Comparison of open gastrectomy and the laparoscopic procedure in advanced gastric cancer. / Comparación de gastrectomía abierta frente a laparoscópica en cáncer gástrico avanzado.

INTRODUCTION AND AIM: Gastric cancer is one of the most frequent neoplasias in Peru and worldwide, with surgery as the only potentially curative or palliative treatment. Laparoscopic gastrectomy is the most frequent alternative surgical technique utilized, but one of its main drawbacks is the technical difficulty involved in perigastric lymphadenectomy. The aim of the present study was to evaluate the clinical and surgical characteristics, postoperative complications, and survival rate in patients with advanced gastric cancer that underwent open gastrectomy or laparoscopic gastrectomy at the Hospital Nacional P.N.P "Luis N. Sáenz" in Lima, Peru, within the time frame of 2005 to 2014. MATERIALS AND METHODS: An analytic, longitudinal, retrospective cohort study was conducted on 482 patients that underwent surgery for gastric cancer, within the time frame of January 2005 to December 2014. The clinical, epidemiologic, and postoperative characteristics were evaluated, and a survival analysis was carried out. RESULTS: Of the 475 patients included in the study, 236 underwent open gastrectomy and 239 had laparoscopic gastrectomy. Median follow-up time was 61.9 months in the open surgery group and 46.7 months in the laparoscopy group. There were fewer postoperative complications in the laparoscopy group and no statistically significant difference between the two groups in relation to the survival analysis. CONCLUSIONS: In our study, laparoscopic gastrectomy resulted in fewer postoperative complications, compared with the open procedure, but did not modify overall survival during the follow-up period.

Semen and urine culture in the diagnosis of chronic bacterial prostatitis.

OBJECTIVE: To assess the diagnostic accuracy of semen and urine culture in the diagnosis of chronic bacterial prostatitis (CBP). MATERIALS AND METHODS: In 70 consecutive men suspected of having chronic bacterial prostatitis along with 17 asymptomatic controls, we obtained urine and semen cultures followed 1 week later by the Meares and Stamey test, our reference standard. The interpretation of each of the cultures was blind to the results of other tests. RESULTS: 139 men were referred for evaluation of chronic bacterial prostatitis and 70 received all tests. Additionally, 17 control men volunteered to participate. The Meares and Stamey Test was positive in 69 (79%) patients. The semen culture had a sensitivity of 45% and a specificity of 94%. The likelihood ratio associated with a positive semen culture was 8.1 (95% confidence interval (CI) 1.2 to 55.3); the likelihood ratio associated with a negative semen culture was 0.6 (95% CI 0.5 to 0.7). The urine culture had a sensitivity of 4% and a specificity of 100%. The likelihood ratio of a positive urine culture was infinity and of a negative urine culture was 0.96 (95% CI 0.9 to 1). CONCLUSIONS: While a positive semen culture in a symptomatic patient may suffice to select and start antibiotic treatment against chronic bacterial prostatitis, a negative culture does not rule out the condition. Urine cultures alone are not useful for diagnosing CBP. The Meares and Stamey test remains important for the diagnosis of CBP in practice.

[Rate of serological markers of hepatitis B and C viruses in first-time users of the hemodialysis program at Hospital Nacional Cayetano Heredia (HNCH)]. / Frecuencia de marcadores serológicos de hepatitis viral B y C en pacientes que ingresan por primera vez al programa de hemodiálisis en el Hospital Nacional Cayetano Heredia.

PURPOSE: Determine the rate of markers of hepatitis B (HBV) and C (HCV) viruses in patients with terminal chronic kidney failure (TCKF) prior to the start of a chronic hemodialysis program (CHD), and assess the time relation between infection and epidemiological history. MATERIALS AND METHODS: This was a prospective and analytical study. The study population was composed of the entire group of TCKF patients using the CHD program for the first time at the HNCH, Lima, from June 2002 to September 2003. HbsAg and HBV Anti-HBc, and HCV anti-VHC markers were assessed. RESULTS: 86 patients were studied, 45 female (52.3%) and 41 male (47.7%). During the study, the total rate of HBV markers was 20.9%, HBsAg(+) was 2.3%, and anti-HBcT(+) was only 18.7%. Anti-HCV rate was 4.65%. Related factors for potential carriers of only anti-HBcT(+) were: elder age, sexual intercourse with prostitutes OR=6.1 (1.5-25.3), food consumption at restaurants OR=5.2 (1.6-16.4), or being born in the jungle area OR=6.7 (1.5-30.5). Multi-variance analysis showed that only elder age OR=1.03 (1.00-1.06), being born in the jungle area OR=13.1 (1.8-91.1), and food consumption in restaurants OR=5.0 (1.4-18.0) were related to total anti-HBc count. CONCLUSIONS: The study results suggest a low rate of serological markers of HBV and HCV in TCKF patients using chronic hemodialysis treatment for the first time at HNCH.

Semen and urine culture in the diagnosis of chronic bacterial prostatitis

OBJECTIVE: To assess the diagnostic accuracy of semen and urine culture in the diagnosis of chronic bacterial prostatitis (CBP). MATERIALS AND METHODS: In 70 consecutive men suspected of having chronic bacterial prostatitis along with 17 asymptomatic controls, we obtained urine and semen cultures followed 1 week later by the Meares and Stamey test, our reference standard. The interpretation of each of the cultures was blind to the results of other tests. RESULTS: 139 men were referred for evaluation of chronic bacterial prostatitis and 70 received all tests. Additionally, 17 control men volunteered to participate. The Meares and Stamey Test was positive in 69 (79 percent) patients. The semen culture had a sensitivity of 45 percent and a specificity of 94 percent. The likelihood ratio associated with a positive semen culture was 8.1 (95 percent confidence interval (CI) 1.2 to 55.3); the likelihood ratio associated with a negative semen culture was 0.6 (95 percent CI 0.5 to 0.7). The urine culture had a sensitivity of 4 percent and a specificity of 100 percent. The likelihood ratio of a positive urine culture was infinity and of a negative urine culture was 0.96 (95 percent CI 0.9 to 1). CONCLUSIONS: While a positive semen culture in a symptomatic patient may suffice to select and start antibiotic treatment against chronic bacterial prostatitis, a negative culture does not rule out the condition. Urine cultures alone are not useful for diagnosing CBP. The Meares and Stamey test remains important for the diagnosis of CBP in practice.

Frecuencia de marcadores serológicos de hepatitis viral B y C en pacientes que ingresan por primera vez al programa de hemodiálisis en el Hospital Nacional Cayetano Heredia / Rate of serological markers of hepatitis B and C viruses in first-time users of the hemodialysis program at Hospital Nacional Cayetano Heredia

Objetivo: Determinar la frecuencia de marcadores de hepatitis viral B (VHB) y C (VHC) en pacientes con insuficiencia renal crónica terminal (IRC-T) antes de ingresar a un programa de hemodiálisis crónica (HDC) y evaluar la relación temporal de la infección con antecedentes epidemiológicos. Materiales y métodos: Se realizó un estudio de serie de casos prospectivo y analítico. La población se conformó por la totalidad de pacientes nuevos con IRC-T que ingresaron por primera vez al programa de HDC del HNCH-Lima, desde Junio del 2002 hasta Setiembre del 2003, se evaluaron los marcadores HBsAg y anti-HBcTotal del VHB y anti-VHC del VHC. Resultados: Se estudiaron 86 pacientes , 45 (52.3 por ciento) fueron mujeres y 41 (47.7 por ciento) varones. En el periodo de estudio se halló una frecuencia total de marcadores de VHB del 20.9 por ciento, siendo 2.3 por ciento HBsAg(+) y 18.7 por ciento sólo anti-HBcT(+). En tanto la frecuencia de anti-VHC fue de 4.65 por ciento. Los factores relacionados para ser portador de sólo anti-HBcT(+) fueron: edad avanzada, relaciones sexuales con prostitutas OR=6.1 (1.5-25.3), ingerir alimentos en restaurantes OR=5.2(1.6-16.4) y haber nacido en la Selva OR=6.7 (1.5-30.5). En el análisis multivariado solo la edad avanzada OR=1.03 (1.00-1.06), haber nacido en la Selva OR=13.1 (1.8-91.1) e ingerir alimentos en restaurantes OR=5.0 (1.4-18.0), se relacionaron con la presencia de anti-HBcTotal. Conclusión: Los resultados de este estudio sugieren baja frecuencia de los marcadores serológicos de VHB y VHC en pacientes con IRCT que ingresan por primera vez al tratamiento de HDC en el HNCH.

Purpose: Determine the rate of markers of hepatitis B (HBV) and C (HCV) viruses in patients with terminal chronic kidney failure (TCKF) prior to the start of a chronic hemodyalisis program (CHD), and assess the time relation between infection and epidemiological history. Materials and Methods: This was a prospective and analytical study. The study population was composed of the entire group of TCKF patients using the CHD program for the first time at the HNCH, Lima, from June 2002 to September 2003. HbsAg and HBV Anti-HBc, and HCV anti-VHC markers were assessed. Results: 86 patients were studied, 45 female (52.3 per cent) and 41 male (47.7 per cent). During thestudy, the total rate of HBV markers was 20.9 per cent, HBsAg(+) was 2.3 per cent, and anti-HBcT(+) was only 18.7 per cent. Anti-HCV rate was 4.65 per cent. Related factors for potentialcarriers of only anti-HBcT(+) were: elder age, sexual intercourse with prostitutes OR=6.1 (1.5-25.3), food consumption at restaurants OR=5.2 (1.6-16.4), or being born in the jungle area OR=6.7 (1.5-30.5). Multi-variance analysis showed that only elder age OR=1.03 (1.00-1.06), being born in the jungle area OR=13.1 (1.8-91.1), and food consumption in restaurants OR=5.0 (1.4-18.0) were related to total anti-HBc count. Conclusions: The study results suggest a low rate of serological markers of HBV and HCV in TCKF patients using chronic hemodyalisis treatment for the first time atHNCH.