Prevalence of Anxiety and Depression Symptoms and Their Relationship with Nutritional Status and Mortality in Patients with Colorectal Cancer.

BACKGROUND: Anxiety and depression are common in patients with cancer. The aim of this study is to determine the prevalence of anxiety and depression symptoms in colorectal cancer (CRC) patients awaiting elective surgery and whether there is an association with their preoperative nutritional status and postoperative mortality. METHODS: A prospective study was conducted on 215 patients with CRC proposed for surgery. Data about nutritional status were collected using the Global Leadership Initiative on Malnutrition (GLIM) criteria, while anxiety and depression symptoms data were collected using Hospital Anxiety and Depression Scale (HADS). RESULTS: HADS detected possible anxiety in 41.9% of patients, probable anxiety in 25.6%, possible depression in 21.9%, and probable depression in 7.9%. GLIM criteria found 116 (53.9%) patients with malnutrition. The HADS score for depression subscale was significantly higher in malnourished patients than in well-nourished (5.61 ± 3.65 vs. 3.95 ± 2.68; p = 0.001). After controlling for potential confounders, malnourished patients were 10.19 times more likely to present probable depression (95% CI 1.13-92.24; p = 0.039). Mortality was 1.9%, 4,2%, and 5.6% during admission and after 6 and 12 months, respectively. Compared to patients without depressive symptomatology, in patients with probable depression, mortality risk was 14.67 times greater (95% CI 1.54-140.21; p = 0.02) during admission and 6.62 times greater (95% CI 1.34-32.61; p = 0.02) after 6 months. CONCLUSIONS: The presence of anxiety and depression symptoms in CRC patients awaiting elective surgery is high. There is an association between depression symptoms, preoperative nutritional status, and postoperative mortality.

Poor Physical Performance Is Associated with Postoperative Complications and Mortality in Preoperative Patients with Colorectal Cancer.

Introduction: Poor physical performance has been shown to be a good predictor of complications in some pathologies. The objective of our study was to evaluate, in patients with colorectal neoplasia prior to surgery, physical performance and its relationship with postoperative complications and in-hospital mortality, at 1 month and at 6 months. Methods: We conducted a prospective study on patients with preoperative colorectal neoplasia, between October 2018 and July 2021. Physical performance was evaluated using the Short Physical Performance Battery (SPPB) test and hand grip strength (HGS). For a decrease in physical performance, SPPB < 10 points or HGS below the EWGSOP2 cut-off points was considered. Nutritional status was evaluated using subjective global assessment (SGA). The prevalence of postoperative complications and mortality during admission, at 1 month, and at 6 months was evaluated. Results: A total of 296 patients, mean age 60.4 ± 12.8 years, 59.3% male, were evaluated. The mean BMI was 27.6 ± 5.1 kg/m2. The mean total SPPB score was 10.57 ± 2.07 points. A total of 69 patients presented a low SPPB score (23.3%). Hand grip strength showed a mean value of 33.1 ± 8.5 kg/m2 for men and 20.7 ± 4.3 kg/m2 for women. A total of 58 patients presented low HGS (19.6%). SGA found 40.2% (119) of patients with normal nourishment, 32.4% (96) with moderate malnutrition, and 27.4% (81) with severe malnutrition. Postoperative complications were more frequent in patients with a low SPPB score (60.3% vs. 38.6%; p = 0.002) and low HGS (64.9% vs. 39.3%, p = 0.001). A low SPPB test score (OR 2.57, 95% CI 1.37−4.79, p = 0.003) and low HGS (OR 2.69, 95% CI 1.37−5.29, p = 0.004) were associated with a higher risk of postoperative complications after adjusting for tumor stage and age. Patients with a low SPPB score presented an increase in in-hospital mortality (8.7% vs. 0.9%; p = 0.021), at 1 month (8.7% vs. 1.3%; p = 0.002) and at 6 months (13.1% vs. 2.2%, p < 0.001). Patients with low HGS presented an increase in mortality at 6 months (10.5% vs. 3.3%; p = 0.022). Conclusions: The decrease in physical performance, evaluated by the SPPB test or hand grip strength, was elevated in patients with colorectal cancer prior to surgery and was related to an increase in postoperative complications and mortality.

Are there intra-operative hemodynamic differences between the Coliseum and closed HIPEC techniques in the treatment of peritoneal metastasis? A retrospective cohort study.

BACKGROUND: Although two main methods of intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) are currently accepted, the superiority of one over the other has not yet been demonstrated. The purpose of this study was to determine whether there are hemodynamic and temperature differences between patients who received HIPEC in two different techniques, open versus closed abdomen. METHODS: This retrospective study was conducted in our center between 2011-2015 in 30 patients who underwent surgery for peritoneal carcinomatosis secondary to colorectal cancer, in whom cytoreduction and HIPEC were performed by the Coliseum (15) or closed techniques (15). The main end points were morbidity, mortality, hemodynamic changes, and abdominal temperature. The comparative analysis of quantitative variables at different times was done with the parametric repeated measure ANOVA for those variables that fulfilled the suppositions of normality and independence and the Friedman non-parametric test for the variables that did not fulfill either of these suppositions. RESULTS: There were no deaths in either group. The incidence of postoperative complications in the Coliseum group was 53% (8 patients), grade II-III. The incidence of complications in the closed group was 13% (2 patients), grade II-III. The intra-operative conditions regarding the systolic and diastolic pressures were more stable using the closed abdomen technique (but not significantly so). We found statistically significant differences in abdominal temperature in favor of the closed technique (p = 0.009). CONCLUSIONS: Both HIPEC procedures are similar. In our series, the closed technique resulted in a more stable intra-abdominal temperature.

Linfangioma quístico esplénico / Splenic cystic lymphangioma

No disponible

Tumores retrorrectales: un reto diagnósticoterapéutico / Retrorectal tumors - a diagnostic-therapeutic challenge

No disponible

Revision surgery for one anastomosis gastric bypass with anti-reflux mechanism: a new surgical procedure using only not previously operated intestine / Cirugía de revisión de bypass gástrico de una anastomosis con mecanismo anti-reflujo: un nuevo procedimiento quirúrgico utilizando solo intestino no operado anteriormente

Introduction: Obesity is now an epidemic in industrialized countries with high prevalence (U.S. with 67%, Europa from 40% to 50%). This had led to the development of many bariatric procedures. Nevertheless, the primary surgery could fails due to several conditions. There is no standard re-operative procedure of revision for primary bariatric failure. Re-operate in the place of the primary surgery imply high rate of risks. We have developed a new procedure for revision surgery working only on not previously operated tissue. Methods: We measure the common channel from gastro- jejunal anastomosis until the ileocecal valve. Depending on the measure, we decide the length of intestine to be excluded (biliopancreatic limb and common channel). We interrupt the afferent loop before gastro-jejunostomy and the efferent loop 20 cm below the gastro-jejunostomy. For restoring the gastro-intestinal transit, we anastomose the upper part of the afferent and efferent loop side-to-side and the efferent loop segment to the upper part of the new common channel. Discussion: There is no standard procedure for revision of primary surgery. Even, the gold standard surgery Roux-en-Y gastric bypass is one of the most failed procedure (≤ 35%). We have developed the revision for One Anastomosis Gastric Bypass (BAGUA) working always in healthy tissue not previously used. Conclusions: A few number of patients with tailored BAGUA for morbid obesity will require a surgical rescue procedure due to excess or insufficient weight loss or weight regain. This new procedure has been proven to be easy and safe, avoiding the surgical difficulties of the classical revision through the scar tissue (AU)

Introducción: La obesidad es ahora una epidemia en los países industrializados con una alta prevalencia (Estados Unidos con el 67%, Europa desde el 40% al 50%). Esto ha llevado al desarrollo de muchos de los procedimientos bariátricos. Sin embargo, la cirugía primaria puede fallar debido a diversas condiciones. No existe un procedimiento quirúrgico standard para realizar revisión para la cirugía bariátrica que ha fallado. Re-operar en el lugar de la cirugía primaria implicar una alta tasa de riesgos. Nosotros hemos desarrollado un nuevo procedimiento para la cirugía de revisión trabajando únicamente en el tejido no operado previamente. Métodos: Nosotros medimos el canal común desde de la anastomosis gastro-yeyunal hasta la válvula ileocecal. Dependiendo de la medición, decidimos la longitud del intestino para ser excluido (asa biliopancreática y canal común). Interrumpimos el asa aferente antes gastro-yeyunostomía y el asa eferente a 20 cm por debajo de la gastro- yeyunostomía. Para restaurar el tránsito gastro-intestinal, anastomosamos la parte superior del asa aferente y eferente en forma latero-lateral, y el segmento del asa eferente a la parte superior del nuevo canal común. Discusión: No existe un procedimiento estándar para la revisión de la cirugía primaria. Incluso, la cirugía Gold standard el bypass gástrico Roux-en-Y, es uno de los procedimientos con más fracasos (≤ 35%). Hemos desarrollado la revisión del Bypass Gástrico de Una Anastomosis (BAGUA) trabajando siempre en tejido sano no utilizado previamente. Conclusiones: Un escaso número de pacientes con BAGUA a medida para obesidad mórbida requerirá un procedimiento de rescate quirúrgico debido a exceso de peso o pérdida de peso insuficiente, o la re-ganancia del peso. Este nuevo procedimiento ha demostrado ser fácil y seguro, evitando las dificultades quirúrgicas de la revisión clásica a través del tejido cicatrizado (AU)

Revision surgery for one anastomosis gastric bypass with anti-reflux mechanism: a new surgical procedure using only not previously operated intestine.

INTRODUCTION: Obesity is now an epidemic in industrialized countries with high prevalence (U.S. with 67%, Europa from 40% to 50%). This had led to the development of many bariatric procedures. Nevertheless, the primary surgery could fails due to several conditions. There is no standard re-operative procedure of revision for primary bariatric failure. Re-operate in the place of the primary surgery imply high rate of risks. We have developed a new procedure for revision surgery working only on not previously operated tissue. METHODS: We measure the common channel from gastro- jejunal anastomosis until the ileocecal valve. Depending on the measure, we decide the length of intestine to be excluded (biliopancreatic limb and common channel). We interrupt the afferent loop before gastro-jejunostomy and the efferent loop 20 cm below the gastro-jejunostomy. For restoring the gastro-intestinal transit, we anastomose the upper part of the afferent and efferent loop side-to-side and the efferent loop segment to the upper part of the new common channel. DISCUSSION: There is no standard procedure for revision of primary surgery. Even, the gold standard surgery Roux-en-Y gastric bypass is one of the most failed procedure (≤ 35%). We have developed the revision for One Anastomosis Gastric Bypass (BAGUA) working always in healthy tissue not previously used. CONCLUSIONS: A few number of patients with tailored BAGUA for morbid obesity will require a surgical rescue procedure due to excess or insufficient weight loss or weight regain. This new procedure has been proven to be easy and safe, avoiding the surgical difficulties of the classical revision through the scar tissue.

Introducción: La obesidad es ahora una epidemia en los países industrializados con una alta prevalencia (Estados Unidos con el 67%, Europa desde el 40% al 50%). Esto ha llevado al desarrollo de muchos de los procedimientos bariatricos. Sin embargo, la cirugía primaria puede fallar debido a diversas condiciones. No existe un procedimiento quirúrgico standard para realizar revisión para la cirugía bariátrica que ha fallado. Re-operar en el lugar de la cirugía primaria implicar una alta tasa de riesgos. Nosotros hemos desarrollado un nuevo procedimiento para la cirugia de revision trabajando únicamente en el tejido no operado previamente. Métodos: Nosotros medimos el canal común desde de la anastomosis gastro-yeyunal hasta la valvula ileocecal. Dependiendo de la medición, decidimos la longitud del intestino para ser excluido (asa biliopancreatica y canal común). Interrumpimos el asa aferente antes gastro-yeyunostomia y el asa eferente a 20 cm por debajo de la gastro- yeyunostomía. Para restaurar el tránsito gastro-intestinal, anastomosamos la parte superior del asa aferente y eferente en forma latero-lateral, y el segmento del asa eferente a la parte superior del nuevo canal común. Discusión: No existe un procedimiento estandar para la revisión de la cirugía primaria. Incluso, la cirugía Gold standard el bypass gástrico Roux-en-Y, es uno de los procedimientos con más fracasos (≤ 35%). Hemos desarrollado la revisión del Bypass Gástrico de Una Anastomosis (BAGUA) trabajando siempre en tejido sano no utilizado previamente. Conclusiones: Un escaso número de pacientes con BAGUA a medida para obesidad mórbida requerirá un procedimiento de rescate quirúrgico debido a exceso de peso o pérdida de peso insuficiente, o la re-ganancia del peso. Este nuevo procedimiento ha demostrado ser fácil y seguro, evitando las dificultades quirúrgicas de la revisión clásica a través del tejido cicatrizado.

Uso endoscópico de electrocauterio en el tratamiento de estenosis anastomótica ileorrectal / Endoscopic treatment with diathermy of ileorectal anastomotic stricture

No disponible

Metabolic disorders of liver and iron in diabetic and non-diabetic patients BMI < 35 or > 35 before gastric bypass.

INTRODUCTION: The presence of abnormalities in the metabolic pathways of iron and liver functioning can produce insulin resistance or metabolic syndrome. Therefore, it is important to examine those alterations that may lead to the development of diseases. Nutritional status is another important factor that is intimately linked to diabetes and obesity. PATIENTS AND METHODS: We studied 131 patients (78 nondiabetic patients and 53 diabetic), 37 patients BMI ≤35 (3 BMI < 25, 18 BMI 25-29.9, 16 BMI 30-34.9) and 94 patients BMI ≥35 (81 BMI 35-49.9 and 13 BMI ≥50). Subjects underwent to laboratory studies related to liver functioning and iron metabolism. Nutritional status was also determined in our patients. RESULTS: Iron was altered 14% of patients BMI >35 and diabetics reached 3% to 25%. Vitamin B12 was low 4% of non-diabetics BMI > 35, and high in 6% of diabetics BMI < 35. The 6% of diabetics BMI < 35 had hyperbilirubinemia. Transaminases are elevated in patients BMI >35 but exacerbated on diabetics. GGT is raised 41% to 47% in BMI >35. ALP is elevated in 25% of diabetics. Total protein and serum albumin were altered in diabetics causing mild malnutrition. 90% of patients had normal nutrition and 10% mild malnutrition. CONCLUSIONS: The metabolisms Hepatic and iron are closely related to the onset of obesity and diabetes. If there is weight gain, cumulative metabolic risks rise. The presence of diabesity and increased duration of diabetes produce altered metabolism. Nutritional status is altered in obesity but is worse with the addition of diabetes.

Introducción: La presencia de anormalidades en las vías metabólicas del hierro y el funcionamiento del hígado pueden producir resistencia a la insulina o síndrome metabólico. Por lo tanto, es importante examinar esas alteraciones que pueden conducir al desarrollo de enfermedades. El estado nutricional es otro factor importante que está íntimamente ligada a la diabetes y la obesidad. Pacientes y métodos: Se estudiaron 131 pacientes (78 pacientes no diabéticos y 53 diabéticos), 37 pacientes IMC ≤35 (3 IMC < 25, 18 IMC 25-29,9, 16 IMC 30-34,9) y 94 pacientes IMC ≥35 (81 IMC 35-49,9 y 13 de IMC ≥50). Los sujetos fueron sometidos a estudios de laboratorio relacionadas con el funcionamiento del hígado y el metabolismo del hierro. Se determinó también el estado nutricional en nuestros pacientes. Resultados: El hierro estuvo alterado en 14% de los pacientes IMC >35 y los diabéticos alcanzaron 3% a 25%. La vitamina B12 fue baja en 4% de los no diabéticos IMC > 35, y alta en el 6% de los diabéticos IMC < 35. El 6% de los diabéticos IMC < 35 tenía hiperbilirrubinemia. Las transaminasas estuvieron elevadas en pacientes IMC > 35, pero exacerbados en los diabéticos. GGT se eleva del 41% al 47% en BMI > 35. ALP estuvo elevada en el 25% de los diabéticos. Las proteínas séricas totales y la albúmina estuvieron alterados en los diabéticos causando desnutrición leve. 90% de los pacientes tenían una nutrición normal y 10% desnutrición leve. Conclusiones: El metabolismo hepático y del hierro están estrechamente relacionadas con el inicio de la obesidad y la diabetes. Si hay un aumento de peso, los riesgos metabólicos acumulados se elevan. La presencia de la diabesidad y el aumento de la duración de la diabetes empeoran el metabolismo. El estado nutricional se altera en la obesidad, pero es peor con la adición de la diabetes.

Glycemic and lipid metabolic disorders in diabetic and non-diabetic patients bmi < 35 or > 35 before gastric bypass.

INTRODUCTION: Obesity and diabetes are diseases with high prevalence worldwide. There is currently no effective medical treatment for combat the weight gain. It is precursor of diseases such as diabetes or metabolic syndrome. It is necessary to know if weight gain has cumulative effects on the glycemic and lipid metabolism as precursors of complications or comorbidities. PATIENTS AND METHODS: We studied 131 patients (78 nondiabetic and 53 diabetic), 37 BMI ≤35 (3 BMI < 25, 18 BMI 25-29.9, 16 BMI 30-34.9) and 94 BMI ≥35 (81 BMI 35-49.9 and 13 BMI ≥50).We analyzed BMI, gender, diabetes and the time of evolution. Lipid profile, glucose, HbA1c and C-peptide evaluated after 12-hour fasting. RESULTS: Diabetic and diabese patients showed high triglycerides. Non-diabetics have impaired glucose (58% BMI < 35 and 36% BMI > 35). The 20% of non-diabetics BMI < 35 had high C-peptide, and 19% of BMI > 35 had high levels. The 5% of diabetics BMI < 35 had low Cpeptide and 36% of BMI > 35 had high levels. HbA1c was higher in 40% of non-diabetic patients BMI < 35 compared to 13% BMI > 35. CONCLUSIONS: Glucose and triglycerides increase with age and years of development of T2DM. Age of 51 and more, and men are more affected. The weight increase has cumulative effect by altering the metabolism favoring the onset of diabetes and comorbidities. Despite having intensive control treatment of diabetes, it continues its deleterious effects on patients through the years.

Introducción: La obesidad y la diabetes son enfermedades de alta prevalencia a nivel mundial. Actualmente no existe un tratamiento médico eficaz para combatir el aumento de peso. La obesidad es precursora de enfermedades tales como la diabetes o el síndrome metabólico. Es necesario saber si el aumento de peso tiene efectos acumulativos sobre el metabolismo de la glucemia y los lípidos como precursores de complicaciones o comorbilidades. Pacientes y métodos: Se estudiaron 131 pacientes (78 no diabéticos y 53 diabéticos), 37 IMC ≤35 (3 IMC < 25, 18 IMC 25-29,9, 16 IMC 30-34,9) y 94 IMC ≥35 (81 IMC 35- 49,9 y 13 de IMC ≥50). Se analizó el IMC, el género, la diabetes y su tiempo de evolución. El perfil lipídico, glucosa, HbA1c y el péptido C fueron evaluados después de un ayuno de 12 horas. Resultados: Los pacientes diabéticos y diabesos mostraron niveles altos de triglicéridos. Los pacientes no diabéticos tienen alteración de la glucosa (58% IMC 35). El 20% de los no diabéticos IMC 35 tenían niveles altos. El 5% de los diabéticos IMC < 35 tenía bajos niveles de péptido C y 36% de IMC > 35 tenían niveles altos. HbA1c fue mayor en 40% de pacientes no diabéticos IMC < 35 frente al 13% de IMC > 35. Conclusiones: La glucosa y los triglicéridos aumentan con la edad y los años de evolución de la DMT2. La edad de ≥51 años y los hombres son los más afectados. El aumento de peso tiene efecto acumulativo alterando el metabolismo favoreciendo la aparición de la diabetes y sus comorbilidades. A pesar de tener un tratamiento de control intensivo de la diabetes, esta continúa con sus efectos nocivos sobre los pacientes a través de los años.

Metabolic disorders of liver and iron in diabetic and non-diabetic patients BMI < 35 or > 35 before gastric bypass / Trastornos del metabolismo del hígado y el hierro en pacientes diabéticos y no diabéticos con imc < 35 ó > 35 antes de bypass gástrico

Introduction: The presence of abnormalities in the metabolic pathways of iron and liver functioning can produce insulin resistance or metabolic syndrome. Therefore, it is important to examine those alterations that may lead to the development of diseases. Nutritional status is another important factor that is intimately linked to diabetes and obesity. Patients and Methods: We studied 131 patients (78 nondiabetic patients and 53 diabetic), 37 patients BMI ≤ 35 (3 BMI < 25, 18 BMI 25-29.9, 16 BMI 30-34.9) and 94 patients BMI ≥ 35 (81 BMI 35-49.9 and 13 BMI ≥ 50). Subjects underwent to laboratory studies related to liver functioning and iron metabolism. Nutritional status was also determined in our patients. Results: Iron was altered 14% of patients BMI >35 and diabetics reached 3% to 25%. Vitamin B12 was low 4% of non-diabetics BMI > 35, and high in 6% of diabetics BMI < 35. The 6% of diabetics BMI < 35 had hyperbilirubinemia. Transaminases are elevated in patients BMI >35 but exacerbated on diabetics. GGT is raised 41% to 47% in BMI >35. ALP is elevated in 25% of diabetics. Total protein and serum albumin were altered in diabetics causing mild malnutrition. 90% of patients had normal nutrition and 10% mild malnutrition. Conclusions: The metabolisms Hepatic and iron are closely related to the onset of obesity and diabetes. If there is weight gain, cumulative metabolic risks rise. The presence of diabesity and increased duration of diabetes produce altered metabolism. Nutritional status is altered in obesity but is worse with the addition of diabetes (AU)

Introducción: La presencia de anormalidades en las vías metabólicas del hierro y el funcionamiento del hígado pueden producir resistencia a la insulina o síndrome metabólico. Por lo tanto, es importante examinar esas alteraciones que pueden conducir al desarrollo de enfermedades. El estado nutricional es otro factor importante que está íntimamente ligada a la diabetes y la obesidad. Pacientes y métodos: Se estudiaron 131 pacientes (78 pacientes no diabéticos y 53 diabéticos), 37 pacientes IMC ≤ 35 (3 IMC < 25, 18 IMC 25-29,9, 16 IMC 30-34,9) y 94 pacientes IMC ≥ 35 (81 IMC 35-49,9 y 13 de IMC ≥ 50). Los sujetos fueron sometidos a estudios de laboratorio relacionadas con el funcionamiento del hígado y el metabolismo del hierro. Se determinó también el estado nutricional en nuestros pacientes. Resultados: El hierro estuvo alterado en 14% de los pacientes IMC >35 y los diabéticos alcanzaron 3% a 25%. La vitamina B12 fue baja en 4% de los no diabéticos IMC > 35, y alta en el 6% de los diabéticos IMC < 35. El 6% de los diabéticos IMC < 35 tenía hiperbilirrubinemia. Las transaminasas estuvieron elevadas en pacientes IMC > 35, pero exacerbados en los diabéticos. GGT se eleva del 41% al 47% en BMI > 35. ALP estuvo elevada en el 25% de los diabéticos. Las proteínas séricas totales y la albúmina estuvieron alterados en los diabéticos causando desnutrición leve. 90% de los pacientes tenían una nutrición normal y 10% desnutrición leve. Conclusiones: El metabolismo hepático y del hierro está estrechamente relacionadas con el inicio de la obesidad y la diabetes. Si hay un aumento de peso, los riesgos metabólicos acumulados se elevan. La presencia de la diabesidad y el aumento de la duración de la diabetes empeoran el metabolismo. El estado nutricional se altera en la obesidad, pero es peor con la adición de la diabetes (AU)

Glycemic and lipid metabolic disorders in diabetic and non-diabetic patients bmi < 35 or > 35 before gastric bypass / Trastornos del metabolismo glicémico y lipídico en pacientes diabéticos y no diabéticos con imc < 35 ó > 35 antes de bypass gástrico

Introduction: Obesity and diabetes are diseases with high prevalence worldwide. There is currently no effective medical treatment for combat the weight gain. It is precursor of diseases such as diabetes or metabolic syndrome. It is necessary to know if weight gain has cumulative effects on the glycemic and lipid metabolism as precursors of complications or comorbidities. Patients and methods: We studied 131 patients (78 nondiabetic and 53 diabetic), 37 BMI ≤ 35 (3 BMI < 25, 18 BMI 25-29.9, 16 BMI 30-34.9) and 94 BMI ≥ 35 (81 BMI 35-49.9 and 13 BMI ≥ 50).We analyzed BMI, gender, diabetes and the time of evolution. Lipid profile, glucose, HbA1c and C-peptide evaluated after 12-hour fasting. Results: Diabetic and diabese patients showed high triglycerides. Non-diabetics have impaired glucose (58% BMI < 35 and 36% BMI > 35). The 20% of non-diabetics BMI < 35 had high C-peptide, and 19% of BMI > 35 had high levels. The 5% of diabetics BMI < 35 had low Cpeptide and 36% of BMI > 35 had high levels. HbA1c was higher in 40% of non-diabetic patients BMI < 35 compared to 13% BMI > 35. Conclusions: Glucose and triglycerides increase with age and years of development of T2DM. Age of 51 and more, and men are more affected. The weight increase has cumulative effect by altering the metabolism favoring the onset of diabetes and comorbidities. Despite having intensive control treatment of diabetes, it continues its deleterious effects on patients through the years (AU)

Introducción: La obesidad y la diabetes son enfermedades de alta prevalencia a nivel mundial. Actualmente no existe un tratamiento médico eficaz para combatir el aumento de peso. La obesidad es precursora de enfermedades tales como la diabetes o el síndrome metabólico. Es necesario saber si el aumento de peso tiene efectos acumulativos sobre el metabolismo de la glucemia y los lípidos como precursores de complicaciones o comorbilidades. Pacientes y métodos: Se estudiaron 131 pacientes (78 no diabéticos y 53 diabéticos), 37 IMC ≤ 35 (3 IMC < 25, 18 IMC 25-29,9, 16 IMC 30-34,9) y 94 IMC ≥ 35 (81 IMC 35- 49,9 y 13 de IMC ≥ 50). Se analizó el IMC, el género, la diabetes y su tiempo de evolución. El perfil lipídico, glucosa, HbA1c y el péptido C fueron evaluados después de un ayuno de 12 horas. Resultados: Los pacientes diabéticos y diabesos mostraron niveles altos de triglicéridos. Los pacientes no diabéticos tienen alteración de la glucosa (58% IMC 35). El 20% de los no diabéticos IMC 35 tenían niveles altos. El 5% de los diabéticos IMC < 35 tenía bajos niveles de péptido C y 36% de IMC > 35 tenían niveles altos. HbA1c fue mayor en 40% de pacientes no diabéticos IMC < 35 frente al 13% de IMC > 35. Conclusiones: La glucosa y los triglicéridos aumentan con la edad y los años de evolución de la DMT2. La edad de ≥51 años y los hombres son los más afectados. El aumento de peso tiene efecto acumulativo alterando el metabolismo favoreciendo la aparición de la diabetes y sus comorbilidades. A pesar de tener un tratamiento de control intensivo de la diabetes, esta continúa con sus efectos nocivos sobre los pacientes a través de los años (AU)

[Abdominal stab wound involving a horseshoe kidney]. / Traumatismo abdominal por arma blanca con afectación de riñón en herradura.

Abdominal stab wounds represent approximately 7% of abdominal injuries in our environment. However, renal involvement in these cases is relatively uncommon (2% of visceral lesions). We present a case of a stab wound in the anterior abdominal wall. In addition to intestinal lesions, the injury produced a lesion in a horseshoe kidney, a relatively uncommon malformation of the urinary system (1/400 individuals). Despite the rarity of this occurrence, when dealing with an emergency affecting a malformed kidney, knowledge of the inherent peculiarities of these defects is essential for the appropriate management of these patients.

Traumatismo abdominal por arma blanca con afectación de riñón en herradura / Abdominal stab wound involving a horseshoe kidney

La herida abdominal por arma blanca supone aproximadamente el 7% de los traumatismos abdominales en nuestro medio; sin embargo, la afectación renal es relativamente infrecuente en estos casos (2% de las lesiones viscerales). Se presenta un caso clínico en que una herida por arma blanca en la pared abdominal anterior produjo, además de lesiones intestinales, una lesión renal que afectaba a un riñón en herradura, malformación del sistema urinario relativamente infrecuente (1/400 individuos). A pesar de la rareza de esta eventualidad, ante una urgencia que comprometa a un riñón malformado puede ser de capital importancia conocer las peculiaridades inherentes a estas malformaciones, lo que sin duda va a permitir un correcto manejo de estos pacientes (AU)

Abdominal stab wounds represent approximately 7% of abdominal injuries in our environment. However, renal involvement in these cases is relatively uncommon (2% of visceral lesions). We present a case of a stab wound in the anterior abdominal wall. In addition to intestinal lesions, the injury produced a lesion in a horseshoe kidney, a relatively uncommon malformation of the urinary system (1/400 individuals). Despite the rarity of this occurrence, when dealing with an emergency affecting a malformed kidney, knowledge of the inherent peculiarities of these defects is essential for the appropriate management of these patients (AU)