The influence of the percentage of the common limb in weight loss and nutritional alterations after laparoscopic gastric bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is considered the gold standard for the treatment of morbid obesity. There is no consensus over ideal limb length when the bypass is created and published studies do not take into account the influence of the common limb (CL) on weight loss. The objective was to study the influence of the common limb after RYGB. The setting was the Virgen de la Arrixaca University Clinical Hospital in Murcia, Spain. MATERIAL AND METHODS: This prospective study includes 151 patients undergoing laparoscopic RYGB surgery for morbid obesity. The patients were divided into 2 groups according to their body mass index. The small intestine (SI) was measured using micro forceps so that the percentage of common limb (%CL) could then be compared against the total SI in each patient. The percentage of excess weight loss (%EWL) in relation to the %CL was calculated at 3, 12, and 24 months. A series of tests was conducted simultaneously to analyze nutritional deficiencies and their relation to the %CL. RESULTS: The total jejunoileal segment and the %CL in the groups of both obese and super-obese patients had no influence on the %EWL in either group for any of the periods studied. The patients with a %CL<50% had greater nutritional deficiencies in the follow-up period and required supplements and more frequent laboratory tests. CONCLUSIONS: The %CL has no effect on weight loss in RYGB patients. A lower %CL is related to greater nutritional deficiencies.

Morbidity and mortality outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with primary and recurrent advanced ovarian cancer.

BACKGROUND: The aim of this study is to report the perioperative outcomes of CRS and HIPEC from a single institution and review those factors that are associated with a poor perioperative outcome in patients with peritoneal dissemination from primary or recurrent ovarian cancer. PATIENTS AND METHOD: A retrospective cohort study setting was conducted in a third level hospital peritoneal surface malignancy program. Ninety one patients diagnosed with ovarian peritoneal carcinomatosis, primary and recurrent without extraperitoneal metastasis were included for cytoreductive surgery and HIPEC with paclitaxel. We analyzed the postoperative morbidity rates and a univariate and multivariate analysis of factors associated with overall (grade I-IV) and major (grade III-IV) postoperative morbidity were performed. RESULTS: Peritoneal Cancer Index (PCI) upper than 12 (OR = 2.942 95%: 1.892-9.594 p = 0.044) was an independent factor associated with the occurrence of I-IV postoperative morbidity. Regarding major complications (grade III-IV), on multivariate analysis, in addition to PCI >12 (OR = 6.692, 95% CI: 1974-45, 674, p = 0.032), the need to carry out intestinal resection (OR = 4.987, 95% CI: 1350-27, 620, p = 0.046) was an independent factor related with major morbidity (grade III-IV). CONCLUSIONS: The use of HIPEC after aggressive cytoreductive surgery in patients with ovarian cancer with peritoneal dissemination can be performed with acceptable postoperative morbidity rates. Knowledge of the factors associated with the onset of these postoperative adverse events allows better management of the same and offers the patient a safe procedure.

Estimulación del asa eferente previa al cierre de ileostomía / Afferent loop stimulation prior to ileostomy closure

El número de complicaciones tras el cierre de ileostomía es del 17%. El íleo paralítico es la complicación más frecuente. Con el objetivo de disminuir esta complicación, en las 2 semanas previas al cierre del estoma, se realizó una estimulación diaria a través del asa eferente (AU)

There is a 17% complications rate after ileostomy closure, with paralytic ileus being the most common. With the aim of reducing this complication, stimulation via the afferent loop was performed daily for the 2 weeks prior to the stoma (AU)

[Urinary tract surgery in patients with ovarian peritoneal carcinomatosis treated with cytoreduction and hyperthermic intraoperative intraperitoneal chemotherapy]. / Cirugía del tracto urinario en pacientes con carcinomatosis peritoneal ovárica tratadas con citorreducción y quimioterapia intraperitoneal intraoperatoria hipertérmica.

INTRODUCTION: The objective of the present work is to describe our experience in the surgery of the ureter and bladder in patients with primary and recurrent ovarian cancer subjected to peritonectomy procedures and the administration of hyperthermic intraoperative intraperitoneal chemotherapy (HIIC). PATIENTS AND METHOD: Those patients who required surgical procedures on the distal ureter or bladder, were selected from a prospective data base constructed at the beginning of the peritoneal carcinomatosis program in our centre. Seven patients fulfilled this requirement and were included in the study. A total of 81 patients diagnosed with primary or recurrent ovarian cancer from December 2007 to April 2011 were included for maximum effort cytoreduction and HIIC. RESULTS: It was necessary to perform some surgical manoeuvre on the ureter or bladder in seven patients, with a median age of 46 years (40-71). Four patients were operated on due to recurrence of the ovarian disease and in the other 3 patients the indication was surgical rescue after non-optimal surgery in another centre. There was direct tumour involvement of the lower urinary tract in 4 of them. Three patients (42%) in the series developed at least one postoperative complication. CONCLUSION: The performing of peritonectomy procedures that include the eventual resection of the ureter or bladder, and the subsequent application of HIIC in a selected group of patients with peritoneal dissemination due to an ovarian carcinoma can be done with reasonable rates of postoperative morbidity. These surgical procedures may be necessary to achieve optimal surgery.

Tratamiento quirúrgico del GIST avanzado en la era del imatinib / Surgical treatment of an advanced GIST the age of imatinib

La aplicación clínica del imatinib en el manejo de los tumores de la estroma gastrointestinal ha cambiado radicalmente su pronóstico, especialmente en sus formas avanzadas, ya sean metastásicas, la mayoría, o localmente avanzadas. Las elevadas tasas de respuesta obtenidas permiten, en muchos casos, el empleo de la cirugía en situaciones en que antes era imposible, e incluso se llega a considerar la cirugía como un arma terapéutica de primera línea en combinación con imatinib. Aun así, su empleo no debe ser indiscriminado. Serán las diferentes respuestas que estos tumores poseen al imatinib lo que determine su utilidad y su forma de empleo. El uso combinado de cirugía e imatinib supone un claro y exitoso ejemplo de tratamiento multimodal en el contexto de lo que se ha denominado terapia molecular dirigida (AU)

The use of imatinib in the management of gastrointestinal stromal tumours has radically changed their prognosis, particularly in their advanced forms, whether they are metastasic (the majority) or locally advanced. The high rates of response obtained means that, in many cases, surgery can be performed in situations where it was impossible to do so, even to the extent of considering surgery as a first line therapeutic weapon in combination with imatinib. Even so, it must not be used indiscriminately. It will be the different responses of these tumours to imatinib that will determine its usefulness and the way it is used. The combined use of surgery and imatinib is a clear and successful example of multimodal treatment in the context of the so-called targeted molecular therapy (AU)

Genetic and pharmacological inhibition of poly(ADP-ribose) polymerase-1 interferes in the chlamydial life cycle.

Chlamydiaceae are intracellular bacteria responsible for a variety of infections, ranging from asymptomatic to very severe, in humans and animals. We have investigated the role of poly(ADP-ribose) polymerase-1 (PARP-1) in Chlamydophila abortus infection using PARP-1-/- and their littermates PARP-1+/+ mice. Infection was resolved more efficiently by PARP-1-/- than PARP-1+/+ mice. However, the inflammatory response was similar in both strains, suggesting a potential role for PARP-1 in the cross-talk between this microorganism and the host cells. PARP-1-/- fibroblasts showed a 10-fold lower rate of chlamydiae production than PARP-1+/+. Moreover, a strong inhibition of bacterial production was also observed after pharmacological inhibition of PARP-1 activity in McCoy cells. Likewise, PARP-1 inhibition induced a higher level of cell death of infected cells, interfering in this way with the normal bacterial cell cycle. Overall, we identify PARP-1 as a new molecule involved in chlamydial developmental cycle, although the intrinsic mechanisms deserve further studies.

Tratamiento quirúrgico del bocio multinodular en pacientes geriátricos / Surgical treatment of multinodular goiter in the elderly

Introducción. Aunque la edad no es contraindicación para la cirugía tiroidea, pocos pacientes añosos son intervenidos, dado su mayor riesgo de morbilidad. Los objetivos del estudio son determinar en los pacientes de más de 65 años: a) si las indicaciones de cirugía en el bocio multinodular difieren respecto a los más jóvenes; b) los resultados de la cirugía, y c) si la morbimortalidad posquirúrgica es mayor. Pacientes y método. Se analizan 81 bocios multinodulares intervenidos con más de 65 años, 40 de los cuales (49 por ciento) presentaban comorbilidades asociadas (hipertensión, diabetes, etc.). El 60 por ciento tenía clínica tiroidea, compresiva (n = 36; 44 por ciento) y/o tóxica (n = 18; 22 por ciento). Todos fueron intervenidos de forma programada, previa estabilización y control estricto de las comorbilidades. Como grupo control se utilizaron 510 bocios multinodulares intervenidos, con edades comprendidas entre 30 y 65 años. Se aplicaron los tests de la 2 y de la t de Student. Resultados. Los pacientes geriátricos presentan, respecto al grupo control, mayor tiempo de evolución del bocio (160 frente a 87 meses; p = 0,0321), mayor presencia de sintomatología (el 60 frente al 41 por ciento; p = 0,0001) y mayor porcentaje de componente intratorácico (el 63 frente al 37 por ciento; p = 0,0001). Respecto a las indicaciones de la cirugía destaca una mayor indicación por clínica compresiva (el 43 frente al 21 por ciento; p = 0,0012). Se presentaron complicaciones postoperatorias en el 40 por ciento de los pacientes (n = 32), índice superior al del grupo control (el 28 por ciento; p = 0,0113), aunque en un alto porcentaje fueron complicaciones transitorias. Como complicaciones definitivas se presentaron 2 lesiones recurrenciales (2,5 por ciento). En todos los casos la sintomatología preoperatoria remitió, y sólo se asoció un carcinoma tiroideo en 3 pacientes (3,7 por ciento), uno de ellos anaplásico. Conclusiones. El bocio multinodular intervenido en pacientes añosos presenta una mayor evolución y un mayor componente intratorácico, por lo que la indicación de cirugía se produce de forma restrictiva. Con un buen control de las comorbilidades y una intervención programada los resultados en cuanto a la morbimortalidad son semejantes a los obtenidos en edades más tempranas (AU)

Utilidad de la laparoscopia en el abdomen agudo de la mujer en edad fértil / Utility of laparoscopy in acute abdomen in women of childbearing age

Introducción. El objetivo de este trabajo es analizar la utilidad del abordaje laparoscópico para establecer un diagnóstico y tratamiento correcto en mujeres jóvenes que se operan con dolor agudo en la fosa ilíaca derecha. Pacientes y método. Operamos por laparoscopia a 167 mujeres de entre 12 y 49 años de edad que fueron vistas en urgencias de nuestro hospital con dolor agudo en la fosa ilíaca derecha. Las mujeres con sospecha de apendicitis aguda eran operadas por laparoscopia siempre que hubiera el material necesario y un cirujano con experiencia suficiente en esta técnica. No hubo otros criterios de exclusión. El período estudiado fue entre junio de 1991 y diciembre de 1997. Estudiamos los hallazgos operatorios, la tasa de conversión a laparotomía, las complicaciones, el tiempo operatorio y la estancia operatoria. Resultados. Se confirmó una apendicitis aguda en 128 de las 167 pacientes (76,6 por ciento). De las 39 restantes (23,3 por ciento), 26 (66,6 por ciento) presentaban alguna patología ginecológica que justificaba los síntomas. En sólo 4 pacientes no encontramos ninguna patología abdominal causante del dolor abdominal. La tasa de conversión fue del 6 por ciento. Diez pacientes (6 por ciento) sufrieron complicaciones directamente relacionadas con la cirugía. Conclusiones. La laparoscopia es un método con alta capacidad diagnóstica (97,6 por ciento) que permite diagnosticar y resolver la mayoría de los cuadros que causan dolor agudo en la fosa ilíaca derecha (AU)