ABSTRACT
Background Pancreatectomy plus celiac axis resection (CAR) is performed in patients with locally advanced pancreatic cancer. The morbidity rates are high, and no survival benefit has been confirmed. It is not known at present whether it is the type of pancreatectomy, or CAR itself, that is the reason for the high complication rates. Methods Observational retrospective multicenter study. Inclusion criteria: patient undergoing TP, PD or DP plus CAR for a pancreatic cancer. Results Sixty-two patients who had undergone pancreatic cancer surgery (PD,TP or DP) plus CAR were studied. Group 1: 17 patients who underwent PD/TP-CAR (13TP/4PD); group 2: 45 patients who underwent DP-CAR. Groups were mostly homogeneous. Operating time was longer in the PD/TP group, while operative complications did not differ statistically in the two groups. The number of lymph nodes removed was higher in the PD/TP group (26.5 vs 17.3), and this group also had a higher positive node ratio (17.9% vs 7.6%). There were no statistical differences in total or disease-free survival between the two groups. Conclusion It seems that CAR, and not the type of pancreatectomy, influences morbidity and mortality in this type of surgery. International multicenter studies with larger numbers of patients are now needed to validate the data presented here (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Celiac Artery/surgery , Pancreatectomy/methods , Pancreatic Neoplasms/surgery , Retrospective Studies , Treatment Outcome , Disease-Free Survival , Lymph Node Excision/statistics & numerical data , Neoplasm Invasiveness , Pancreatectomy/adverse effects , Pancreatectomy/mortality , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/pathology , SpainABSTRACT
BACKGROUND: Pancreatectomy plus celiac axis resection (CAR) is performed in patients with locally advanced pancreatic cancer. The morbidity rates are high, and no survival benefit has been confirmed. It is not known at present whether it is the type of pancreatectomy, or CAR itself, that is the reason for the high complication rates. METHODS: Observational retrospective multicenter study. INCLUSION CRITERIA: patient undergoing TP, PD or DP plus CAR for a pancreatic cancer. RESULTS: Sixty-two patients who had undergone pancreatic cancer surgery (PD,TP or DP) plus CAR were studied. Group 1: 17 patients who underwent PD/TP-CAR (13TP/4PD); group 2: 45 patients who underwent DP-CAR. Groups were mostly homogeneous. Operating time was longer in the PD/TP group, while operative complications did not differ statistically in the two groups. The number of lymph nodes removed was higher in the PD/TP group (26.5 vs 17.3), and this group also had a higher positive node ratio (17.9% vs 7.6%). There were no statistical differences in total or disease-free survival between the two groups. CONCLUSION: It seems that CAR, and not the type of pancreatectomy, influences morbidity and mortality in this type of surgery. International multicenter studies with larger numbers of patients are now needed to validate the data presented here.
Subject(s)
Celiac Artery/surgery , Pancreatectomy/methods , Pancreatic Neoplasms/surgery , Body Mass Index , Disease-Free Survival , Female , Humans , Kaplan-Meier Estimate , Lymph Node Excision/statistics & numerical data , Male , Middle Aged , Neoplasm Invasiveness/pathology , Operative Time , Pancreatectomy/adverse effects , Pancreatectomy/mortality , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/pathology , Postoperative Complications , Retrospective Studies , Spain , Treatment OutcomeABSTRACT
BACKGROUND: We analyzed the prevalence, etiology, and risk factors of culture-positive preservation fluid and their impact on the management of solid organ transplant recipients. METHODS: From July 2015 to March 2017, 622 episodes of adult solid organ transplants at 7 university hospitals in Spain were prospectively included in the study. RESULTS: The prevalence of culture-positive preservation fluid was 62.5% (389/622). Nevertheless, in only 25.2% (98/389) of the cases were the isolates considered "high risk" for pathogenicity. After applying a multivariate regression analysis, advanced donor age was the main associated factor for having culture-positive preservation fluid for high-risk microorganisms. Preemptive antibiotic therapy was given to 19.8% (77/389) of the cases. The incidence rate of preservation fluid-related infection was 1.3% (5 recipients); none of these patients had received preemptive therapy. Solid organ transplant (SOT) recipients with high-risk culture-positive preservation fluid receiving preemptive antibiotic therapy presented both a lower cumulative incidence of infection and a lower rate of acute rejection and graft loss compared with those who did not have high-risk culture-positive preservation fluid. After adjusting for age, sex, type of transplant, and prior graft rejection, preemptive antibiotic therapy remained a significant protective factor for 90-day infection. CONCLUSIONS: The routine culture of preservation fluid may be considered a tool that provides information about the contamination of the transplanted organ. Preemptive therapy for SOT recipients with high-risk culture-positive preservation fluid may be useful to avoid preservation fluid-related infections and improve the outcomes of infection, graft loss, and graft rejection in transplant patients.
ABSTRACT
Nitric oxide (NO) plays a relevant role during cell death regulation in tumor cells. The overexpression of nitric oxide synthase type III (NOS-3) induces oxidative and nitrosative stress, p53 and cell death receptor expression and apoptosis in hepatoblastoma cells. S-nitrosylation of cell death receptor modulates apoptosis. Sorafenib is the unique recommended molecular-targeted drug for the treatment of patients with advanced hepatocellular carcinoma. The present study was addressed to elucidate the potential role of NO during Sorafenib-induced cell death in HepG2 cells. We determined the intra- and extracellular NO concentration, cell death receptor expression and their S-nitrosylation modifications, and apoptotic signaling in Sorafenib-treated HepG2 cells. The effect of NO donors on above parameters has also been determined. Sorafenib induced apoptosis in HepG2 cells. However, low concentration of the drug (10nM) increased cell death receptor expression, as well as caspase-8 and -9 activation, but without activation of downstream apoptotic markers. In contrast, Sorafenib (10 µM) reduced upstream apoptotic parameters but increased caspase-3 activation and DNA fragmentation in HepG2 cells. The shift of cell death signaling pathway was associated with a reduction of S-nitrosylation of cell death receptors in Sorafenib-treated cells. The administration of NO donors increased S-nitrosylation of cell death receptors and overall induction of cell death markers in control and Sorafenib-treated cells. In conclusion, Sorafenib induced alteration of cell death receptor S-nitrosylation status which may have a relevant repercussion on cell death signaling in hepatoblastoma cells.
Subject(s)
Antineoplastic Agents/pharmacology , Gene Expression Regulation, Neoplastic , Niacinamide/analogs & derivatives , Phenylurea Compounds/pharmacology , Receptors, TNF-Related Apoptosis-Inducing Ligand/metabolism , Receptors, Tumor Necrosis Factor, Type I/metabolism , Signal Transduction , Caspase 3/genetics , Caspase 3/metabolism , Caspase 8/genetics , Caspase 8/metabolism , Caspase 9/genetics , Caspase 9/metabolism , Cell Death/drug effects , Cysteine/analogs & derivatives , Cysteine/chemistry , Cysteine/pharmacology , Hep G2 Cells , Humans , Niacinamide/pharmacology , Nitric Oxide/chemistry , Nitric Oxide/pharmacology , Nitric Oxide Donors/chemistry , Nitric Oxide Donors/pharmacology , Nitric Oxide Synthase Type III/genetics , Nitric Oxide Synthase Type III/metabolism , Receptors, TNF-Related Apoptosis-Inducing Ligand/genetics , Receptors, Tumor Necrosis Factor, Type I/genetics , S-Nitrosothiols/chemistry , S-Nitrosothiols/pharmacology , SorafenibABSTRACT
La cirugía de control de daños o damage control surgery (DCS) intenta mejorar los resultados de los traumatismos abdominales en pacientes críticos con escasa reserva fisiológica. Se define como una "cirugía por etapas", con un primer tiempo quirúrgico corto para controlar el sangrado y la contaminación, seguido de un periodo de reanimación y, finalmente, de reparación definitiva de las lesiones. Debe basarse en la toma rápida de decisiones, identificando aquellos pacientes, politraumatizados o no,que pueden ser candidatos a esta cirugía. Se revisan las indicaciones, las etapas, los procedimientos quirúrgicos y los factores pronósticos de estos pacientes (AU)
Damage control surgery (DCS) seeks to improve outcome in critical trauma patients with abdominal injuries and diminished physiological reserve. DCS is a staged approach to surgery that starts with a rapid intervention to control bleeding and contamination; this step is followed by a period of reanimation and eventually the definitive repair of lesions. Fast decision-making and selection of candidates, whether they have multiple injuries or not, are fundamental in DCS. We review the indications, stages, and surgical procedures to follow in DCS. We also discuss prognostic factors (AU)
Subject(s)
Humans , Multiple Trauma/surgery , Abdominal Injuries/surgery , Emergency Treatment/methods , Intra-Abdominal Hypertension/epidemiology , Severity of Illness Index , Abdominal Wound Closure Techniques , Hemorrhage/surgeryABSTRACT
La hernia pulmonar intercostal es una entidad rara. Pueden clasificarse en congénitas o adquiridas, y a su vez, en traumáticas, patológicas o espontáneas; este grupo representa las menos frecuentes. Los síntomas son variables y suelen estar enmascarados en las secundarias a traumatismos. Pueden plantear el diagnóstico diferencial en pacientes con dolor persistente tras toracotomía. La tomografía axial computarizada (TAC) de tórax es la prueba más valiosa para su diagnóstico y con vistas al tratamiento, que puede ser motivo de controversia. Aunque pueden tener indicación quirúrgica de entrada, como en las complicadas o con gran componente herniario, el tratamiento conservador podría contemplarse en ciertos grupos de pacientes con resultados controvertidos. Dentro de las opciones quirúrgicas, el empleo de mallas proporciona la menor tasa de recidivas. Presentamos el caso de un paciente con herniación pulmonar intercostal y se realiza una revisión de la literatura en cuanto a la etiología, diagnóstico y tratamiento de esta entidad (AU)
Intercostal lung hernia is a rare entity. It can be classified as congenital or acquired, and then as pathological, traumatic or spontaneous, the latter being the least common. Symptoms are variable and frequently masked within those secondary to traumas. The differential diagnosis should be considered in patients with persistent postthoracotomy chest pain. The computed tomography (CT) is the best test for its diagnosis and therapeutic approach, which is usually controversial. Although surgical management may be indicated on diagnosis, as in big hernial sac or complicated ones, conservative treatment should be considered in a select group of patients with controversial results. As surgical options, the lowest rate of relapse is obtained through the use of a mesh. We report a case of a patient with intercostal lung hernia, and review the literature regarding etiology, diagnosis and treatment of this entity (AU)
Subject(s)
Humans , Hernia , Lung , Intercostal Muscles , Thoracic Wall , Surgical MeshSubject(s)
Humans , Male , Middle Aged , Histiocytic Necrotizing Lymphadenitis/complications , Histiocytic Necrotizing Lymphadenitis/diagnosis , Histiocytic Necrotizing Lymphadenitis/therapy , Abdominal Pain/etiology , Histiocytic Necrotizing Lymphadenitis/physiopathology , Histiocytic Necrotizing Lymphadenitis , Abdomen/pathology , Abdomen , Abdominal Neoplasms , Magnetic Resonance Imaging/methods , Mesentery/anatomy & histology , Mesentery/pathology , Lymph Nodes/anatomy & histology , Lymph NodesABSTRACT
Osteoclastoid (osteoclast-like) giant cell carcinoma of the pancreas is an infrequent entity. There has long been discussion concerning its epithelial or mesenchymal origin. Whether its prognosis is better than that of other exocrine tumours of the pancreas has not yet been established. We present a case of this rare entity. The patient has remained disease-free now for 30 months.
Subject(s)
Carcinoma, Giant Cell/pathology , Pancreatic Neoplasms/pathology , Aged , Carcinoma, Giant Cell/diagnostic imaging , Carcinoma, Giant Cell/therapy , Female , Humans , Osteoclasts/cytology , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/therapy , Radiography , Treatment OutcomeABSTRACT
El carcinoma de páncreas de células grandes de tipo osteoclastoide es una entidad infrecuente. Durante tiempo se ha discutido sobre su origen epitelial o mesenquimal. No está establecido que su pronóstico sea mejor que otros tumores exocrinos de páncreas. Presentamos un caso de esta rara entidad que permanece libre de enfermedad después de un seguimiento de 30 meses (AU)
Subject(s)
Female , Humans , Aged , Treatment Outcome , Osteoclasts , Carcinoma, Giant Cell , Pancreatic NeoplasmsABSTRACT
We present a case of gallbladder agenesis, an uncommon bile duct malformation, which was found on attempting to perform a laparoscopic cholecystectomy. The diagnosis was confirmed postoperatively on a nuclear magnetic resonance cholangiogram.
Subject(s)
Gallbladder/abnormalities , Adult , Cholangiography , Female , Humans , Magnetic Resonance SpectroscopyABSTRACT
La hernia intercostal es una entidad muy rara, caracterizada por la aparición de un defecto en la continuidad de algún espacio intercostal a través del cual se produce la protrusión del contenido intratorácico. Suelen ser poco sintomáticas y diagnosticarse mediante la exploración física y radiografía de tórax. El tratamiento es controvertido. Para algunos autores se puede tratar de forma conservadora con vendaje inmovilizador de la zona y si éste falla optar por la cirugía, mientras que para otros el tratamiento quirúrgico está indicado en prácticamente todos los casos. Presentamos el caso de un paciente con una hernia intercostal con neumotórax asociado. (AU)
Subject(s)
Male , Aged, 80 and over , Humans , Hernia/complications , Pneumothorax/etiology , Lung Diseases , Hernia , Hernia/therapy , Pleural Effusion , Fatal OutcomeABSTRACT
Presentamos un caso de agenesia de vesícula, malformación infrecuente de las vías biliares, que se halló al intentar realizar una colecistectomía laparoscópica y cuyo diagnóstico se confirmó en el postoperatorio al practicar una colangiorresonancia magnética nuclear (AU)
Subject(s)
Adult , Female , Humans , Magnetic Resonance Spectroscopy , Cholangiography , GallbladderABSTRACT
OBJECTIVE: The aim of this study was to analyze the usefulness of biofeedback techniques based on manometrical procedures in the treatment of defecation disorders in patients with myelomeningocele. PATIENTS AND METHODS: We studied 24 patients with myelomeningocele, aged 13 days to 15 years, who were referred to our Instrumental Diagnosis Unit for evaluation of anorectal function, or constipation and/or fecal incontinence study. Biofeedback was given to 12 patients who fulfilled the following criteria: age more than 5 years, existence of anorectal sensitivity with a perceptual threshold of less than 60 ml of rectal expansion, ability to contract and relax the gluteus muscles and thus be able to exercise pressure on the anal margin, and collaboration on the part of child and the family. As a complement defecatory maneuvers were performed. RESULTS: Between 4 and 65 sessions took place (35.14 19.97) after which rectal perceptual volume decreased from 24.66 14.13 to 3.33 2.95 ml and pressure on the anal margin increased from 45.62 17.82 to 114.37 13.99 mmHg. These differences were statistically significant (p < 0.001). Clear clinical improvement was produced in 10 of 12 patients who achieved good fecal continence with spontaneous depositions. Partial improvement was produced in 2 patients. CONCLUSIONS: We consider that biofeedback based on manometrical procedures is more useful than other conservative therapies in the treatment of defecatory problems in patients with myelomeningocele. In most patients this technique produces clinical improvement with satisfactory continence and without the drawbacks of other procedures.
Subject(s)
Biofeedback, Psychology , Defecation/physiology , Fecal Incontinence/etiology , Fecal Incontinence/therapy , Meningomyelocele/complications , Adolescent , Anal Canal/physiology , Child , Child, Preschool , Constipation/etiology , Constipation/therapy , Humans , Infant , ManometryABSTRACT
Objetivo: Analizar la utilidad de las técnicas de biorretroalimentación basadas en procedimientos anomanométricos en el tratamiento de los trastornos de la defecación de los pacientes con mielomeningocele. Pacientes y método: Estudio de 24 pacientes afectados de mielomeningocele, con edades comprendidas entre 13 días y 15 años, remitidos a la Unidad de Diagnóstico Instrumental para valoración funcional anorrectal o estudio de estreñimiento y/o incontinencia. Se realizó biorretroalimentación a 12 pacientes que reunieron los criterios preestablecidos: edad superior a 5 años, existencia de sensibilidad anorrectal con un umbral de percepción menor de 60 ml de distensión rectal, habilidad del niño para contraer y relajar los músculos glúteos y de esta forma poder ejercer presión sobre el margen anal, colaboración por parte del niño y su familia. Como complemento se realizan maniobras defecatorias. Resultados: Se realizaron entre 4 y 65 sesiones (35,14 ± 19,97) tras las cuales se consiguió una disminución del volumen de percepción rectal de 24,66 ± 14,13 a 3,33 ± 2,95 ml y un aumento de la presión sobre el margen anal que pasó de 45,62 ± 17,82 a 114,37 ± 13,99 mmHg. Estas diferencias fueron estadísticamente significativas (p < 0,001). Así mismo, se consiguió una mejoría clínica clara en 10 de los 12 pacientes, que pasaron a tener una continencia fecal adecuada con deposiciones espontáneas y una mejoría parcial en dos pacientes. Conclusiones: Consideramos que la biorretroalimentación basada en procedimientos anomanométricos es un medio más útil que otras terapias conservadoras, para los problemas defecatorios de los pacientes afectados de mielomeningocele, puesto que consigue una mejoría clínica en la mayoría de los pacientes, con una continencia adecuada y sin los inconvenientes de otros procedimientos (AU)
