Resistance to apoptosis in complicated Crohn's disease: Relevance in ileal fibrosis.

BACKGROUND AND AIMS: The stiffening of the extracellular matrix, and changes in its cellular and molecular composition, have been reported in the pathogenesis of fibrosis. We analyze the mechanisms that perpetuate ileal fibrosis in surgical resections of complicated Crohn's disease patients. METHODS: Ileal resections were obtained from affected and non-affected tissue of stenotic or penetrating Crohn's disease behavior. Ilea from non-IBD patients were used as control tissue. All samples underwent RNA sequencing. Human small intestinal fibroblasts were treated for 48 h with IL-1ß, TFGß1, PDGFB or TNF-α. Resistance to apoptosis was analysed by RT-PCR, western blot and immunohistochemistry in ileal tissue and by RT-PCR and FACS in cultured cells. RESULTS: Growth factor-driven signaling pathways and increased RAS GTPase activity were up-regulated in affected ilea in which we found expression of both the antiapoptotic molecule MCL1 and the transcription factor ETS1 in submucosal fibroblasts, and a senescence-associated secretory phenotype. In cultured intestinal fibroblasts, PDGFB induced an ETS1-mediated resistance to apoptosis that was associated with the induction of both of TGFB1 and IL1B, a cytokine that replicated the expression of SASP detected in ileal tissue. ETS1 drove fibroblast polarization between inflammatory and fibrogenic phenotypes in IL1ß-treated cells. CONCLUSIONS: Our data show resistance to apoptosis in complicated ileal CD, and demonstrate that PDGFB induce an ETS1-mediated resistance to apoptosis associated with an inflammatory and fibrogenic pattern of expression in intestinal fibroblasts. Results point to PDGFRB, IL1R1 or MCL1 as potential targets against ileal fibrosis.

Prospective evaluation of intraoperative peripheral nerve injury in colorectal surgery.

AIM: Intraoperative peripheral nerve injury can have permanent neurological consequences. Its incidence is not known and varies according to the location and the surgical specialty. This study was a prospective analysis of intraoperative peripheral nerve injury as a complication of abdominal colorectal surgery. METHOD: All patients who underwent major colorectal abdominal surgery in our Colorectal Unit between 1996 and 2009 were analyzed. Data on nerve injury were prospectively collected. RESULTS: There were 2304 patients, of whom eight (0.3%) experienced intraoperative peripheral nerve injury. This occurred in 5/2211 (0.2%) open procedures and in 3/93 (3%) laparoscopic procedures. There was no association between intraoperative peripheral nerve injury and age, gender, body mass index, surgeon, operation time, American Society of Anesthesiology (ASA) score and urgent surgery. The use of Allen-type stirrups and a vacuum bag (in laparoscopic surgery) seemed to be protective for nerve injury in the lower and upper limbs respectively. CONCLUSION: Adequate positioning and the use of pressure-free positioning devices may prevent intraoperative peripheral nerve injury, particularly during laparoscopy.

Estudio comparativo de la efectividad del bloqueo ilioinguinal con dexketoprofeno como coadyuvante anestésico versus administración intramuscular de dexketoprofeno en los pacientes sometidos a hernioplastia inguinal elective / Effectiveness of ilioinguinal blockade with dexketoprofen in comparison to parenteral administration in patients undergoing elective open inguinal hernia repair

Objetivo: Análisis del resultado de la utilización de dexketoprofeno en la solución anestésica del bloqueo ilioinguinal (DKT INC) en comparación con la administración intramuscular (DKT im) en la hernioplastia inguinal electiva. Material y métodos: Estudio prospectivo, aleatorizado con análisis retrospectivo de los resultados de 120 pacientes consecutivos sometidos a hernioplastia inguinal convencional ambulatoria mediante anestesia local y sedación controlada por anestesista. Principales medidas de resultados: Tolerancia al procedimiento, necesidad de dosis suplementarias de propofol, intervalo libre de dolor tras la intervención, consumo diario de analgésicos en la primera semana postoperatoria, puntuación diaria de dolor percibido y recuperación de las actividades de la vida diaria. Resultados: Ambos grupos fueron comparables en relación a edad, sexo y tipo de hernia. El intervalo libre de dolor fue mayor de 12 horas en el 91,6 % del grupo DKT INC. El porcentaje de pacientes que no requirieron analgesia postoperatoria fue de 43,3, 40, 65,0 y 70 % en el grupo de DKT INC en los días 1 a 4 postoperatorio. El análisis de la varianza de medidas repetidas demostró un menor consumo de analgésicos (p = 0,004) y un menor dolor postoperatorio (p = 0,054) sin mostrar influencia en el grado de recuperación de las AVD. Conclusiones: La administración de DKT en la solución anestésica durante el bloqueo ilioinguinal en la hernioplastia inguinal mejora considerablemente el postoperatorio en términos de dolor percibido y consumo de analgésicos en comparación con la administración intramuscular, por lo que debería considerase su inclusión en los protocolos de bloqueo ilioinguinal en la reparación protésica de la hernia inguinal (AU)

Objective: Analysis of dexketorpofen action in anesthetic solution during ilioinguinal blockade in comparison with intramuscular administration in patients undergoing elective inguinal hernia repair. Patients and methods: Prospective, aleatorized with retrospective analysis of 120 consecutive patients undergoing elective open prosthetic inguinal hernia repair in the ambulatory setting with local anaesthesia and anaesthetic monitored sedation. Main results measures: Procedure tolerance, propofol administration requierements, free pain interval after operation, analgesic comsumption , daily pain score and recovery for daily activities where considered. Results: Both groups were similar in terms of age, sex and hernia classification. The pain free interval was grater than 12 hours in 91.6 % on INC DKT. The percentage of patients which didn’t required analgesia was 43.4, 40, 65.0 and 70 % in INC DKT group within postoperative days 1 and 4. ANOVA repeated measures showed a lower comsumption of analgesics (p = 0.004) and less postoperative pai (p = 0.054) but not influence in postoperative recovery. Conclusion: DKT administration in the anaesthetic solution at the time of ilioinguinal blockade increases postoperative recovery in terms of analgesic compsuntion and pain score in comparison with parenteral administration, therefor it should be considered in patients undergoing elective inguinal hernia repair with local anaesthesia (AU)

Fundoplicatura Nissen laparoscópica ambulatoria: estudio prospectivo observacional / Laparoscopic Nissen fundoplication surgery ambulatory: descriptive observational study

Objetivo: analizar la factibilidad del desarrollo de un programa de fundoplicatura de Nissen laparoscópica ambulatoria (FNLA) en pacientes sometidos a cirugía antirreflujo por enfermedad por reflujo gastroesofágico (ERGE) en el Instituto de Cirugía y Aparato Digestivo de la Clínica Quirón de Valencia. Material y método: estudio descriptivo observacional de 67 pacientes consecutivos sometidos a FNLA analizados en intención de tratamiento. Se analizan los índices principales de cirugía mayor ambulatoria, ingresos no planeados, reingresos, tasa de ambulatorización, porcentaje de estancia over-night e influencia de los factores demográficos y clasificación de la ERGE. Resultados: la estancia postoperatoria media en los pacientes ambulatorios fue de 5,65 ± 1,25 horas, el índice de ambulatorización fue de 47,8%, con un porcentaje de ingresos no planeados de 56,2%. La tasa de reingresos fue de 3,1%, con un porcentaje de consultas no planificadas de 9,4%. La causa más frecuente de ingreso no esperado fue la social (55,6%) seguida de la hora de alta inadecuada (29,6%). Los pacientes ambulatorios presentaron edad media y duración de intervención significativamente inferior a los del grupo con ingreso, así como una ERGE más avanzada. Conclusiones: los resultados de nuestro estudio muestran que la FNLA es un procedimiento factible, seguro, con resultados a largo plazo similares a los obtenidos con hospitalización convencional y una mayor tolerancia para el paciente respecto a la CLA en términos de dolor, consumo de analgésicos y recuperación de las actividades diarias (AU)

Objective: prospective evaluation of the feasibility of a programm of outpatient laparoscopic Nissen Fundoplication (OLNF) in patients undergoing antirreflux surgery for gastroesophageal reflux disease (GORD) at Institute of Gastrointestinal Surgery from the Quiron Hospital at Valencia. Methods: prospective observational study of 67 consecutive patients undergoing OLNF in intention to treat analysis. Main ambulatory surgical index, non planned admission, ambulatorization index, over-night stay requierements and demographics with GORD classification with REFA scale are reviewed. A comparative analysis of analgesic compsuntiom and daily activities recovery was performed comparing a paired group of patients undergoing ambulatory laparoscopic cholecystectomy (ALC) and those who underwent OLNF. Results: mean postoperative stay in outpatients was 5.65 ± 1.25 hours. Ambulatorization was achieved in 47.8% with a non planned admission index of 56.2%. Re-admissions were recorded in 3.1% and non scheduled visits reached 9.4%. The most frequent reason for admission was due to social reasons (55.6%), followed by inadecuated discharge time in 29.6%. Outpatients showed mean age and mean surgical time lower than admitted patients and also a more advanced GORD. In terms of pain, analgesic comsumption and daily activities recovery OLNF achieved better results than ALC. Conclussion: our results show that OLNF is a feasible procedure with long term results similar to traditional in hospital operations with a better result in terms of pain, analgesic compsumtion and recovery of daily activities in comparison with ALC (AU)