RESUMEN
AIM: There has been controversy about the presentation and treatment of acute colonic diverticulitis (AD) in young patients. The aim of this observational study was to evaluate the virulence and natural history of AD in three different age groups of patients. METHOD: The study was performed on 686 patients with the diagnosis of a first episode of AD admitted between January 1998 and December 2008. Patients were classified into three groups: age 45 years or younger (group 1), 45-70 years of age (group 2) and 70 years or more (group 3). The variables studied were gender, American Society of Anesthesiologists status, associated comorbidity, type of treatment, length of hospital stay and recurrence of AD. RESULTS: Group 1 included 99 (14.4%) patients, group 2 339 (49.4%) and group 3 248 (36.2%). Of these, 144 patients needed emergency operation at the first admission, 25 underwent elective surgery after the first episode of AD and 10 died after medical treatment; 507 patients were followed for recurrence. In all, 104 (20.5%) patients had a recurrence of AD that required hospitalization. Fifty (9.9%) presented with one episode of severe recurrence, without any difference between the groups (P = 0.533). There were no differences in the analysis of cumulative recurrence (Kaplan-Maier) between the three groups. CONCLUSION: AD does not present a more aggressive clinical course in younger patients and it can be safely managed using the same strategy as in middle aged and older patients.
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Absceso Abdominal/etiología , Colon/cirugía , Diverticulitis del Colon/terapia , Absceso Abdominal/terapia , Enfermedad Aguda , Adulto , Factores de Edad , Anciano , Anastomosis Quirúrgica , Antibacterianos/uso terapéutico , Distribución de Chi-Cuadrado , Colectomía , Diverticulitis del Colon/complicaciones , Diverticulitis del Colon/diagnóstico , Femenino , Fluidoterapia , Humanos , Estimación de Kaplan-Meier , Tiempo de Internación , Masculino , Persona de Mediana Edad , Peritonitis/etiología , Recurrencia , Estadísticas no ParamétricasRESUMEN
AIM: This paper addresses the current status of the treatment of acute colonic diverticulitis by an evidence-based review. METHOD: A systematic search in PUBMED, MEDLINE, EMBASE and Google scholar on colonic diverticulitis was performed. Diagnostic tools, randomized controlled trials, non-randomized comparative studies, observational epidemiological studies, national and international guidelines, reviews of observational studies on elective and emergency surgical treatment of diverticulitis, and studies of prognostic significance were reviewed. Criteria for eligibility of the studies were diagnosis and classification, medical treatment, inpatients and outpatients, diverticulitis in young patients, immunosuppression, recurrence, elective resection, emergency surgery, and predictive factors. RESULTS: Some 92 publications were selected for comprehensive review. The review highlighted that computed tomography is the most effective test in the diagnosis and staging of acute diverticulitis; outpatient treatment can be performed for uncomplicated diverticulitis in patients without associated comorbidities; conservative treatment is aimed at those patients with uncomplicated acute diverticulitis; elective surgery must be done on an individual basis; laparoscopic approach for elective treatment of diverticulitis is appropriate but may be technically complex; in perforated diverticulitis, resection with primary anastomosis is a safe procedure that requires experience and should take into account strict exclusion criteria. CONCLUSION: The heterogeneity of patients with colonic diverticular disease means that both elective and urgent treatment should be tailored on an individual basis.
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Diverticulitis del Colon/diagnóstico , Diverticulitis del Colon/terapia , Enfermedad Aguda , Ensayos Clínicos como Asunto , Diagnóstico por Imagen , HumanosRESUMEN
AIM: To study any possible differences in morbidity, mortality and overall survival rate after curative surgery for obstructive colon cancer according to tumour location. METHOD: From January 1994 to December 2006, patients with colonic cancer presenting as obstruction were analysed. The two groups were defined as proximal and distal according to the tumour location with respect to the splenic flexure. In relation to the surgeon specialization, patients were operated on by a colorectal surgeon and by a general surgeon. Postoperative morbidity and mortality and cancer-related survival at 3 years were analysed. RESULTS: Of the 377 patients included in the study, there were 173 patients (45.9%) in the proximal group and 204 patients (54.1%) in the distal group. The global morbidity was 54.9% without differences in postoperative morbidity except for anastomotic leakage, which was higher in the proximal group (P < 0.014). No differences in postoperative mortality were observed. After patients were stratified by the tumour node metastasis system, the differences between the groups, with respect to 3-year overall survival, cancer-related survival and probability of being free from recurrence, did not reach statistical significance. The overall survival after radical surgery for colonic obstruction was 57.6%. CONCLUSION: Mortality and morbidity after emergency surgery for obstructing colon cancer are high. Specialization in colorectal surgery influences postoperative results in terms of lower anastomotic dehiscence rate after emergency proximal colon resection. After radical surgery, tumour location does not appear to influence the prognosis of obstructive colon cancer.
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Colectomía/mortalidad , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Obstrucción Intestinal/cirugía , Fuga Anastomótica/etiología , Colectomía/efectos adversos , Neoplasias del Colon/complicaciones , Cirugía Colorrectal , Femenino , Cirugía General , Humanos , Obstrucción Intestinal/etiología , Masculino , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVE: Retrospective analysis of all surgical, early postoperative, and 1-week to detect risk factors. MATERIAL AND METHODS: A database was established to record clinical, anesthetic, and surgical variables, grouped as preoperative, intraoperative and postoperative factors, and reflecting comorbidities and postoperative complications. Each patient's cause of death was also recorded. Factors influencing mortality during surgery, at 48 hours, and at 1 week were explored by comparing frequencies to detect correlations. RESULTS: From 2004 to 2008, a total of 809 deaths occurred in the 82412 hospitalized surgical patients. Patients who died during surgery or within 48 hours were younger, had a higher ASA physical status classification, had more cardiovascular risk factors, were less likely to have a diagnosis of cancer, and had spent less time in hospital before the operation. Intraoperative complications, particularly bleeding and cardiac events, were more frequent in patients whose condition was more complex and who died during surgery; that pattern was similar but less marked in patients dying within 48 hours. The patients who died within 48 hours had a higher rate of postoperative hemodynamic complications; the patients who died during the week following surgery had higher rates of septic, neurologic, and respiratory complications. CONCLUSIONS: Emergency surgery stands out as an important predictor of death during or after surgery; other significant risk factors are postoperative complications.
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Procedimientos Quirúrgicos Operativos/mortalidad , Anciano , Estudios Transversales , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Estudios Retrospectivos , Factores de TiempoAsunto(s)
Coristoma/cirugía , Hiperparatiroidismo/cirugía , Paratiroidectomía/métodos , Enfermedades Torácicas/cirugía , Cirugía Asistida por Video/métodos , Adenoma/complicaciones , Adenoma/cirugía , Anciano , Coristoma/complicaciones , Femenino , Humanos , Hiperparatiroidismo/etiología , Mediastino/cirugía , Glándulas Paratiroides , Neoplasias de las Paratiroides/complicaciones , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía/efectos adversos , Enfermedades Torácicas/complicaciones , Cirugía Asistida por Video/efectos adversosRESUMEN
BACKGROUND: Subtotal thyroidectomy is a widely accepted surgical procedure for Graves' disease. The purpose of this work is to evaluate functional long-term results and determine predictive prognostic factors of postoperative thyroid function. STUDY DESIGN: This is a retrospective study conducted on 202 patients with Graves' disease undergoing subtotal thyroidectomy during the period 1979-2002. Predictive prognostic factors of final thyroid status were investigated by logistic ordinal regression, and probability of hypothyroidism during the years of follow-up was obtained by the Kaplan-Meier method. RESULTS: Surgery controlled hyperthyroidism in 196 out of 202 patients (97%). The probability of hypo-, eu-, and hyperthyroidism at 5 years was 62.1%, 35.5%, and 2.4%, respectively. No statistical change in thyroid function occurred in the follow-up after 60 months. Multivariate analysis by a logistic ordinal regression analysis showed that weight of the remnant, age, and gender seemed to influence long-term thyroid function. The higher rates of euthyroidism were obtained when the remnant weight was between 6 and 8 g. No recurrence or persistence of hyperthyroidism occurred with remnant weights under 5 g. CONCLUSIONS: Subtotal thyroidectomy controlled hyperfunction symptoms in 97% of our patients. Cure (euthyroidism) of Graves' disease patients should be attempted by leaving a thyroid tissue remnant between 6 and 8 g. Even more significant, our results suggest that euthyroidism rates could be improved by leaving a smaller remnant in elderly women and greater remnants in young men.
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Enfermedad de Graves/cirugía , Hipertiroidismo/cirugía , Tiroidectomía/métodos , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Hipertiroidismo/etiología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: Prognostic evaluation of patients with left colonic perforation is useful in predicting mortality. The aims of this prospective study were to determine the prognostic value of the left colonic Peritonitis Severity Score (PSS) and to compare it with the Mannheim Peritonitis Index (MPI). METHODS: One-hundred and fifty-six patients underwent emergency operation for distal colonic peritonitis. The PSS and MPI were calculated for each patient. The Spearman rank correlation coefficient was used to measure the association between the two scores. The predictive power of the two scoring systems and their differences were studied using the area under the receiver-operator characteristic (ROC) curve. RESULTS: Forty-one patients died (26.3 per cent). The relationship between scores and mortality was statistically significant for each scoring system (P < 0.001). The Spearman rank correlation coefficient for the correlation between the MPI and PSS was 0.55 (P < 0.001). There was no difference between areas under the ROC curves for the two systems. CONCLUSION: The PSS and MPI are both well validated scoring systems for left colonic peritonitis. Their routine use might allow stratification of patients according to mortality risk.
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Enfermedades del Colon/mortalidad , Perforación Intestinal/mortalidad , Peritonitis/mortalidad , Índice de Severidad de la Enfermedad , Adulto , Anciano , Anciano de 80 o más Años , Urgencias Médicas , Tratamiento de Urgencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Medición de RiesgoRESUMEN
Familiar adenomatous polyposis (FAP) is a hereditary disease characterized by the development of multiple adenomatous polyps in the gastrointestinal tract and colorectal cancer in practically all patients who do not receive appropriate treatment. Although the most commonly involved region in this disease is the colorectal area, it is well known that adenomas can also develop in the upper gastrointestinal tract, mainly in the periampullary area of the duodenum. Because of the possibility of malignant transformation of these polyps, adequate monitoring is required, even though the optimal follow-up schedule has not yet been defined. In the present article, we report a case of a gastric adenocarcinoma detected during the follow-up of a patient diagnosed with FAP, as well as a review of the literature on this subject. We stress the need for early detection and appropriate management of this disease. Sufficient information is available to support the use of upper gastrointestinal endoscopy with lateral vision and serial biopsies of the periampullary region in these patients. The first endoscopy in patients with FAP should be performed at the age of 20 years or at diagnosis. Subsequently, a follow-up schedule should be designed, according to the number and histological characteristics of the polyps observed.
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Adenocarcinoma/etiología , Poliposis Adenomatosa del Colon/complicaciones , Neoplasias Gástricas/etiología , Adenocarcinoma/diagnóstico , Adulto , Endoscopía Gastrointestinal , Femenino , Humanos , Neoplasias Gástricas/diagnósticoRESUMEN
OBJECTIVE: Urinary dysfunction is a well-known complication of rectal surgery, secondary to injury to the autonomic nervous plexus. The object of this study was to evaluate the incidence, prevalence and type of micturition disorders following rectal cancer surgery and their reversibility during long-term follow-up. PATIENTS AND METHODS: A prospective study of 45 patients who underwent surgery for rectal cancer between 1993 and 1998 was undertaken. Those with pre-operative urinary dysfunction were excluded after sequential uroflowmetry and clinical interview. Ten of the surgical interventions were high anterior resections, 18 low anterior resections, and 17 abdominoperineal amputations. Pre-operative radiotherapy was performed in 47.9% of patients. All patients underwent sequential uroflowmetry and a clinical interview 3 and 12 months after the intervention. Subjects who presented micturition disorders underwent urodynamic examination The follow up period was three years. RESULTS: Three months after surgery alterations were found in 14 (31.3%) patients; the most frequent were stress incontinence, urinary tenesmus and the urge to urinate. At the 12-month assessment only 6 (13.3%) patients had urinary symptomatology or uroflowmetry abnormalities. After three years, micturition disorders persisted in 3 (6.6%) patients. CONCLUSION: Urinary dysfunction after rectal cancer excision is associated with a high degree of reversibility. Seventy-eight percent of the alterations detected after three months and 50% of those that persisted after a year disappeared during follow up.
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Complicaciones Posoperatorias , Neoplasias del Recto/cirugía , Recto/cirugía , Espasmo/etiología , Enfermedades de la Vejiga Urinaria/etiología , Trastornos Urinarios/etiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , UrodinámicaRESUMEN
UNLABELLED: Percutaneous ethanol injection is a useful option in the treatment of hepatocellular carcinoma which are not amenable to resection or transplantation. We describe a case of cholecystitis and tumour infiltration of the gallbladder after percutaneous ethanol injection, a complication not previously described in literature. The patient was a 70-year-old woman with a history of asymptomatic HCV+ hepatopathy and a 6 cm hepatocellular carcinoma nodule in segment V which had been treated two months before by percutaneous ethanol injection in another center. She attended our center due to febrile syndrome. Imaging studies suggested cholecystitis with an abscess on the wall of the gallbladder, purulent material obtained by means of a CT-guided puncture. Surgery revealed purulent and neoplasic material inside the gallbladder, with tumor invasion of the posterior wall; a partial cholecystectomy was therefore performed and a drainage inserted. The patient showed no post-operative complications and was discharged after seven days. CONCLUSION: we believe that the percutaneous ethanol injection of hepatocellular carcinomas located close to the gallbladder may occasionally lead to complications in the form of cholecystitis with neoplasic infiltration of the gallbladder. A case of cholecystitis secondary to radiofrequency treatment of a similarly-located tumor has previously been described and, therefore, the use of percutaneous local destructive treatments for tumors close to the gallbladder would seem unadvisable.
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Carcinoma Hepatocelular/tratamiento farmacológico , Colecistitis Aguda/inducido químicamente , Etanol/efectos adversos , Neoplasias Hepáticas/tratamiento farmacológico , Administración Cutánea , Anciano , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/patología , Colecistectomía , Colecistitis Aguda/diagnóstico por imagen , Colecistitis Aguda/terapia , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Invasividad Neoplásica , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , UltrasonografíaRESUMEN
UNLABELLED: Tacrolimus (FK506) is widely used in the organ transplant setting, but not in the treatment of IBD. OBJECTIVE: the aim of this study was to analyse the effectiveness of tacrolimus in specific clinical presentations of inflammatory bowel disease (IBD) in which recurrence is likely. PATIENTS AND METHODS: inclusion criteria were: perianal Crohn's disease (PCD), CD in rectal stump, pouchitis and cuffitis with severely impaired function of the ileoanal pouch (IPAA), and proven refractoriness to other therapies. Clinical assessment: Hughes' classification (PCD); Oresland index (OI) in IPAA, endoscopy-biopsy and Quality of life (QoL) using the Spanish version of the IBDQ. Response was determined as complete (CP), partial (PR) or non-existent (NR). Tacrolimus was administered orally at a dose of 0.1 mg/kg/day (levels 5-15 .g/L). RESULTS: nineteen patients entered the study. Mean duration of treatment was 9.6 +/- 6.3 months. In PCD, CR was reported in 66% of cases and PR in 33%, with disappearance of inflammation, stenosis and ulcers. In patients with pouchitis and cuffitis,77% presented either CR or PR. The OI scores and QoL improved significantly after treatment (p<0.006 and p<0.002, respectively). Adverse effects were minor and controlled by regulating the dose. CONCLUSION: oral administration of tacrolimus is easy to per-form and has few adverse effects when used to treat IBD in certain clinical presentations with a high likelihood of recurrence.
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Inmunosupresores/uso terapéutico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Tacrolimus/uso terapéutico , Adolescente , Adulto , Endoscopía del Sistema Digestivo , Femenino , Humanos , Inmunosupresores/efectos adversos , Enfermedades Inflamatorias del Intestino/patología , Enfermedades Inflamatorias del Intestino/psicología , Masculino , Persona de Mediana Edad , Reservoritis/tratamiento farmacológico , Reservoritis/patología , Estudios Prospectivos , Calidad de Vida , Tacrolimus/efectos adversosRESUMEN
INTRODUCTION: Palliative treatment for nondisseminated irresectable hilar cholangiocarcinoma (HCC) carries a 0% 5-year survival rate. The role of orthotopic liver transplantation (OLT) in these patients is controversial because the survival rate is lower than that for other indications for transplantation and the lack of available donor organs. The aim of this paper was to review the Spanish experience in OLT for HCC and identify prognostic factors for survival. METHODS: We retrospectively reviewed 36 patients undergoing OLT for HCC over 13 years. RESULTS: The actuarial survival rate at 1, 3, and 5 years was 82%, 53%, and 30%, respectively. The main cause of death was tumor recurrence (53%). In the univariate analysis, the factors for a poor prognosis were vascular invasion (P<.001) namely 0% survival at 3 years when present versus 63% and 35% at 3 and 5 years, respectively, when it was not; and stages III to IVA (P<.05), namely 15% survival at 5 years versus 47% for stages I to II. Lymph node and perineural invasion also reduce survival. In the multivariate analysis, the factors for poor prognosis included vascular invasion (P<.01) and stages III to IVA (P<.01). CONCLUSION: OLT for nondisseminated irresectable HCC has higher survival rates at 3 and 5 years than palliative treatments, especially with initial stage tumors, which means that more information is needed to better select cholangiocarcinoma patients for transplantation.
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Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Intrahepáticos , Colangiocarcinoma/cirugía , Trasplante de Hígado/mortalidad , Estudios de Seguimiento , Humanos , Estadificación de Neoplasias , Cuidados Paliativos , Estudios Retrospectivos , Análisis de Supervivencia , Factores de TiempoRESUMEN
INTRODUCTION: Palliative treatment for nondisseminated unresectable peripheral cholangiocarcinoma (PCC) carries a 0% 5-year survival rate. The role of orthotopic liver transplantation (OLT) in these patients is controversial because the survival rate is lower than with other indications for transplantation and the lack of available donor organs. The aim of this paper was to review the Spanish experience in OLT for PCC to identify prognostic factors for survival. METHODS: We retrospectively reviewed 23 patients undergoing OLT in Spain for PCC over a period of 13 years. RESULTS: The actuarial survival rates were 77%, 65%, and 42% at 1, 3, and 5 years, respectively. The main cause of death was tumor recurrence (35%). Prognotic factors for an adverse outcome were pTNM classification (P<.05) in the univariate analysis and perineural invasion (P<.05) and stages III or IVA (P<.05) in the multivariate analysis. CONCLUSIONS: OLT for nondisseminated irresectable PCC displays higher survival rates at 3 and 5 years than palliative treatments, especially for tumors in the initial stages, which means that more information is needed to help better select PCC patients for transplantation.
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Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Intrahepáticos , Colangiocarcinoma/cirugía , Neoplasias de los Conductos Biliares/mortalidad , Neoplasias de los Conductos Biliares/patología , Colangiocarcinoma/mortalidad , Colangiocarcinoma/patología , Estudios de Seguimiento , Humanos , Trasplante de Hígado , Metástasis de la Neoplasia , Cuidados Paliativos , Recurrencia , Estudios Retrospectivos , Análisis de Supervivencia , Factores de TiempoRESUMEN
AIM: Our goal was to retrospectively analyze graft loss and mortality risk factors using multi-centre data on liver retransplantation. MATERIAL AND METHODS: Between 1991-1995, 640 patients underwent 718 liver transplants in Barcelona. Mean age of the 74 patients receiving a second transplant was 47.6 years (range 19-65). Causes of retransplantation were immunologic in 26 patients (35.1%), technical in 23 (31.1%), primary dysfunction in 12 (16.2%), recurrent original disease in 7 (9.5%), and other causes in 6 (8.1%). Mean time between first and second transplant was less than 7 days in 20 patients (27%), between 8 and 30 days in 4 (5.4%) and more than 30 days in 50 patients (67.6%). Recipient, donor, and operative variables were analyzed using univariate (Kaplan-Meier curves) and multivariate techniques (Cox regression) to identify risk factors. RESULTS: Retransplant patient survival at 1 and 5 years was 60.8% and 49.5%, respectively, compared to 75.6% and 64.8% in a series of 640 first transplant patients. Mortality risk factors identified by multivariate analysis were bilirubin >12 mg/dL (RR 2.3; P=.010), recipient age (RR increase 0.04 for each additional year; P=.02), cause for retransplant (immunologic RR 4.01, technical RR 2.7 and other causes RR 6.9; compared to primary dysfunction RR 1; P=.020). Urea >54 mg/dL (0.02) and multiple transfusions >15 units red blood cells (0.001) were only significant in the univariate analysis. CONCLUSIONS: In our experience, retransplantation for primary dysfunction is the setting that has the best prognosis. Of the other causes, retransplantation should be performed before the total bilirubin reaches >12 mg/dL or before the appearance of variables indicative of severe renal insufficiency.
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Trasplante de Hígado/mortalidad , Reoperación/mortalidad , Adulto , Anciano , Alanina Transaminasa/sangre , Análisis de Varianza , Aspartato Aminotransferasas/sangre , Bilirrubina/sangre , Femenino , Humanos , Trasplante de Hígado/fisiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Factores de TiempoRESUMEN
INTRODUCTION: Nitric oxide (NO) is an important mediator of both physiological and pathological responses. Its dual role in the ischemia-reperfusion syndrome is still a matter of controversy. The aim of this study was to analyze the effect of NO on apoptosis and cell necrosis associated with heterotopic small bowel transplant. METHODS: Sprague-Dawley rats underwent heterotopic small bowel transplants with 3 hours of cold ischemia and 5 hours of reperfusion. Animals were assigned to the following study groups: Sham; bowel transplant (Trp); bowel transplant + NO donor (Trp + NONOS); bowel transplant + NO synthesis inhibitor (Trp + L-NAME). We studied histological changes and bacterial translocation in mesenteric nodes, liver and spleen as parameters of cell necrosis and caspase-3 activity as a parameter of apoptosis. RESULTS: Histological changes and bacterial translocation showed that exogenous administration of NO protected the transplant. Simple bowel transplant, with or without inhibition of NO synthesis, did not display this protective effect. Significantly greater levels of apoptosis were observe in grafts among the group administered NO at pharmacological doses. CONCLUSIONS: In experimental bowel transplantation rats administered exogenous NO show less necrosis but at the same time stimulation of apoptosis.
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Apoptosis/fisiología , Traslocación Bacteriana , Supervivencia de Injerto/efectos de los fármacos , Intestinos/patología , Intestinos/trasplante , NG-Nitroarginina Metil Éster/uso terapéutico , Donantes de Óxido Nítrico/uso terapéutico , Óxido Nítrico/uso terapéutico , Espermina/análogos & derivados , Espermina/uso terapéutico , Trasplante Homólogo/patología , Animales , Apoptosis/efectos de los fármacos , Masculino , Necrosis , Óxidos de Nitrógeno , Ratas , Ratas Sprague-Dawley , Trasplante Heterólogo , Trasplante Homólogo/métodosRESUMEN
BACKGROUND: Oral Gastrografin has been used to differentiate partial from complete small bowel obstruction (SBO). It may have a therapeutic effect and predict the need for early surgery in adhesive SBO. The aim of this study was to determine whether contrast examination in the management of SBO allows an early oral intake and reduces hospital stay. METHODS: Eighty-three patients admitted between February 2000 and November 2001 with 90 episodes of symptoms and signs suggestive of postoperative adhesive SBO were randomized into two groups, a control group and Gastrografin group. Patients in the control group were treated conservatively. If symptoms of strangulation developed or the obstruction did not resolve spontaneously after 4-5 days, a laparotomy was performed. Patients in the Gastrografin group received 100 ml Gastrografin. Those in whom the contrast medium reached the colon in 24 h were considered to have partial SBO, and were fed orally. If Gastrografin failed to reach the colon and the patient did not improve in the following 24 h a laparotomy was performed. RESULTS: Conservative treatment was successful in 77 episodes (85.6 per cent) and 13 (14.4 per cent) required operation. Among patients treated conservatively, hospital stay was shorter in the Gastrografin group (P < 0.001). All patients in whom contrast medium reached the colon tolerated an early oral diet. Gastrografin did not reduce the need for operation (P = 1.000). No patient died in either group. CONCLUSION: Oral Gastrografin helps in the management of patients with adhesive SBO and allows a shorter hospital stay.
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Medios de Contraste , Diatrizoato de Meglumina , Obstrucción Intestinal/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Medios de Contraste/administración & dosificación , Diatrizoato de Meglumina/administración & dosificación , Femenino , Humanos , Obstrucción Intestinal/cirugía , Intestino Delgado/cirugía , Laparotomía , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Adherencias Tisulares/diagnóstico por imagen , Adherencias Tisulares/cirugía , Resultado del TratamientoAsunto(s)
Inmunosupresores/uso terapéutico , Trasplante de Hígado/fisiología , Complicaciones Posoperatorias/epidemiología , Tacrolimus/uso terapéutico , Corticoesteroides/uso terapéutico , Suero Antilinfocítico/efectos adversos , Suero Antilinfocítico/uso terapéutico , Azatioprina/uso terapéutico , Glucemia/metabolismo , Presión Sanguínea , Colesterol/sangre , Creatinina/sangre , Quimioterapia Combinada , Femenino , Rechazo de Injerto/epidemiología , Humanos , Trasplante de Hígado/inmunología , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Monitoreo Fisiológico , Complicaciones Posoperatorias/clasificación , Estudios Retrospectivos , Seguridad , Tacrolimus/sangre , Tacrolimus/farmacocinéticaRESUMEN
BACKGROUND: There is ongoing controversy concerning the virulence and management of diverticulitis in young patients. This study reports on the management of acute diverticulitis with reference to the virulence and outcome of the disease with respect to age. METHODS: Between January 1994 and June 1999, 327 patients were treated for acute left colonic diverticulitis. Patients were divided in two groups: those aged 50 years or less (group 1, 72 patients) and those older than 50 years (group 2, 255 patients). The diagnosis was confirmed histologically or radiologically in all patients. RESULTS: There were differences in gender distribution related to age (P < 0.001). During the first hospital stay, 226 patients (69.1 per cent) had successful conservative treatment, 78 (23.9 per cent) needed emergency surgery and 23 (7.0 per cent) had a semielective operation (P = 0.47). The recurrence rate was 25.5 per cent in group 1 and 22.3 per cent in group 2 (P = 0.93). The type of surgical procedure and grade of peritonitis in emergency patients were similar in the two groups. Overall the mortality rate in patients who underwent an operation was 16.3 per cent. The mortality rate was zero in group 1 and 2.2 per cent in group 2 after elective or semielective operation (P = 1.0), and zero in group 1 and 34.9 per cent in group 2 after emergency operation (P < 0.001). CONCLUSION: Diverticulitis in young patients does not have a particularly aggressive course and the risk of recurrence is similar to that of older patients.
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Colectomía/métodos , Diverticulitis del Colon/cirugía , Enfermedad Aguda , Adulto , Procedimientos Quirúrgicos Electivos/métodos , Urgencias Médicas , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Recurrencia , Distribución por SexoRESUMEN
BACKGROUND: In domino liver transplantation (LT), the explanted liver of a patient with familial amyloidotic polyneuropathy (FAP) is donated to another patient. PATIENTS AND METHOD: Between February 1999 and March 2001 we performed 131 LT with 121 cadaveric donors in our unit. Ten domino LTs were performed. RESULTS: Patients with FAP were younger (37 years) than recipients of the second LT (64 years). The evolution of patients undergoing transplantation for FAP was excellent and all are currently alive and without complications. Among recipients of the second LT, one patient died in the postoperative period. A further two patients died from tumoral recurrence and hepatitis C virus recurrence 18 months and 9 months after transplantation, respectively. The remaining patients have shown no symptoms of FAP during the follow-up. CONCLUSION: The results of this study show that domino LT is technically feasible. The technique increases the number of grafts without apparent risk either to the recipient with FAP or to the recipient of the latter's explanted liver.