Selective effects of a brain tumor on the metric representation of the hand: a pre- versus post-surgery comparison.

Body representation disorders are complex, varied, striking, and very disabling in most cases. Deficits of body representation have been described after lesions to multimodal and sensorimotor cortical areas. A few studies have reported the effects of tumors on the representation of the body, but little is known about the changes after tumor resection. Moreover, the impact of brain lesions on the hand size representation has been investigated in few clinical cases. Hands are of special importance, as no other body part has the ability for movement and interaction with the environment that the hands have, and we use them for a multitude of daily activities. Studies with clinical population can add further knowledge into the way hands are represented. Here, we report a single case study of a patient (AM) who was an expert bodybuilder and underwent a surgery to remove a glioblastoma in the left posterior prefrontal and precentral cortex at the level of the hand's motor region. Pre- (20 days) and post- (4 months) surgery assessment did not show any motor or cognitive impairments. A hand localization task was used, before and after surgery (12 months), to measure possible changes of the metric representation of his right hand. Results showed a post-surgery modulation of the typically distorted hand representation, with an overall accuracy improvement, especially on width dimension. These findings support the direct involvement of sensorimotor areas in the implicit representation of the body size and its relevance on defining specific size representation dimensions.

Occipital encephalocele associated with Dandy-Walker malformation: a case-based review.

INTRODUCTION: Occipital encephalocele is a brain malformation that has been remotely associated with Dandy-Walker; only case reports and very small series have been published so far; therefore, their behavior and management are still under investigation. The goal of the present case-based review is to provide a summary of the state of the art in this association. METHODS AND RESULTS: The pertinent literature has been reviewed, and an exemplary case has been reported (an 11-month-old female with Dandy-Walker malformation and occipital encephalocele). So far, 33 cases have been described, with a mean age at surgery of 5, 1 day). The majority of the cases tend to present with hydrocephalus. There are no specific surgery approaches or global consensus about this association. The management possibly relies on surgery with shunt or encephalocele excision but without a dedicated protocol yet. CONCLUSIONS: The clinical research on occipital encephalocele in association with Dandy-Walker malformation is just at the beginning. New targets and wide-ranging clinical trials are needed to get an optimal management protocol.

Bloodstream Infections With Candida auris Among Children in Colombia: Clinical Characteristics and Outcomes of 34 Cases.

BACKGROUND: Candida auris is an emerging multidrug-resistant yeast that can cause invasive infections and healthcare-associated outbreaks. Here, we describe 34 cases of pediatric C. auris bloodstream infections (BSIs) identified during July 2014-October 2017 in 2 hospitals in Colombia. METHODS: We conducted a retrospective review of microbiology records for possible C. auris cases in 2 hospitals in Barranquilla and Cartagena. BSIs that occurred in patients aged <18 years confirmed as C. auris were included in this analysis. RESULTS: We identified 34 children with C. auris BSIs. Twenty-two (65%) patients were male, 21% were aged <28 days, 47% were aged 29-365 days, and 32% were aged >1 year. Underlying conditions included preterm birth (26%), being malnourished (59%), cancer (12%), solid-organ transplant (3%), and renal disease (3%). Eighty-two percent had a central venous catheter (CVC), 82% were on respiratory support, 56% received total parenteral nutrition (TPN), 15% had a surgical procedure, and 9% received hemodialysis. Preinfection inpatient stay was 22 days (interquartile range, 19-33 days), and in-hospital mortality was 41%. CONCLUSIONS: Candida auris affects children with a variety of medical conditions including prematurity and malignancy, as well as children with CVCs and those who receive TPN. Mortality was high, with nearly half of patients dying before discharge. However, unlike most other Candida species, C. auris can be transmitted in healthcare settings, as suggested by the close clustering of cases in time at each of the hospitals.Candida auris is an emerging multidrug-resistant yeast that can cause invasive infections and healthcare-associated outbreaks. This report describes 34 cases of pediatric C. auris bloodstream infections, identified in two hospitals in Colombia, South America.

Type and Consequences of Short-Term Complications in Colon Cancer Surgery, Focusing on the Oldest Old.

BACKGROUND: While the proportion of colon cancer occurring in older patients is expected to increase, these patients may have more complications that may lead to serious consequences. The aim of this study was assess postoperative complications and their short-term consequences in colon cancer surgery according to age. PATIENTS AND METHODS: Patients undergoing surgery for primary invasive colon cancer in 22 centers between June 2010 and December 2012 were included. Presurgical and surgical variables were analyzed, and in-hospital major postoperative complications and its most serious consequence (no relevant, transfusion, reintervention, admission to the intensive care unit, or death) were estimated according to age group. Chi-square tests were used to analyze the possible associations between variables and age groups. RESULTS: Data from 1976 patients, mean (range) age 68 (24-97) years, 62% men, were analyzed; 52.2% were aged > 69 years and 17.7% were aged > 79 years. The complication rate was 25.3%, reaching 30.9% in those aged ≥ 80 years. Older age was associated with a higher rate of postoperative infections during the hospital stay. The most common surgical complication in patients aged > 85 years was dehiscence of the anastomosis (11.5%). About 5% of patients with major complications died in the hospital (11.1% of those aged 80-84 years and 14.3% aged > 85 years). Among patients aged > 85 years, 38.1% required transfusions. CONCLUSION: Older patients should receive appropriate functional preparation before the intervention, and when the risks of the intervention outweigh the potential benefits, a nonsurgical approach may be preferable.

[Functional impairment and quality of life after rectal cancer surgery]. / Afectación funcional y calidad de vida tras cirugía de cáncer rectal.

OBJECTIVE: This study determines the quality of life and the anorectal function of these patients. METHOD: Observational study of two cohorts comparing patients undergoing rectal tumor surgery using TaETM or conventional ETM after a minimum of six months of intestinal transit reconstruction. EORTC-30, EORTC-29 quality of life questionnaires and the anorectal function assessment questionnaire (LARS score) are applied. General variables are also collected. RESULTS: 31 patients between 2011 and 2014: 15 ETM group and 16 TaETM. We do not find statistically significant differences in quality of life questionnaires or in anorectal function. Statistically significant general variables: longer surgical time in the TaETM group. Nosocomial infection and minor suture failure in the TaETM group. CONCLUSION: The performance of TaETM achieves the same results in terms of quality of life and anorectal function as conventional ETM.

ANTECEDENTES: La técnica de referencia de la cirugía rectal sigue siendo la escisión total del mesorrecto (ETM), en la que se aplica la laparoscopia por sus ventajas. El intento de evitar el 17% de reconversión hace que se apliquen técnicas transanales. La ETM transanal (TaETM) se lleva a cabo por grupos experimentales con buenos resultados oncológicos y de morbimortalidad. OBJETIVO: Este estudio determina la calidad de vida y la función anorrectal de estos pacientes. MÉTODO: Estudio observacional de dos cohortes que compara pacientes intervenidos por tumor rectal mediante TaETM o ETM convencional después de 6 meses mínimo de la reconstrucción del tránsito intestinal. Se aplican los cuestionarios de calidad de vida EORTC-30 y EORTC-29, y el cuestionario de valoración de función anorrectal (LARS score). También se recogen variables generales. RESULTADOS: Entre 2011 y 2014 fueron intervenidos 31 pacientes: 15 en el grupo de ETM y 16 en el de TaETM. No se encuentran diferencias estadísticamente significativas en cuanto a cuestionarios de calidad de vida ni respecto a la función anorrectal. Variables generales estadísticamente significativas: tiempo quirúrgico mayor en el grupo TaETM, e infección nosocomial y fallo de sutura menores en el grupo TaETM. CONCLUSIÓN: La realización de TaETM obtiene los mismos resultados en cuanto a calidad de vida y función anorrectal que la ETM convencional. BACKGROUND: The gold standard of rectal surgery remains total mesorrectal excision (ETM) in which laparoscopy is applied for its advantages. The attempt to avoid 17% conversion rate implies that transanal techniques are applied. Transanal ETM (TaETM) is performed by experimental groups with good oncological and morbimortality results.

Parámetros sanguíneos y perfil de hormonas reproductivas de hembras de Choloepus hoffmanni en cautiverio / Blood parameters and reproductive hormone profile of female Choloepus hoffmanni in captivity

Resumen El uso de técnicas no invasivas ni estresantes para determinar perfiles hormonales, como la medición de esteroides fecales, ha incrementado la comprensión de la fisiología reproductiva en animales silvestres. Debido a la escasa información con respecto a perfiles hormonales reproductivos del perezoso de dos dedos, Choloepus hoffmani, se realizó un estudio en hembras en cautiverio en el centro de rescate "Sloth Sanctuary" (Cahuita, Limón, Costa Rica) con el fin de determinar (i) la confiabilidad de la extracción de progesterona y estradiol en heces, y su cuantificación en el analizador AIA-360®, (ii) evaluar los parámetros sanguíneos en esta especie y (iii) establecer si existe una correlación entre los esteroides plasmáticos y fecales. El estudio se realizó en un periodo de tres meses, durante noviembre de 2013 a enero de 2014, con un total de 208 muestras de heces provenientes de cinco hembras sexualmente maduras, con peso promedio de 6.32 kg. El promedio de las concentraciones medianas en las heces de las cinco hembras fue 124.21 ng/g para progesterona y 1 708.95 pg/g de estradiol. En plasma, los valores de mediana fueron 1.26 ng/mL con un mínimo de 0.32 ng/mL y 12.84 ng/mL como valor máximo; los valores plasmáticos de estrógeno se encontraron por debajo del límite de detección del equipo (25 pg/mL). Aunque no se encontró una correlación estadísticamente significativa entre la progesterona plasmática y la fecal, nuestros datos sugieren que los eventos plasmáticos se reflejan en heces durante los dos días posteriores. Asimismo, los niveles de progesterona se mantuvieron elevados durante la primera mitad de noviembre, y posteriormente mostraron una reducción importante en todas las hembras. Nuestros resultados demuestran que las extracciones en heces y su medición en el AIA-360® permiten la detección y el seguimiento de variaciones hormonales en C. hoffmani, aunque no remplaza las mediciones plasmáticas para determinar valores absolutos.

Abstract In wild animal species, the use of non-invasive and non-stressful procedures to determine hormone profiles, such as fecal steroid measurements, has considerably increased the comprehension of their reproductive physiology. Since there is limited information related to the reproductive hormone profiles of the two-toed sloth, Choloepus hoffmani, a study was conducted in captive specimens at the "Sloth Sanctuary" (Cahuita, Limón, Costa Rica), in order to determine: (i) the reliability of the fecal progesterone and estrogen extraction and its quantification with an AIA-360® analyzer, (ii) assess blood parameters in this species and (iii) evaluate if there is a correlation between fecal and plasmatic steroids. The study was performed over a three-month period, from November, 2013 to January, 2014, with a total amount of 208 fecal samples collected from five sexually mature females weighing 6.32 kg in average. The average of the median concentrations of progesterone in feces of the five females was 124.21 ng/g, and 1 708.95 pg/g for estrogen. The average minimal and maximal values were 50.96 ng/g and 1 057.46 ng/g for progesterone and, 1 191.77 pg/g and 2 159.24 pg/g for estradiol. In plasma, progesterone median values were 1.26 ng/mL, showing a minimum of 0.32 ng/mL and 12.84 ng/mL as maximum values. The plasmatic estrogen levels were below the detection limit of the equipment (25 pg/mL). Although there was no strong statistical correlation between the fecal and plasmatic progesterone fluctuations, our data suggests that the plasmatic events are mostly reflected in feces two days afterwards. Also, the levels of progesterone were elevated during the first half of November and, subsequently, showed a successive and important reduction in all the females tested. Finally, our results demonstrated that fecal steroid extractions and their measurement in a AIA-360®, allowed the successful detection and represents an alternative non-invasive determination of hormone profiles in C. hoffmani. Rev. Biol. Trop. 66(1): 280-292. Epub 2018 March 01.

Subtotal colectomy versus left hemicolectomy for the elective treatment of splenic flexure colonic neoplasia.

BACKGROUND: Optimal elective surgical treatment for splenic flexure neoplasm (SFN) is unclear. Subtotal colectomy (STC) and left hemicolectomy (LHC) are the two more common strategies used. METHODS: Observational multicentric study comparing postoperative morbidity, mortality and long-term survival on patients with SFN electively operated by STC versus LHC between 2003 and 2014. RESULTS: After revision of the databases, 144 patients were included (STC group, n = 68; LHC group, n = 76). No differences were found on epidemiological and surgical data. A higher global morbidity (58%vs37%, p = 0.014), surgical morbidity (50%vs33%, p = 0.037), postoperative ileus (37%vs20%, p = 0.023) and harvested lymph nodes (26vs18, p = 0.0001) were found on the STC group. No significant differences in complications according to severity, reoperation rate, hospital stay, mortality, recurrence or long-term survival were found between groups. CONCLUSIONS: A higher surgical morbidity was found on the STC group, mainly due to mild postoperative ileus. No differences on long-term oncological results were found.

COPD is a clear risk factor for increased use of resources and adverse outcomes in patients undergoing intervention for colorectal cancer: a nationwide study in Spain.

BACKGROUND: We hypothesized that patients undergoing surgery for colorectal cancer (CRC) with COPD as a comorbidity would consume more resources and have worse in-hospital outcomes than similar patients without COPD. Therefore, we compared different aspects of the care process and short-term outcomes in patients undergoing surgery for CRC, with and without COPD. METHODS: This was a prospective study and it included patients from 22 hospitals located in Spain - 472 patients with COPD and 2,276 patients without COPD undergoing surgery for CRC. Clinical variables, postintervention intensive care unit (ICU) admission, use of invasive mechanical ventilation, and postintervention antibiotic treatment or blood transfusion were compared between the two groups. The reintervention rate, presence and type of complications, length of stay, and in-hospital mortality were also estimated. Hazard ratio (HR) for hospital mortality was estimated by Cox regression models. RESULTS: COPD was associated with higher rates of in-hospital complications, ICU admission, antibiotic treatment, reinterventions, and mortality. Moreover, after adjusting for other factors, COPD remained clearly associated with higher and earlier in-hospital mortality. CONCLUSION: To reduce in-hospital morbidity and mortality in patients undergoing surgery for CRC and with COPD as a comorbidity, several aspects of perioperative management should be optimized and attention should be given to the usual comorbidities in these patients.

Risk factors and outcomes of organ-space surgical site infections after elective colon and rectal surgery.

BACKGROUND: Organ-space surgical site infections (SSI) are the most serious and costly infections after colorectal surgery. Most previous studies of risk factors for SSI have analysed colon and rectal procedures together. The aim of the study was to determine whether colon and rectal procedures have different risk factors and outcomes for organ-space SSI. METHODS: A multicentre observational prospective cohort study of adults undergoing elective colon and rectal procedures at 10 Spanish hospitals from 2011 to 2014. Patients were followed up until 30 days post-surgery. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Oral antibiotic prophylaxis (OAP) was considered as the administration of oral antibiotics the day before surgery combined with systemic intravenous antibiotic prophylaxis. RESULTS: Of 3,701 patients, 2,518 (68%) underwent colon surgery and 1,183 (32%) rectal surgery. In colon surgery, the overall SSI rate was 16.4% and the organ-space SSI rate was 7.9%, while in rectal surgery the rates were 21.6% and 11.5% respectively (p < 0.001). Independent risk factors for organ-space SSI in colon surgery were male sex (Odds ratio -OR-: 1.57, 95% CI: 1.14-2.15) and ostomy creation (OR: 2.65, 95% CI: 1.8-3.92) while laparoscopy (OR: 0.5, 95% CI: 0.38-0.69) and OAP combined with intravenous antibiotic prophylaxis (OR: 0.7, 95% CI: 0.51-0.97) were protective factors. In rectal surgery, independent risk factors for organ-space SSI were male sex (OR: 2.11, 95% CI: 1.34-3.31) and longer surgery (OR: 1.49, 95% CI: 1.03-2.15), whereas OAP with intravenous antibiotic prophylaxis (OR: 0.49, 95% CI: 0.32-0.73) was a protective factor. Among patients with organ-space SSI, we found a significant difference in the overall 30-day mortality, being higher in colon surgery than in rectal surgery (11.5% vs 5.1%, p = 0.04). CONCLUSIONS: Organ-space SSI in colon and rectal surgery has some differences in terms of incidence, risk factors and outcomes. These differences could be considered for surveillance purposes and for the implementation of preventive strategies. Administration of OAP would be an important measure to reduce the OS-SSI rate in both colon and rectal surgeries.

Preventing Parastomal Hernia Using a Modified Sugarbaker Technique With Composite Mesh During Laparoscopic Abdominoperineal Resection: A Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to assess the reduction in the incidence of parastomal hernia (PH) after placement of prophylactic synthetic mesh using a modified Sugarbaker technique when a permanent end-colostomy is needed. SUMMARY OF BACKGROUND DATA: Prevention of PH formation is crucial given the high prevalence of PH and difficulties in the surgical repair of PH. METHODS: A randomized, prospective, double-blind, and controlled trial. Rectal cancer patients undergoing laparoscopic abdominoperineal resection with permanent colostomy were randomized (1 : 1) to the mesh and nonmesh arms. In the mesh group, a large-pore lightweight composite mesh was placed in the intraperitoneal/onlay fashion using a modified Sugarbaker technique. PH was detected by computed tomography (CT) after a minimum follow-up of 12 months. Analysis was per-protocol. RESULTS: The mesh group included 24 patients and the control group 28. Preoperative data, surgical time, and postoperative morbidity were similar. The median follow-up was 26 months. After CT examination, 6 of 24 PHs (25%) were observed in the mesh group compared with 18 of 28 (64.3%) in the nonmesh group (odds ratio 0.39, 95% confidence interval 0.18-0.82; P = 0.005). The Kaplan-Meier curves showed significant differences in favor of the mesh group (long-rank = 4.21, P = 0.04). The number needed to treat was 2.5, which confirmed the effectiveness of the intervention. CONCLUSIONS: Placement of a prosthetic mesh by the laparoscopic approach following the modified Sugarbaker technique is safe and effective in the prevention of PH, reducing significantly the incidence of PH.