Bundles reduce anastomosis leak in patients undergoing elective colorectal surgery. A propensity score-matched study.

Background: anastomosis leak still being a handicap in colorectal surgery. Bowel mechanical preparation and oral antibiotics are not a practice recommended in many clinical practice guides. The aim is to analyse the decrease in frequency and severity of postoperative complications, mainly related to anastomotic leak, after the establishment of a bundle. Methods: Single-center, before-after study. A bundle was implemented to reduce anastomotic leaks and their consequences. The Bundle group were matched to Pre-bundle group by propensity score matching. Mechanical bowel preparation, oral and intravenous antibiotics, inflammatory markers measure and early diagnosis algorithm were included at the bundle. Results: The bundle group shown fewer complications, especially in Clavien Dindós Grade IV complications (2.3% vs. 6.2% p < 0.01), as well as a lower rate of anastomotic leakage (15.5% vs. 2.2% p < 0.01). A significant decrease in reinterventions, less intensive unit care admissions, a shorter hospital stay and fewer readmissions were also observed. In multivariate analysis, the application of a bundle was an anastomotic leakage protective factor (OR 0.121, p > 0.05). Conclusions: The implementation of our bundle in colorectal surgery which include oral antibiotics, mechanical bowel preparation and inflammatory markers, significantly reduces morbidity adjusted to severity of complications, the anastomotic leakage rate, hospital stay and readmissions. Register study: The study has been registered at clinicaltrials.gov Code: nct04632446.

Influence of nitric oxide signaling mechanisms in cancer.

Nitric oxide (NO) is a molecule with multiple biological functions that is involved in various pathophysiological processes such as neurotransmission and blood vessel relaxation as well as the endocrine system, immune system, growth factors, and cancer. However, in the carcinogenesis process, it has a dual behavior; at low doses, NO regulates homeostatic functions, while at high concentrations, it promotes tissue damage or acts as an agent for immune defense against microorganisms. Thus, its participation in the carcinogenic process is controversial. Cancer is a multifactorial disease that presents complex behavior. A better understanding of the molecular mechanisms associated with the initiation, promotion, and progression of neoplastic processes is required. Some hypotheses have been proposed regarding the influence of NO in activating oncogenic pathways that trigger carcinogenic processes, because NO might regulate some signaling pathways thought to promote cancer development and more aggressive tumor growth. Additionally, NO inhibits apoptosis of tumor cells, together with the deregulation of proteins that are involved in tissue homeostasis, promoting spreading to other organs and initiating metastatic processes. This paper describes the signaling pathways that are associated with cancer, and how the concentration of NO can serve a beneficial or pathological function in the initiation and promotion of neoplastic events.

Ultrasound-guided percutaneous liver biopsy in children. Five-year experience at a tertiary care center.

INTRODUCTION AND AIMS: Percutaneous liver biopsy with histopathologic analysis is a valuable tool for the diagnosis, prognosis, and treatment evaluation of liver diseases. Its ultrasound-guided performance is useful, making the procedure safer and reducing the risk for complications and hospital stay. Our aim was to describe the indications, histopathologic study, and complications associated with the performance of ultrasound-guided percutaneous liver biopsy in pediatric patients. MATERIAL AND METHODS: The study included 102 ultrasound-guided percutaneous liver biopsies performed on patients <16 years of age, within the time frame of January 2014 and December 2019. The information was obtained from electronic files and histopathologic studies and the data were analyzed through descriptive statistics. RESULTS: A total of 102 procedures were carried out on 99 patients. Mean patient age was 72 months and 58.8% of the patients were female. Over 65% of the indications for liver biopsy included autoimmune hepatitis (23.5%), elevated liver enzymes (21.5%), and chronic liver disease (20.5%). Four patients presented with immediate complications (3.9%), three of which were major (2.9%), concurring with that reported in the international literature. CONCLUSIONS: Our study corroborates the importance of ultrasound-guided liver biopsy in the diagnosis and follow-up of pediatric patients. The procedure also had a low complication rate of only 3.9%.

Ultrasound-guided percutaneous liver biopsy in children. Five-year experience at a tertiary care center. / Biopsia hepática percutánea guiada por ultrasonido en pediatría. Experiencia de 5 años en un centro de tercer nivel.

INTRODUCTION AND AIMS: Percutaneous liver biopsy with histopathologic analysis is a valuable tool for the diagnosis, prognosis, and treatment evaluation of liver diseases. Its ultrasound-guided performance is useful, making the procedure safer and reducing the risk for complications and hospital stay. Our aim was to describe the indications, histopathologic study, and complications associated with the performance of ultrasound-guided percutaneous liver biopsy in pediatric patients. MATERIAL AND METHODS: The study included 102 ultrasound-guided percutaneous liver biopsies performed on patients <16 years of age, within the time frame of January 2014 and December 2019. The information was obtained from electronic files and histopathologic studies and the data were analyzed through descriptive statistics. RESULTS: A total of 102 procedures were carried out on 99 patients. Mean patient age was 72 months and 58.8% of the patients were female. Over 65% of the indications for liver biopsy included autoimmune hepatitis (23.5%), elevated liver enzymes (21.5%), and chronic liver disease (20.5%). Four patients presented with immediate complications (3.9%), three of which were major (2.9%), concurring with that reported in the international literature. CONCLUSIONS: Our study corroborates the importance of ultrasound-guided liver biopsy in the diagnosis and follow-up of pediatric patients. The procedure also had a low complication rate of only 3.9%.

Mucormicosis Rinocerebral asociado a Cetoacidosis diabética / Rhinocerebral Mucormycosis associated to diabetic ketoacidosis

Mucormycosis is an infrequent fungal infection This infection is difficult to diagnose and treat and have a high morbility and mortality and affects immunocompromised patients, especially those patients with decompensated diabetes mellitus. We report the case of a 60 years old diabetic patient with poor metabolic control who was admitted for diabetic ketoacidosis and days later present right periorbital swelling and pain, is diagnosed of mucomycosis and is successfully treated with amphoterin B and surgery.

Acute Abdomen Secondary to a Spontaneous Perforation of the Biliary Tract, a Rare Complication of Choledocholithiasis.

INTRODUCTION: The spontaneous perforation of the biliary tract (SPBT) is an extremely rare cause of peritonitis, which was first described by Freeland in 1982, to date only around 70 cases have been reported. Here we present a case of spontaneous perforation of the biliary tract, in a patient with choledocholithiasis, which was treated with ultrasound-guided drainage and ERCP. CASE REPORT: A 51-year-old male was admitted to the emergency room for 15-day evolution jaundice, localized pain in the right flank and hypochondrium of 3days. He had a history of cholecystectomy 15 years ago and 4 episodes of cholangitis, the last one in 2015. A magnetic resonance imaging (MRI) was performed, that showed evidence of choledocholithiasis, in addition to a possible biliary leakage. The patient was treated with ultrasound-guided drainage and ERCP successfully. DISCUSSION: Spontaneous perforation of the biliary tract is a disease entity in which wall of the extrahepatic or intrahepatic duct is perforated without any traumatic or iatrogenic injury. The clinical presentation varies from nonspecific abdominal pain to biliary peritonitis, in most of the cases forming bilomas. Universal management involves decompression of the biliary tree and repair of the leak site. CONCLUSION: The spontaneous perforation of the biliary tract is a disease that represents a diagnostic challenge. The treatment in the patients with SPBT is not well established and has to be individualized for each case, depending on the history of the patient, the site of perforation, the time of evolution, the suspicion of infection, and the patient status.

Dopamine D2 and angiotensin II type 1 receptors form functional heteromers in rat striatum.

Identification of G protein-coupled receptors and their specific function in a given neuron becomes essential to better understand the variety of signal transduction mechanisms associated with neurotransmission. We hypothesized that angiotensin II type 1 (AT1) and dopamine D2 receptors form heteromers in the central nervous system, specifically in striatum. Using bioluminescence resonance energy transfer, a direct interaction was demonstrated in cells transfected with the cDNA for the human version of the receptors. Heteromerization did not affect cAMP signaling via D2 receptors but attenuated the coupling of AT1 receptors to Gq. A common feature of heteromers, namely cross-antagonism, i.e. the blockade of the signaling of one receptor by the blockade of the partner receptor, was tested in co-transfected cells. Candesartan, the selective AT1 receptor antagonist, was able to block D2-receptor mediated effects on cAMP levels, MAP kinase activation and ß-arrestin recruitment. This effect of candesartan, which constitutes a property for the dopamine-angiotensin receptor heteromer, was similarly occurring in primary cultures of neurons and rat striatal slices. The expression of heteromers in striatum was confirmed by robust labeling using in situ proximity ligation assays. The results indicate that AT1 receptors are expressed in striatum and form heteromers with dopamine D2 receptors that enable drugs selective for the AT1 receptor to alter the functional response of D2 receptors.

[Analysis of factors conditioning admission at the critical care unit of surgical patients. Prospective study of 764 patients operated for 1 year at a university and reference hospital]. / Análisis de los factores que condicionan el ingreso de los pacientes quirúrgicos en una unidad de críticos. Un estudio prospectivo sobre 764 pacientes intervenidos durante 1 año en un hospital universitario y de referencia.

OBJECTIVE: Assess what factors determine the income of surgical patients in critical care unit after surgery. MATERIAL AND METHODS: It included a survey of the 10% of all patients operated by the services of General Surgery, Thoracic Surgery, Maxillofacial Surgery, Vascular Surgery, Urology and Otolaryngology during 2012. We performed a prospective, observational study. Pre-, intra-, and post-operative variables were analyzed. Comparisons were made between patients operated under elective and emergency surgery, and between patients admitted in critical care and admitted directly in the ward, using χ(2) of Pearson correlation with a confidence interval of 95%. RESULTS: Seven hundred and sixty-four patients were included into the study, 304 were admitted in critical care after surgery and 460 were admitted in the ward. The medical history showed a statistically significant association with intensive care unit admission, well as the fact of being labeled with a high risk for the risk scales. Complexity and duration of the surgery showed a statistically significant association with intensive care unit admission, as well as the fact of present intra-operative complications. Emergency surgery was not significantly associated with intensive care unit admission of surgical patients, although these patients had significantly higher numbers of intra- and post-operative complications, and more exitus than those undergoing elective surgery. CONCLUSIONS: A greater incidence of intensive care unit admission of patients undergoing emergency surgery should significantly reduce morbimortality rate. The existence of specific protocols for intensive care unit admission for urgent surgery, and greater availability of beds could be useful in this regard.

Polymeric micelles containing reversibly phospholipid-modified anti-survivin siRNA: a promising strategy to overcome drug resistance in cancer.

The discovery that survivin, a small anti-apoptotic protein, is involved in chemoresistance, opens a new scenario to overcome the drug resistance in cancer. It was shown that siRNA can efficiently inhibit the expression of survivin in cancer cells. However, the clinical use of siRNA is still hampered by an unfavorable pharmacokinetic profile. To address this problem, earlier we developed a novel system to deliver siRNA into cancer cells. Namely, we reversibly modified the survivin siRNA with a phosphothioethanol (PE) portion via a reducible disulfide bond and incorporated the resulting siRNA-S-S-PE conjugate into nanosized polyethyelene glycol 2000-phosphatidyl ethanolamine (PEG2000-PE)-based polymeric micelles (PM), obtaining survivin siRNA PM. The activity of these nanopreparations was evaluated by survivin protein down-regulation, tumor cell growth inhibition, and chemosensitization of the treated tumor cells to paclitaxel (PXL). We found a significant decrease of cell viability and down-regulation of survivin protein levels after treatment with survivin siRNA PM in several cancer cell lines. In addition, the down-regulation of survivin by treating cells with survivin siRNA PM, elicited a significant sensitization of the cells to PXL, in both sensitive and resistant cancer cell lines. Finally, we demonstrated successful co-delivery of PXL and survivin siRNA in the same PM leading to superior therapeutic activity compared to their sequential administration. Our results support the use of this new platform for the treatment of the most aggressive tumors.

Optimal timing for initiation of highly active antiretroviral therapy in treatment-naïve human immunodeficiency virus-1-infected individuals presenting with AIDS-defining diseases: the experience of the PISCIS Cohort.

In this prospective, multicentre cohort study, we analysed specific prognostic factors and the impact of timing of highly active antiretroviral therapy (HAART) on disease progression and death among 625 human immunodeficiency virus (HIV)-1-infected, treatment-naïve patients diagnosed with an AIDS-defining disease. HAART was classified as early (<30 days) or late (30-270 days). Deferring HAART was significantly associated with faster progression to a new AIDS-defining event/death overall (p 0.009) and in patients with Pneumocystis jiroveci pneumonia (p 0.017). In the multivariate analysis, deferring HAART was associated with a higher risk of a new AIDS-defining event/death (p 0.002; hazard ratio 1.83; 95% CI 1.25-2.68). Other independent risk factors for poorer outcome were baseline diagnosis of AIDS-defining lymphoma, age >35 years, and low CD4(+) count (<50 cells/µL).

Oestrogens improve human pancreatic islet transplantation in a mouse model of insulin deficient diabetes.

AIMS/HYPOTHESIS: Pancreatic islet transplantation (PIT) offers a physiological treatment for type 1 diabetes, but the failure of islet engraftment hinders its application. The female hormone 17ß-oestradiol (E2) favours islet survival and stimulates angiogenesis, raising the possibility that E2 may enhance islet engraftment following PIT. METHODS: To explore this hypothesis, we used an insulin-deficient model with xenotransplantation of a marginal dose of human islets in nude mice rendered diabetic with streptozotocin. This was followed by 4 weeks of treatment with vehicle, E2, the non-feminising oestrogen 17α-oestradiol (17α-E2), the oestrogen receptor (ER) α agonist propyl-pyrazole-triol (PPT), the ERß agonist diarylpropionitrile (DPN) or the G protein-coupled oestrogen receptor (GPER) agonist G1. RESULTS: Treatment with E2, 17α-E2, PPT, DPN or G1 acutely improved blood glucose and eventually promoted islet engraftment, thus reversing diabetes. The effects of E2 were retained in the presence of immunosuppression and persisted after discontinuation of E2 treatment. E2 produced an acute decrease in graft hypoxic damage and suppressed beta cell apoptosis. E2 also acutely suppressed hyperglucagonaemia without altering insulin secretion, leading to normalisation of blood glucose. CONCLUSIONS/INTERPRETATION: During PIT, E2 synergistic actions contribute to enhancing human islet-graft survival, revascularisation and functional mass. This study identifies E2 as a short-term treatment to improve PIT.

Micronucleated lymphocytes in parents of Down syndrome children

Down syndrome (DS) is the most common disease due to an autosomal aneuploidy in live born children and also the major known genetic cause of mental retardation. The risk of a DS pregnancy increases substantially with increasing maternal age. However, several women aged less than 35 years at conception have a child with DS. The micronucleus (MN) assay can identify chromosome breakage or chromosome malsegregation and is an ideal biomarker to investigate genomic instability. The aim of the present study was to determine the frequency of peripheral lymphocytes with MN in the parents of DS individuals. The subjects were 17 couples, 1 father and 9 mothers, and 24 couples who had at least one healthy child formed the control group. For each individual we evaluated the frequency of binucleated micronucleated lymphocytes (BNMN%) as number of binucleated lymphocytes containing one or more MN per 1000 binucleated cells. The mean age of DS parents and controls was 32.6 and 29.8 years, respectively. The frequency of MN in DS parents was significantly higher compared to controls. The higher frequency of MN in DS parents suggests a higher predisposition of DS parents to aneuploidy events in this sample.

The postprandial inflammatory response after ingestion of heated oils in obese persons is reduced by the presence of phenol compounds.

SCOPE: Heating during the process of cooking alters the chemical properties of foods and may affect subsequent postprandial inflammation. We tested the effects of four meals rich in different oils subjected to heating on the postprandial inflammatory metabolism of peripheral blood mononuclear cells (PBMCs). METHODS AND RESULTS: Twenty obese participants received four breakfasts following a randomized crossover design, consisting of milk and muffins made with different oils (virgin olive oil (VOO), sunflower oil (SFO), and a mixture of seeds oil (SFO/canola oil) with added either dimethylpolysiloxane (SOD), or natural antioxidants from olive mill wastewater alperujo (phenols; SOP)), previously subjected to 20 heating cycles. Postprandial inflammatory status in PBMCs was assessed by the activation of nuclear NF-κB, the concentration in cytoplasm of the NF-κB inhibitor (IκB-α), the mRNA levels of NF-κB subunits and activators (p65, IKKß, and IKKα) and other inflammatory molecules (TNF-α, IL-1ß, IL-6, MIF, and JNK), and lipopolysaccharide (LPS) levels. VOO and SOP breakfasts reduced NF-κB activation, increased IκB-α, and decreased LPS plasma concentration. SFO increased IKKα, IKKß, p65, IL-1b, IL-6, MIF, and JNK mRNA levels, and plasma LPS. CONCLUSION: Oils rich in phenols, whether natural (VOO) or artificially added (SOP), reduce postprandial inflammation, compared with seed oil (sunflower).

Photocatalytic degradation of eight pesticides in leaching water by use of ZnO under natural sunlight.

Photodegradation of eight pesticides in leaching water at pilot plant scale using the tandem ZnO/Na(2)S(2)O(8) as photosensitizer/oxidant and compound parabolic collectors under natural sunlight is reported. The pesticides, habitually used on pepper culture and belonging to different chemical groups were azoxyxtrobin, kresoxim-methyl, hexaconazole, tebuconazole, triadimenol, and pyrimethanil (fungicides), primicarb (insecticide), and propyzamide (herbicide). As expected, the influence of the semiconductor used at 150 mg L(-1) on the degradation of pesticides was very significant in all cases. Photocatalytic experiments show that the addition of photosensitizer strongly improves the elimination of pesticides in comparison with photolytic tests; significantly increasing the reaction rates. The use of Na(2)S(2)O(8) implies a significant reduction in treatment time showing a quicker reaction time than ZnO alone. On the contrary, the addition of H(2)O(2) into illuminated ZnO suspensions does not improve the rate of photooxidation. The disappearance of the pesticides followed first-order kinetics according to Langmuir-Hinshelwood model and complete degradation occurs from 60 to 120 min. The disappearance time (DT(75)), referred to the normalized illumination time (t(30 W)) was lower than 3 min in all cases.

Reparación del prolapso anterior por vía vaginal con malla subvesical sin tensión: técnica quirúrgica / Anterior vaginal wall prolapse repair with subvesical tension free mesh: surgical technique

El prolapso de la pared anterior de la vagina es una patología muy frecuente queocasiona gran impacto en la calidad de vida de las mujeres que lo padecen. Es sabidoque la reparación quirúrgica tradicional del cistocele presenta altas tasas de recidiva.Por esta razón y gracias a los conceptos de la biocirugía, se han desarrollado variadastécnicas quirúrgicas utilizando mallas de polipropileno para disminuir su recurrencia.Se presenta a continuación la descripción de la técnica quirúrgica utilizando una mallade polipropileno y ácido poliglactínico, colocada sin tensión ni fijación para la reparacióndel prolapso anterior grado II y III.

Anterior vaginal wall prolapse is a very frecquent entity has a very impact on quality of life. Classic cistocele repair has a very high relapse rate. For this reason, and to avoid repair failure, many surgical techniques have evolved using polipropylene meshes. We report our surgical technique using a tension free polypropylene and poliglactin acid mesh for grade II and III anterior wall prolapse.

Reparación del cistocele por vía vaginal con malla subvesical sin tensión: técnica y resultados / Tension-free vaginal mesh repair for anterior vaginal wall prolapse: technique and outcomes

Objetivos: Determinar la eficacia y tolerancia de la interposición de una malla de polipropileno monofilamento colocada sin tensión por vía vaginal bajo la vejiga para la corrección quirúrgica del cistocele, evaluando sus resultados anatómicos postoperatorios, la mejoría en la calidad de vida y sus complicaciones a mediano plazo. Pacientes y Método: El ensayo incluyó a 28 mujeres consecutivas (edad promedio 64 años), portadoras de cistocele grado II o III según la clasificación POP-Q, quienes fueron intervenidas entre septiembre de 2004 y octubre de 2006. Después de una completa disección de la vejiga y plicatura de la fascia perivesical, se labraron 2 túneles laterales hasta perforar la fascia endopélvica a cada lado; luego se configuró la malla de polipropileno monofilamento (Ginemesh®), dimensionada con un cuerpo central y dos ramas laterales, posicionándola sin tensión ni fijación bajo la vejiga, introduciendo y abandonando sus extensiones laterales hacia el espacio paravesical. Del total de la serie, 8 pacientes tenían cistocele G II (29 por ciento) y 20 tenían prolapso G III (71 por ciento); 11 mujeres presentaban además IOE (39 por ciento). El promedio de duración de la cirugía fue de 30 minutos. Como evaluación del resultado anatómico se utilizó la clasificación POP-Q. Para evaluar la satisfacción personal objetiva se usó el cuestionario validado de calidad de vida (I-QOL) al 3º, 6º y 12º mes post cirugía. El promedio de seguimiento fue de 18 meses (10-36).Resultados: La cirugía fue realizada sin problemas en todas las pacientes. La tasa de complicaciones tempranas fue de 7 por ciento (una erosión vaginal y 1 hematoma severo). No se reportó infección de la malla. La tasa de éxito fue de un 93 por ciento. Al sexto mes, el índice de satisfacción en la calidad de vida fue de 89 por ciento, al 12º mes fue de 86 por ciento...

Objectives: To determine the efficacy and tolerance of the introduction of a vaginal tension-free monofilament polypropylene mesh placed under the bladder for the surgical correction of cystocele. Patients and Methods: The trial included 28 consecutive women mean age 64 years), with diagnosis of grade II - III cystocele based on POP-Q classification, who were operated between September2004 and October 2006. Surgical technique include a complete dissection of the bladder and fixation of perivesical fascia. Two laterals tunnels were developed to pierce the lateral side of the endopelvic fascia at either side. Then a designed monofilament polypropylene mesh (Ginemesh ®), was placed without any tension free the bladder, positioning their lateral extensions into paravesical space. We evaluated the postoperative anatomical results, improvement in the quality of life and mid-terms complications. Results: Of the total series, 8 patients had G II cystocele (29 percent) and 20 had G III prolapse (71 percent ), 11women had also SUI (39 percent). Mean operative time for surgery was 30 minutes. Anatomical results were objectively measured with POP-Q classification. Evaluate of personal satisfaction was done by application of a validated questionnaire of quality of life (I-QOL) that was full filled at 3, 6 and 12months post surgery. Mean follow-up of the series was 18 months (10-36). No operative complication occurred. Early complication rate was 7 percent (a vaginal erosion and severe bruising ). No infection was reported in the mesh. The success rate for the series was 93 percent. At the sixth month, the rate of satisfaction in the quality of life was has been 89 percent and 86 percent at 12 months...

Nefrectomía laparoscópica transperitoneal video asistida: resultados de nuestra experiencia inicial / Transperitoneal laparoscopic nephrectomy: inicial experience

Desde la introducción de la laparoscopía avanzada en urología, se han descrito distintos abordajes video asistidos por vía transperitoneal y lumboscópica en el tratamiento del cáncer renal etapa T1 y para la nefrectomía por causa no oncológica. En la actualidad la cirugía laparoscópica en tumores renales órgano confinados y riñones hipofuncionantes se ha transformado en una alternativa superior a la cirugía abierta tradicional, considerando que posee una menor morbilidad peri operatoria y la misma seguridad oncológica. Objetivos: Describir la experiencia inicial de nuestro Servicio en una serie consecutiva de pacientes, sometidos a nefrectomía radical laparoscópica transperitoneal por cáncer renal estadio T1, y nefrectomía total transperitoneal por causa no oncológica, evaluando el tiempo de duración quirúrgico, complicaciones peri operatorias, estadía intrahospitalaria y dolor post operatorio. Pacientes y Método: Nuestra serie prospectiva se constituyó por 21 pacientes consecutivos que fueron intervenidos entre mayo de 2006 a julio de 2007. Del total de pacientes (12 mujeres y 9 hombres), 11 se intervinieron por cáncer renal etapa T1 y el resto (n= 10) por patología benigna:atrofia o hipotrofia renal, cálculos coraliformes en riñones no funcionantes e hidroureteronefrosis (HUN) con atrofia de parénquima. En un caso se realizó una heminefrectomía laparoscópica por atrofia e HUN severa del sistema pielocaliciario superior. Todos se intervinieron por vía transperitoneal utilizando 3 ó 4 puertos de acceso abdominal en posición de decúbito parcial lateralizado modificada, realizando la 1a incisión para el laparoscopio siempre lateral al ombligo. En los primeros 6 pacientes sólo se utilizó corriente monopolar en tanto que en el resto siguiente se usó electro bisturí bipolar y radiofrecuencia (Ligasure®). Para la ligadura vascular se utilizó según preferencia Hem-olok® y/o endo gia universal®. Los datos fueron registrados en una planilla...

Different approaches have been described for laparoscopic radical nephrectomy (LRN). Both oncologic and benign pathology bearing patients benefit from the advantages of the laparoscopic approach. We report our initial experience in a series of consecutive patients that underwent nefrecto laparoscopic radical nephrectomy for T1 stage renal tumors and non oncologic causes. Operative time, postoperative pain, perioperative complications and hospital stay are evaluated. Patients and method: A total of 21 patients underwent LRN between May 2006 and July 2007. Male to female ratio was 3:4. Out of these, 11 were for T1 renal tumors, the other 10 underwent LRN for renal atrophy, stag horn calculi in non functioning kidneys. In one case partial nephrectomy was performed in a patient with atrophy of superior calicial system. All patients underwent a transperitoneal approach using a 3 to 4 trocar layout with the patient in a partial lateral decubitous. Different cutting devices were employed along with both Hem-o-lok® and endo gia universal®. All data was collected prospectively. Results: All patients were operated by the same surgeon. Mean operative time was 161 minutes (range 54-300). Operative bleeding was 146 ml (20-1800), 4 patients required blood transfusion. Two patients required conversion to open surgery for venous bleeding and diaphragmatic lesion. Mean hospital stay was 4.8 days (2-6 days). No patient required epidural steroids. Conclusion: Laparoscopic radical nephrectomy is a safe alternative for malignant and benign pathology. Considerable advantages make it preferable over open surgery.

Impacto de gastroenteritis severa por rotavirus en niños chilenos menores de 3 años de edad / Incidence of severe rotavirus gastroenteritis among Chilean children under three years of age

Background: Rotavirus infections account every year in Chile, for approximately 53,000 emergency consultations and 8,000hospital admissions among children under three years of age. Aim: To estimate incidence rates of severe rotavirus gastroenteritis in children <3 years of age, living in the V and VIII Regions and to identify the predominant viral serotypes. Material and methods: A prospective hospital-based surveillance for severe gastroenteritis was implemented in public and private hospitals of Viña del Mar and Valparaiso (Region V) and of Chiguayante, Concepción, Penco, San Pedro de la Paz, Talcahuano and Tomé (Region VIII). All children <3 years of age residing in the districts, who consulted for severe gastroenteritis requiring oral or intravenous rehydration (equivalent to WHO plan B or C), or who were admitted to the hospital, were enrolled. Demographic and clinical information and a stool sample were obtained. Rotavirus was detected by ELISA and positive samples were serotyped by ELISA or real time PCR. Results: Between January 23 and June 30, 2003, a total of 760 children were recruited. Among these, 343 (45 percent) were admitted to the hospital. Stool samples were collected from 433 children. Among these, 214 were positive for rotavirus (49.4 percent). Overall, monthly disease incidence rates were 124/100,000 in V Region, and 114/100,000 in VIIIRegion. The predominant serotype was G4. Conclusions: Rotavirus was responsible for nearly half of the severe gastroenteritis episodes among children <3 years, during a predominantly G4 serotype season. Every year, approximately one every 70 children <3 years will have a severe rotavirus gastroenteritis episode.

Influence of the neo-adjuvant radiochemotherapy as a factor in the surgical treatment of rectal cancer by expert surgeon. A comparative study.

BACKGROUND AND AIMS: Total mesorectal excision and surgeon experience are prognostic factors in rectal cancer surgery, in terms of local recurrence and conservative sphincter surgery. Pre-operative radiation-chemotherapy can even improve those results. The aim of this study is to assess the utility of pre-operative radiation therapy (PRT) on the results of surgical treatment for rectal cancer comparing two consecutive series of patients operated on by surgeons with experience in rectal cancer surgery according to whether they had received PRT. MATERIALS AND METHODS: Retrospective review of 118 patients with rectal cancer, divided into two groups: group I, 57 patients without pre-operative radiation-chemotherapy, and group II, 61 patients with rectal cancer who received pre-operative radiation-chemotherapy. Both groups were homogeneous. The short-term results (surgical technique, post-operative stay, post-operative complications) and long-term results (local recurrences, liver metastases and both overall and tumour-related survival) were analysed. RESULTS: The rate of anterior resection in the lower third was significantly higher (p = 0.037) in group II than in group I (56 vs 23%), the rate of abdominoperineal resection in the middle third was significantly lower (p = 0.046) in group II (3.5 vs 21%). The incidence of post-operative complications was similar in both groups, but the rate of anastomotic leaks was higher in group II. The local recurrences was lower in group II (p = 0.002), but the disease free survival and the overall survival was similar in both groups. At the multivariate analysis, the only prognostic factor for the local recurrence was the use of pre-operative radiation-chemotherapy. CONCLUSION: Besides surgeon experience and total mesorectal excision, a very important prognostic factor is the administration of pre-operative radiation-chemotherapy in cases of locally advanced rectal cancer, as it does not increase post-operative morbidity and mortality and significantly influences the rate of local recurrences and the conservative sphincter surgery.