El sobrecrecimiento bacteriano de intestino delgado es una entidad frecuente tras gastrectomía, pero con escasa relevancia en el estado nutricional / Small intestinal bacterial overgrowth is common after gastrectomy but with little impact on nutritional status

Antecedentes: La evidencia disponible que evalúa el impacto de la presencia de sobrecrecimiento bacteriano de intestino delgado (SIBO) después de una gastrectomía es escasa. Objetivos: Evaluar la frecuencia de SIBO tras gastrectomía y su asociación con malnutrición. Describir las líneas antibióticas necesarias para su corrección y si mejora el estado nutricional. Material y métodos: Estudio de cohortes prospectivo en el ámbito de la Agencia Sanitaria Costa del Sol desde 2012 hasta 2015. Se realizó test del aliento en hidrógeno y en metano espirado con sobrecarga oral de glucosa. Recogida de variables demográficas y valoración nutricional, basal y al mes del tratamiento eficaz del SIBO. Se evaluaron las pautas antibióticas y el número de tratamientos. Resultados: Se analizaron 60 pacientes gastrectomizados, 58,3%varones. Se realizó un subanálisis de la curva a los 45min para minimizar los posibles falsos positivos con una frecuencia de SIBO del 61,6%. En presencia de SIBO, se observó una tendencia no significativa a presentar un menor IMC. Tras el tratamiento con rifaximina, el SIBO permaneció positivo en el 94,6% y tras metronidazol, en el 85,7%. El multifracaso de la terapia antibiótica fue de 67,6%. No hay cambios estadísticamente significativos en parámetros nutricionales después del tratamiento. Conclusiones: El SIBO está presente en el 61,6% de los pacientes gastrectomizados, sin que se demuestre asociación con el deterioro nutricional. Rifaximina y metronidazol son escasamente efectivos en la erradicación del SIBO. Cuando este se consigue, el efecto sobre la malnutrición es escaso, pudiendo correlacionarse con otros factores

Background: Available evidence assessing the impact of small intestinal bacterial overgrowth (SIBO) following gastrectomy is limited. Objectives: To evaluate the prevalence of SIBO after gastrectomy and its association with malnutrition. To describe the antibiotic treatment required to correct it and if nutritional status improves. Material and methods: A prospective cohort study was performed at the Agencia Sanitaria Costa del Sol (Costa del Sol Health Agency) from 2012 to 2015. A hydrogen-methane breath test with oral glucose overload was performed. Demographic variables and nutritional parameters were collected at baseline and one month after effective treatment of SIBO. The antibiotic regimens and the number of treatment lines used were assessed. Results: Sixty gastrectomy patients were analysed, 58.3% of which were male. A sub-analysis of the curve was performed at 45min to minimise possible false positives, and SIBO was identified in 61.6% of cases. SIBO patients tended to have a lower BMI, although this trend was not statistically significant. After treatment with rifaximin, 94.6% of patients were still positive for SIBO, which fell to 85.7% after metronidazole. The rate of total antibiotic treatment failure was 67.6%. No statistically significant changes were found in nutritional parameters after treatment. Conclusions: SIBO was identified in 61.6% of patients after gastrectomy. No correlation was found with any malnutrition parameter. Rifaximin and metronidazole were found to be largely ineffective in eradicating SIBO. When treatment was effective, the impact on malnutrition was negligible and may have been associated with other factors

Solitary metastasis in a nasal fossa as the first manifestation of a renal carcinoma

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Renal cell carcinoma is an uncommon tumor inadults. Metastasis in the nasal fossa is rare, and canbecome apparent as a result of repeated epistaxis.We report a patient with renal cell carcinoma presentingwith epistaxis secondary to a metastasis inthe right nasal fossa. The primary tumor was treatedwith nephrectomy and the nasal fossa metastasiswas treated successfully with embolization, chemoimmunotherapy,surgery, and radiotherapy. Thepresence of repeated epistaxis may very occasionallybe the first symptom of renal cell carcinoma, andsystemic treatment combined with local treatmentmay enable adequate control of the disease

Secondary signet-ring cell tumour of the prostate derived from a primary gastric malignancy

Primary signet-ring cell carcinoma of the prostate is infrequent and even more so as secondary spread of this pathologic sub-type to the prostate. We describe the sixth reported case with a diagnosis of a secondary signet-ring cell tumour of the prostate secondary to a gastric cancer. Five years post-gastrectomy to resect signet-ring cell carcinoma, we detected a secondary intra-prostatic spread with urinary tract obstruction. The physical appearance of the tumour cells was similar to that of the pre-viously-resected signet-cell carcinoma of the stomach. There were no metastases in other sites and the patient was treated with radiotherapy. When confronted with intra-prostatic signet-ring cell adenocarcinoma it is necessary to distinguish between primary and secondary aetiology since this would reflect in the choice of treatment and prognosis