Gut microbiome composition better reflects host phylogeny than diet diversity in breeding wood-warblers.

Understanding the factors that shape microbiomes can provide insight into the importance of host-symbiont interactions and on co-evolutionary dynamics. Unlike for mammals, previous studies have found little or no support for an influence of host evolutionary history on avian gut microbiome diversity and instead have suggested a greater influence of the environment or diet due to fast gut turnover. Because effects of different factors may be conflated by captivity and sampling design, examining natural variation using large sample sizes is important. Our goal was to overcome these limitations by sampling wild birds to compare environmental, dietary and evolutionary influences on gut microbiome structure. We performed faecal metabarcoding to characterize both the gut microbiome and diet of 15 wood-warbler species across a 4-year period and from two geographical localities. We find host taxonomy generally explained ~10% of the variation between individuals, which is ~6-fold more variation of any other factor considered, including diet diversity. Further, gut microbiome similarity was more congruent with the host phylogeny than with host diet similarity and we found little association between diet diversity and microbiome diversity. Together, our results suggest evolutionary history is the strongest predictor of gut microbiome differentiation among wood-warblers. Although the phylogenetic signal of the warbler gut microbiome is not very strong, our data suggest that a stronger influence of diet (as measured by diet diversity) does not account for this pattern. The mechanism underlying this phylogenetic signal is not clear, but we argue host traits may filter colonization and maintenance of microbes.

Persistent pulmonary abnormalities after 18 months of SARS-CoV-2 pneumonia.

OBJECTIVE: To describe persistent pulmonary abnormalities detected on HRCT after 18 months of SARS-CoV-2 pneumonia, and to determine their extension and correlation with pulmonary function. PATIENTS AND METHODS: A prospective cross-sectional study with an initial cohort of 90 patients in follow-up due to persisting lung abnormalities on imaging, functional respiratory impairment and/or respiratory symptoms. Of these, 31 (34%) were selected for analysis due to the persistence of their lung abnormalities on HRCT at 18 months after infection. A double reading was performed for each HRCT (62 observations). RESULTS: Of the 31 patients included: 20 (65%) were men; mean age was 67 years; 17 (55%) were smokers/ex-smokers. The mean hospitalisation time was 38 days. Eighteen (58%) patients were admitted to intensive care units. Five patients (16%) suffered an acute pulmonary thromboembolism and three (9.7%) had a pneumothorax. The mean time between the onset of pneumonia and the follow-up HRCT was 20.34 months. Nineteen percent of patients suffered from total lung function abnormalities; and ground-glass opacities and reticulation were present in 12% and 4.5% respectively. The findings of the 62 readings were: ground-glass opacities (100%), reticulation (83%), subpleural curvilinear lines (62%), parenchymal bands (34%), traction bronchiectasis (69%), displacement of vessels/fissures (46%) and honeycombing (4.9%). Pulmonary function 18 months after the acute episode revealed a mean FVC of 92% of predicted value, with an FVC < 80% of predicted value in 11 patients (35.4%). Mean DLCO was 71% of predicted value, with a DLCO < 80% in 22 patients (70%). We observed a statistically significant relationship between total lung function abnormalities on HRCT and FVC (P < 0.05), and a trend towards statistical significance with DLCO (P = 0.051); there was a statistically significant relationship between the presence of ground-glass opacities and FEV1/FVC (P < 0.01). The relationships between reticulation and FVC, FVC%, FEV1, FEV1% and DLCO% were also considered statistically significant (P < 0.05). CONCLUSION: Persistent interstitial lung abnormalities are seen on HRCT for a subset of patients infected with SARS-CoV-2 pneumonia. Seventy percent of these patients suffered a slight decrease in DLCO.

Immunogenicity of BNT162b2 vaccine after two and three doses in health personnel and institutionalized elderly people not infected with SARS-CoV-2.

OBJECTIVE: The aim of our research was to compare the evolution of the immune response induced by the BNT162b2 vaccine after the administration of two and three doses in healthcare personnel and in institutionalized elderly people (>65 years of age) without previous SARS-CoV-2 infection. MATERIAL AND METHODS: A prospective observational study was carried out on a convenience sample made up of health workers and institutionalized elderly people, measuring antibodies against S and N proteins of SARS-CoV-2 two and six months after receiving the second vaccine dose, as well as two months after receiving the third dose. RESULTS: A significant reduction of the anti-S humoral immune response was reported six months after the second dose of vaccine in both health workers and residents. The administration of a third dose of vaccine induced a significant increase in this antibody response in both investigated groups reaching a similar proportion of responders two months after this third dose. CONCLUSIONS: Humoral immunity induced by two doses of the BNT162b2 vaccine in persons without prior SARS-CoV-2 infection wanes over time. The administration of a third dose significantly increases anti-S antibodies being highly recommended, especially in people over 65 years of age.

Addition of induction therapy offsets the hazard of marked calcineurin minimization among renal transplant recipients treated with sirolimus.

AIMS: We sought to examine the improvement in renal function with preserved immunosuppression consequent to reducing de novo cyclosporine (CsA) doses combined with sirolimus and induction antibody treatment. MATERIALS AND METHODS: 408 renal recipients treated de novo with CsA-sirolimus included 91 patients who received high (> 5); 125, medium (2.5-5.0); or 192, low CsA doses (< 2.5 mg/kg/day) together with induction antibody among 5, 48 and 68% of subjects, respectively. At 2 years we excluded 21 (23), 30 (24) and 49 (25%) subjects who experienced the composite end-point, yielding 70 (71), 95 (76) and 143 (74%) cases, whose mean de novo CsA C2 values were 725, 400 and 306 ng/ml; for all cohorts, sirolimus C0 = 10-15 de novo and 8-12 ng/ml during maintenance treatment. The primary end-point--mean 4-year GFR by aMDRD--ascribed "0" to patients who experienced death or graft loss after 2 years. RESULTS: Although low-dose subjects were older (p = 0.008) and heavier (p < 0.001) with grafts exposed to longer cold ischemia times (p < 0.001), they displayed greater GFR: 64.8 versus 48.4 among the high and 54.1 ml/min/1.73 m(2) in the medium dose arms (p = 0.002). Polychotomous logistic regression revealed significant GFR predictors to be CsA dose (p = 0.015) and younger donor age (p < 0.001). Between 2 and 4 years, the incidences of the composite end-point were 17, 14 and 16%; including 13, 10 and 11% rejections. CONCLUSION: 80% reduction in de novo CsA exposure with antibody induction improved renal function at 4 years compared with 50 or 66% reductions.

Fibromuscular dysplasia recurrence after kidney transplantation: case report.

We report the extremely rare recurrence of intimal fibroplasia, a rare form of fibromuscular dysplasia, in a kidney recipient at 6 months after transplantation from a living-related donor. The patient was successfully treated and maintains good kidney function, however, the case raises the question of whether kidneys with fibromuscular dysplasia should be included in the expanded criteria for kidney transplantation.

Biliary Complications After Liver Transplantation: Incidence, Risk Factors and Impact on Patient and Graft Survival.

INTRODUCTION: Biliary complications (BC) are one of the most frequent surgical complications after liver transplantation. They include biliary stenosis, leaks, choledocolitiasis and sphincter of Oddi dysfunction. These complications can cause graft dysfunction, retrasplantation, or even death. The purpose of this study was to identify factors related to BC. MATERIALS AND METHODS: The medical records of all adult patients who underwent their first liver transplantation in our institution from 2005 to 2013 were reviewed, and any BC that required management was recorded. Cumulative incidence of BC was estimated using Kaplan-Meier. Patient and graft survival was compared using the log-rank test. The Cox regression model was used to establish associated factors. RESULTS: Of the 236 patients who underwent liver transplantation, 41 patients (17.8%) developed BC. Cumulative incidence was 12.9%, 17.2%, and 20%, after 1, 3 and 5 years of the transplantation, respectively. Twenty-six cases of biliary stenosis, 11 of leaks, and 4 of choledocolitiasis were identified. Most patients were managed endoscopically (82.9%). There were no differences in patient or graft survival. DISCUSSION: Biliary stenosis is the most frequent BC. Patients with higher risk of BC were of blood type AB (P < .001), had viral hepatitis (P = .049), or had alcoholic cirrhosis (P = .036). The success with the endoscopic treatment reduced the need for surgical interventions. CONCLUSIONS: The incidence of BC in our institution is comparable with the incidence reported in other institutions. Further prospective studies with larger series of patients are warranted to identify other factors associated with development of BC.

Rabbit antithymocyte globulin: a postoperative risk factor for sirolimus-treated renal transplant patients?

AIMS: Randomized controlled studies suggest an increased incidence of perioperative wound complications among sirolimus-treated renal transplant patients. The present study analyzed the effect of rabbit antithymocyte globulin (rATG) on these postoperative complications. METHODS: Four hundred and twelve renal transplants were performed and managed postoperatively at two University-affiliated hospitals between January 1, 2001, and December 31, 2003. The patients received corticosteroids and Sirolimus, with delayed introduction of cyclosporine when the serum creatinine had decreased below 2.5 mg/dL. Two groups of patients were discriminated: group 1 received Basiliximab 20 mg on day 0 and day 4 (n = 283); group 2 recipients with a high panel of reactive antibody (PRA > 20%) and retransplant patients received rATG for induction (n = 129) for a maximum of 2 weeks postoperatively. The incidence of rejection was 14.5% for group 1 vs. 8.5% for group 2 patients. To avoid confounding variable associated with the rejection treatment, any patient with rejection was excluded for statistical analysis, as were patients with follow- up less than 30 days. The final study group for analysis included 350 patients: 235 with Basiliximab induction (group 1) and 115 rATG induction (group 2). The mean follow-up was 21.8 +/- 11 months. Differences in the incidences of postoperative hernia, wound infections, or lymphoceles requiring any form of drainage were analyzed for statistical significance using the chi-square test. RESULTS: The percentage of patients with wound complications was 26.0% versus 39.1% (P < .025) for group 1 versus group 2, respectively. Incisional hernias occurred in 10.6% versus 18.3% patients (P < .05), wound infections in 11.1% versus 16.5% (P = NS), and lymphoceles in 10.6% versus 15.9% (P = NS) for the two groups, respectively. CONCLUSIONS: rATG-induced renal transplants recipients treated with sirolimus, cyclosporine, and steroids show a significantly increased incidence of postoperative incisional hernias and a trend toward a greater number of lymphocele and wound infection complications.

Folate levels and N(5),N(10)-methylenetetrahydrofolate reductase genotype (MTHFR) in mothers of offspring with neural tube defects: a case-control study.

BACKGROUND: Neural tube defects (NTDs) have been associated with biochemical factors involved in the conversion of homocysteine to methionine as folate deficiency and the mutation 677T in the N(5),N(10)-methylenetetrahydrofolate reductase gene (MTHFR). METHODS: A case-control study was performed to detect this mutation in 38 unrelated women with NTD deceased products and 31 mothers without antecedents of NTD offspring. All products were born in Nuevo León (northeastern Mexico) during 1997. Erythrocyte and plasmatic folate levels and the genotype of the 677 polymorphism at the MTHFR locus were analyzed in both groups. RESULTS: Although no significant differences were found in mean blood folate levels, the percentage of women in the case group with erythrocyte folate levels <160 ng/mL was significantly higher than in the control group (75 vs. 51.2%, p <0.05). The proportion of women with plasma folate levels <3.5 ng/mL was higher in the case group (16.2 vs. 0%, p <0.01). Genotype analysis demonstrated a significantly higher proportion of 677T homozygous mothers with NTD products (39.6 vs. 9.1%, p <0.05). Allele frequencies for the 677T mutation were 0.55 and 0.36 for cases and controls, respectively. The odds ratio (OR) for having a NTD product was 6.1 (95%, CI 1.56-23.6) for homozygous 677T mothers vs. homozygous 677C and heterozygous mothers. Significantly low levels of erythrocyte folate were found in the 677C homozygous case group and in plasma folate in the 677C/677T heterozygous case mothers. CONCLUSIONS: Our study suggests that folate deficiency and MTHFR unfavorable genotype in mothers are important risk factors for severe NTD phenotype in our population.

Increasing accuracy and decreasing latency during clean intermittent self-catheterization procedures with young children.

We examined the effects of simulation training on performance of clean intermittent self-catheterization procedures with 2 young girls. Simulation training was conducted, after which independent performance was assessed within a multiple baseline design. The training resulted in increased accuracy and decreased latency for both girls.

[Latex allergy in children with spina bifida]. / Alergia al látex en niños con espina bífida.

Latex allergy is a frequent happening in children with spina bifida or congenital urologic abnormalities. These patients have multiples exposures to derivatives of latex as part of the management increasing the risk of allergic reactions. We present three children who developed general anaphylactic reaction during urodynamic exploration with a rectal latex catheter. All patients showed positive skin test and positive latex specific IgE test (RAST). A prospective survey of 17 patients with spina bifida at the time of cystometry showed positive RAST levels in 7 (41%). Recommendations for prophylaxis are included, suggesting the avoidance of latex products in children with spina bifida since birth.

Cost-effectiveness analysis of the early conversion of tacrolimus to mammalian target of rapamycin inhibitors in patients with renal transplantation.

BACKGROUND: Renal replacement therapies which consist of renal transplantation and dialysis are the only treatment options for patients with terminal renal failure. These therapies have changed the outcome from being fatal to being a chronic disease. Kidney transplantation involves the use of immunosuppressive agents to prevent rejection. Currently, several immunosuppressive agents have shown efficacy, safety, and different costs. OBJECTIVE: The aim was to evaluate the cost-effectiveness of early conversion from tacrolimus to mammalian target of rapamycin inhibitors sirolimus or everolimus versus continuous treatment with tacrolimus among renal transplantat patients in Colombia. METHODS: We performed systematic literature review to extract data for clinical effectiveness and safety of tacrolimus replacement schemes for immunosuppressive therapy in renal transplantation in adults. A Markov model in TreeAge was developed, simulating the patient's natural history with renal transplantation. The perspective of the Colombian Health System was used, including only direct costs. The cost-effectiveness ratio and incremental cost-effectiveness ratio were estimated. Deterministic and probabilistic sensitivity analyses were performed. A 5% discount rate was applied in costs and health results. RESULTS: Results for the replacement of tacrolimus to sirolimus are provided. The cost per year of additional life gained for sirolimus was Col$2,441,171.43; the cost for avoided loss was Col$4,014,152.84. The acceptability curve shows that a strategy with sirolimus is the most cost-effective one. CONCLUSIONS: This study suggested that the sirolimus strategy is cost-effective in Colombia for patients with renal transplantation using as threshold less than three times the gross domestic product (GDP) per capita of Colombia per life of years gained.

Protein hydrolysis by immobilized and stabilized trypsin.

The preparation of novel immobilized and stabilized derivatives of trypsin is reported here. The new derivatives preserved 80% of the initial catalytic activity toward synthetic substrates [benzoyl-arginine p-nitroanilide (BAPNA)] and were 50,000-fold more thermally stable than the diluted soluble enzyme in the absence of autolysis. Trypsin was immobilized on highly activated glyoxyl-Sepharose following a two-step immobilization strategy: (a) first, a multipoint covalent immobilization at pH 8.5 that only involves low pK(a) amino groups (e.g., those derived from the activation of trypsin from trypsinogen) is performed and (b) next, an additional alkaline incubation at pH 10 is performed to favor an intense, additional multipoint immobilization between the high concentration of proximate aldehyde groups on the support surface and the high pK(a) amino groups at the enzyme surface region that participated in the first immobilization step. Interestingly, the new, highly stable trypsin derivatives were also much more active in the proteolysis of high molecular weight proteins when compared with a nonstabilized derivative prepared on CNBr-activated Sepharose. In fact, all the proteins contained a cheese whey extract had been completely proteolyzed after 6 h at pH 9 and 50°C, as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Under these experimental conditions, the immobilized biocatalysts preserve more than 90% of their initial activity after 20 days. Analysis of the three-dimensional (3D) structure of the best immobilized trypsin derivative showed a surface region containing two amino terminal groups and five lysine (Lys) residues that may be responsible for this novel and interesting immobilization and stabilization. Moreover, this region is relatively far from the active site of the enzyme, which could explain the good results obtained for the hydrolysis of high-molecular weight proteins.

Consenso chileno sobre Abobotulinumtoxina A (Dysport®): indicaciones, técnicas / Chilean Consensus for on abobotulinumtoxin A (Dysport®): indications, techniques

Botulinum neurotoxin is widely used to treat a variety of movement disorders, especially dystonia and spasticity. There botúlica different preparations of botulinum type A, that because biologics are difficult to compare. AbobotulinumtoxinA (Dysport ®) has recently been introduced in Chile for treating dystonia and spasticity. The aim of this paper is to provide a review by experts on the existing evidence and propose a practical guide to the use of the drug. Methods and Results: A group of Chilean experts met on 6 and 7 July 2012 to review AbobotulinumtoxinA doses along with injection protocols for dystonia, spasticity and other movement disorders. We worked in two groups, one composed of neurologists who reviewed the on dystonias and other by physiatrists who reviewed the indications for spasticity. Conclusions: Finally, there is a proposal in terms of dose, injection points and recommendations for dystonia and spasticity...

La neurotoxina botulínica es ampliamente usada para tratar una variedad de trastornos del movimiento, especialmente la distonía y la espasticidad. Existen diferentes preparados de toxina botúlica tipo A, que por ser productos biológicos resultan difícilmente comparables. La abobotulinumtoxinA (Dysport®) ha sido introducida en Chile recientemente para el tratamiento de la distonía y la espasticidad. El objetivo de este trabajo es entregar una revisión hecha por expertos sobre la evidencia existente y plantear una guía práctica para el uso del medicamento. Métodos y Resultados: Un grupo de expertos chilenos se reunieron el 6 y 7 julio de 2012 para revisar las dosis abobotulinumtoxin A, junto con los protocolos de inyección para la distonía, la espasticidad y otros trastornos del movimiento. Se trabajó en dos grupos, uno compuesto por neurólogos que revisaron las indicaciones en distonías y otro por fisiatras que revisaron las indicaciones para espasticidad. Conclusiones: Finalmente, se realiza una propuesta en cuanto a dosis, puntos a inyectar y recomendaciones para la distonia y espasticidad...

Consenso Nacional de Expertos: recomendaciones para el manejo del paciente con enfermedad de Parkinson / Recommendations for the management of patients with Parkinson’s disease. National Experts’ Consensus

Parkinson's disease (PD) is a progressive neurodegenerative disease with a high impact on individuals who experience it and their families. In 2010, the Chilean Health System included PD in the Health's explicit guarantees, and clinical guidelines were developed for the diagnosis and management of PD. We reviewed the guidelines for diagnosis and treatment of PD published in the literature worldwide, in order to adapt them to our country's reality from the perspective of a national group of experts.

La enfermedad de Parkinson (EP) es una enfermedad neurodegenerativa progresiva de alto impacto para las personas que la sufren y sus familiares. El año 2010 el Ministerio de Salud de Chile la incorporó al sistema de garantías explicitas en Salud, lo que dio origen al desarrollo de las guías clínicas para el manejo de la EP. Un grupo de expertos nacionales realizó una revisión de las guías sobre diagnóstico y tratamiento de la EPpublicadas en la literatura a nivel mundial, con el propósito de evaluarlas y adaptarlas a la realidad chilena.

Contaminación por material particulado (PM2, 5 y PM10) y consultas por enfermedades respiratorias en Medellín (2008-2009) / Particulate air pollution (PM2, 5 and PM10) and medical consultations due to respiratory disease in Medellín (2008-2009)

La evidencia científica muestra cómo la contaminación del aire genera efectos negativos en la salud humana. En Medellín, Colombia, se registra un alto nivel de contaminación del aire por material particulado (medido por Redaire) y un considerable volumen de consultas externas y por urgencias a causa de enfermedades respiratorias, medidas por Metrosalud. OBJETIVO: presentar evidencia estadística de la relación positiva entre contaminación por material particulado PM2,5 y PM10 y las consultas externas y por urgencia debidas a enfermedades respiratorias (asma, bronquitis, infecciones, rinitis). METODOLOGIA: se emplearon modelos de series de tiempo sobreregistros diarios de medición para PM10 y PM2,5; se estimaron diez modelos por mínimos cuadrados ordinarios con corrección de White para ajustar problemas de heterocedasticidad; cinco modelos con consultas por enfermedades respiratorias y PM10; y cinco modelos con consultas por enfermedades respiratorias y PM2,5. RESULTADOS: se concluye que la contaminación del aire por material particulado provoca problemas respiratorios y, en consecuencia, es un problema de salud pública en Medellín.

Scientific evidence shows how air pollution has negative effects on human health. Medellin city (Colombia) has high levels of air pollution (according to Redaire's measurements) as well as a high rate of medical and emergency consultations due to respiratory disease (according to Metrosalud's measurements). OBJECTIVE: to show statistical evidence of the positive relationship between pollution due to PM2.5 and PM10 particulate matter and the medical and emergency consultations due to respiratory diseases (asthma, bronchitis, infections, and rhinitis). METHODOLOGY: a number of time series models were applied on daily records of PM10 and pm2.5 particles. A total of ten models were calculated using ordinary least squares (OLS) with White's correction in order to adjust heteroskedasticity problems. Initially, five models were used for the consultations caused by respiratory disease and PM10 particles. Then, five additional models were used for the consultations caused by respiratory diseases and PM2.5 particles. RESULTS: particulate air pollution leads to respiratory disease, thus becoming a public health problem in Medellín, Colombia.

Seguimiento mayor a 10 años de pacientes operados por cáncer gástrico incipiente / Ten years survival of patients operated for an incipient gastric cancer

Background: Five years survival after surgery for incipient gastric cancer is high. However there is a paucity of information for longer follow up periods. Aim: To analyze long term survival after surgery for incipient gastric cancer. Material and Methods: Review of medical records of patients operated for incipient gastric cancer with an oncologic follow up of 10 years or more. Results: Data from 161 patients, aged 25 to 88 years, 55 percent males, was retrieved. Eight percent of tumors were multifocal and a mean of 17 lymph nodes per patient, were dissected. There was lymph node involvement in 11 and 3 percent of submucosal and mucosal lesions, respectively. Ten years survival was 78 percent. The causes of death were medical in 68 percent, another cancer in 18 percent and gastric cancer in 18 percent. Incipient gastric cancer 10 years specific survival was 95 percent. The figures for submucocal and mucosal lesions were 98 and 91 percent respectively. The figures for patients with or without lymph node involvement were 75 and 94 percent respectively. Conclusions: Ten years mortality due to incipient gastric cancer is exceedingly low and other causes will be the cause of death among these patients.

Introducción: Los resultados del tratamiento quirúrgico del cáncer gástrico incipiente (CGI) son satisfactorios en el seguimiento a 5 años. Sin embargo, en Chile, se desconoce el comportamiento a mayor plazo. Objetivo: Describir los resultados del tratamiento quirúrgico del CGI en el seguimiento mayor a 10 años. Material y Método: Revisión retrospectiva de los pacientes operados por CGI con seguimiento oncológico mayor a 10 años. El análisis de supervivencia se realizó a través de curvas Kaplan-Meier y el análisis univariado con el test de Fisher. Se consideró significancia estadística con p < 0,05. Resultados: La serie está constituida por 161 pacientes. La edad promedio fue 57 años. Un 7,6 por ciento son cánceres multifocales. Se disecaron 17,4 linfonodos en promedio por paciente. Se identificó compromiso linfático en 11,5 por ciento de las lesiones submucosas y 2,9 por ciento de las mucosas. La supervivencia general fue de 78,3 por ciento a 10 años. La mortalidad se distribuye: 67,7 por ciento por patología médica, 14,5 por ciento por otro cáncer y 17,7 por ciento por CGI. La supervivencia específica por CGI fue de 94,7 por ciento a 10 años. Según profundidad: las lesiones mucosas fue de 98 por ciento y de las submucosas de 91,3 por ciento (p = 0,186). La supervivencia en ausencia de ganglios comprometidos fue de 96,4 por ciento y 75 por ciento en presencia de adenopatías (p = 0,026). La muerte acumulada por CGI a los 10 años fue de 3,72 por ciento. Conclusión: El seguimiento a 10 años o más de los pacientes operados por CGI mostró que es más probable la muerte por otra causa que por cáncer gástrico, el riesgo de muerte por CGI persiste en el tiempo.

Valoración del análisis de la pieza operatoria en el cáncer gástrico por el cirujano / Concordance between the surgical piece observation by the surgeon and final pathological report for gastric cancer

Background: The systematic dissection of the surgical piece, performed by the surgeon during surgical treatment of gastric cancer, gives information about borders and lymph node involvement. Aim: To determine the concordance between the findings of the surgeon during initial dissection and the final pathological report. Material and Methods: Prospective study of 48 patients aged 64 +/- 10 years (74 percent males) subjected to curative surgery for gastric cancer. Patients were staged according to 2010 TNM classification. Stomach size from the lesser curvature, oral and caudal limits, macroscopic aspect, tumor diameter and lymph node involvement were determined by the surgeon observing the surgical piece. The concordance of this observation with the final pathological report was assessed. Results: Fifty nine percent of patients were subjected to a total gastrectomy and there was a mean of 30 lymph nodes excised. There was a good concordance between surgeon observation and final pathological report for tumor depth (Kappa = 0.64), macroscopic aspect (Kappa = 0.69) and tumor size (Lin = 0.84). There was a bad concordance for lymph node involvement (Kappa = 0.21). The percentage of retraction of lesser curvature length was 24 percent, 30 percent for oral and 22 percent for caudal limits. Conclusions: There is a good concordance between surgeon observation and pathological report for macroscopic aspect, tumor size and depth but the concordance for lymph node involvement is bad.

Introducción: La disección de la pieza operatoria (PO) en forma sistemática en la cirugía por cáncer gástrico (CG) permite al cirujano obtener información de los bordes, compromiso linfonodal y estandarizar. Objetivos: 1) Determinar la concordancia de los hallazgos de la PO disecada por el cirujano y el informe patológico final; 2) Determinar el porcentaje de retracción del estómago; 3) Mostrar una forma de registrar la PO en el CG. Material y Método: Estudio prospectivo de los pacientes operados con intención curativa desde septiembre de 2009 hasta mayo de 2010. Se etapificó con TNM de 2010. De la PO se registró el tamaño del estómago por curvatura menor, límite oral (LO), límite caudal (LC), profundidad, aspecto macroscópico, diámetro tumoral, grupos ganglionares comprometidos y cantidad de ganglios comprometidos. Se compararon estas variables con el informe patológico. El análisis de concordancia se realizó con el test de Kappa y el test de Lin. Resultados: Fueron estudiados 48 pacientes, 74 por ciento hombres, la edad promedio fue 63,7 años (DE 9,8), 59,5 por ciento fueron gastrectomías totales. El promedio de ganglios disecados fue 30,18 (DE 11,8). Se obtiene una buena concordancia para la profundidad del tumor (Kappa = 0,64), aspecto macroscópico (Kappa = 0,69) y tamaño tumoral (Lin = 0,84). Y una mala concordancia para el compromiso ganglionar (Kappa = 0,21). El porcentaje de retracción del largo por curvatura menor fue 24,3 por ciento, del LO fue 30,1 por ciento, del LC fue 22 por ciento. Conclusión: La concordancia de la PO es buena en la profundidad, aspecto macroscópico del tumor y diámetro tumoral, pero es mala en el compromiso ganglionar. Se determina que la retracción del estómago es mayor al 24 por ciento.

Encuesta nacional sobre tratamiento quirúrgico de patología del hígado, vía biliar y páncreas / An enquiry about liver, biliary and pancreatic surgery in Chile

Background: Chile has a high incidence of cholelithiasis and associated complications, that usually require surgical treatment. Aim: Lo carry out an enquiry about biliary diseases and their surgical treatment in public and prívate surgical services in Chile. Material and Methods: An enquiry about liver and biliary diseases and their treatment was designed and sent by electronic mail to 35 surgical services. Results: Lhe enquiry was answeredby 17 services. A total of 9.505 cholecystectomies were reported. Between21 and 98 percent of the procedures were laparoscopic. Iatrogenic lesions of the biliary tree were reported in 0.3 percent of the procedures. Choledocolithiasis was found associated to cholelithiasis in 0 to 21 percent of procedures. However, the use of intraoperative cholangiography was incidental. Lhe incidence of gallbladder cancer in cholecystectomies for cholelithiasis fluctuated between 0.2 and 8.9 percent. Liver metastases derived from colorectal cancer were the most common liver tumor operated. Hydatidosis was more common in southern Chile. Pancreatic excision was almost exclusively performed in Metropolitan Santiago. Conclusions: This information will allow the establishment of information and collaboration channels among the surgical services throughout Chile.

Se trata de una encuesta realizada con el objeto de conocer la frecuencia e incidencia de las principales patologías y técnicas quirúrgicas de la esfera hepato-bilio-pancreática atendida en centros de salud públicos y privados del país durante el año 2007. La encuesta fue respondida por 17 instituciones nacionales. Entre los resultados resaltan el total de colecistectomías reportadas de 9.505, de las cuales entre un 21 y 98 por ciento son realizadas por vía laparoscópica. Lesiones iatrogénicas de vía biliar ocurrieron dentro de un rango de 0 a 1,5 por ciento, con una mediana de 0,3 por ciento. La frecuencia de coledocolitiasis asociada a la colelitiasis ocurrió entre un 0 a 21 por ciento, aunque el empleo de colangiografía intraoperatoria es en general de ocurrencia incidental. La incidencia de cáncer vesicular en colecistectomías por colelitiasis es claramente distinta según se trate de instituciones de centro-norte y sur del país, con incidencias que varían entre 0,2 y 8,9 por ciento. Las metástasis hepáticas operadas son principalmente de origen colorrectal, y son los tumores hepáticos más frecuentemente tratados. La hidatidosis hepática manifiesta en esta encuesta su conocida distribución geográfica, siendo más frecuentemente tratada en los centros del sur del país. La cirugía pancreática resectiva tiende a estar concentrada en las instituciones de la región metropolitana.

Gastrectomía vertical posterior a retiro de banda gástrica / Sleeve gastrectomy performed simultaneously to extraction of a gastric band: experience in 10 patients

Background: Sleeve gastrectomy is replacing gastric banding in the management of morbid obesity. Aim: To report the results of sleeve gastrectomy performed simultaneously with the extraction of a gastric band. Material and Methods: We report ten patients aged 34 to 53 years (nine women) operated between 2008 and 2009. Results: The main indication for sleeve gastrectomy was the failure of the gastric band. No complications were recorded and patients were discharged 72 hours after the procedure. Conclusions: Sleeve gastrectomy can be carried out simultaneously with the extraction of a gastric band, without increasing operative complications.

Introducción: La Gastrectomía Vertical ha reemplazado a la banda gástrica en el manejo de un importante número de pacientes portadores de obesidad. El objetivo de este trabajo es mostrar los resultados de una serie de pacientes, en los que se realizó una Gastrectomía Vertical posterior a la extracción de una banda gástrica en un mismo tiempo operatorio. Método: La serie incluye a 10 pacientes operados entre Mayo de 2008 y Noviembre de 2009. La principal indicación de la Gastrectomía Vertical fue el fracaso de la banda como tratamiento de la obesidad. Resultados: En los 10 pacientes estudiados, la gastrectomía se pudo efectuar sin mayores dificultades ni diferencias con respecto al procedimiento habitual. No existieron complicaciones post operatorias, siendo la totalidad de los pacientes dados de alta dentro de las 72 horas. Conclusión: La Gastrectomía Vertical representa una alternativa de manejo en pacientes portadores de una banda gástrica con indicación de extracción de esta, ya sea por fracaso o por síntomas asociados a su presencia. El procedimiento puede efectuarse de manera segura en el mismo acto operatorio y sus resultados son comparables a los observados cuando la técnica se efectúa en pacientes que no han sido intervenidos previamente.