Vaginal Microbiota Is Stable and Mainly Dominated by Lactobacillus at Third Trimester of Pregnancy and Active Childbirth: A Longitudinal Study of Ten Mexican Women.

In healthy women at reproductive age, the vaginal microbiota is mainly dominated by Lactobacillus bacteria during pregnancy and non-pregnancy stages. However, little is known about longitudinal changes within the vaginal microbiota composition from the third trimester of pregnancy to childbirth in healthy women. Thus, we conducted an exploratory longitudinal study of vaginal microbiota composition of 10 Mexican pregnant women, sampling from the same volunteer at two-time points: third trimester of pregnancy and active childbirth. Vaginal bacterial microbiota was characterized by V3-16S rDNA libraries by high-throughput sequencing and bioinformatics methods. Out of ten, vaginal microbiota from eight women was dominated by the Lactobacillus genus at both time points, whereas the other two women showed vaginal microbiota composition with high abundance of genera Gardnerella, Prevotella, and members of the Atopobiaceae family, without any preterm birth correlation. Importantly, we found no statistically significant differences in relative abundances, absolute reads count, alpha and beta diversity between the third trimester of pregnancy, and active childbirth time points. However, compared to the third trimester of pregnancy, we observed a trend with higher absolute reads counts for Gardnerella, Faecalibaculum, Ileibacterium, and Lactococcus genus at active childbirth and lower absolute reads count of Lactobacillus genus. Our results suggest that the vaginal microbiota composition is stable, and Lactobacillus genus is the dominant taxa in Mexican women's vagina at the third trimester of pregnancy and childbirth.

Lymphopenia in hospitalized patients and its relationship with severity of illness and mortality.

BACKGROUND: Lymphopenia is associated with various pathologies such as sepsis, burns, trauma, general anesthesia and major surgeries. All these pathologies are clinically expressed by the so-called Systemic Inflammatory Response Syndrome which does not include lymphopenia into defining criteria. The main objective of this work was to analyze the diagnosis of patients admitted to a hospital related to lymphopenia during hospital stay. In addition, we investigated the relationship of lymphopenia with the four levels of the Severity of Illness (SOI) and the Risk of Mortality (ROM). METHOD AND FINDINGS: Lymphopenia was defined as Absolute Lymphocyte Count (ALC) <1.0 x109/L. ALC were analyzed every day since admission. The four levels (minor, moderate, major and extreme risk) of both SOI and ROM were assessed. A total of 58,260 hospital admissions were analyzed. More than 41% of the patients had lymphopenia during hospital stay. The mean time to death was shorter among patients with lymphopenia on admission 65.6 days (CI95%, 57.3-73.8) vs 89.9 (CI95%, 82.4-97.4), P<0.001. Also, patients with lymphopenia during hospital stay had a shorter time to the mortality, 67.5 (CI95%, 61.1-73.9) vs 96.9 (CI95%, 92.6-101.2), P<0.001. CONCLUSIONS: Lymphopenia had a high prevalence in hospitalized patients with greater relevance in infectious pathologies. Lymphopenia was related and clearly predicts SOI and ROM at the time of admission, and should be considered as clinical diagnostic criteria to define SIRS.

Chromium propionate improves performance and carcass traits in broilers.

There is evidence to suggest that poultry may have a dietary requirement for metabolically available chromium (Cr) that exceeds the amount provided through wheat soybean meal diets. The objective of the present study was to investigate the effects of dietary supplemental organic Cr from Cr propionate at different dose levels (control = 0 µg/kg, T1 = 200 µg/kg, T2 = 400 µg/kg) on the growth performance, carcass traits, and meat quality of broilers. Weight gain and feed intake of each treatment were recorded at the start and after 14, 28 and 35 d, and feed conversion ratios (FCR) were calculated accordingly. At 35 d of age, birds were randomly selected and euthanized for carcass evaluation. Results of the first trial indicate that both Cr propionate treatments increased final body weight (P < 0.05), feed efficiency (P < 0.05) and body weight gain (P < 0.0001). Furthermore, Cr propionate supplementation improved (P < 0.0001) all carcass characteristics. Interestingly, with increased Cr dosage, carcass yield, dressing percentage and breast meat yield increased linearly (P < 0.0001). The second study reveals that the feed intake in the control group was significantly higher compared to both Cr propionate supplemented groups (T1 & T2). Furthermore, the Cr propionate supplemented T2 group displayed a significantly lower FCR than the control and T1 group (P = 0.027). Finally, Cr propionate supplementation increased the dressing percentage compared to control birds (P < 0.0001). In the third experiment, Cr propionate supplementation (T1 & T2) increased final body weight and decreased FCR compared with the control treatment. These effects were highly significant (P < 0.0001) throughout all feeding phases of the trial. Cr propionate supplementation also increased (P < 0.0001) carcass yield, dressing percentage, breast meat yield, leg and thigh weights compared with the control treatment. In conclusion, growth performance, feed conversion, carcass yield, breast and leg meats of broiler birds can be significantly improved by dietary inclusion of Cr propionate. Cr propionate can be supplemented to broiler birds from 1 d old of age at a level that provides 200 or 400 µg/kg organic Cr and can increase the efficiency of broiler production.

Atención de la urgencia quirúrgica durante la pandemia COVID-19. Recomendaciones de la Asociación Española de Cirujanos / Emergency Surgery and Trauma Care During COVID-19 Pandemic. Recommendations of the Spanish Association of Surgeons

La infección por el nuevo coronavirus SARS-CoV-2 (enfermedad por coronavirus 2019 [COVID-19]) ha determinado la necesidad de la reorganización de muchos centros hospitalarios en el mundo. España, como uno de los epicentros de la enfermedad, ha debido asumir cambios en la práctica totalidad de su territorio. Sin embargo, y desde el inicio de la pandemia, en todos los centros que atienden urgencias quirúrgicas ha sido necesario el mantenimiento de su cobertura, aunque igualmente ha sido inevitable introducir directrices especiales de ajuste al nuevo escenario que permitan el mantenimiento de la excelencia en la calidad asistencial. Este documento desarrolla una serie de indicaciones generales para la cirugía de urgencias y la atención al politraumatizado desarrolladas desde la literatura disponible y consensuadas por un subgrupo de profesionales desde el grupo general Cirugía-AEC-COVID-19. Estas medidas van encaminadas a contemplar un riguroso control de la exposición en pacientes y profesionales, a tener en cuenta las implicaciones de la pandemia sobre diferentes escenarios perioperatorios relacionados con la urgencia y a una adaptación ajustada a la situación del centro en relación con la atención a pacientes infectados

New coronavirus SARS-CoV-2 infection (coronavirus disease 2019 [COVID-19]) has determined the necessity of reorganization in many centers all over the world. Spain, as an epicenter of the disease, has been forced to assume health policy changes in all the territory. However, and from the beginning of the pandemic, every center attending surgical urgencies had to guarantee the continuous coverage adopting correct measures to maintain the excellence of quality of care. This document resumes general guidelines for emergency surgery and trauma care, obtained from the available bibliography and evaluated by a subgroup of professionals designated from the general group of investigators Cirugía-AEC-COVID-19 from the Spanish Association of Surgeons, directed to minimize professional exposure, to contemplate pandemic implications over different urgent perioperative scenarios and to adjust decision making to the occupational pressure caused by COVID-19 patients

Emergency surgery and trauma care during COVID-19 pandemic. Recommendations of the Spanish Association of Surgeons / Atención de la urgencia quirúrgica durante la pandemia COVID-19. Recomendaciones de la Asociación Española de Cirujanos

New coronavirus SARS-CoV-2 infection (coronavirus disease 2019 [COVID-19]) has determined the necessity of reorganization in many centers all over the world. Spain, as an epicenter of the disease, has been forced to assume health policy changes in all the territory. However, and from the beginning of the pandemic, every center attending surgical urgencies had to guarantee the continuous coverage adopting correct measures to maintain the excellence of quality of care. This document resumes general guidelines for emergency surgery and trauma care, obtained from the available bibliography and evaluated by a subgroup of professionals designated from the general group of investigators Cirugía-AEC-COVID-19 from the Spanish Association of Surgeons, directed to minimize professional exposure, to contemplate pandemic implications over different urgent perioperative scenarios and to adjust decision making to the occupational pressure caused by COVID-19 patients

La infección por el nuevo coronavirus SARS-COV-2 (enfermedad por coronavirus 2019 [COVID-19]) ha determinado la necesidad de la reorganización de muchos centros hospitalarios en el mundo. España, como uno de los epicentros de la enfermedad, ha debido asumir cambios en la práctica totalidad de su territorio. Sin embargo, y desde el inicio de la pandemia, en todos los centros que atienden urgencias quirúrgicas ha sido necesario el mantenimiento de su cobertura, aunque igualmente ha sido inevitable introducir directrices especiales de ajuste al nuevo escenario que permitan el mantenimiento de la excelencia en la calidad asistencial. Este documento desarrolla una serie de indicaciones generales para la cirugía de urgencias y la atención al politraumatizado desarrolladas desde la literatura disponible y consensuadas por un subgrupo de profesionales desde el grupo general Cirugía-AEC-COVID-19. Estas medidas van encaminadas a contemplar un riguroso control de la exposición en pacientes y profesionales, a tener en cuenta las implicaciones de la pandemia sobre diferentes escenarios perioperatorios relacionados con la urgencia y a una adaptación ajustada a la situación del centro en relación con la atención a pacientes infectados

[Emergency Surgery and Trauma Care During COVID-19 Pandemic. Recommendations of the Spanish Association of Surgeons]. / Atención de la urgencia quirúrgica durante la pandemia COVID-19. Recomendaciones de la Asociación Española de Cirujanos.

New coronavirus SARS-CoV-2 infection (coronavirus disease 2019 [COVID-19]) has determined the necessity of reorganization in many centers all over the world. Spain, as an epicenter of the disease, has been forced to assume health policy changes in all the territory. However, and from the beginning of the pandemic, every center attending surgical urgencies had to guarantee the continuous coverage adopting correct measures to maintain the excellence of quality of care. This document resumes general guidelines for emergency surgery and trauma care, obtained from the available bibliography and evaluated by a subgroup of professionals designated from the general group of investigators Cirugía-AEC-COVID-19 from the Spanish Association of Surgeons, directed to minimize professional exposure, to contemplate pandemic implications over different urgent perioperative scenarios and to adjust decision making to the occupational pressure caused by COVID-19 patients.

The ropAe gene encodes a porin-like protein involved in copper transit in Rhizobium etli CFN42.

Copper (Cu) is an essential micronutrient for all aerobic forms of life. Its oxidation states (Cu+ /Cu2+ ) make this metal an important cofactor of enzymes catalyzing redox reactions in essential biological processes. In gram-negative bacteria, Cu uptake is an unexplored component of a finely regulated trafficking network, mediated by protein-protein interactions that deliver Cu to target proteins and efflux surplus metal to avoid toxicity. Rhizobium etliCFN42 is a facultative symbiotic diazotroph that must ensure its appropriate Cu supply for living either free in the soil or as an intracellular symbiont of leguminous plants. In crop fields, rhizobia have to contend with copper-based fungicides. A detailed deletion analysis of the pRet42e (505 kb) plasmid from an R. etli mutant with enhanced CuCl2 tolerance led us to the identification of the ropAe gene, predicted to encode an outer membrane protein (OMP) with a ß-barrel channel structure that may be involved in Cu transport. In support of this hypothesis, the functional characterization of ropAe revealed that: (I) gene disruption increased copper tolerance of the mutant, and its complementation with the wild-type gene restored its wild-type copper sensitivity; (II) the ropAe gene maintains a low basal transcription level in copper overload, but is upregulated when copper is scarce; (III) disruption of ropAe in an actP (copA) mutant background, defective in copper efflux, partially reduced its copper sensitivity phenotype. Finally, BLASTP comparisons and a maximum likelihood phylogenetic analysis highlight the diversification of four RopA paralogs in members of the Rhizobiaceae family. Orthologs of RopAe are highly conserved in the Rhizobiales order, poorly conserved in other alpha proteobacteria and phylogenetically unrelated to characterized porins involved in Cu or Mn uptake.

Nonoperative management of perforated acute diverticulitis with extraluminal air: results and risk factors of failure.

AIM: The aim of this study was to analyze the results of nonoperative management of patients with perforated acute diverticulitis with extraluminal air and to identify risk factors that may lead to failure and necessity of surgery. METHODS: Methods included observational retrospective cohort study of patients between 2010 and 2015 with diagnosis of diverticulitis with extraluminal air and with nonoperative management initial. Patient demographics, clinical, and analytical data were collected, as were data related with computed tomography. Univariate and multivariate analyses with Wald forward stepwise logistic regression were performed to analyze results and to identify risk factors potentially responsible of failure of nonoperative management. RESULTS: Nonoperative management was established in 83.12% of patients diagnosed with perforated diverticulitis (64 of 77) with an overall success rate of 84.37%, a mean hospital stay of 11.98 ± 7.44 days and only one mortality (1.6%). Patients with pericolic air presented a greater chance of success (90.2%) than patients with distant air (61.5%). American Society of Anesthesiologists (ASA) grade III-IV (OR, 5.49; 95% CI, 1.04-29.07) and the distant location of air (OR, 4.81; 95% CI, 1.03-22.38) were the only two factors identified in the multivariate analysis as risk factors for a poor nonoperative treatment outcome. Overall recurrence after conservative approach was 20.4%; however, recurrence rate of patients with distant air was twice than that of patients with pericolic air (37.5 vs 17.39%). Only 14.8% of successfully treated patients required surgery after the first episode. CONCLUSION: Nonoperative management of perforated diverticulitis is safe and efficient. Special follow-up must be assumed in patients ASA III-IV and with distant air in CT.

A comprehensive phylogenetic analysis of copper transporting P1B ATPases from bacteria of the Rhizobiales order uncovers multiplicity, diversity and novel taxonomic subtypes.

The ubiquitous cytoplasmic membrane copper transporting P1B-1 and P1B-3 -type ATPases pump out Cu+ and Cu2+ , respectively, to prevent cytoplasmic accumulation and avoid toxicity. The presence of five copies of Cu-ATPases in the symbiotic nitrogen-fixing bacteria Sinorhizobium meliloti is remarkable; it is the largest number of Cu+ -transporters in a bacterial genome reported to date. Since the prevalence of multiple Cu-ATPases in members of the Rhizobiales order is unknown, we performed an in silico analysis to understand the occurrence, diversity and evolution of Cu+ -ATPases in members of the Rhizobiales order. Multiple copies of Cu-ATPase coding genes (2-8) were detected in 45 of the 53 analyzed genomes. The diversity inferred from a maximum-likelihood (ML) phylogenetic analysis classified Cu-ATPases into four monophyletic groups. Each group contained additional subtypes, based on the presence of conserved motifs. This novel phylogeny redefines the current classification, where they are divided into two subtypes (P1B-1 and P1B-3 ). Horizontal gene transfer (HGT) as well as the evolutionary dynamic of plasmid-borne genes may have played an important role in the functional diversification of Cu-ATPases. Homologous cytoplasmic and periplasmic Cu+ -chaperones, CopZ, and CusF, that integrate a CopZ-CopA-CusF tripartite efflux system in gamma-proteobacteria and archeae, were found in 19 of the 53 surveyed genomes of the Rhizobiales. This result strongly suggests a high divergence of CopZ and CusF homologs, or the existence of unexplored proteins involved in cellular copper transport.

Acute abdomen in patients with systemic lupus erythematosus and antiphospholipid syndrome. Importance of early diagnosis and treatment.

Systemic lupus erithematosus (SLE) is an autoimmune disease with multiorgan involvement caused principally by vasculitis of small vessels. The gastrointestinal tract is one of the most frequently affected by SLE, with abdominal pain as the most common symptom. An early diagnosis and treatment of lupus enteritis is essential to avoid complications like hemorrhage or perforation, with up to 50 % of mortality rate. However, differential diagnosis sometimes is difficult, especially with other types of gastrointestinal diseases as digestive involvement of antiphospholipid syndrome (APS), moreover when both entities may coexist. We describe the case of a patient with both diseases that was diagnosed with lupus enteritis and treated with steroid therapy; the patient had an excellent response.

Abdomen agudo en paciente con lupus eritematoso sistémico y síndrome antifosfolípido. Importancia del diagnóstico y tratamiento precoz / Acute abdomen in patients with systemic lupus erythematosus and antiphospholipid syndrome. Importance of early diagnosis and treatment

El lupus eritematoso sistémico es una enfermedad autoinmune con afectación multivisceral causada principalmente por vasculitis de pequeño vaso. El tracto gastrointestinal es uno de los órganos más frecuentemente afectados, siendo el dolor abdominal el síntoma predominante. La enteritis lúpica requiere un diagnóstico y tratamiento precoces para evitar complicaciones como la hemorragia digestiva y la perforación intestinal, que pueden alcanzar una mortalidad de hasta el 50 %. Su diagnóstico a veces se ve dificultado por la presencia de otras patologías con afectación gastrointestinal similar como ocurre en el síndrome antifosfolípido. Presentamos el caso de una paciente con ambas enfermedades que fue diagnosticada de enteritis lúpica y tratada de forma conservadora con terapia corticoidea de choque. La paciente tuvo una respuesta excelente al tratamiento

Systemic lupus erithematosus (SLE) is an autoimmune disease with multiorgan involvement caused principally by vasculitis of small vessels. The gastrointestinal tract is one of the most frequently affected by SLE, with abdominal pain as the most common symptom. An early diagnosis and treatment of lupus enteritis is essential to avoid complications like hemorrhage or perforation, with up to 50 % of mortality rate. However, differential diagnosis sometimes is difficult, especially with other types of gastrointestinal diseases as digestive involvement of antiphospholipid syndrome (APS), moreover when both entities may coexist. We describe the case of a patient with both diseases that was diagnosed with lupus enteritis and treated with steroid therapy; the patient had an excellent response

Acute necrotizing pancreatitis: Surgical indications and technical procedures.

Necrosis of pancreatic parenchyma or extrapancreatic tissues is present in 10%-20% of patients with acute pancreatitis, defining the necrotizing presentation frequently associated with high morbidity and mortality rates. During the initial phase of acute necrotizing pancreatitis the most important pillars of medical treatment are fluid resuscitation, early enteral nutrition, endoscopic retrograde colangiopancreatography if associated cholangitis and intensive care unit support. When infection of pancreatic or extrapancreatic necrosis occurs, surgical approach constitutes the most accepted therapeutic option. In this context, we have recently assited to changes in time for surgery (delaying the indication if possible to around 4 wk to deal with "walled-off" necrosis) and type of access for necrosectomy: from a classical open approach (with closure over large-bore drains for continued postoperative lavage or semiopen techniques with scheduled relaparotomies), trends have changed to a "step-up" philosophy with initial percutaneous drainage and posterior minimally invasive or endoscopic access to the retroperitoneal cavity for necrosectomy if no improvement has been previously achieved. These approaches are progressively gaining popularity and morbidity and mortality rates have decreased significantly. Therefore, a staged, multidisciplinary, step-up approach with minimally invasive or endoscopic access for necrosectomy is widely accepted nowadays for management of pancreatic necrosis.

Infección de sitio quirúrgico tras apendicectomía urgente: tasa global y tipo según la vía de abordaje (abierta/laparoscópica) / Postappendectomy surgical site infection: Overall rate and type according to open/laparoscopic approach

OBJETIVO: Evaluar la incidencia y el perfil de la infección de sitio quirúrgico (ISQ) postapendicectomía en relación con la vía de abordaje (abierta [AA] vs laparoscópica [AL]).Material y método Estudio observacional analítico de cohortes, con pacientes > 14 años intervenidos por sospecha de apendicitis aguda a lo largo de 4 años (2007-2010) en un hospital de tercer nivel (n = 868), divididos en 2 grupos según la vía de abordaje para la apendicectomía (AL, grupo de estudio, 135; AA, grupo control, 733). Variable resultado: ISQ, global y por tipos. Estratificación del riesgo infeccioso mediante: a) índice NNIS (bajo riesgo: NNIS 0E, 0 y 1; alto riesgo: NNIS 2 y 3); b) estadio evolutivo apendicular (bajo riesgo: normal o flemonoso; alto riesgo: gangrenoso o perforado). Análisis estadístico: software SPSS. Resultado principal y análisis estratificado con el test de χ2. Parámetros de riesgo: OR cruda y de Mantel-Haenszel respectivamente, con su IC 95% y aceptando significación estadística con p < 0,05.ResultadosAmbos grupos fueron homogéneos en cuanto a edad, género, ASA y formas evolucionadas. ISQ global: 13,4% (más de la mitad detectadas en el seguimiento tras el alta). Distribución: AA, 13% (superficial 9%, profunda 2%, órgano-espacio 2%); AL, 14% (superficial 5%, profunda 1%, órgano-espacio 8%) (global: n.s.; distribución: p < 0,000). El análisis estratificado mostró asociación entre ISQ parietal/acceso abierto e ISQ órgano-espacio/abordaje laparoscópico y que resulta especialmente evidente en pacientes de alto riesgo de ISQ postoperatoria (NNIS alto o presentación evolucionada).Conclusión La AA conlleva un mayor riesgo de ISQ parietal y la AL de órgano-espacio. Esta asociación es especialmente evidente en pacientes con especial riesgo de ISQ

OBJECTIVE: To compare the incidence and profile of surgical site infection (SSI) after laparoscopic (LA) oropen (OA) appendicectomy. MATERIAL AND METHOD: Observational and analytical study was conducted on patients older than 14 years old with suspected acute appendicitis operated on within a 4-year period (2007-2010) at a third levelhospital (n = 868). They were divided in two groups according to the type of appendicectomy (LA, study group, 135; OA, control group, 733). The primary endpoint was a surgical site infection (SSI), and to determine the overall rate and types (incisional/organ-space). The risk of SSI was stratified by: i) National Nosocomial Infection Surveillance (NNIS) index (low risk: 0E, 0 and 1; high risk: 2 and 3); ii) status on presentation (low risk: normal or phlegmonous; high risk: gangrenous or perforated). The statisticalanalysis was performed using the software SPSS. The main result and stratified analysis was determined with 2, and the risk parameters using OR and Mantel-Haenszel OR with 95%CI, accepting statistical significance with P < .05. RESULTS: Age, gender, ASAindex and incidence of advanced cases were similar in both groups. The overall lSSI rate was 13.4% (more than a half of them detected during follow-up after discharge). Type of SSI: OA,13% (superficial 9%, deep 2%, organ-space 2%); AL, 14% (superficial 5%, deep 1%, organ-space 8%) (overall:not significant; distribution: P < .000). Stratified analysis showed that there is an association between incisional SSI/OA and organ-space SSI/LA, and is particularly stronger in those patients with high risk of postoperative SSI (high risk NNIS or gangrenous-perforated presentation).CONCLUSION: OA and LA are associated with a higher rate of incisional and organ-space SSI respectively. This is particularly evident in patients with high risk of SSI

[Post-appendectomy surgical site infection: overall rate and type according to open/laparoscopic approach]. / Infección de sitio quirúrgico tras apendicectomía urgente: tasa global y tipo según la vía de abordaje (abierta/laparoscópica).

OBJECTIVE: To compare the incidence and profile of surgical site infection (SSI) after laparoscopic (LA) or open (OA) appendicectomy. MATERIAL AND METHOD: Observational and analytical study was conducted on patients older than 14years-old with suspected acute appendicitis operated on within a 4-year period (2007-2010) at a third level hospital (n=868). They were divided in two groups according to the type of appendicectomy (LA, study group, 135; OA, control group, 733). The primary endpoint was a surgical site infection (SSI), and to determine the overall rate and types (incisional/organ-space). The risk of SSI was stratified by: i)National Nosocomial Infection Surveillance (NNIS) index (low risk: 0E, 0 and 1; high risk: 2 and 3); ii)status on presentation (low risk: normal or phlegmonous; high risk: gangrenous or perforated). The statistical analysis was performed using the software SPSS. The main result and stratified analysis was determined with χ(2), and the risk parameters using OR and Mantel-Haenszel OR with 95%CI, accepting statistical significance with P<.05. RESULTS: Age, gender, ASA index and incidence of advanced cases were similar in both groups. The overall SSI rate was 13.4% (more than a half of them detected during follow-up after discharge). Type of SSI: OA, 13% (superficial 9%, deep 2%, organ-space 2%); AL, 14% (superficial 5%, deep 1%, organ-space 8%) (overall: not significant; distribution: P<.000). Stratified analysis showed that there is an association between incisional SSI/OA and organ-space SSI/LA, and is particularly stronger in those patients with high risk of postoperative SSI (high risk NNIS or gangrenous-perforated presentation). CONCLUSION: OA and LA are associated with a higher rate of incisional and organ-space SSI respectively. This is particularly evident in patients with high risk of SSI.

Empleo, eficacia y repercusión clínica del apoyo radiológico al diagnóstico de la apendicitis aguda / Radiological support for diagnosis of acute appendicitis: Use, effectiveness and clinical repercussions

OBJETIVO: Analizar el incremento del apoyo radiológico solicitado para el diagnóstico de la apendicitis aguda (AA), su justificación a partir de su repercusión clínica así como los parámetros de rentabilidad diagnóstica de ECO y TAC para esta enfermedad. MATERIAL Y MÉTODO: Estudio observacional analítico de cohortes, con pacientes intervenidos por sospecha de AA en un hospital de tercer nivel, excluyendo menores de 14 años y gestantes. Grupo de estudio: enero de 2010-diciembre de 2011 (n1 = 419). Grupo control: muestra de pacientes entre 18 y 65 años intervenidos entre octubre de 2001 y septiembre de 2003 (n2 = 237). Variables de estudio en ambas muestras: 1) porcentaje de exploraciones realizadas como apoyo radiológico al diagnóstico de la apendicitis; 2) sensibilidad y valor predictivo positivo (VPP) de ECO y TAC; 3) tasa de cirugías en blanco y con diagnósticos diferentes de AA. Análisis estadístico: software SPSS, con test de la χ2, aceptando como significativos niveles de p < 0,05 y calculando la odds ratio (OR) con su intervalo de confianza al 95% (IC95%). RESULTADOS: Ambas muestras fueron homogéneas en cuanto a edad, género o porcentaje de localizaciones atípicas y formas evolucionadas. El número de exploraciones solicitadas durante el periodo de estudio fue significativamente mayor que en el control (78,8 vs. 30,4%; p < 0,000). La sensibilidad de la TAC fue superior a la de la ECO (97 vs. 86%), aunque ambas pruebas presentaron valores similares de VPP (92 vs. 94%). El porcentaje de intervenciones con diagnóstico certero de AA fue significativamente mayor en el grupo de estudio (94,5 vs. 88,6%; p < 0,006; OR: 2,2; IC95% 1,25-4). CONCLUSIÓN: El incremento de solicitudes de apoyo radiológico al diagnóstico de AA conlleva un significativo aumento de intervenciones con diagnóstico certero

OBJECTIVE: The aim of this study is to analyze the increasing need of radiological support in the diagnosis of acute appendicitis (AA), the clinical repercussions associated, and the parameters of diagnostic accuracy of ultrasound and computed tomography (CT) scan for AA. MATERIAL AND METHODS: Observational and analytical study. Cohort, patients operated on for suspected AA at a tertiary referral hospital. Pregnancy and < 14 years were exclusion criteria. Study group: January 2010-December 2011 (n1 = 419). CONTROL GROUP: set of patients aged 18 to 65 years old operated between October 2001-September 2003 (n2 = 237). Variables analyzed in both groups: 1) percentage of radiological support for diagnosis of acute appendicitis; 2) sensitivity and positive predictive value (PPV) of ultrasound and CT scan; 3) rate of surgical explorations with negative result or with diagnosis other than acute appendicitis. Statistical analysis: SPSS software, χ2 test, statistical significance accepted with P<.05, 95% confidence interval (95% CI) for the odds ratio (OR). RESULTS: Age, gender, percentage of atypical locations and gangrenous/perforated episodes were similar in both groups. The number of radiological examinations needed for diagnosis was significantly higher in the study group (78.8% vs. 30.4%, P < .0,000). Sensitivity was significantly superior for CT than for ultrasound scan (97% vs. 86%), but PPV was similar in both tests (92% vs. 94%). Surgical exploration percent values with diagnosis of acute appendicitis was significantly higher in the study group (94.5% vs. 88.6%; P < .006, OR 2.2; CI 95% 1.25-4). CONCLUSIONS: CT and ultrasound scan are excellent diagnostic tools for acute appendicitis, and have contributed to a significant increase in surgical explorations with correct diagnosis

[Radiological support for diagnosis of acute appendicitis: use, effectiveness and clinical repercussions]. / Empleo, eficacia y repercusión clínica del apoyo radiológico al diagnóstico de la apendicitis aguda.

OBJECTIVE: The aim of this study is to analyze the increasing need of radiological support in the diagnosis of acute appendicitis (AA), the clinical repercussions associated, and the parameters of diagnostic accuracy of ultrasound and computed tomography (CT) scan for AA. MATERIAL AND METHODS: Observational and analytical study. Cohort, patients operated on for suspected AA at a tertiary referral hospital. Pregnancy and <14 years were exclusion criteria. STUDY GROUP: January 2010-December 2011 (n1=419). CONTROL GROUP: set of patients aged 18 to 65 years old operated between October 2001-September 2003 (n2=237). Variables analyzed in both groups: 1) percentage of radiological support for diagnosis of acute appendicitis; 2) sensitivity and positive predictive value (PPV) of ultrasound and CT scan; 3) rate of surgical explorations with negative result or with diagnosis other than acute appendicitis. STATISTICAL ANALYSIS: SPSS software, χ(2) test, statistical significance accepted with P<.05, 95% confidence interval (95% CI) for the odds ratio (OR). RESULTS: Age, gender, percentage of atypical locations and gangrenous/perforated episodes were similar in both groups. The number of radiological examinations needed for diagnosis was significantly higher in the study group (78.8% vs. 30.4%, P<.0,000). Sensitivity was significantly superior for CT than for ultrasound scan (97% vs. 86%), but PPV was similar in both tests (92% vs. 94%). Surgical exploration percent values with diagnosis of acute appendicitis was significantly higher in the study group (94.5% vs. 88.6%; P<.006, OR 2.2; CI 95% 1.25-4). CONCLUSIONS: CT and ultrasound scan are excellent diagnostic tools for acute appendicitis, and have contributed to a significant increase in surgical explorations with correct diagnosis.

Posterior approach (Kraske procedure) for surgical treatment of presacral tumors.

Presacral tumors are rare, but can comprise a great variety of histological types. Congenital tumors are the most common. Once the diagnosis is established, surgical resection is essential because of the potential for malignancy or infection. Previous biopsy is not necessary or may be even harmful. To decide the best surgical approach (abdominal, sacral or combined) an individual and multidisciplinary analysis must be carried out. We report three cases of cystic presacral masses in which a posterior approach (Kraske procedure) enabled complete resection, the only way to decrease local recurrence. All patients had a satisfactory recovery. A brief overview of retrorectal tumors is presented, focusing on classification, clinical presentation, diagnosis and surgical management.

Tratamiento agresivo de las complicaciones arteriales del trasplante hepático. Impacto sobre la supervivencia y las complicaciones biliares / Aggressive management of the arterial complications of liver transplantation. Impact upon survival and biliary complications

Se estudian las complicaciones arteriales (CA) ocurridas en 400 trasplantes realizados entre 1997 y 2006. Se dividen en 2 grupos según el tipo de tratamiento realizado: grupo i: tratamiento invasivo (tratamiento sobre la arteria o retrasplante), y grupo ii: tratamiento conservador o sintomático. Se analizan el impacto del tratamiento sobre la supervivencia y las complicaciones biliares (CB).Resultados Se han presentado 18 CA (4,5%), 10 complicaciones precoces (7 trombosis y 3 estenosis) y 8 complicaciones tardías (5 trombosis y 3 estenosis). El 90% de las complicaciones precoces se trató de forma invasiva (4 trombectomías urgentes, un retrasplante, 3 angioplastias y una ligadura de arteria hepática), y el 25% de las complicaciones tardías se trató con retrasplante (3); el 75% restante recibió tratamiento sintomático. Resultados La supervivencia a 12 y 60 meses fue inferior en el grupo ii (el 57 y el 42%) que en el grupo i (el 90 y el 68%), aunque sin alcanzar significación estadística. La tasa global de CB de enfermos con trombosis arterial fue del 50%. En el grupo i del %, significativamente menor que el grupo ii con el 71% (p<0,04).Conclusiones El tratamiento invasivo de las CA en el trasplante hepático se asocia a una mayor supervivencia a corto plazo y reduce de forma significativa la aparición de CB. En nuestra experiencia, los pacientes se benefician de un diagnóstico precoz y un tratamiento intensivo en este tipo de complicaciones (AU)

Abstract A study was made of the arterial complications documented in 400 transplants performed between 1997 and 2006. The patients were divided into two groups according to the type of treatment provided. Group I: invasive management (arterial treatment or re-transplant), and Group II: conservative or symptomatic management. The impact of management upon survival and biliary complications was analysed. Results There were 18 arterial complications (4.5%): 10 early (7 thromboses and 3 stenoses) and 8 late (5 thromboses and 3 stenoses). Ninety percent of the early complications were subjected to invasive management (4 emergency thrombectomies, 1 re-transplant and 3 angioplasties), while 25% of the late complications were treated in the form of re-transplant and the remaining 75% were subjected to symptomatic treatment. Survival after 12 and 60 months was lower in Group II (57% and 42%) than in Group I (90% and 68%), although without reaching statistical significance. The overall biliary complications rate among the patients with arterial thrombosis was 50%. The rate was significantly lower in Group I than in Group II (10% versus 71%) (P<04).Conclusions Invasive management of the arterial complications of liver transplantation is associated with longer short-term survival and significantly fewer biliary complications. In our experience, patients benefit from an early diagnosis and aggressive management of complications of this kind (AU)