First wave of COVID-19 impact on emergency general surgery in a Spanish tertiary hospital. A cohort study.

INTRODUCTION: The need to care for patients with emergency symptoms still continues during the COVID-19 pandemic. The number of emergency surgery procedures performed in Spanish hospitals decreased significantly during the first wave of COVID-19. PATIENTS AND METHODS: We performed a retrospective cohort study comparing the emergency surgery activity in a Spanish tertiary Hospital during the COVID-19 pandemic and emergency surgery activity registered in 2019 during the equivalent time period. RESULTS: A total of 1802 patients were included in control group (CG) versus 756 in pandemic group (PG). Mean number of patients who underwent emergency surgery during the control and pandemic periods was 3.42 patients per day, in contrast to 1.62 during the pandemic period, which represents a 52.6% decrease in emergency surgery activity. During the pandemic period, most of the patients consulted after more than 72 h of symptoms, representing a delay in presenting in the ER of 23.7% when compared to CG. Surgeries due to complications from previous elective procedures decreased (12% vs. 6.1%) in PG, probably because elective procedures are being postponed. We had a 13.1% COVID-19 positivity rate. Morbidity was higher during pandemic (52.5% vs. 35.2%). Mortality rates in patients undergoing emergency surgery was higher in PG (12.1% vs. 4.8%). CONCLUSIONS: The impact of the first wave of COVID-19 in emergency surgery activity has been profound. A significant reduction in emergency surgery was observed, along with longer time periods between patients' onset of symptoms and their arrival at the Emergency Department. Higher morbidity was also observed during the pandemic period.

Escisión Mesorrectal Total Transanal (Tatme): Aspectos Prácticos De La Técnica Quirúrgica / Transanal Total Mesorectal Excision: Practical Aspects Of Surgical Technique

INTRODUCCIÓN: El cáncer de recto es la séptima neoplasia más frecuente en España con una incidencia de 12570 casos/100.000 hab/año. La supervivencia a 5 años en Europa es del 55-62 % y tiende a aumentar gracias a la introducción de cambios en el tratamiento y nuevas técnicas quirúrgicas. La TaTME permite visualizar directamente el margen distal del tumor, evita las dificultades técnicas que aparecen al introducir las endograpadoras lineales en pelvis estrechas para seccionar el recto y ofrece una visualización directa de las estructuras pélvicas durante la EMT. El objetivo de este estudio es describir la técnica quirúrgica de la TaTME minuciosamente destacando los aspectos más prácticos del procedimiento. MATERIAL Y MÉTODOS: Se ha realizado una búsqueda bibliográfica sistemática en la base de datos Cochrane, MEDLINE y EMBASE mediante los términos "transanal total mesorectal excision". RESULTADOS: Durante la fase transanal se coloca el dispositivo gel-point monopuerto y multicanal transanal para la creación del neumorrecto. La luz del recto se cierra mediante una sutura en bolsa de tabaco. Tras completar la rectotomía se procede a la escisión mesorrectal total. Para la fase abdominal se crea un neumoperitoneo. Los vasos mesentéricos inferiores se seccionan en origen. Una vez que ambos equipos han avanzado en la escisión mesorrectal los campos se comunican abriendo el por el plano anterior. Se pueden construir varios tipos de anastomosis colorrectales. CONCLUSIÓN: La TaTME es un tratamiento quirúrgico del cáncer de recto medio y bajo seguro y factible

INTRODUCTION: Rectal cancer is the seventh most common cancer in Spain with an incidence of 12570 cases/100000 h/year. The 5-year overall survival of rectal cancer in Europe was 55-62% and this rate tends to improve due to new challenges and the development of new surgical techniques. TaTME offers a direct vision of the distal end of tumour, it avoids technical difficulties for in-troducing staplers down a narrow pelvis and it improves a direct visualization of pelvic structures during total mesorectal excision. The aim of this study is to describe the surgical technique for TaTME selecting the most practical aspects of this procedure. MATERIAL AND METHODS: The relevant studies were identified by a search of MEDLINE, EMBASE and Cochrane Oral Health Group Specialized Register using terms transanal total mesorectal excision. RESULTS: During transanal phase pneumorectum is created using Gel Point Path Transanal Access platform. The rectal lumen is closed with a purse.string suture. After a complete rectotomy the total mesorectal excision is performed circumferentially. Pneu-moperitoenum is created for abdominal phase. When transanal and abdominal teams have achieved a complete total mesorectal excision both planes are connected at the anterior plane. Several types of colorectal anastomosis can be performed. CONCLUSIÓN: TaTME is a secure and feasible surgical treatment for low-mid rectal cancer

Medicina basada en la evidencia y la cirugía del cáncer de recto / Evidence based medicine and surgery for rectal cancer

Introducción: El cáncer colorrectal es la cuarta neoplasia más frecuente en el mundo. La supervivencia del cáncer de recto tiende a aumentar debido a las actualizaciones en las estrategias terapéuticas basadas en recomendaciones que siguen las pautas de la medicina basada en la evidencia. El objetivo de este artículo es realizar una revisión sobre la evidencia científica publicada en relación a la cirugía del cáncer de recto. Material y Métodos: Se ha realizado una búsqueda bibliográfica sistemática en la base de datos Cochrane, MEDLINE y EMBASE mediante los términos "rectal cancer AND surgical treatment AND evidence based medicine". Resultados: El tratamiento del cáncer de recto requiere de un equipo multidisciplinar que considere guías clínicas elaboradas por las sociedades médicas. Se recomienda la resección quirúrgica en bloque del recto y de los tejidos invadidos por tumor junto con la obtención de márgenes de resección libres (distal y circunferencial) y la escisión completa del mesorrecto. El lavado y las pruebas de estanqueidad de la anastomosis intraoperatorios mejoran los resultados de la cirugía. La cirugía laparoscópica del cáncer de recto realizada por cirujanos expertos mejora la recuperación postoperatoria con los mismos resultados oncológicos. Conclusión: La medicina basada en la evidencia proporciona unas recomendaciones para el tratamiento quirúrgico del cáncer de recto con el fin de lograr los mejores resultados

Introduction: Colorectal cancer is the fourth most common malignant in the world. The improvement in the 5-year survival for rectal cancer is probably related to multidimensional management included in clinical practice guidelines based on the scientific evidence. This systematic review was to evaluate the recommendations about surgery for rectal cancer. Materials and Methods: The relevant studies were identified by a search of MEDLINE, EMBASE and Cochrane Oral Health Group Specialized Register using terms rectal cancer AND surgical treatment AND evidence based medicine. Results: Management of rectal cancer requires a coordinated multidisciplinary team that applies the recommendations included in clinical practice guidelines. Surgical resection for rectal cancer follow the main oncologic principles as resection on bloc for locally advanced rectal tumors, adequate distal and circumferential margins and complete mesorectal excision. Intraluminal rectal washout and anastomotic leak testing were recommended. Laparoscopic approach by expert surgeons improves immediate postoperative outcomes and is as safe as the open approach in terms of oncological results. Conclusion: Adherence to evidence-based medicine included in surgical guidelines and personalization improves outcomes in rectal cancer surgery

Bases genéticas y moleculares del cáncer colorrectal / Genetic and molecular basis in colorectal cancer

El cáncer colorrectal (CCR) es la tercera neoplasia más frecuente a un nivel mundial. El riesgo de CCR depende de factores genéticos y ambientales que interactúan en el proceso de carcinogénesis mediante mecanismos epigenéticos. Aunque sólo el 25 % de los CCR presenta agregación familiar, en todos los casos de CCR entre los que se incluyen los esporádicos se producen mutaciones genéticas que desencadenan tres tipos distintos de vías moleculares de carcinogénesis que influyen en un comportamiento tumoral diferente. El conocimiento de los genes y las vías moleculares implicados en el desarrollo del CCR tiene unas aplicaciones clínicas debido a que ayuda a definir el pronóstico, a elaborar un consejo genético en caso de síndromehereditario y a diseñar un plan terapéutico más específico de acuerdo a las características moleculares del tumor. Por otro lado, según la teoría de las células madre, una célula madre del epitelio colónico con una acumulación de aberraciones genéticas puede ser la célula origen del CCR. El diseño de nuevos fármacos dirigidos contra marcadores de las células madre del CCR pueden potenciar la respuesta de la quimioterapia convencional y disminuir las recurrencias locales y metástasis a distancia (AU)

Colorectal cancer is the third most common cancer wordlwide. Relative CRC risk is defined by genetic and environmental factors contributing to carcinogenesis by epigenetic mechanisms. Though only a 25 % CRC has been determined to have a familiar agregation with an important genetic component, all cases of CRC including sporadic ones present genetic aberrations that initiate three distinct molecular pathways of carcinogenesis implicating in different tumoral behaviours. Investigations about genes and molecular pathways implicated in the development of CRC have clinic aplications due to it could contribute to determine prognosis, elaborate a genetic conseling in case of familiar agregation and design therapeutic strategies according with molecular characteristics of tumor. On the other hand, A stem cell located in colonic epithelium with an acumulation of genetic mutations could be the cell that initiates the origin of CRC. The design of stem cell-targeted drugs could enhance reponsiveness to traditional therapeutic strategies and reduce local recurrence and metástasis (AU)

Liberación de óxido nítrico en arterias tumorales de pacientes con cáncer colorrectal / Nitric oxide release on tumour arteires form patients with colorectal cancer

INTRODUCCIÓN. El óxido nítrico es un factor liberado por el endotelio vascular que participa en los procesos de formación de tumores porque es capaz de estimular la proliferación celular, fomentar la angiogénesis y regular el flujo sanguíneo tumoral. Además, la dilatación de los vasos sanguíneos tumorales provocada por el NO puede aumentar la eficacia de los tratamientos oncológicos ya que facilita el acceso al tumor de los fármacos antineoplásicos e incrementa la oxigenación de la masa tumoral potenciando los efectos beneficiosos de la radioterapia. MATERIAL Y MÉTODO. Para estudiar si la liberación de NO está alterada en las arterias tumorales, se obtuvieron de 19 pacientes intervenidos quirúrgicamente por cáncer de colon y recto, arterias mesentéricas irrigando el tumor y arterias mesentéricas de una región alejada del tumor, y asimismo se obtuvieron arterias mesentéricas de pacientes intervenidos de diverticulitis (n=4) o enfermedad inflamatoria intestinal (n=3). Los segmentos vasculares se montaron en un sistema de registro de la tensión isométrica y se realizaron curvas de concentraciónrespuesta a la bradikinina, con las arterias previamente contraídas con U46619 en presencia de placebo, del inhibidor de óxido nítrico cintaza L-NAME y del inhibidor de la ciclooxigenasa meclofenamato. RESULTADOS. La relajación a la bradikinina fue similar en los tres grupos de arterias y esta vasodilatación era disminuida en presencia de L-NAME y no se modificaba con meclofenamato. CONCLUSIÓN. La liberación de NO está preservada en las arterias humanas que irrigan los tumores de colon y recto (AU)

INTRODUCTION. Nitric oxide is an endothelium-derived relaxing factor involved in tumour growth because it could regulate celular proliferation, tumour angiogenesis and tumor blood flow. So this relaxation of tumour arteries could enhance medical effects of oncological therapy because facilitates the delivery of anticancer drugs to tumor cells and stimulates oxygenation of tumor tissue increasing the response to radiotherapy. MATERIAL AND METHOD. To study whether release of nitric oxide is altered in tumooir arteries, mesenteric arteries suppying blood flow to colorectal tumor, mesenteric arteries far from said tumor were obtained from 19 patients undergoing colectomy and mesenteric arteries were also obtained from surgical patients with diveticulitis (n=4) or inflammatory bowel disease (n=3). Arteries were prepared for isometric tension recording in an organ bath and were precontrated with U46619. The relaxation produced by bradykinin was recorded in each of these arteries with and without the nitric oxide sinthase inhibitor L-NAME and cyclooxygenase inhibitor meclofenamate. RESULTS. Bradykinin produced a dose-dependent relaxation that was similar in all the three types of artery. This relaxation was reduced with L-NAME and was not modified with meclofenamate. CONCLUSION. Nitric oxide release is preservered in human arteries supplying blood flow to colorectal tumors (AU)

Absence of allelic imbalance involving EMSY, CAPN5, and PAK1 genes in papillary thyroid carcinoma.

Papillary thyroid cancer (PTC) accounts for 80% of all thyroid malignancies, and genetic alterations associated to its etiology remain largely unknown. Chromosomal band 11q13 seems to be one of the most frequently amplified regions in human cancer, providing several candidate genes that need detailed characterization. The aim of our study was to investigate the existence of allelic imbalance at EMSY, CAPN5, and PAK1, as candidate genes within 11q13.5-q14 region using a single nucleotide polymorphism-based analysis. We selected a panel of 9 polymorphisms that were analyzed in 41 thyroid carcinoma samples, their contralateral non-pathological tissue and 178 controls from the general population. We did not detect allelic imbalance at these loci in our series. However, we observed a difference in the EMSY-haplotype distribution among PTC patients when compared to controls (odds ratio=2.00; p=0.02). We conclude that 11q13.5-q14 is not imbalanced in PTC, but there is evidence suggesting that EMSY might be of relevance in PTC etiology.

[Effect of endothelin-1 on tumor arteries in patients with colorectal cancer]. / Efecto de la endotelina-1 sobre las arterias tumorales de pacientes con neoplasia colorrectal.

Endothelin-1 is an endothelium-derived vasoconstrictor peptide whose plasma levels are increased in patients with colorectal cancer, and which may be involved in tumor blood flow regulation. To study whether response to this peptide is altered in tumor arteries, mesenteric arteries supplying blood flow to colorectal tumors, and mesenteric arteries far from said tumors were obtained from 13 patients undergoing colectomy; mesenteric arteries were also obtained from patients with diverticulitis (n = 4) or inflammatory bowel disease (n = 3). Arteries were prepared for isometric tension recording in an organ bath, and in this preparation it was found that endothelin-1 induced contraction in all three types of arteries, but that sensitivity to this peptide was greater in arteries supplying blood flow to the tumor than in arteries far from the tumor or arteries from patients without cancer. These results suggest that endothelin-1 may regulate blood flow to colorectal tumors by inducing a greater contraction in tumor-supplying arteries than in non-tumor arteries.

Efecto de la endotelina-1 sobre las arterias tumorales de pacientes con neoplasia colorrectal / No disponible

La endotelina-1 es un péptido vasoconstrictor producido por elendotelio vascular, cuyos niveles plasmáticos están aumentadosen los pacientes con cáncer colorrectal y que puede participar enla regulación del flujo sanguíneo tumoral. Para estudiar si la respuestaa este péptido está alterada en las arterias tumorales, seobtuvieron, de 13 pacientes intervenidos quirúrgicamente porcáncer colorrectal, arterias mesentéricas irrigando el tumor y arteriasmesentéricas de una región alejada del tumor, y asimismo seobtuvieron arterias mesentéricas de pacientes intervenidos por diverticulitis(n = 4) o enfermedad inflamatoria intestinal (n = 3). Lasarterias mesentéricas se montaron en una preparación para el registrode la contracción isométrica en un baño de órganos, encontrándoseque la endotelina-1 producía contracción en los tres tiposde arterias, pero la sensibilidad a este péptido fue mayor enlas arterias irrigando el tumor que en las arterias alejadas del tumoro en las arterias de pacientes sin patología tumoral. Estos resultadosindican que la endotelina-1 puede regular el flujo sanguíneoen los tumores colorrectales, produciendo una mayorvasoconstricción en las arterias que irrigan el tumor que en las arteriasno tumorales

Endothelin-1 is an endothelium-derived vasoconstrictor peptidewhose plasma levels are increased in patients with colorectal cancer,and which may be involved in tumor blood flow regulation.To study whether response to this peptide is altered in tumor arteries,mesenteric arteries supplying blood flow to colorectal tumors,and mesenteric arteries far from said tumors were obtainedfrom 13 patients undergoing colectomy; mesenteric arteries werealso obtained from patients with diverticulitis (n = 4) or inflammatorybowel disease (n = 3). Arteries were prepared for isometrictension recording in an organ bath, and in this preparation it wasfound that endothelin-1 induced contraction in all three types ofarteries, but that sensitivity to this peptide was greater in arteriessupplying blood flow to the tumor than in arteries far from the tumoror arteries from patients without cancer. These results suggestthat endothelin-1 may regulate blood flow to colorectal tumorsby inducing a greater contraction in tumor-supplying arteriesthan in non-tumor arteries

Neoplasia epitelial sólida quística y papilar del páncreas. Un reto de diagnóstico y tratamiento / Repercussions of chromium picolinate in the protein metabolism based on the age

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Pancreatic cancer. Management.

Pancreatic cancer still represents a serious medical concern for which no adequate solution has thus far been found. Surgery is the only appropriate therapy, but has a survival rate of around 30-35% at three years, with an operative mortality below 3% and an operative morbidity approaching 10% of radically resected patients, all of which applies to surgery performed by expert teams in highly experienced sites.