmoid adenomas and adenocarcinomas in patients younger than 50 years old referred for proctorrhagia].

BACKGROUND: Rectal bleeding is a sign of colorectal cancer (CRC). Its early diagnosis decreases mortality and improves survival. In young population with no risk factors for the disease, CRC is infrequent. Moreover, benign anorectal disorders are most frequent causes of bleeding and generally, when anal pathology is identified, it is assumed as the origin of the sign. For all these reasons, rectal bleeding sometimes is sub-assessed in young patients. OBJECTIVE: Estimate the prevalence of adenomas and adenocarcinomas in sigmoid and rectum in patients younger than 50 years old referred for proctorrhagia. METHODS: The study design was descriptive, retrospective and cross-sectional. Procedures were performed under sedation and Olympus CF 160 y CF 180 scopes were used. Proctorrhagia was considered as rectal bleeding registered as indication of the procedure. Histology was established according to Vienna classification. Informed consent was signed before the procedures. Colonoscopy reports were reviewed. The study took place in an outpatient clinic in Buenos Aires city, between October 2010 and October 2011. High risk patients for CRC were excluded RESULTS: We included 1,203 from 1,257 reviewed VCC, 49

were female and the median age was 38 years old (range: 18-49 years old). The prevalence of adenomas and adenocarcinomas in sigmoid and rectum was 67

CI): 5.4-8.3] and 1.6

CI 1-2.5), respectively. CONCLUSIONS: Adenocarcinomas and adenomas are infrequent in a young population without risk factors for CRC. However, even when benign anal disorders are the most frequent cause for rectal bleeding, miss evaluation of this sign could have a serious impact in almost 10 of 100 individuals.

Correlation between total nitrite/nitrate concentrations and monoamine oxidase (types A and B) and semicarbazide-sensitive amine oxidase enzymatic activities in human mesenteric arteries from non-diabetic and type 2 diabetic patients

The aim of this study was to determine the correlation between total nitrite/nitrate concentrations (NOx) and the kinetic parameters of monoamine oxidase enzymes (MAO-A and MAO-B) and semicarbazide-sensitive amine oxidase (SSAO) in human mesenteric arteries. Arteries were from non-diabetic and type 2 diabetic patients with sigmoid or rectum carcinoma for whom surgery was the first option and who were not exposed to neo-adjuvant therapy. Segments of human inferior mesenteric arteries from non-diabetic (61.1 ± 8.9 years old, 7 males and 5 females, N = 12) and type 2 diabetic patients (65.8 ± 6.2 years old, 8 males and 4 females, N = 12) were used to determine NOx concentrations and the kinetic parameters of MAO-A, MAO-B and SSAO by the Griess reaction and by radiochemical assay, respectively. The NOx concentrations in arteries from diabetic patients did not differ significantly from those of the non-diabetic group (10.28 ± 4.61 vs 10.71 ± 4.32 nmol/mg protein, respectively). In the non-diabetic group, there was a positive correlation between NOx concentrations and MAO-B parameters: Km (r = 0.612, P = 0.034) and Vmax (r = 0.593, P = 0.042), and a negative correlation with the SSAO parameters: Km (r = -0.625, P = 0.029) and Vmax (r = -0.754, P = 0.005). However, in the diabetic group no correlation was found between NOx concentrations and the three kinetic parameters of the enzymes. These results suggest an important function of sympathetic nerves and vascular NOx concentrations in arteries of non-diabetic patients. Thus, these results confirm the importance of a balance between oxidants and antioxidants in the maintenance of vascular homeostasis to prevent oxidative stress.

Vía aérea en el paciente con paladar hendido: presentación de un caso / Airway in a patient with cleft palate: a case report

El paladar hendido es un defecto congénito de las estructuras que forman la bóveda palatina, y es característico por una hendidura o apertura en el paladar superior. Objetivo: describir el manejo de la vía aérea en el paciente con paladar hendido. Caso Clínico: se presenta un caso, sobre el manejo de la vía aérea de un paciente con paladar hendido tipo IV de 45 años, que se anunció para tratamiento quirúrgico electivo con el diagnóstico de tumor de sigmoide, en el Hospital Universitario Manuel Ascunce Domenech.

Cleft palate is a congenital defect of structures that form the palatal vault, and it is characterized by an aperture or opening in the upper palate. Objective: to describe the handling of the airway in a patient with cleft palate. Clinical case: a case of a patient with type IV cleft palate of 45 year-old was presented, with diagnosis of sigmoid tumor, who was approached the airway for elective surgical treatment at the Teaching Hospital Manuel Ascunce Domenech.

Abordaje cosmético supra/infratentorial pre-sigmoideo en bloque: técnica original / Cosmetic supra/infratentoral presigmoid approach: original technique

Objetivo: presentar una variante original del abordaje supra/infratentorial presigmoideo que preserva la apófisis mastoidea. Material y método: se practicó este abordaje en ocho cráneos secos, dos procedimientos por espécimen y posteriormente fue realizado en un preparado fresco. Posteriormente se realizó esta técnica quirúrgica en una paciente que presentaba una lesión compatible con un meningioma petroclivalen las imágenes de IRM. Discusión: el abordaje supra/ifratentorial pre-sigmoideo ofrece la posibilidad de resecar lesiones complejas de la región petroclival. Desde su popularización han sido diversas las variantes descriptivas sobre esta técnica quirúrgica con el objetivo de obtener un buen resultado cosmético postoperatorio. Conclusión: el abordaje supra/infratentorial pre-sigmoideo con preservación de la porción mastoidea en una sola pieza es una variante interesante del procedimiento clásico que tiene el propósito de lograr un buen resultado cosmético.

Hemipelvectomia externa ampliada para tratar adenocarcinoma de sigmóide / Extended external hemipelvectomy for sigmoid adenocarcinoma treatment

Surgery is the most effective way of treating a locally advanced colorectal carcinoma and an extended en bloc resection is necessary to achieve the best overall survival rate. In this rare case, a multi-visceral resection was performed along with the entire lower left limb and left iliac bone for a sigmoid carcinoma. The T4N0M0 (B3) tumor involved the left iliac vessels, left pelvic wall, small bowel and both rectus muscles, besides presenting with a skin fistula. A Hartmann colostomy was also performed. Chemotheraphy was interrupted because of toxicity. The patient is free of disease after 38 months. There are very few cases that describe an extended hemipelvectomy as part of a colorectal carcinoma treatment.

Metástasis testicular de un adenocarcinoma de colon: reporte de un caso / Testicular matastases in colon adenocarcinoma: a case report

Reportamos el caso de un paciente con metástasis hepáticas, secundarias a adenocarcinoma de colon, quien presentaba una masa paratesticular dolorosa, cuya aparición coincidió con una progresión de la neoplasia de base. La resección quirúrgica de la masa identificó células neoplásicas provenientes del adenocarcinoma de colon.

We report the case of a patient with hepatic metastases secondary to colon adenocarcinoma. Who presented a par testicular and pain mass, which apparitions coincide with a progression of his basic neoplasic. The surgical resection of the mass identifies neoplásica cells with colon adenocarcinoma origin.

Propuesta alternativa para el tratamiento del vólvulo sigmoideo / Alternative proposal for the treatment of the sigmoid volvulus

La sigmoidectomía con anastomosis primaria del colon constituye una alternativa para el tratamiento quirúrgico del vólvulo sigmoideo. Objetivo: demostrar la validez de esta técnica en pacientes seleccionados y conocer sus ventajas sobre el resto de procederes quirúrgicos a emplear.Método: se realizó sigmoidectomía con anastomosis primaria en dos planos a veintidós pacientes portadores de vólvulo sigmoideo. El estudio intervencionista longitudinal prospectivo se inició en octubre del 2003 en el Royal Victoria Teaching Hospital, La Gambia. Se concluyó en el Hospital Amalia Simoni de Camagüey en septiembre de 2007. Los datos se extrajeron de los expedientes clínicos de los pacientes al momento de su egreso hospitalario. Se procesaron en microcomputadora IBM. Se establecieron criterios de inclusión, exclusión y criterios que permitieran evaluar la eficacia del tratamiento. Se empleó antibioticoterapia preoperatoria profiláctica sistémica. Resultados: el íleo paralítico predominó como complicación.No existieron complicaciones relativas a la anastomosis primaria. No se reintervinieron pacientes ni existió mortalidad. Todos los pacientes al momento de su egreso manifestaron sentir satisfacción con el tratamiento quirúrgico realizado. Conclusiones: la técnica realizada aportó a los pacientes bienestar biopsicosocial. Aportó beneficios económicos por concepto de ahorro a las instituciones de salud y al estado. Los pacientes y familiares que económicamente dependen de estos se beneficiaron por la rápida reincorporación laboral de los mismos.

The sigmoidectomy with primary anastomosis of the colon constitutes an alternative for the surgical treatment of the sigmoid volvulus. Objective: to demonstrate the validity of this technique in selected patients and to know their advantages on the rest of surgical procedures to use. Method: sigmoidectomy with primary anastomosis in two planes to twenty-two patients carriers of sigmoid volvulus. A prospective longitudinal interventionist study began in October 2003 in Royal Victoria Teaching Hospital, Gambia and was concluded at "Amalia Simoni" Hospital of Camagüey in September 2007. Data were extracted of the clinical records from the patients at the moment of their hospital discharge. It were processed in IBM microcomputer. Inclusion, exclusion criteria that allowed evaluating the effectiveness of the treatment were established. Systemic prophylactic preoperative antibiotic-therapy was used. Results: the paralytic ileus prevailed as complication. Relative complications didn't exist to the primary anastomosis. No patients were reintervened neither mortality existed. All patients at the moment of their discharge manifested to feel satisfaction with the carried out surgical treatment. Conclusions: the carried out technique contributed to the patient biopsychosocial well-being. It contributed economic profits for saving concept to health institutions and to the state. Patients and family that economically depend of these were benefited from their quick labor reincorporation.

Resultados del tratamiento quirúrgico del cáncer del tercio superior del recto y de colon sigmoides: análisis comparativo / Comparative results of the surgical treatment of tumors located in the upper third of the rectum and sigmoid colon

Background: Tumors located in the upper third of the rectum can be treated in the same way as sigmoid tumors. This means that mesorrectum excision and neoadjuvant therapies are not necessary. Aim: To compare the results in terms of relapse and survival of elective surgery for sigmoid and upper third rectal tumors. Material and Methods: Retrospective analysis of patients operated for an upper third rectal or sigmoid cancer that were prospectively included in a database and had a minimum follow up of 18 months. Clinical and pathological variables and staging using TNM classification were considered as covariates in the analysis. Results: Fifty patients with a tumor of the upper third of the rectum, aged 30 to 84 years (24 females), with a follow up ranging from 12 to 206 months, and 107 patients with a sigmoid tumor, aged 22 to 91 years (62 females), with a follow up ranging from 13 to 204 months, were analyzed. Seven patients with rectal tumors (14 percent) and 12 patients with sigmoid tumors (11 percent), died during follow up (p = NS). Ten years actuarial overall survival was 85 percent for both groups. Conclusions: No differences in survival or relapse were observed in this group of patients with tumors located in the upper third of the rectum or sigmoid colon. Therefore both types of tumors can be treated in the same way.

Introducción: Se ha sugerido que los pacientes con un tumor del tercio superior del recto (RS) podrían tratarse en forma similar que los portadores de un cáncer de sigmoides (CS). Ello implica no realizar la resección total del mesorrecto ni someterlos a terapias neoadyuvantes. El objetivo de este estudio es comparar los resultados del tratamiento quirúrgico electivo de ambos tumores respecto de la recidiva y la sobrevida global. Pacientes y Método: Análisis retrospectivo de las características demográficas de los pacientes intervenidos por un adenocarcinoma de recto superior y de colon sigmoides con intención curativa en forma electiva en forma consecutiva con un seguimiento mínimo de 18 meses. Se considera variables clínicas (edad, género, enfermedades asociadas, antígeno carcinoembrionario (CEA) preoperatorio), histopatológicas (diferenciación y tamaño tumoral, número de ganglios examinados) y la estadificación de ambos grupos según TNM. Resultados: Se compara 50 pacientes portadores de un adenocarcinoma de RS en los estadios I a III con 107 pacientes intervenidos en el mismo período por un cáncer de CS con intención curativa. El seguimiento promedio de los pacientes con un tumor de RS fue de 88,62 meses (extremos 12-206), y de 71,67 meses en los casos de CS (extremos 13-204) (p = 0,05). Durante este período fallecen por la enfermedad 7 pacientes (14 por ciento) del grupo RS, 1 por recidiva locorregional y 6 por recidiva a distancia, con un rango entre 12 y 78 meses. En el grupo CS fallecen 12 pacientes (11,2 por ciento), 3 (2,8 por ciento) con recidiva locorregional y 9 con recidiva a distancia, entre 24 y 82 meses de seguimiento (p = 0,24). La sobrevida actuarial global a 10 años para ambos grupos fue de 85 por ciento. Conclusión: En este estudio no existen diferencias en cuanto a la recidiva global, la recidiva local ni la recidiva a distancia entre ambos grupos, lo que avala la estrategia de tratar en forma similar los tumores...

Epithelioid hemangioma of the colon: a case report / Hemangioma epitelióide do cólon: relato de caso

CONTEXT: Epithelioid hemangioma or angiolymphoid hyperplasia with eosinophilia is an uncommon benign vascular neoplasm that is usually located on the face or neck. Exceptionally, it has been described affecting the colon, with only two such cases described in the worldwide literature. The aim here was to present a case of primary epithelioid hemangioma of the sigmoid colon with confirmation by immunohistochemical examination. CASE REPORT: A 37-year-old woman had had a complaint of intermittent abdominal pain for six months. Two months after the condition started, she began to present changes in her intestinal habit, with evacuations containing blood and mucus and a weight loss of 4 kg over this period. At physical examination, a palpable mass was noted in the lower left quadrant of the abdomen. Neoplasia of the colon was clinically suspected and she underwent colonoscopy. This demonstrated the presence of a vegetating sessile lesion of approximately 5 cm in diameter, at a distance of 36 cm from the anal margin. It occupied 80 percent of the intestinal lumen. A biopsy collected during the examination suggested a diagnosis of neoplasia of vascular origin. After surgical resection, histopathological examination of the resected specimen confirmed the diagnosis of epithelioid hemangioma of the colon, which was backed up by the immunohistochemical panel (factor VIII, Ki-67, CD-34). At present, three years after the surgery, the patient is asymptomatic, she has recovered her normal weight and she has normal findings from control colonoscopy. Despite the rarity of neoplasia of vascular origin, this possibility should be considered in the differential diagnosis for colorectal tumors.

CONTEXTO: Hemangioma epitelióide ou hiperplasia angiolinfóide com eosinofilia são neoplasias vasculares benignas raras, habitualmente localizadas na face e pescoço. O acometimento do intestino grosso é excepcionalmente descrito, existindo apenas dois casos descritos na literatura mundial. O objetivo deste artigo é apresentar um caso de hemangioma epitelióide primário do sigmóide com diagnóstico histopatológico confirmado por meio de estudo imunoistoquímico. RELATO DE CASO: Mulher de 37 anos apresentou queixa de dor abdominal de forte intensidade, intermitente, localizada no hipogástrio. Dois meses após o início do quadro, notou alteração do hábito intestinal, evacuações com sangue, muco e perda ponderal de 4 quilos no período. Ao exame físico abdominal, identificou-se massa palpável no quadrante inferior esquerdo. Com suspeita clínica de neoplasia de cólon foi submetida a colonoscopia, que demonstrou presença de lesão vegetante de aproximadamente cinco centímetros de diâmetro, ocupando cerca de 80 por cento da luz colônica. A biópsia mostrou a presença de neoplasia de origem vascular. Após a ressecção cirúrgica, o exame histopatológico do espécime extirpado estabeleceu o diagnóstico de hemangioma epitelióide do cólon, confirmado por meio de painel imunoistoquímico (fator VIII, Ki-67, CD-34). No momento, a paciente encontra-se bem, tendo recuperado o peso inicial três anos após a cirurgia e apresenta resultado de colonoscopia de controle normal. Não obstante a raridade, deve-se considerar a possibilidade das neoplasias de origem vascular no diagnóstico diferencial dos tumores colorretais.

Resultados y eventos adversos de la sigmoidectomía por cáncer: laparoscopia versus laparotomía / Results and complications in patients with sigmoid cancer: laparoscopic versus laparotomy

Objetivo: Comparar resultados y complicaciones inmediatas al realizar una sigmoidectomía laparoscópica (SL) versus abierta (SA) en pacientes con cáncer de colon sigmoides. Material y método: Inclusión prospectiva y consecutiva, mediante protocolo de estudio de pacientes operados mediante SL entre el 2000 y el 2006. Análisis comparativo caso-control, mediante pareo según edad, sexo y ASA entre pacientes operados mediante SL con SA. Análisis por intención de tratamiento, mediante test t de Student, chi cuadrado, Mann-Withney y exacto de Fischer; consideramos estadísticamente significativo p <0,05. Resultados: Treinta y dos pacientes por grupo fueron comparados. Los grupos (SL v/s SA) fueron similares estadísticamente en edad (65,6 v/s 67,3 años), sexo (femenino 31,25 por ciento), y ASA (p> 0,05). La mediana del tiempo operatorio fue mayor en SL (220 v/s 172 minutos, p <0,01). Un 9,3 por ciento se convirtió a técnica abierta en SL. El tiempo medio a la expulsión de gases y realimentación con líquidos fue menor en SL (2 v/s 4 días, p<0,01 y 3 v/s 5 días, p< 0,01). La estadía media postquirúrgica (5 v/s 8 días p<0,01) fue menor en SL. Las complicaciones postoperatorias médicas, fueron menores en SL (9,3 por ciento v/s 37,5 por ciento p<0,01), pero las quirúrgicas fueron iguales (6,25 por ciento cada grupo). Los linfonodos resecados y tamaños de piezas operatorias fueron similares (SL v/s SA: 22,7 v/s 22,1 linfonodos p= 0,9 y 21,8 v/s 19,3 cm. p= 0,2). Conclusión: El desarrollo de la cirugía laparoscópica colorrectal mediante un protocolo, permite realizar la SL por cáncer con resultados quirúrgicos similares a la SA.

Background: The laparoscopic surgery for colorectal cancer is an alternative to the laparotomy. The aim of this study is to compare results and early complications after a laparoscopic sigmoidectomy (LS) versus open surgery (OS) in patients with sigmoid cancer. Material and Method: Prospective and consecutive inclusion, by a study protocol of patients operated on for LS between 2000 and 2006. Comparative case-control design, the LS group was match with the OS group by age, sex, and ASA classification. Statistical analysis: Results were analyzed with intention to treat. The variables were analyzed with T Student, Chi-square, Mann-Withney and Fischer exact test, considering statistically significant a P value < 0.05. Results: Thirty-two patients by group were compared. The groups (LS vs OS) were statistically similar in age (65.6 v/s 67.3 years), gender (31.25 percent females each group), and ASA (p > 0.5). The mean operative time was higher in LS group (220 v/s 172 minutes, p <0.01). Conversion rate was 9.3 percent. The mean time to passing flatus and the time to reinitiate oral feeding were both shorter for LS group (2 v/s 4 days, p<0.01; and 3 v/s 5 days p <0.01). The mean total postoperative stay (5 v/s 8 days, p<0.01) was shorter for LS group. The postoperative medical complications were minor in LS group (9.3 v/s 27.5 percent, p <0.01), but the surgical complications were similar (6.25 percent each group). Lymph nodes resected and length of surgical specimens were similar for both groups (SL v/s OS: 22.7 v/s 22.1 lymphatic nodes p = 0.9 and 21.8 v/s 19.3 cm, p= 0.2). Conclusion: The development of laparoscopic colorectal surgery within a protocol, allows feasible the realization of laparoscopic sigmoidectomy for patients with sigmoid cancer with comparable surgical outcomes.

Tumor diverticular que imita una enfermedad neoplásica en un paciente VIH-positivo / Diverticular tumor imitating neoplastic disease in an HIV positive patient

Introducción: A pesar de que en la era de la terapia antirretroviral de alta eficacia (HAART) la incidencia de los tumores malignos en la población VIH/SIDA está en creciente aumento y es actualmente su mayor causa de muerte, estos pacientes también pueden presentar lesiones tumorales de origen inflamatorio, micótico, parasitario, o bacteriano, que en algunos casos puede resultar muy difícil diferenciar de una neoplasia antes de la exéresis quirúrgica completa de la lesión. Objetivo: Comunicar el caso de un paciente VIH-positivo con un tumor inflamatorio de origen diverticular y discutir los posibles diagnósticos diferenciales. Paciente y método: Paciente masculino de 42 años, drogadependiente y VIH positivo (estadio AI), en tratamiento con HAART, con constipación y mucorrea de 4 años de evolución y proctorragia postevacuatoria y dolor abdominal a predominio de FII intermitentes desde hace un año. Examen fisico, laboratorio de rutina, CEA y perfil inmunológico normales. La videocolonoscopía y el colon por enema mostraron una estenosis sigmoidea infranqueable con mucosa conservada. La tomografia computada abdominopelviana evidenció engrosamiento parietal del colon sigmoides y múltiples ganglios no adenomegálicos. Resultados: Se indicó el tratamiento quirúrgico con el diagnóstico de un probable tumor extramucoso benigno, o de bajo grado de malignidad. Se encontró un tumor sigmoideo duro-elástico de 9 x 7 cm, con la serosa congestiva y adherencias laxas a la cara posterior de la vejiga, acompañado por varias adenopatías mesentéricas. Se realizó una resección anterior con carácter oncológico. Abierta la pieza se constató un gran engrosamiento parietal con mucosa edematosa. No tuvo complicaciones postoperatorias. La anatomia patológica informó una enfermedad diverticular del colon con peridiverticulitis y marcada fibrosis parietal. (TRUNCADO) (AU)...

Introduction: Despite the fact that in the highly active antiretroviral therapy (HAART) era the incidence of malignant tumors in HIV/AIDS population is increasing, and is currently the major cause of death, these patients can also present tumoral lesions of inflammatory, fungal, parasitic, or bacterial origin in some cases very difficult to differentiate from a neoplasia before complete surgical resection. Objective: Report on a HIV positive patient with an inflammatory diverticular tumor, and discuss the possible differential diagnosis. Patient and methods: Male, 42 years old, intravenous drug abuser, and HIV-positive (AI stage), on HAART, complaining of constipation and mucous discharge the last 4 years, and intermittent rectal bleeding and abdominal pain (predominantly in the right iliac fossae) the last year. Physical examination, blood tests, CEA, and immune status were normal. Colonoscopy and barium enema showed a not negotiable sigmoid stenosis with normal mucosa. The computed tomography of the abdomen and pelvis showed parietal thickening of the sigmoid colon and multiple not enlarged lymphoid nodes. Results: Surgical treatment, with the diagnosis of probable extramucosal benign or low-grade malignant tumor, was indicated. A 9 x 7 cm, rubber consistency sigmoid tumor was found. It had congestive serosa and smooth adhesions to the posterior aspect of the bladder, associated with several mesenteric nodes. An oncologíc anterior resection was carried out. The opened specimen showed a 4 cm thickening of the intestinal wall, with edematous, non tumoral mucosa. The postoperative course was uneventful. The histopathology report was diverticular colonic disease with peridiverticulitis, and marked parietal fibrosis. Conclusion: Currently, in the HIV-positive population the incidence of malignant tumors related or not to AIDS has increased, due to better management of opportunistic infections, and the best life expectancy... (TRUNCADO)