Laparoscopic and robotic intracorporeal resection and end-to-end anastomosis in left colectomy: a prospective cohort study - stage 2a IDEAL framework for evaluating surgical innovation.

PURPOSE: To analyze the safety and feasibility of intracorporeal resection and anastomosis in upper rectum, sigmoid, and left colon surgery, via both laparoscopic and robotic approaches. The secondary aim was to assess possible short-term differences between laparoscopic versus robotic surgery. METHODS: A prospective observational cohort study according to IDEAL framework exploration and assessment stage (Development, stage 2a), evaluating and comparing the laparoscopic approach and the robotic approach in left colon, sigmoid, and upper rectum surgery with intracorporeal resection and end-to-end anastomosis. Demographic, preoperative, surgical, and postoperative variables of patients undergoing laparoscopic and robotic surgery are described and compared according to the surgical technique used. RESULTS: Between May 2020 and March 2022, seventy-nine patients were consecutively included in the study, 41 operated via laparoscopy (laparoscopic left colectomy: LLC) and 38 by robotic surgery (robotic left colectomy: RLC). There were no statistically significant differences between the two groups in terms of demographic variables. In surgical variables, the median surgical times differed significantly: 198 min (SD 48 min) for LLC vs. 246 min (SD 72 min) for RLC (p = 0.01, 95% CI: - 75.2 to - 20.5)). The only significant difference regarding postoperative complications was a higher degree of relevant morbidity in the LLC (Clavien-Dindo > II (14.6% vs. 0%, p = 0.03) and Comprehensive Complication Index (IQR 22 vs. IQR 0, p = 0.03). The pathological results were similar in both approaches. CONCLUSION: Laparoscopic and robotic intracorporeal resection and anastomosis are feasible and safe, and obtain similar surgical, postoperative, and pathological results than described in literature. However, morbidity seems to be higher in LLC group with fewer relevant postoperative complications. The results of this study enable us to proceed to stage 2b of the IDEAL framework. CLINICAL TRIAL REGISTRATIONS: The study is registered in Clinical trials with the registration code NCT0445693.

Labeled adenosine(5')tetraphospho(5')adenosine (Ap4A) and adenosine(5')tetraphospho(5')nucleoside (Ap4N). Synthesis with firefly luciferase.

Labeled dinucleoside polyphosphates are not commercially available, in spite of being important molecules in metabolic regulation. Firefly luciferase (EC 1.13.12.7) is a useful enzyme for the synthesis of adenosine(5')tetraphospho(5')adenosine (Ap4A). As luciferase behaves as a nucleotidase at low ATP concentration, adequate concentrations (higher than 0.1 mM ATP) should be used to obtain a good yield of labeled Ap4A. [32P]Ap4A has also been synthesized from ATP and [32P]PPi. In a first step, [beta, gamma-32P]ATP is generated in a ATP-[32P]PPi exchange reaction catalyzed by luciferase. In a second step, the reaction is supplemented with pyrophosphatase and 32P labeled Ap4A is obtained. Radioactive adenosine(5')tetraphospho(5')nucleoside (Ap4N) can also be synthesized from ATP gamma S and labeled NTP or from low concentrations of labeled ATP and high concentrations of cold NTP. The syntheses of radioactive ApnA and pnA (n > 4) can also be approached with luciferase.

[Liver transplantation in pediatrics. Nutritional measures]. / Trasplante hepático en pediatría. Medidas nutricionales.

Malnutrition is a constant in candidates for liver transplant. Because of their particular characteristics, pre-operative nutritional intervention is difficult to apply, so that post-transplant action is necessary. A retrospective study was made, reviewing the clinical records of all the children undergoing liver transplants in 1992 in the "La Paz" Children's Hospital, while they were in the Pediatric Intensive Care Unit. Two groups of patients were established--A and B--respectively of 15 and 7 children, according to whether or not they had received immediate post-transplant TPN. In Group A, a total of 150 days was evaluated, with TPN (x = 10 +/- 8.3). The amino acid solutions used were for liver insufficiency (48.8%), Kidney insufficiency (33.3%) and standard (17.8%). Lipids were administered on 6.3% of days in four patients' nutrition. In 54.5% of interventions, infectious complications occurred due to immune-suppression. Comparison of the two patient groups show significant results: those in Group A had a 3.2 relative risk of suffering infection (certainty interval 1.3-1.8). In terms of time in the ICU, the Group A patients were admitted for an average of 13.4 days (range 2-37) as opposed to the 6.28 days of Group B (range 3-15). Results were significant, with p < 0.05. In terms of evolution, the survival rate in patients receiving TPN was 86.6% against 71.4% in those receiving enteral nutritional (n.s.). Our results show a high rate of survival (86.6%). It is not possible to conclude the extent to which the introduction of TPN influenced post-operative evolution, as there was no consistency in terms of the patients' clinical situation.

[Standard formulas of parenteral nutrition. A study of their use in a general hospital]. / Fórmulas estándar de nutrición parenteral. Estudio de su utilización en un hospital general.

The goal of the study was to evaluate the use of parenteral nutrition formulas with standardized g. of nitrogen, carbohydrates and lipids, and to analyze whether the nutritional requirements of the patients treated in our hospital were covered by said formulas or whether it was necessary to change and/or standardize a new formula. To do so, a review was made of 5.646 parental nutrition mixtures prepared in the Pharmacy Service and patterned by the Nutrition Service from April, 1991, to May, 1992, for 308 adult patients. The distribution of the mixtures by services, diagnoses and the frequency of the different standard formulas were studied, comparing standard formula frequency with that of non-standard formulas. Findings showed that 41.9% of nutrition mixtures were patterned in surgery, and the most common diagnosis, cancer, appeared in 24%. Of the mixtures, 67.6% were preestablished formulas, and 32.4% were non-standard formulas. The order of frequency among standard formulas was: basic standard formulas, stress formulas, initial formulas, peripheral formulas, hemodialysis formulas and low-volume formulas. All covered the nutritional needs of a large share of the patients for the different pathologies in which they were indicated. Nevertheless the question of designing a new formula to cover a greater number of situations was raised. Protocolization should take place rationally, to meet the hospital's most frequent pathologies, and effectiveness should be evaluated after tracking and checking each patient.

[Retroperitoneal hibernoma]. / Hibernoma retroperitoneal.

We report a new case of retroperitoneal hibernoma. Hibernoma is a rare, benign soft tissue tumor whose constituent cells resemble those of brown fat tissue, which is present in human fetus and newborn infant and it gradually diminishes in quantity throughout adult life. Retroperitoneal location is unusual. Differential diagnosis with the liposarcoma (the most frequent tumour on this location) is based on the high vascularity of the hibernoma. Total resection of the tumour can achieve complete cure without recurrence nor metastasis.

[Intraabdominal desmoid tumor associated with Gardner's syndrome]. / Tumor desmoide intraabdominal asociado a síndrome de Gardner.

An intra-abdominal desmoid tumour included in Gardner's syndrome is described. Some aspects of this unusual tumour are reviewed, emphasizing the value of CT to evaluate shape, location, size and relation with adjacent structures and therefore to decide the therapeutic plan, to avoid the need for exploratory laparotomies which are, moreover, so inadvisable in these patients. Although the, treatment of choice is surgery, it must be performed in accordance with CT findings. When surgery is not possible is incomplete or after recurrences, alternative methods are recommended.

Induction of tyrosine aminotransferase in galactosamine hepatitis.

We have induced acute hepatitis in rats with the amino sugar Galactosamine by i.p. injection. The development of the disease was controlled by measurements of several metabolites and enzymes in serum, and light and electronic microscopy. Tyrosine transaminase was induced by i.p. injection of Cortisol, that increases ten times enzyme activity in liver parenchyma of normal rats. This inductive phenomenon cannot be observed in animals with galactosamine hepatitis. We discuss the probable mechanism and their relationship with some forms of viral hepatitis in human beings.

Idiopathic fibrosing pancreatitis associated with ulcerative colitis.

Idiopathic fibrosing pancreatitis has been associated with Sjögren's syndrome, primary biliary cirrhosis and primary sclerosing cholangitis. This condition frequently develops in childhood and youth, and has also been related to ulcerative colitis and pericholangitis. Pancreatic complications have been rarely described as systemic complications of ulcerative colitis. A 25-year-old man presented with epigastric pain and jaundice. Abdominal ultrasonography, computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) revealed a diffuse enlargement of the pancreas, filiform distal stenosis of the common bile duct and intrahepatic bile ducts, and pancreatic duct dilatation. At operation, a rock-hard and nodular pancreas was noted. Cholecystectomy and Roux-en-Y hepaticojejunostomy, with an access loop, was successfully performed. Idiopathic fibrosing pancreatitis should be considered in young patients with obstructive jaundice, especially those affected with chronic inflammatory or autoimmune diseases. Glucocorticoid therapy would be the first-line treatment, although many patients require operation.

Uric acid synthesis by rat liver supernatants from purine bases, nucleosides and nucleotides. Effect of allopurinol.

The synthesis of uric acid from purine bases, nucleosides and nucleotides has been measured in reaction mixtures containing rat liver supernatant and each one of the following compounds at 1 mM concentration (except xanthine, 0.5 mM and guanosine and guanine, 0.1 mM). The rates of the reaction, expressed as nanomoles of uric acid synthesized g-1 of wet liver min-1 were: ATP, 10; ADP, 37; AMP, 62; adenosine, 108; adenine 6; adenylosuccinate, 9; IMP 32; inosine, 112; hypoxanthine, 50; GTP, 19; GDP, 19; GMP, 27; guanosine, 34; guanine, 72; XMP, 10; xanthosine, 24; xanthine, 144. These figures divided by 55 correspond to nanomoles of uric acid synthesized min-1 per mg-1 of protein. The rate of synthesis of uric acid obtained with each one of those compounds at 0.1 and 0.05 mM concentrations was also determined. ATP (1 mM) strongly inhibited uric acid synthesis from 0.05 mM AMP (91 per cent) and from 0.05 mM ADP (88 per cent), but not from adenosine. CTP or UTP (1 mM) also inhibited (by more than 90 per cent) the synthesis of uric acid from 0.05 mM AMP. Xanthine oxidase was inhibited by concentrations of hypoxanthine higher than 0.012 mM. The results favour the view that the level of uric acid in plasma may be an index of the energetic state of the organism. Allopurinol, besides inhibiting uric acid synthesis, reduced the rate of degradation of AMP. The ability of crude extracts to catabolize purine nucleotides to uric acid is an important factor to be considered when some enzymes related to purine nucleotide metabolism, particularly CTP synthase, are measured in crude liver extracts.

Metabolic fate of AMP, IMP, GMP and XMP in the cytosol of rat brain: an experimental and theoretical analysis.

A systematic study of the metabolic fate of AMP, IMP, GMP and XMP (NMP) in the presence of cytosol from rat brain is here presented; the kinetics of both disappearance of NMP, and appearance of their degradation products was followed by HPLC. In the absence of ATP, AMP was preferentially degraded to adenosine with concomitant appearance of inosine and hypoxanthine. In the presence of ATP, AMP was preferentially degraded via IMP. The nucleosides generated in the course of the reactions are further degraded, almost exclusively, via nucleoside phosphorylase using as cofactor the P(i) generated in the reaction mixture. In order to quantify the effect of each one of the enzymes involved in the degradation of NMP, two complementary approaches were followed: (i) the V:(max) and K:(m) values of the enzymes acting in the intermediate steps of the reactions were determined; (ii) these data were introduced into differential equations describing the concentration of the nucleotides and their degradation products as a function of the time of incubation. Factors affecting kinetic parameters of the equation velocity as a function of ATP concentration were introduced when required. The differential equations were solved with the help of Mathematica 3.0. The theoretical method can be used to simulate situations not feasible to be carried out, such as to measure the influence of nM-microM concentrations of ATP on the metabolism of AMP.

[Accidents in childhood: apropos of 14,301 cases treated in the course of one year]. / Accidentes en la infancia: a propósito de los 14.301 casos atendidos durante 1 año.

The present study aims: to revise all the cases of paediatric accidents attended at a Emergency Service of a tertiary Hospital; to analyze the epidemiological variables; and to try to draw conclusions in view of prevention. In order to achieve that, the 14.301 accidents attended during 1989 have been collected. The relation between little boys and little girls is 58.2:41.8. The average age is 7.12 years, though the mode has been 2 years. A larger number of accidents occur during non holiday. 44.3% of cases are attended between 18 and 23 hours. 89% of the accidents are, first of all, traumatisms and/or wounds; secondly, those which are produced by strange bodies (4.4%). In 51.9% of cases no complementary trial was carried out. Only 2.9% of cases were admitted to hospital, whereas 104% requires observation, and the rest returns home. The variables in the admitted patients are also analyzed, and a brief exposition of results for each of the 6 diagnostic groups is made.

[Prognosis in recurrent peripheral idiopathic facial paralysis in childhood]. / Pronóstico de la parálisis facial periférica idiopática y recidivante en la infancia.

Fifty-nine cases of idiopathic peripheral facial palsy were diagnosed in our unit during the period from January 1, 1984 to December 31, 1989. During follow-up examinations we observed a relapse in eleven cases, corresponding to 18.6% of the patients. Nine patients suffered a relapse once, one case twice and another case four times. The children that presented more than one recurrence have later shown functional sequelae, both clinical and neurophysiological. We conclude that in our series of patients relapse of facial palsy is a factor that worsens the prognosis for recovery. Furthermore, the existence of facial palsy in the family history leads to a greater risk of a recurrence.