Endoscopic resection as unique treatment for early colorectal cancer.

Colonoscopic screening in developed countries allows detection and resection of a great number of early colorectal cancers. There is a strong controversy to decide when endoscopic treatment is enough or when surgical resection is necessary. To this contributes the diverse names to define the lesions, the wide number of classifications and the different criteria of each author. We perform an extense literature review, aiming to clarify concepts and unify criteria that can be used as a guide for the treatment of early colorectal cancer. We conclude that in early colorectal cancer arising in pedunculated polyps (0-Ip), mucosal endoscopic resection would be indicated as only treatment in Haggitt levels 1, 2 and 3, tumors smaller than 2 cm, well- or moderately differentiated, without vascular or lymphatic affection, with submucosal infiltration lower than 1 microm from the muscularis mucosae and maximal submucosal width lower than 4 microm, and undergoing en bloc resection. In sessile polyps (0-Is) or non-polypoideal elevated (0-IIa) or plain (0-IIb) lesions, recommendations will be similar, without applicability of Haggitt levels.

A randomized trial comparing two corticosteroid regimens combined with mycophenolate mofetil and cyclosporine for prevention of acute renal allograft rejection.

INTRODUCTION: The launching of mycophenolate mofetil (MMF) has reduced the incidence of acute rejection episodes. We sought to evaluate the efficacy of decreasing the steroid dose. MATERIALS AND METHODS: This was a quasiexperimental, randomized, prospective trial. We enrolled 150 patients who received de novo renal transplantations from living or cadaveric donors, fulfilling the screening criteria. Patients were randomized to one of the following two arms: (A) MMF at a 2 g/d dose, cyclosporine (CsA) at a dose necessary to achieve target levels, and corticosteroids at the usual doses; (B) MMF at a 2 g/d dose, CsA at a dose necessary to achieve target levels, and corticosteroids at doses 50% lower than those of group A. RESULTS: Group A included 72 (48%) and group B, 78 patients (52%). There were no differences among the variables: leukopenia occurred in 11 patients in group A, and five patients in group B. Complications occurred in 67.4% (56) of group A, but only 32.6% (27) were related to infections. One case of urinary infection occurred in group B, while six occurred in group A. There was one case of acute rejection in group A, and none in group B. One graft loss occurred in group A. There were no differences in the remaining variables under study. DISCUSSION: The results showed an increased complication rate related to receiving usual steroid doses. There was no increase in acute rejection episodes among patients receiving 50% of the usual steroid dose.

Lipid metabolism during the perinatal phase, and its implications on postnatal development.

During pregnancy, lipid metabolism plays a major role to warrant the availability of substrates to the foetus. By using different experimental designs in the rat we have been able to answer several questions that were open about the short- and long-term effects of alterations of lipid metabolism during the perinatal stage. The first one was to demonstrate the importance of maternal body fat depot accumulation during the first half of pregnancy. We found that conditions like undernutrition circumscribed to this specific period when foetal growth is still small, that impede such fat accumulation not only restrain intrauterine development but also have long-term consequences, as shown by an impaired glucose tolerance when adults. Secondly, undernutrition during suckling has major long-term effect decreasing body weight, even though food intake was kept normal from the weaning period. Present findings also show that a diet rich in omega-3 fatty acids during pregnancy and lactation has negative effects on offspring development, but cross fostered experiments showed that the effect was a consequence of the intake of these fatty acids during the lactation period rather than during pregnancy. Pups from dams that were fed a fish oil-rich diet during pregnancy and lactation were found to have altered glucose/insulin relationship at the age of 10 weeks. Since a omega-3 fatty acid-rich diet decreases milk yield during lactation, additional experiments were carried out to determine whether decreased food intake, altered dietary fatty acid composition, or both were responsible for the long-term effects on the glucose/insulin axis. Results show that the decreased food intake caused by a omega-3 fatty acid-rich diet rather than the change in milk composition during suckling was responsible for the reduced pancreatic glucose responsiveness to insulin release at 16 weeks of age. In conclusion, present findings indicate that impaired maternal fat accumulation during early pregnancy and food intake during lactation, rather than a difference in dietary fatty acid composition have a greater influence on postnatal development and affect glucose/insulin relationships in adult rats.

Experimental models for studying perinatal lipid metabolism. Long-term effects of perinatal undernutrition.

By using different experimental designs in the rat we have been able to answer several unanswered questions on the short- and long-term effects of alterations of lipid metabolism during the perinatal stage. The first was to demonstrate the importance of maternal body fat accumulation during the first half of pregnancy, since undernutrition in this critical period when fetal growth is slow, impedes fat depot accumulation and not only restrains intrauterine development but has long-term consequences, as shown by an impaired glucose tolerance when adults. Secondly, undernutrition during suckling has major long-term effect of decreasing body weight, even though food intake is kept normal from the weaning period. Our findings also show that a diet rich in n-3 fatty acids during pregnancy and lactation has adverse effects on offspring development, but cross fostered experiments showed that this effect was a consequence of the intake of these fatty acids during the lactation period rather than during pregnancy. Pups from dams that were fed a fish oil-rich diet during pregnancy and lactation were found to have altered glucose/insulin relationship at the age of 10 weeks. Since a n-3 fatty acid-rich diet decreases milk yield during lactation, additional experiments were carried out to determine whether decreased food intake or altered dietary fatty acid composition, or both, were responsible for the long-term effects on the glucose/insulin axis. Results show that the decreased food intake caused by a n-3 fatty acid-rich diet rather than the change in milk composition during suckling was responsible for the reduced pancreatic glucose responsiveness to insulin release at 16 weeks of age. In conclusion, present findings indicate that impaired maternal fat accumulation during early pregnancy and food intake during lactation, rather than a difference in dietary fatty acid composition, have major effects on postnatal development and affect glucose/insulin relationships in adult rats.

Resección endoscópica de cáncer colorrectal temprano como único tratamiento / No disponible

El screening mediante colonoscopia que se realiza en paísesoccidentales ha permitido la detección y resección de un númeroelevado de tumores colorrectales en estadio temprano. Existe unagran controversia a la hora de decidir cuándo el tratamiento endoscópicoes suficiente y cuándo debe realizarse la resección quirúrgica.A ello contribuye la gran diversidad en la nomenclaturapara definir estas lesiones, la amplia variedad de clasificaciones delas mismas y los diferentes criterios que tiene cada autor. Medianteuna revisión extensa de la literatura, pretendemos aclarar conceptos,enlazar los datos de las diferentes clasificaciones y unificarunos criterios que sirvan de guía para el tratamiento del cáncercolorrectal temprano. Tras ello, llegamos a la conclusión de queen el cáncer colorrectal temprano que aparece en pólipos pedunculados(0-Ip), estaría indicada la resección endoscópica comoúnico tratamiento en los niveles 1, 2 y 3 de Haggitt, tumores menoresde 2 cm de diámetro, en tumores bien o moderadamentediferenciados, sin afectación vascular ni linfática, con infiltraciónde la submucosa menor de 1 mm desde la muscularis mucosae yanchura máxima en la submucosa menor de 4 mm y resecados enbloque. En las lesiones polipoideas sésiles (0-Is) y no polipoideaselevadas (0-IIa) o planas (0-IIb) las recomendaciones serían las mismasdescritas anteriormente, no siendo aplicables los niveles deHaggitt(AU)

Colonoscopic screening in developed countries allows detectionand resection of a great number of early colorectal cancers.There is a strong controversy to decide when endoscopic treatmentis enough or when surgical resection is necessary. To thiscontributes the diverse names to define the lesions, the wide numberof classifications and the different criteria of each author. Weperform an extense literature review, aiming to clarify conceptsand unify criteria that can be used as a guide for the treatment ofearly colorectal cancer. We conclude that in early colorectal cancerarising in pedunculated polyps (0-Ip), mucosal endoscopic resectionwould be indicated as only treatment in Haggitt levels 1, 2and 3, tumors smaller than 2 cm, well- or moderately differentiated,without vascular or lymphatic affection, with submucosal infiltrationlower than 1 mm from the muscularis mucosae and maximalsubmucosal width lower than 4 mm, and undergoing en blocresection. In sessile polyps (0-Is) or non-polypoideal elevated (0-IIa) or plain (0-IIb) lesions, recommendations will be similar, withoutapplicability of Haggitt levels(AU)

Tratamiento de una fístula linfática post-colectomía total por colitis isquémica / Treatment of a total post-colectomy lymphatic fistula by ischemic colitis

No disponible

Intubación orotraqueal con laringoscopio óptico Airtraq en un niño con síndrome de Smith-Lemli-Opitz y vía aérea difícil / Orotracheal intubation with an Airtraq optical laryngoscope in a child with Smith-Lemli-Opitz syndrome and a difficult airway

No disponible

Reacción de hipersensibilidad tras inyección de azul patente V sódico para detección de ganglio centinela / No disponible

No disponible

Eventroplastia laparoscópica:mejora de resultados con el usode 4 puntos / Laparoscopic repair of primary and incisional hernias: improved results with the use of 4 sutures

No disponible

Un caso de paraganglioma del arco aórtico / A case of paraganglioma of the aortic arch

Se presenta el caso de una mujer de 20 años con un paraganglioma secretor de localización infrecuente en el arco aórtico. Su presentación clínica tuvo lugar tras una cesárea, precisando de tratamiento previo a la cirugía para normalizar la tensión arterial. Su tratamiento quirúrgico fue la escisión completa, con buena evolución clínica de la paciente. Se comentan las peculiaridades de dicha presentación anatómica y su frecuencia. (AU)

Curva de aprendizaje en la técnica de Stoppa / Learning curve in stoppa´s technique

Introducción. Para adquirir experiencia en una técnica quirúrgica se requiere un período de aprendizaje. Objetivo. Estudiar la curva de aprendizaje de la técnica de Stoppa (GPRVS), para la reparación de la hernia inguinal bilateral. Pacientes y métodos. Se incluyó a 170 pacientes (340 hernias) intervenidos entre enero de 1995 y diciembre de 2001 por hernia inguinal bilateral mediante la técnica de Stoppa. Su edad media era de 57,2 años (rango, 28-89), 7 eran mujeres y 163 varones (96 por ciento). Se practicó cirugía urgente por hernia incarcerada en 6 casos (3,5 por ciento).Resultados. La tasa de hernias reproducidas, enfermedades concomitantes y técnicas quirúrgicas asociadas fue similar en el período. El tiempo operatorio disminuyó de 100 (1995) a 61 min (2001). Se dejó drenaje en el 100 por ciento de los casos en 1995 y sólo en el 6,6 por ciento en 2001. La anestesia regional pasó del 25 (1995) al 83 por ciento (2001), la estancia hospitalaria de 5,1 a 1,5 días (2001) y la morbilidad del 50 (1995) al 13 por ciento (2001) (p < 0,0001). La tasa media de recidivas fue del 1,7 por ciento, con dos casos en los 30 primeros (6,6 por ciento) y uno en los 140 restantes (0,7 por ciento) (seguimiento, 1-76 meses). En 1995 la técnica era iniciada y realizada por un cirujano en el 100 por ciento de los casos, mientras que en 2001 este porcentaje se redujo al 42 por ciento, incrementándose la participación del resto del servicio y de los residentes. Conclusiones. Los primeros 25-30 casos de una técnica quirúrgica constituyen la curva de aprendizaje, con la mayor tasa de morbilidad, dificultades técnicas y operatorias y días de estancia hospitalaria. Con la experiencia mejoran los resultados, lo que afecta a todos los cirujanos que la ejecutan (AU)