Enhancing the accuracy of mid-infrared spectroscopy-based liver steatosis quantification using digital image analysis as a reference.

The assessment of liver steatosis is crucial in both hepatology and liver transplantation (LT) surgery. Steatosis can negatively impact the success of LT. Steatosis is a factor for excluding donated organs for LT, but the increasing demand for transplantable organs has led to the use of organs from marginal donors. The current standard for evaluating steatosis is a semi-quantitative grading based on the visual examination of a hematoxylin and eosin (H&E)-stained liver biopsy, but this method is time-consuming, subjective, and lacks reproducibility. Recent research has shown that infrared (IR) spectroscopy could be used as a real-time quantitative tool to assess steatosis during abdominal surgery. However, the development of IR-based methods has been hindered by the lack of appropriate quantitative reference values. In this study, we developed and validated digital image analysis methods for the quantitation of steatosis in H&E-stained liver sections using univariate and multivariate strategies including linear discriminant analysis (LDA), quadratic DA, logistic regression, partial least squares-DA (PLS-DA), and support vector machines. The analysis of 37 tissue samples with varying grades of steatosis demonstrates that digital image analysis provides accurate and reproducible reference values that improve the performance of IR spectroscopic models for steatosis quantification. A PLS model in the 1810-1052 cm-1 region using first derivative ATR-FTIR spectra provided RMSECV = 0.99%. The gained improvement in accuracy critically enhances the applicability of Attenuated Total Reflectance-Fourier Transform Infrared (ATR-FTIR) to support an objective graft evaluation at the operation room, which might be especially relevant in cases of marginal liver donors to avoid unnecessary graft explantation.

Initial results of the oesophageal and gastric cancer registry from the Comunidad Valenciana. / Resultados iniciales del registro de carcinomas esófago-gástricos de la Comunidad Valenciana.

AIMS: To evaluate the initial results of the oesophagogastric cancer registry developed for the Sociedad Valenciana de Cirugía and the Health Department of the Comunidad Valenciana (Spain). METHODS: Fourteen of the 24 public hospitals belonging to the Comunidad Valenciana participated. All patients with diagnosis of oesophageal or gastric carcinomas operated from January 2013 to December 2014 were evaluated. Demographic, clinical and pathological data were analysed. RESULTS: Four hundred and thirty-four patients (120 oesophageal carcinomas and 314 gastric carcinomas) were included. Only two hospitals operated more than 10 patients with oesophageal cancer per year. Transthoracic oesophaguectomy was the most frequent approach (84.2%) in tumours localized within the oesophagus. A total gastrectomy was performed in 50.9% patients with gastroesophageal junction (GOJ) carcinomas. Postoperative 30-day and 90-day mortality were 8% and 11.6% in oesophageal carcinoma and 5.9 and 8.6% in gastric carcinoma. Before surgery, middle oesophagus carcinomas were treated mostly (76,5%) with chemoradiotherapy. On the contrary, lower oesophagus and GOJ carcinomas were treated preferably with chemotherapy alone (45.5 and 53.4%). Any neoadjuvant treatment was administered to 73.6% of gastric cancer patients. Half patients with oesophageal carcinoma or gastric carcinoma received no adjuvant treatment. CONCLUSIONS: This registry revealed that half patients with oesophageal cancer were operated in hospitals with less than 10 cases per year at the Comunidad Valenciana. Also, it detected capacity improvement for some clinical outcomes of oesophageal and gastric carcinomas.

Resultados iniciales del registro de carcinomas esófago-gástricos de la Comunidad Valenciana / Initial results of the oesophageal and gastric cancer registry from the Comunidad Valenciana

Objetivos: Evaluar los resultados iniciales del registro de tumores esófago-gástricos desarrollado conjuntamente por la Sociedad Valenciana de Cirugía y la Consellería de Sanitat de la Comunidad Valenciana. Métodos: Participaron 14 de los 24 hospitales públicos de la Comunidad Valenciana. Se evaluaron todos los pacientes con diagnóstico de carcinoma de esófago y de estómago operados desde enero 2013 hasta diciembre 2014. Se analizaron variables demográficas, clínicas e histopatológicas. Resultados: Se incluyeron 434 pacientes, 120 con carcinoma de esófago y 314 con carcinoma gástrico. Solo en 2 centros se operaron a más de 10 pacientes con cáncer de esófago/año. La esofaguectomía transtorácica fue el abordaje más frecuente (84,2%) en los tumores de localización esofágica. En el 50,9% de los carcinomas de la unión esófago-gástrica (UEG) se realizó una gastrectomía total. La mortalidad postoperatoria a los 30 y 90 días fue del 8 y 11,6% en el carcinoma de esófago y del 5,9 y 8,6% en el carcinoma gástrico. Antes de la cirugía, los tumores esofágicos del tercio medio fueron tratados mayoritariamente (76,5%) con quimiorradioterapia. Por el contrario, los de tercio inferior y los de la UEG fueron tratados preferentemente solo con quimioterapia (45,5 y 53,4%). El 73,6% de los pacientes con carcinoma gástrico no recibió tratamiento neoadyuvante. La mitad de los pacientes con carcinoma esofágico o gástrico no recibió ningún tratamiento adyuvante. Conclusiones: Este registro muestra que en la Comunidad Valenciana, la mitad de los pacientes con cáncer de esófago son operados en hospitales con una casuística menor de 10 casos/año. Asimismo, ha detectado posibilidades de mejora relevantes en indicadores de resultado de los carcinomas esófago-gástricos (AU)

Aims: To evaluate the initial results of the oesophagogastric cancer registry developed for the Sociedad Valenciana de Cirugía and the Health Department of the Comunidad Valenciana (Spain). Methods: Fourteen of the 24 public hospitals belonging to the Comunidad Valenciana participated. All patients with diagnosis of oesophageal or gastric carcinomas operated from January 2013 to December 2014 were evaluated. Demographic, clinical and pathological data were analysed. Results: Four hundred and thirty-four patients (120 oesophageal carcinomas and 314 gastric carcinomas) were included. Only two hospitals operated more than 10 patients with oesophageal cancer per year. Transthoracic oesophaguectomy was the most frequent approach (84.2%) in tumours localized within the oesophagus. A total gastrectomy was performed in 50.9% patients with gastroesophageal junction (GOJ) carcinomas. Postoperative 30-day and 90-day mortality were 8% and 11.6% in oesophageal carcinoma and 5.9 and 8.6% in gastric carcinoma. Before surgery, middle oesophagus carcinomas were treated mostly (76,5%) with chemoradiotherapy. On the contrary, lower oesophagus and GOJ carcinomas were treated preferably with chemotherapy alone (45.5 and 53.4%). Any neoadjuvant treatment was administered to 73.6% of gastric cancer patients. Half patients with oesophageal carcinoma or gastric carcinoma received no adjuvant treatment. Conclusions: This registry revealed that half patients with oesophageal cancer were operated in hospitals with less than 10 cases per year at the Comunidad Valenciana. Also, it detected capacity improvement for some clinical outcomes of oesophageal and gastric carcinomas (AU)

Acute biliary pancreatitis: does the pancreas change morphologically in the long term?

The objective of the study was to assess by means of magnetic resonance cholangiopancreatography whether acute biliary pancreatitis leads to alterations in pancreatic morphology and the main pancreatic duct; to establish whether such alterations are related to the severity of the acute episode and if they are to be considered as sequelae of the illness or on the contrary the findings constitute diagnostic morphological criteria of chronic pancreatitis. Forty patients with acute biliary pancreatitis were prospectively and consecutively studied, 15 female (37.5%) and 25 male (62.5%). During the acute phase the severity was assessed according to the Atlanta criteria. During subsequent follow-up,we assessed the morphology of the gland and the main pancreatic duct with magnetic resonance cholangiopancreatography 5 years after the episode of pancreatitis, and compared the findings with the findings from a control group. We administered secretin in 16 of the study group cases when visualization of the duct was incomplete or absent. The statistical study of diameter and length showed significant differences in the main pancreatic duct of the case and control groups. No relationship was found between the severity of the illness and morphological alterations of the pancreas after pancreatitis. The statistical analysis, which compared the diameter and the length of the main pancreatic duct before and after the injection of secretin in the study group showed significant differences. We conclude that after acute biliary pancreatitis, in the long term, scarring lesions are detected, which are considered to be sequelae of the acute episode, unrelated to its severity. Secretin stimulation improved visualization of the main pancreatic duct in the magnetic resonance cholangiopancreatography.

Exocrine pancreatic changes following acute attack of biliary pancreatitis.

Following the Cambridge and Marseilles Symposia, functional recovery of the pancreas occurs if the primary cause and complications of the disease have been eliminated. However, recent research showed contradictory results, owing to the difference in diagnostic methods and the proportion of patients studied in relation to the etiologic factor and severity of the disease, as well as the differences in the tests utilized. Sixty-three consecutive patients with acute biliary pancreatitis were prospectively studied. Seventeen were men (27%) and 46 were women (73%), with an average age of 62.3 years, 45 were mild cases and 18 were severe. All patients underwent a cholecystectomy. No patient in this series underwent necrosectomy. During the acute phase, severity was evaluated following the Atlanta criteria as well as the existence of necrosis and its percentage by means of dynamic computed tomography (CT). During the follow-up, different tests were used to assess the pancreatic exocrine function, 1 month, 6 months and 1 year after the acute pancreatitis (AP) episode. The possible existence of pancreatic exocrine insufficiency following biliary origin AP as well as whether this possible deficit was related to the severity of the episode was investigated. We found no such insufficiency 1 year after the episode, and no link with the severity of the episode.

Morfología del conducto pancreático a los cinco años de la pancreatitis aguda biliar: estudio con colangio pancreatografía por resonancia magnética / Pancreatic duct morphology five years after acute biliary pancreatitis: evaluation using magnetic resonance cholangiopancreatography

Introducción. La situación clínica, morfológica y funcional del páncreas tras el episodio de pancreatitis retorna a la normalidad si se elimina la causa primaria y las complicaciones. El objetivo del estudio es valorar si existen cambios en la morfología del conducto pancreático después de la pancreatitis aguda de origen biliar. Pacientes y método. Se estudia prospectivamente a 40 pacientes consecutivos con pancreatitis aguda biliar, 15 varones (37,5 por ciento) y 25 mujeres (62,5 por ciento), 27 leves y 13 graves. Durante la fase aguda se evaluó la gravedad siguiendo los criterios de Atlanta, así como la existencia de necrosis y su porcentaje mediante tomografía computarizada dinámica. A todos los pacientes se les practicó colecistectomía. Durante el seguimiento valoramos la morfología de la glándula y el conducto pancreático principal mediante colangiopancreatografía por resonancia magnética, realizando el mismo estudio con un grupo control. Analizamos si tras la pancreatitis aguda de origen biliar existe alteración de la morfología de la glándula y del conducto pancreático, y si estas alteraciones se relacionan con la gravedad del episodio, valorando su progresión hacia la cronicidad. Resultados. Se aprecian algunas diferencias significativas al comparar el diámetro y la longitud del conducto pancreático principal de los casos y los controles. No se encontró ninguna relación entre la gravedad de la enfermedad y las alteraciones morfológicas del páncreas tras la pancreatitis. Conclusiones. Tras la pancreatitis aguda se detectan alteraciones morfológicas pancreáticas consideradas como secuelas cicatrizales, sin traducción hacia la cronicidad y sin relación con la gravedad (AU)

Formación del residente en cirugía laparoscópica: un reto actual / Resident training in laparoscopic surgery: a current challenge

El desarrollo de las técnicas laparoscópicas ha revolucionado la cirugía de la última década. Es fundamental, por tanto, una formación adecuada de nuestros residentes que permita su progresiva incorporación a la realización de intervenciones por vía laparoscópica.En esta revisión abordamos la problemática actual de la formación de los residentes en cirugía laparoscópica en nuestro país. Consideramos las siguientes cuestiones: la laparoscopia como entidad diferente a la cirugía abierta convencional; la laparoscopia como técnica de máxima dificultad; los medios disponibles para el aprendizaje en cirugía laparoscópica, y los aspectos particulares del mismo en la formación de los residentes. Elaboramos una propuesta de mejora para la preparación laparoscópica de nuestros residentes: revisión de la Guía de Formación del Residente del Ministerio de Sanidad y Consumo; adquisición de un adecuado nivel en cirugía laparoscópica de los hospitales docentes españoles, y necesidad de que el residente finalice su formación tras haber realizado un número mínimo de intervenciones laparoscópicas básicas (AU)

Influencia de la octreótida en la anastomosistras obstrucción cólica experimental / Influence of octreotide in anastomosis after experimental colonic obstruction

Introducción. Se valora el efecto de la octreótida sobre la oclusión experimental del colon y posterior anastomosis. Material y método. Se realiza una oclusión de colon en dos grupos de ratas Wistar, a uno de los cuales se le administra octreótida. A las 48 h se relaparotomizó a los animales, se valoraron el grado de oclusión y el contenido intestinal y se resecó un fragmento intestinal para estudio histológico, confeccionando una anastomosis término-terminal. A los 7 días se reintervino a los animales y se valoraron las complicaciones, determinando la presión de rotura de la anastomosis, la cantidad de colágeno que contiene y su histología. Resultados. El grupo tratado con octreótida presentó un mayor radio intestinal y peso de las heces en el asa ocluida, así como de la presión de rotura y tensión parietal de rotura, con diferencias estadísticamente significativas. La presencia de dehiscencia, fuga y complicaciones fue similar en ambos grupos. El valor de hidroxiprolina fue mayor en el grupo tratado, sin valor estadísticamente significativo. La ausencia de isquemia en el asa ocluida fue mayor en el grupo tratado y este valor predice una mayor tensión parietal de rotura de la posterior cicatriz anastomótica. Conclusiones. El tratamiento con octreótida de la oclusión cólica experimental mejora la pared intestinal que va a ser sometida a una anastomosis (AU)