Pure laparoscopic vs. hand-assisted liver surgery for segments 7 and 8: propensity score matching analysis.

BACKGROUND: Laparoscopic liver resection of tumors located in segments 7 and 8 are considered a complex resection. The aim of this study was to compare the intraoperative and early postoperative outcomes of patients operated by pure laparoscopic (PLS) vs hand-assisted laparoscopic surgery (HALS). METHODS: From January 2003 to January 2021, we included patients with minimally invasive surgery for lesions located in segments 7 and 8. To overcome selection bias, we performed 1:1 propensity score matching (PSM) between HALS and PLS cohorts, including 30 patients in each of the groups. Of the 60 patients who underwent PSM, we compared the first 30 patients with the following 30 patients. RESULTS: A total of 79 LLRs were performed, 46 by HALS and 33 by PLS. After PSM, in the PLS cohort, cirrhosis was more frequent (33.3% vs. 13.3%, p = 0.02). The surgical time, blood loss, Pringle maneuver, clamping time, and morbidity were similar between both groups, but with a lower hospital stay in the PLS group (3 days vs. 4 days, p < 0.01). In the first 30 patients who underwent LLR, the use of PLS was lower than the use of HALS, increasing due to the learning curve (16.7% in the first period vs. 83.3% in the second period; p < 0.01). The hospital stay was lower in the second period due to the more frequent use of PLS (3 vs. 4 days, p < 0.01). CONCLUSION: PLS presents similar intraoperative and early postoperative results with lower hospital stay for lesions located in segments 7 and 8 compared to HALS. In centers with experience in LLRs, PLS could be performed safely in these segments.

Evolution of gastroesophageal reflux after laparoscopic vertical gastrectomy. A radiographic, manometric and pH-metric study.

INTRODUCTION: the relationship between laparoscopic vertical gastrectomy (LVG) and gastroesophageal reflux (GER) is still controversial. Therefore, its study is of great interest in order to obtain definitive conclusions. The goal of the study was to establish whether LVG modifies pH-metric GER in obese patients and to analyze the associated factors. PATIENTS AND METHODS: the first 26 patients who underwent LVG in our institution were enrolled in the study. A barium swallow, 24-hour ambulatory pH-metry and four-channel intraluminal esophageal manometry (IEM) were all performed before and one year after surgery. RESULTS: among the pH-metric data, there was a significant increase in the DeMeester index after the procedure (p = 0.028), while other parameters remained unchanged. Furthermore, 50% of patients with preoperative pH-metric GER had normal values at one year after surgery. IEM showed a decrease in lower esophageal sphincter (LES) pressure and in the mean wave amplitude at the distal third of the esophagus (p = 0.007 and p = 0.025, respectively). The rate of newly-developed hiatal hernias in the radiographic study was 36.4%. CONCLUSION: LVG mildly increases GER, which is likely related to the development of hiatal hernias and a decrease in LES pressure and esophageal sweep. However, LVG should not be contraindicated for patients with preoperative pH-metric GER, as this may clear after the procedure.

Role of 18F-FDG PET/CT vs CT-scan in patients with pulmonary metastases previously operated on for colorectal liver metastases.

OBJECTIVE: There is currently no conclusive scientific evidence available regarding the role of the 18F-FDG PET/CT for detecting pulmonary metastases from colorectal cancer (PMCRC) in patients operated on for colorectal liver metastases (CRLM). In the follow up of patients who underwent surgery for CRLM, we compare CT-scan and 18F-FDG PET/CT in patients with PMCRC. METHODS: We designed the study prospectively performing an 18F-FDG PET/CT on all patients operated on for CRLM where the CT-scan detected PMCRC during the follow up. We included patients who were operated on for PMCRC because the histological findings were taken as a control rather than biopsies. RESULTS: Of the 101 pulmonary nodules removed from 57 patients, the CT-scan identified a greater number (89 nodules) than the 18F-FDG PET/CT (75 nodules) (p < 0.001). Sensitivity was greater with the CT-scan (90 vs 76%, respectively) with a lower specificity (50 vs 75%, respectively) than with the 18F-FDG PET/CT. There were no differences between positive-predictive value and negative-predictive value. The 18F-FDG PET/CT detected more pulmonary nodules in four patients (one PMCRC in each of these patients) and more extrapulmonary disease in six patients (four mediastinal lymph nodes, one retroperitoneal lymph node and one liver metastases) that the CT-scan had not detected. CONCLUSION: Although CT-scans have a greater capacity to detect PMCRC, the 18F-FDG PET/CT could be useful in the detection of more pulmonary and extrapulmonary disease not identified by the CT-scan. Advances in knowledge: We tried to clarify the utility of 18F-FDG PET/CT in the management of this subpopulation of patients.

Resultados de dos encuestas dirigidas a inmigrantes y nativos del sureste español: salud, uso de servicios y necesidad de asistencia médica / Results of two surveys of immigrants and natives in Southeast Spain: health, use of services, and need for medical assistance

Objetivo. Comparar la salud, uso de servicios sanitarios y necesidad insatisfecha de atención médica (NIAM) entre inmigrantes y nativos del sureste español. Material y métodos. Estudio transversal de dos muestras representativas de población: inmigrante (n=1150) y nativa (n=1303; Encuesta Nacional de Salud). Se creó una única base de datos con ponderación específica para cada muestra y se estimaron razones de prevalencia (RP) mediante regresión multivariante. Resultados. Marroquíes, ecuatorianos y europeos del este (EE) declararon peor salud que los nativos (RPs [IC95%]: 2.45 [1.91-3.15]; 1.51 [1.28-1.79] y 1.44 [1.08-1.93], respectivamente). Los inmigrantes hicieron mayor uso de las urgencias (excepto EE) y consumieron menos fármacos. Los marroquíes mostraron la mayor diferencia en la frecuencia de NIAM (RP [IC95%]: 12.20 [5.25-28.37]), principalmente por razones laborales (46%). Conclusiones. La salud y el uso de servicios sanitarios difirieron significativamente entre inmigrantes y nativos. Destaca la NIAM alta en marroquíes por causa laboral.

Objective. To compare the self-perceived health, use of health services and unmet need for health care (UNHC) among immigrants and native populations of Southeast Spain. Materials and methods. Cross-sectional study of two representative samples of 1150 immigrants, and 1303 native participants from the National Health Survey. A single database was created with specific weights for each sample, and prevalence ratios (PR) were estimated by multivariate regression. Results. Moroccans, Ecuadorians and Eastern Europeans (EE) reported poorer health than the native population (PRs [CI95%]: 2.45 [1.91-3.15]; 1.51 [1.28-1.79] and 1.44 [1.08-1.93], respectively). Immigrants made greater use of emergencies that natives (except for EE) and had lower use of medication. Moroccan showed the greatest difference in the frequency of UNHC (PR [CI95%]:12.20 [5.25 - 28.37]), mainly because of working limitations (46%). Conclusions. The health status and use of health services among immigrants differ significantly from those of natives. Results highlight the higher frequency of UNHC among immigrants, especially high in Moroccans.

[Results of two surveys of immigrants and natives in Southeast Spain: health, use of services, and need for medical assistance]. / Resultados de dos encuestas dirigidas a inmigrantes y nativos del sureste español: salud, uso de servicios y necesidad de asistencia médica.

OBJECTIVE: To compare the self-perceived health, use of health services and unmet need for health care (UNHC) among immigrants and native populations of Southeast Spain. MATERIALS AND METHODS: Cross-sectional study of two representative samples of 1150 immigrants, and 1303 native participants from the National Health Survey. A single database was created with specific weights for each sample, and prevalence ratios (PR) were estimated by multivariate regression. RESULTS: Moroccans, Ecuadorians and Eastern Europeans (EE) reported poorer health than the native population (PRs [CI95%]: 2.45 [1.91-3.15]; 1.51 [1.28-1.79] and 1.44 [1.08-1.93], respectively). Immigrants made greater use of emergencies that natives (except for EE) and had lower use of medication. Moroccan showed the greatest difference in the frequency of UNHC (PR [CI95%]:12.20 [5.25 - 28.37]), mainly because of working limitations (46%). CONCLUSIONS: The health status and use of health services among immigrants differ significantly from those of natives. Results highlight the higher frequency of UNHC among immigrants, especially high in Moroccans.

Screening for hazardous drinking in migrant workers in southeastern Spain.

OBJECTIVES: Despite the great impact the migration has had in economic, social and health-related fields, and the repercussions of alcohol consumption on them, few data exist concerning the extent of alcohol consumption in migrant workers. The aims of this study were to identify workers with a hazardous drinking problem by means of a self-reported questionnaire (Alcohol Use Disorders Identification Test-AUDIT) and a biomarker (carbohydrate-deficient transferrin-CDT) and to ascertain associated risk factors. METHODS: A cross-sectional survey was conducted using a random sample of 385 migrant workers, undergoing a routine health examination as part of occupational health services. RESULTS: The results showed that 13.8% (n=53) of the workers were screened as positive with the AUDIT (≥8) and/or CDT (>2.6) and identified as hazardous drinkers and that 53.8% (n=207) were teetotallers. Being a man (OR: 2.0), working in the construction industry (OR: 2.8) or agriculture (OR: 2.2), being resident in Spain for more than 7 years (OR: 2.3) and sharing a house with friends were the factors most closely associated with hazardous drinking. CONCLUSIONS: Prevention-orientated programs, adjusted to the characteristics of each country and the origin of the migrants themselves, should be instituted to modify the drinking habits of migrant workers considered at risk.

[Liver transplantation increases R0 resection and survival of patients with a non-disseminated unresectable Klatskin tumour]. / El trasplante hepático aumenta la resecabilidad R0 y la supervivencia de los pacientes con tumor de Klatskin irresecable no diseminado.

INTRODUCTION: There are no established indications for Liver transplant (LT) in patients with a Klatskin tumour (KT) due to the differences in the published results. OBJECTIVE: To report on our patients who have non-disseminated unresectable KT and who were given a LT, and to compare results with those of patients who have had tumour resection and those who have not. PATIENTS AND METHOD: We have treated 75 patients diagnosed with KT. The mean age was 62 + or - 11 years (range: 38-88 years) and 50 were males (66%). Twenty patients were inoperable. Of the 55 patients who underwent surgery: tumour resection (TR) was performed in 29 cases; there was no tumour dissemination in 11 unresectable cases and therefore these patients were added to the LT waiting list and the remaining 15 unresectable cases had tumour dissemination and remained on palliative treatment. RESULTS: In the LT group there was no postoperative mortality (during the first month) and the survival rate was 95%, 59% and 36% with a disease-free survival of 75%, 40% and 20%; whereas the patients given RT had a survival rate of 80%, 52% and 38% at 1, 3 and 5 years, with a disease-free survival of 65%, 35% and 19%, without any differences compared to the LT group. Patients with unresectable tumour left on palliative therapy had a lower survival than the unresectable who underwent LT (p<0.001). CONCLUSIONS: In patients with non-disseminated unresectable KT, LT has a similar survival to that obtained in cases with resectable R0 liver resection. LT improves the survival rate achieved using palliative treatment in patients with non-disseminated unresectable KT.

[Prognostic factors after resection of colorectal cancer liver metastases]. / Factores pronósticos tras resección hepática de metástasis hepáticas de cáncer colorrectal.

INTRODUCTION: There are many studies that analyse preoperative factors with a poor prognosis in patients undergoing surgery for colorectal carcinoma liver metastases, in order to avoid unnecessary surgery. However, there are few studies that evaluate the intraand postoperative prognostic factors. The aim of this study is to analyse pre-, intra- and postoperative prognostic factors in a series of 210 patients undergoing surgery for colorectal carcinoma liver metastases, with special emphasis on the postoperative factors that can give us information on the aggressiveness of the tumour and the curative effectiveness of the surgery. PATIENTS AND METHOD: Between September 1996 and December 2006, 210 patients undergoing surgery for colorectal carcinoma liver metastases in whom we analysed pre-, intra- and postoperative factors of survival. Mean follow-up was 55+/-3 months (range: 12-124 months). RESULTS: The postoperative mortality rate was 1.4% and the morbidity rate was 22%. Actuarial and disease-free survival at 1-, 3- and 5-years was 89.9% vs 63%, 66.9% vs 32%, and 53.8% vs 23%, respectively. Among the preoperative factors analysed, the age>65 years and LM size>5 cm were independent predictors of poor overall survival, whereas the other two significant factors were obtained from those analysed postoperatively: presence of microsatellitosis and postoperative CEA levels (at 1 and 3 months). CONCLUSIONS: In patients with colorectal carcinoma liver metastases we must take into account certain postoperative factors that can give us information on the aggressiveness of the tumour and the effectiveness of the surgery.

Elevated glucocorticoid levels are responsible for induction of tyrosine hydroxylase mRNA expression, phosphorylation, and enzyme activity in the nucleus of the solitary tract during morphine withdrawal.

Chronic opiate exposure induces neurochemical adaptations in the noradrenergic system. Enhanced responsiveness of the hypothalamo-pituitary-adrenal axis after morphine withdrawal has been associated with hyperactivity of ascending noradrenergic input from the nucleus of the solitary tract (NTS-A(2)) cell group to the hypothalamic paraventricular nucleus (PVN). This study addressed the role of morphine withdrawal-induced corticosterone (CORT) release in regulation of tyrosine hydroxylase (TH), the rate-limiting enzyme of catecholamine biosynthesis in adrenalectomized (ADX) rats supplemented with low CORT pellet (ADX plus CORT). Present results show that in sham-ADX rats, noradrenergic neurons in the NTS-A(2) became activated during morphine withdrawal, as indicated by increased TH mRNA expression. However, this induction of TH expression is not detected in ADX plus CORT rats that are unable to mount CORT secretory response to morphine withdrawal. Total TH protein levels were elevated in the NTS-A(2) from sham-operated rats during morphine dependence and withdrawal, whereas we did not find any alteration in ADX plus CORT animals. Furthermore, high levels of TH phosphorylated (activated) at Ser31 (but not at Ser40) were found in the A(2) area from sham-morphine withdrawn rats. Consistent with these effects, we observed an increase in the enzyme activity of TH in the PVN. However, induction of morphine withdrawal to ADX plus CORT animals did not alter the phosphorylation (activation) of TH in NTS-A(2) and decreased TH activity in the PVN. These results suggest the existence of a positive reverberating circle in which elevated glucocorticoids during morphine abstinence play a permissive role in morphine withdrawal-induced activation of noradrenergic pathway innervating the PVN.

[Attitudes of family doctors to patients' rights]. / Actitudes de los médicos de familia hacia los derechos de los pacientes.

OBJECTIVES: To examine the attitudes of family doctors to patients' rights and to ascertain the social and professional variables that influence these views. DESIGN: Descriptive, cross-sectional study based on a questionnaire. SETTING: Primary care, Murcia, Spain. PARTICIPANTS: Two-hundred and twenty-seven family physicians, who filled in a postal questionnaire. INTERVENTIONS: The questionnaire included social and professional variables, evaluation of job satisfaction (by Likert scale 1-5), evaluation of patients' rights (Likert scale 1-5). MAIN MEASUREMENTS AND RESULTS: The most valued right in the overall view of the doctors questioned was the right to suitable health care within a humane framework (4.86; 95% CI, 4.81-4.91), while the least valued right was the access to medical records (3.91; 95% CI, 3.76-4.05). Mean job satisfaction was 2.79 (95% CI, 2.71-2.87). We found: statistically significant differences in the assessment of patients' rights, which depended on various social and professional factors; direct associations between doctors' satisfaction and their views on patients' rights; and a significant correlation between overall evaluation of rights and total satisfaction (P=.039). CONCLUSIONS: Overall, family doctors attach a lot of importance to patients' rights. However, social and professional characteristics seem to have some influence on their attitudes: older doctors, those working in an urban context, those with few patients on their lists, in teaching centres, and those feeling the greatest professional satisfaction tend to attach greater importance to patients' rights.

Prevalence of diabetes in Murcia (Spain): a Mediterranean area characterised by obesity.

The aim of this cross-sectional study was to describe the prevalence of total, known and unknown diabetes mellitus and impaired fasting glucose (IFG) in the population of Murcia (SE Spain), a Mediterranean area with a high prevalence of obesity. Therefore, 2562 subjects (>or=20 years) were selected by stratified random sampling and a survey was carried out by telephone, together with a physical examination and biochemical determinations. The ADA-1997 diagnostic criteria were used. The crude prevalence of total diabetes was 11% (9.5-12.6%), known diabetes 7.8% (6.5-9.2%), unknown diabetes 3.2% (2.4-4.2%) and IFG 4.9% (3.9-6.1%). Both total diabetes and IFG were higher in men than in women, with prevalence rates increasing with age. People with diabetes and IFG had higher BMI, blood pressure, total cholesterol, LDL-cholesterol and triglyceride values than the rest of the population. No difference in the prevalence of diabetes was observed between the rural and urban populations. The prevalence of diabetes in Murcia is high compared to the rest of Spain and the world, suggesting that the possible benefits attributed to some characteristics of the diet of this Mediterranean population are not sufficient to counteract the risk factors associated with the disease.

Panoramic versus conventional radiography of scaphoid fractures.

OBJECTIVE: The objective of this study was to compare the diagnostic value of panoramic and conventional radiography in the detection of fractures of the carpal scaphoid bone. MATERIALS AND METHODS: Panoramic (orthopantomographic) and conventional radiographs of 90 patients with acute or chronic wrist trauma were reviewed retrospectively. Images were analyzed and reviewed independently by four observers: two radiologists and two traumatologists. The kappa statistic was used to calculate intraand interobserver agreement and the correlation between the two imaging techniques. RESULTS: Panoramic radiography of the wrist was superior to conventional radiography in ruling out scaphoid fractures (74%, 20/27) in patients with suspicious findings on conventional radiography; revealed more cases of scaphoid fractures (21.4%, 12/56); and revealed more cases of delayed union (n = 2), nonunion (n = 3), and union (n = 3). Agreement values were higher, with better inter- and intraobserver agreement, for the panoramic examinations than for the conventional radiographic examinations. CONCLUSION: The panoramic examination of the wrist is a useful technique for the diagnosis and follow-up of scaphoid fractures. Its use is recommended as a complement to conventional radiography in cases with inconclusive findings.