Fox Fordyce disease as a secondary effect of laser hair removal.

Fox Fordyce disease (FFD) has been recently described as an adverse effect of laser hair removal. It is an apocrine gland disorder characterized by pruritus and a folliculocentric papular eruption in apocrine sweat gland areas. Different etiologies have been proposed to be the cause of this entity. It has been suggested that a fisical factor could contribute to FFD phatogenesis. We report a new case of FFD after laser hair removal.

Partial unilateral lentiginosis treated with alexandrite Q-switched laser: case report and review of the literature.

Partial unilateral lentiginosis (PUL) is a rare pigmentary disorder characterized by multiple lentigines grouped within an area of normal skin, often in a segmental pattern and appearing at birth or in childhood. There is no established standard treatment for this condition. We present two cases of PUL succesfully treated with alexandrite Q-switched laser. In our cases, this laser proved to be a safe and effective treatment for cosmetically disfiguring lentigines. Special precautions are needed when treating dark-skinned patients because side effects are more likely. We propose that this modality be considered in the treatment of this rare disorder.

Feasibility and morbidity and mortality in two hundred consecutive cases of pancreaticogastrostomy after pancreaticoduodenectomy. / Factibilidad y morbimortalidad en doscientos casos consecutivos de pancreaticogastrostomía después de duodenopancreatectomía.

BACKGROUND: Postoperative mortality associated with pancreaticoduodenectomy (PD) in high-volume hospitals is below 5%, yet morbidity rates range between 45% and 60%. Recent studies show a lower incidence of complications and postoperative pancreatic fistula (POPF) in pancreaticogastrostomy (PG). The primary objective was to assess the incidence and predictive factors for complications: POPF, post-pancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE) following the criteria of the ISGPS and Clavien-Dindo classifications. METHODS: A prospective observational study that included all patients who underwent PD between 2008 and 2016. PG was the surgical procedure of choice for PD reconstruction. RESULTS: Two hundred forty-nine patients underwent surgery with intention of performing a PD. The feasibility of PG was 90.5%. One hundred and six (53%) patients had complications, 36 (18%) were severe (Clavien-Dindo grade ≥III). Death within 90 postoperative days was 4%. DGE was the most frequent complication (22.5%), followed by PPH (21%). The clinical POPF rate was 15% (6% Clavien-Dindo grade ≥III). The primary risk factors associated with complications were age >70 years (1.9 [1-3.55]), being male (1.89 [1; 3.6]) and soft pancreatic texture (3.38 [1.5; 7.37]). CONCLUSIONS: In this paper, we report a feasibility study for PG (90.5%). The primary risk factors associated with complications were age >70 years, being male and soft pancreatic texture. Soft pancreatic texture is also associated with the development and severity of POPF.

Differences and molecular immunohistochemical parameters in the subtypes of infiltrating ductal breast cancer.

Breast cancer is a heterogeneous disease, and patients are categorized into subtypes according to gene expression. We studied the associations among molecular, immunohistochemical, and clinicopathologic features and their distribution according to the subtypes luminal, HER2, basal, and normal-like in 60 patients with invasive ductal breast carcinoma without distant metastasis at the time of diagnosis (M0). We evaluated the hypermethylation of the CDH-1, RASSF1A, SIAH-1 and TSLC-1 genes by methylation-specific polymerase chain reaction and the expression of p53, bcl-2, cyclin D1, E-cadherin, and beta-catenin proteins in tissue microarrays by immunohistochemical analysis. Expression of bcl-2 was associated with the luminal subtype (P=.003), and CDH-1 hypermethylation was present preferentially in HER2 tumors (P=.038). The basal subtype was characterized by the expression of beta-catenin (P=.003). The hypermethylation of CDH-1 and the expression of bcl-2, cyclin D1, and beta-catenin proteins differ among breast cancer subtypes.

[Association between microsatellite instability and clinico-pathological characteristics in sporadic colon cancer]. / Asociación entre la inestabilidad de microsatélites y las características clínicas y anatomopatológicas en pacientes con cáncer de colon esporádico.

BACKGROUND AND OBJECTIVE: Currently, colon cancer is a leading cause of cancer death world-wide. It progresses according to three molecular pathways, named suppressor, mutador and methylator. Microsatellite instability is a hallmark of the lack of reparation, of DNA mismatches and it characterizes a subset of colon tumors (unstable tumors, MSI). MSI-H patients (high degree of microsatellite instability) seem to share clinico-pathological differences with MSS (microsatellite stable) and MSI-L (low degree of microsatellite instability) patients. In this study, associations between high degree of microsatellite instability and pathological (location, mucinous content, differentiation grade, stages T3N0, stages II and III) and clinical features (response to chemotherapy, disease-free survival and overall survival) were evaluated. PATIENTS AND METHOD: 117 patients with sporadic colon cancer were classified into two populations (MSS/MSI-L and MSI-H) by using PCR and electrophoresis of seven microsatellites, according to the National Cancer Institute recommendations. RESULTS: MSI-H tumors tended to be located in the right colon (p = 0.022) and were of mucinous histologic type (p = 0.04). No differences in disease-free survival and overall survival between group of stage II and III patients with MSS/ MSI-L and corresponding ones with MSI-H colon cancer were found (p = 0.54, p = 0.37, respectively). Conversely, MSI-H patients with stage II colon cancer had a favourable prognosis (p = 0.027). Nevertheless, response to 5-fluorouracil (5-FU) and leucovorin was similar in MSS/ MSI-L and MSI-H groups (p = 0.38). CONCLUSIONS: MSI-H patients are characterized by certain pathological features; those MSI-H patients with a stage II seem to have a better prognosis than MSS/ MSI-L patients.

Differential involvement of RASSF2 hypermethylation in breast cancer subtypes and their prognosis.

Breast cancer is a heterogeneous disease that can be subdivided into clinical, histopathological and molecular subtypes (luminal A-like, luminal B-like/HER2-negative, luminal B-like/HER2-positive, HER2-positive, and triple-negative). The study of new molecular factors is essential to obtain further insights into the mechanisms involved in the tumorigenesis of each tumor subtype. RASSF2 is a gene that is hypermethylated in breast cancer and whose clinical value has not been previously studied. The hypermethylation of RASSF1 and RASSF2 genes was analyzed in 198 breast tumors of different subtypes. The effect of the demethylating agent 5-aza-2'-deoxycytidine in the re-expression of these genes was examined in triple-negative (BT-549), HER2 (SK-BR-3), and luminal cells (T-47D). Different patterns of RASSF2 expression for distinct tumor subtypes were detected by immunohistochemistry. RASSF2 hypermethylation was much more frequent in luminal subtypes than in non-luminal tumors (p = 0.001). The re-expression of this gene by lentiviral transduction contributed to the differential cell proliferation and response to antineoplastic drugs observed in luminal compared with triple-negative cell lines. RASSF2 hypermethylation is associated with better prognosis in multivariate statistical analysis (P = 0.039). In conclusion, RASSF2 gene is differently methylated in luminal and non-luminal tumors and is a promising suppressor gene with clinical involvement in breast cancer.

Factibilidad y morbimortalidad en doscientos casos consecutivos de pancreaticogastrostomía después de duodenopancreatectomía / Feasibility and morbidity and mortality in two hundred consecutive cases of pancreaticogastrostomy after pancreaticoduodenectomy

Introducción: La mortalidad postoperatoria asociada a la duodenopancreatectomía (DP) en centros de alto volumen es inferior al 5%, sin embargo, las tasas de morbilidad oscilan entre el 45% y el 60%. Estudios recientes muestran una menor incidencia de complicaciones y fístula pancreática postoperatoria (POPF) con el uso de la pancreaticogastrostomía (PG). El objetivo de nuestro estudio es evaluar la incidencia y los factores predictivos de las complicaciones: POPF, hemorragia pospancreatectomía y retraso del vaciamiento gástrico según los criterios de las clasificaciones ISGPS y Clavien-Dindo. Material y métodos: Estudio prospectivo observacional en el que se incluyeron todos los pacientes sometidos a DP entre 2008 y 2016. La PG fue la técnica de elección en la reconstrucción de la DP. Resultados. Doscientos cuarenta y nueve pacientes se sometieron a cirugía con la intención de realizar una DP. La viabilidad de PG fue del 90,5%. Ciento seis (53%) pacientes tuvieron complicaciones, 36 (18%) fueron graves (grado Clavien-Dindo ≥ III). La mortalidad a 90 días fue del 4%. El retraso del vaciamiento gástrico fue la complicación más frecuente (22,5%), seguida de la hemorragia pospancreatectomía (21%). La tasa clínica de POPF fue del 15% (6% grado Clavien-Dindo ≥ III). Los principales factores de riesgo asociados a las complicaciones fueron la edad > 70 años (1,9 [1-3,55]), el sexo masculino (1,89 [1; 3,6]) y la textura blanda del páncreas (3,38 [1,5; 7,37]). Conclusiones: En nuestra experiencia la factibilidad de la PG fue del 90,5%. Los principales factores de riesgo asociados a las complicaciones fueron la edad > 70 años, el sexo masculino y la textura blanda del páncreas. La textura blanda del páncreas también está asociada al desarrollo y la gravedad de la POPF

Background: Postoperative mortality associated with pancreaticoduodenectomy (PD) in high-volume hospitals is below 5%, yet morbidity rates range between 45% and 60%. Recent studies show a lower incidence of complications and postoperative pancreatic fistula (POPF) in pancreaticogastrostomy (PG). The primary objective was to assess the incidence and predictive factors for complications: POPF, post-pancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE) following the criteria of the ISGPS and Clavien-Dindo classifications. Methods: A prospective observational study that included all patients who underwent PD between 2008 and 2016. PG was the surgical procedure of choice for PD reconstruction. Results: Two hundred forty-nine patients underwent surgery with intention of performing a PD. The feasibility of PG was 90.5%. One hundred and six (53%) patients had complications, 36 (18%) were severe (Clavien-Dindo grade ≥ III). Death within 90 postoperative days was 4%. DGE was the most frequent complication (22.5%), followed by PPH (21%). The clinical POPF rate was 15% (6% Clavien-Dindo grade ≥ III). The primary risk factors associated with complications were age > 70 years (1.9 [1-3.55]), being male (1.89 [1; 3.6]) and soft pancreatic texture (3.38 [1.5; 7.37]). Conclusions: In this paper, we report a feasibility study for PG (90.5%). The primary risk factors associated with complications were age > 70 years, being male and soft pancreatic texture. Soft pancreatic texture is also associated with the development and severity of POPF

Pathologic response of primary rectal cancer to oxaliplatin-based chemotherapy.

Management of stage IV rectal cancer is controversial, and different strategies may be useful. Preoperative chemotherapy for liver metastases might cause pathologic changes over the primary rectal tumor. In this study, the authors show the pathologic regression of the primary rectal tumor after neoadjuvant chemotherapy treatment. Patients suffering stage IV rectal cancer underwent surgery after oxaliplatin-based chemotherapy. Age, gender, type of surgery, carcinoembryogenic antigen (CEA) level, presence of metastatic disease in one or multiple organs, ypT, ypN, and circumferential resection margin (CRM) were evaluated. Pathologic response of the primary tumor was estimated by using three conventional grading systems and a semiquantitative system assessed by the amount of viable cells out of the total tumor area macroscopically described. Fibrosis, necrosis, and colloid response were evaluated with a semiquantitative system. A complete pathologic response (ypTO) was found in one patient. A good response was observed in the 41.6% of the cases with all grading systems. Presence of fibrosis in the primary tumor was found in six cases. No patient showed CRM involvement. One patient developed a local recurrence. Oxaliplatin-based chemotherapy for stage IV rectal cancer provides high rates of pathologic regression in the rectal tumor and may allow surgery without CRM involvement.

Factores implicados en la localización intraoperatoria del ganglio centinela en pacientes intervenidas por cáncer de mama / Factors affecting intraoperative sentinel lymph node identification in patients undergoing surgery for breast cancer

Objetivos. Existe un número de pacientes en las que no es posible la localización del ganglio centinela, y el objetivo de nuestro estudio fue analizar los distintos factores que afectan a su localización. Material y métodos. Entre junio de 2003 y junio de 2011 realizamos un estudio prospectivo observacional con una serie de 588 pacientes diagnosticadas de cáncer de mama, sin afectación axilar clínica. Se recogieron datos epidemiológicos, tamaño tumoral, tipo histológico y datos relativos al trazador linfático (radiotrazador o colorante), tipo de cirugía (conservadora o mastectomía), región de drenaje linfático (axilar, mamaria interna), migración preoperatoria del isótopo, sistema de localización con distintos tipos de gammacámara, la afectación ganglionar y la experiencia del cirujano. La localización se realizó mediante coloides marcados con radiotrazador (99mTc) y administración intraoperatoria de colorante (azul de metileno) en el 35% de los casos. Resultados. Se han intervenido 588 pacientes. La mediana de edad fue 58 años, índice de masa corporal medio 26,8. El tipo tumoral más frecuente fue el adenocarcinoma ductal invasivo (54%). En 22 pacientes no se pudo localizar el ganglio centinela (3,7%). El análisis multivariante muestra que el índice de masa corporal de las pacientes (p = 0,007), el tipo de drenaje linfático (p < 0,001) y la no migración preoperatoria del isótopo (p < 0,001) presentan una asociación significativa con la no identificación del ganglio centinela. Conclusión. Este estudio identificó el índice de masa corporal y la no migración del radioisótopo como factores asociados a la no localización del ganglio centinela. Por el contrario, no encontró asociación en otros factores propuestos, como la edad o la experiencia del cirujano (AU)

Objectives. In some patients, the sentinel lymph node cannot be identified. The aim of our study was to analyze the various factors that affect its detection. Material and methods. Between June 2003 and June 2011, we conducted a prospective observational study in a series of 588 patients diagnosed with breast cancer without clinical axillary involvement. We collected data on epidemiological factors, tumoral size, histological type, the technique (radiotracer or dye), type of surgery (conservative or mastectomy), region of lymphatic drainage, preoperative isotope migration, localization system (type of gamma camera), lymph node involvement, and surgeon experience. Localization was performed using colloids marked with radiotracer (99mTc) and intraoperative dye administration (methylene blue) in 35% of the patients. Results. A total of 588 patients were studied. The mean age was 58 years, and the mean body mass index was 26.8. The most common tumor type was invasive ductal adenocarcinoma (54%). The sentinel lymph node could not be located in 22 patients (3.7%). Multivariate analysis showed that the factors significantly associated with failure to locate the sentinel lymph node were body mass index (P = .007), type of lymphatic drainage (P < .001), and the absence of preoperative isotope migration (P < .001). Conclusion. In this study, the factors associated with failure to identify the sentinel lymph node were body mass index and the absence of radioisotope migration. No association was found in other factors analyzed, such as age or surgeon experience (AU)

[Surgical site infection in general surgery: 5-year analysis and assessment of the National Nosocomial Infection Surveillance (NNIS) index]. / Infección de sitio quirúrgico en un servicio de cirugía general. Análisis de cinco años y valoración del índice National Nosocomial Infection Surveillance (NNIS).

INTRODUCTION: The aim of this study was to describe the rate of surgical site infections (SSI), classified according to the NNIS index and its components, as well as to evaluate this scale and assess the importance of several factors that influence the development of an SSI. PATIENTS AND METHOD: All episodes of SSI were prospectively registered over a 5-year period. All patients (infected or not) were given an NNIS index and an NNIS category. Postoperative hospital stay and bacteria cultured from the surgical site were also analyzed. Chi2 test, Student's t-test and multiple logistic regression were used. RESULTS: There were 6,218 patients and 513 SSI (8.25%). The infection rate was 2.27% for clean surgery, 9.17% for clean-contaminated surgery, 11.40% for contaminated surgery, and 19.14% for dirty surgery; 4% for ASA I, 8.23% for ASA II, 13.54% for ASA III, 19.55% for ASA IV, and 33.33% for ASA V; 6.97% for length of procedure = 75th percentile, and 23.01% for > 75th percentile; 3.95% for NNIS 0, 8.17% for NNIS 1, 22.08% for NNIS 2, and 37.23% for NNIS 3. Among the components of the NNIS index, the length of the surgical procedure had the greatest influence on the rate of SSI (OR = 3.43 versus OR = 2.60 for the grade of contamination and OR = 2.20 for ASA index). The infection rates according to the type of intervention were: 30.9% in hepatobiliopancreatic surgery, 24.3% in small bowel surgery, 16.1% in colorectal surgery, 15.4% in gastroduodenal surgery; 8.5% in other soft tissue interventions, 7.7% in exploratory laparotomies, 6.4% in appendicectomies for appendicitis, 5.0% in cholecystectomy, 5.0% in other interventions of the digestive tract, 3.3% in breast surgery, 1.5% in herniorrhaphies, and 0.7% in endocrine surgery. CONCLUSIONS: The NNIS index is a valid instrument for classifying surgical patients according to the risk of developing an SSI. Of the three components, the length of the intervention has the greatest influence on increasing the risk of infection. The NNIS categories also distinguish different levels of risk of infection.

Infección de sitio quirúrgico en un servicio de cirugía general. Análisis de cinco años y valoración del índice National Nosocomial Infection Surveillance (NNIS) / Surgical site infection in general surgery: 5-year analysis and assessment of the National Nosocomial Infection Surveillance (NNIS) index

Introducción. Se describe la tasa de infección de sitio quirúrgico (ISQ) valorando la validez del sistema del índice National Nosocomial Infection Surveillance (NNIS) de estratificación del riesgo y la influencia de los diferentes factores en la aparición de una ISQ. Pacientes y método. Registro prospectivo durante 5 años de incidencia de ISQ según el índice y categoría del NNIS, estancias postoperatorias y gérmenes aislados. Se realizaron pruebas de la X2, de la t de Student y regresión logística múltiple. Resultados. El número de pacientes es de 6.218, y el de ISQ, de 513 (8,25%). La tasa de infecciones en cirugía limpia es del 2,27%, la de limpia-contaminada, del 9,17%, la de contaminada, del 11,40%, y la de sucia, del 19,14%. En pacientes con ASA I: 4,0%, ASA II: 8,23%, ASA III: 13,54%, ASA IV: 19,55% y ASA V: 33,33%; con un tiempo intervención percentil 75 del 23,01%. Con índice NNIS 0: 3,95%, NNIS 1: 8,17%, NNIS 2: 22,08% y NNIS 3: 37,23%. La duración de la intervención es el factor del índice NNIS que más influye en la tasa de infecciones (odds ratio [OR] = 3,43, frente a 2,60 del grado de contaminación y 2,20 del nivel ASA). La tasa de infecciones en la categoría de la cirugía hepatobiliopancreática es del 30,9%; la de intervenciones sobre el intestino delgado, del 24,3%; la de la cirugía colorrectal, del 16,1%; la de la cirugía gastroduodenal, del 15,4%; la de otras intervenciones en partes blandas, del 8,5%; la de laparotomías exploradoras, del 7,7%; la de apendicectomías por apendicitis, del 6,4%; la de colecistectomías, del 5,0%; la de otras intervenciones en el aparato digestivo, del 5,0%; la de la cirugía mamaria, del 3,3%; la de herniorrafias, del 1,5%, y la de intervenciones endocrinológicas, del 0,7%. Conclusiones. El índice NNIS es válido en nuestros pacientes para estratificar el riesgo de presentar una ISQ. El factor tiempo es el que tiene mayor peso en el riesgo de infección, y el nivel ASA, el menor. La categoría NNIS también discrimina diferentes grados de riesgo (AU)

Introduction. The aim of this study was to describe the rate of surgical site infections (SSI), classified according to the NNIS index and its components, as well as to evaluate this scale and assess the importance of several factors that influence the development of an SSI. Patients and method. All episodes of SSI were prospectivelly registered over a 5-year period. All patients (infected or not) were given an NNIS index and an NNIS category. Postoperative hospital stay and bacteria cultured from the surgical site were also analyzed. X2 test, Student's t-test and multiple logistic regression were used. Results. There were 6,218 patients and 513 SSI (8.25%). The infection rate was 2.27% for clean surgery, 9.17% for clean-contaminated surgery, 11.40% for contaminated surgery, and 19.14% for dirty surgery; 4% for ASA I, 8.23% for ASA II, 13.54% for ASA III, 19.55% for ASA IV, and 33.33% for ASA V; 6.97% for length of procedure =75th percentile, and 23.01% for >75th percentile; 3.95% for NNIS 0, 8.17% for NNIS 1, 22.08% for NNIS 2, and 37.23% for NNIS 3. Among the components of the NNIS index, the length of the surgical procedure had the greatest influence on the rate of SSI (OR = 3.43 versus OR = 2.60 for the grade of contamination and OR = 2.20 for ASA index). The infection rates according to the type of intervention were: 30.9% in hepatobiliopancreatic surgery, 24.3% in small bowel surgery, 16.1% in colorectal surgery, 15.4% in gastroduodenal surgery; 8.5% in other soft tissue interventions, 7.7% in exploratory laparotomies, 6.4% in appendicectomies for appendicitis, 5.0% in cholecystectomy, 5.0% in other interventions of the digestive tract, 3.3% in breast surgery, 1.5% in herniorrhaphies, and 0.7% in endocrine surgery. Conclusions. The NNIS index is a valid instrument for classifying surgical patients according to the risk of developing an SSI. Of the three components, the length of the intervention has the greatest influence on increasing the risk of infection. The NNIS categories also distinguish different levels of risk of infection (AU)

Asociación entre la inestabilidad de microsatélites y las características clínicas y anatomopatológicas en pacientes con cáncer de colon esporádico / Association between microsatellite instability and clinico-pathological characteristics in sporadic colon cancer

FUNDAMENTO Y OBJETIVO: La inestabilidad de microsatélites derivada del fallo en la reparación delos falsos emparejamientos del ADN es la alteración característica de los tumores de la vía mutadorao inestables (MSI). Tales casos parecen presentar diferencias desde el punto de vista clinicopatológicocon los tumores de la vía supresora o estables (MSS). Los tumores con alto gradode inestabilidad (MSI-H) parecen constituir una nueva entidad de tumores con diferencias endeterminadas características anatomopatológicas y clínicas con respecto a los tumores estables(MSS) e inestables de bajo grado (MSI-L). En el presente estudio se valora la posible asociaciónentre el alto grado de inestabilidad de microsatélites con la localización, contenido mucinoso,grado de diferenciación, estadio, así como el intervalo libre de enfermedad y supervivencia.PACIENTES Y MÉTODO: Se clasifica a 117 pacientes con cáncer de colon esporádico en las poblacionesMSS/MSI-L y MSI-H (siguiendo las recomendaciones del National Cancer Institute) mediantereacción en cadena de la polimerasa y electroforesis de 7 microsatélites.RESULTADOS: Los tumores MSI-H tendieron a localizarse en el colon derecho (p = 0,022) y a presentarcontenido mucinoso (p = 0,04). El conjunto de pacientes MSI-H de estadios II y III no presentóintervalos libres de enfermedad ni períodos de supervivencia más prolongados (p = 0,54, p= 0,37, respectivamente). Los tumores MSI-H de estadio II presentaron períodos de supervivenciamás prolongados que los tumores MSS/MSI-L (p = 0,027). No observamos diferencias en la respuestaa quimioterapia con 5-fluorouracilo y leucovorín entre los grupos MSS/MSI-L y MSI-H (p =0,38).CONCLUSIONES: El alto grado de inestabilidad de microsatélites se asocia con determinadas característicaspatológicas, así como con períodos de supervivencia más prolongados para los tumoresde estadios II

BACKGROUND AND OBJECTIVE: Currently, colon cancer is a leading cause of cancer death worldwide.It progresses according to three molecular pathways, named suppressor, mutador andmethylator. Microsatellite instability is a hallmark of the lack of reparation, of DNA mismatchesand it characterizes a subset of colon tumors (unstable tumors, MSI). MSI-H patients (high degreeof microsatellite instability) seem to share clinico-pathological differences with MSS (microsatellitestable) and MSI-L (low degree of microsatellite instability) patients. In this study,associations between high degree of microsatellite instability and pathological (location, mucinouscontent, differentiation grade, stages T3N0, stages II and III) and clinical features (responseto chemotherapy, disease-free survival and overall survival) were evaluated.PATIENTS AND METHOD: 117 patients with sporadic colon cancer were classified into two populations(MSS/MSI-L and MSI-H) by using PCR and electrophoresis of seven microsatellites, accordingto the National Cancer Institute recommendations.RESULTS: MSI-H tumors tended to be located in the right colon (p = 0.022) and were of mucinoushistologic type (p = 0.04). No differences in disease-free survival and overall survival betweengroup of stage II and III patients with MSS/ MSI-L and corresponding ones with MSI-Hcolon cancer were found (p = 0.54, p = 0.37, respectively). Conversely, MSI-H patients withstage II colon cancer had a favourable prognosis (p = 0.027). Nevertheless, response to 5-fluorouracil(5-FU) and leucovorin was similar in MSS/ MSI-L and MSI-H groups (p = 0.38).CONCLUSIONS: MSI-H patients are characterized by certain pathological features; those MSI-Hpatients with a stage II seem to have a better prognosis than MSS/ MSI-L patients

Gestión clínica basada en la evidencia / Evidence-based clinical management

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Aislamiento de Candida en la infección de sitio quirúrgico en un servicio de cirugía general / Candida isolation in the surgical site in a general surgery department

Introducción. La infección por Candida sp. está caracterizada por una elevada mortalidad. El objetivo de este artículo es conocer las características de los pacientes con infecciones nosocomiales en las que se aísla Candida sp., con el fin de facilitar un diagnóstico temprano y mejorar su pronóstico. Material y método. En el trienio 1998-2000 hemos intervenido a 3.579 pacientes por procedimientos de cirugía mayor. Analizamos a 42 pacientes que han presentado una infección de sitio quirúrgico (SSI) en las que se ha aislado Candida sp., siguiendo los criterios de los Centers for Disease Control (CDC) y los factores de riesgo que componen el índice National Nososcomial Infection Surveillance (NNIS). Se comparan con el resto de los pacientes con SSI. Resultados. Se ha aislado Candida sp. en el 14,5 por ciento de los 289 pacientes con SSI. Ésta era de la variedad Candida albicans en 35 casos (83,3 por ciento) y en 29 estaba asociada con otros gérmenes (69 por ciento). El 83,3 por ciento de los casos (35 pacientes) presentaba una infección de órgano-espacio, asociada con una fístula o dehiscencia de sutura en el 65,7 por ciento de los mismos (23 pacientes), cifras significativamente superiores a las del resto de SSI. Se presentan con mayor frecuencia tras intervenciones urgentes (18,6 por ciento), en pacientes con índice NNIS alto (18,2 por ciento) y en pacientes intervenidos por cirugía gastroduodenal o hepatobiliopancreática (33,8 por ciento). También se caracterizan por una mayor estancia media y mayor tasa de reintervenciones y mortalidad que el resto de las SSI (diferencias significativas).Conclusiones. El aislamiento de Candida sp. es frecuente en infecciones de órgano-espacio en pacientes con elevado índice NNIS, intervenidos por patología gastroduodenal o hepatobiliopancreática y con una tasa de reintervenciones y una mortalidad superior a la del resto de SSI (AU)

Eficacia de un protocolo de manejo de la hemorragia digestiva baja grave / Efficacy of a management protocol for severe lower gastrointestinal bleeding

Objetivo. Evaluar prospectivamente la eficacia de un protocolo de manejo (basado en angiografía y/o colonoscopia urgente) para localizar el foco de sangrado, y analizar la morbilidad y mortalidad de la cirugía urgente en la hemorragia digestiva baja grave (HDB). Pacientes y método. Se incluyeron todos los pacientes con HDB grave (inestabilidad persistente, hemorragia recidivante con transfusiones o sangrado mayor de 1.500 ml) durante un período de 77 meses. Se indicaron colonoscopia y/o angiografía visceral si el sangrado no era anorrectal en la exploración física. Se midió el riesgo quirúrgico con el índice ASA, y la comparación estadística se realizó con la prueba exacta de Fisher. Resultados. Se trataron 40 pacientes con una mediana de edad de 75 años. El 65 por ciento de los pacientes sangraron por enfermedad diverticular o malformaciones arteriovenosas del colon. Se intervino a 35 pacientes, 32 de ellos por laparotomía: se realizaron 3 resecciones de intestino delgado, 5 intervenciones de recto, 5 colectomías totales, 18 colectomías segmentarias y una laparotomía exploradora. El 75 por ciento de las colonoscopias y el 68 por ciento de las angiografías localizaron el foco de sangrado. La mortalidad fue del 28 por ciento, principalmente por insuficiencia cardíaca, resangrado postoperatorio (11 por ciento) y dehiscencia de sutura (14 por ciento). La morbilidad y mortalidad se relacionaron estadísticamente con el índice ASA IV-V y con la cirugía urgente diferida a un segundo episodio de sangrado masivo. Conclusión. La angiografía urgente y la colonoscopia tras preparación mecánica rápida constituye una buena combinación para localizar el foco de HDB en la mayoría de los pacientes. Sin embargo, la gravedad de la HDB asociada a la edad y comorbilidades de esta población provoca una alta mortalidad, que sólo se podrá reducir mejorando aún más los cuidados cardiorrespiratorios y considerando de forma selectiva la realización de ostomías (AU)