Association of laboratory and radiologic parameters in the diagnosis of acute cholecystitis. / Asociación de parámetros analíticos y radiológicos en el diagnóstico de la colecistitis aguda.

INTRODUCTION AND OBJECTIVES: There is currently more evidence suggesting that early surgery should be the treatment of choice for acute calculous cholecystitis, although initial conservative treatment is also reported to be safe. Treatment decision depends on the conditions of the patient, surgical experience, and hospital infrastructure, given that early surgery cannot always be carried out. The aim of the present study was to correlate C-reactive protein values with other variables to determine those situations in which surgery cannot be delayed. MATERIALS AND METHODS: A retrospective study was conducted on patients admitted to the hospital from the emergency service with the diagnosis of acute calculous cholecystitis. The patients were divided into 2groups: 1) patients that required urgent cholecystectomy and 2) patients that responded well to conservative medical treatment and later underwent deferred cholecystectomy. RESULTS: A total of 238 patients (♂ 54.6%, ♀ 45.4%) were analyzed. Urgent surgery was performed on 158 patients, whereas the remaining 80 patients were released from the hospital following conservative treatment. The odds ratio of gangrenous cholecystitis presenting in acute cholecystitis for C-reactive protein was calculated in the logistic regression analysis, obtaining an OR of 1.088 and a 95% CI of 1.031-1.121. CONCLUSION: In patients diagnosed with acute calculous cholecystitis, the combination of elevated values of C-reactive protein levels, gallbladder wall thickness, and number of leukocytes was correlated with less favorable clinical and gallbladder histologic states, resulting in a greater need for urgent surgical treatment.

Serum VEGF and VEGF-C values before surgery and after postoperative treatment in gastric cancer

INTRODUCTION: Angiogenesis and lymphangiogenesis are essential processes for the formation of blood and lymphatic vessels that allow tumour growth and spread. The binding of VEGF and VEGF-C factors with their receptors (VEGFR2, VEGFR3) in endothelial cells triggers signals that regulate these processes. We compared preoperative serum VEGF and VEGF-C levels with samples obtained after completion of surgery and adjuvant treatment in patients with gastric cancer. In addition, we determined the prognostic value and relationship to survival of serum VEGF and VEGF-C levels. METHODS: We used a prospective cohort study of 59 gastric cancer patients who underwent surgery. Serum VEGF and VEGF-C were measured by enzyme-linked immunosorbent assay (ELISA) the day before surgery and 6 months later, after completion of adjuvant treatment. RESULTS: Serum VEGF values decreased after treatment in patients with resectable tumours (mean ± SD) (405.42 ± 298.38 vs. 306.38 ± 212.47 pg/ml; p < 0.01), poorly differentiated and undifferentiated tumours (G3, G4) (438 ± 339.71 vs. 322.47 ± 210.71 pg/ml; p = 0.01), locally advanced gastric tumours (T4 stage) (424.27 ± 323.08 vs. 333.62 ± 221.72 pg/ml; p = 0.03) and tumours with a greater number of involved regional lymph nodes (N3) (442.38 ± 311.52 vs. 337.4 ± 203.64 pg/ml; p = 0.04). Serum preoperative VEGF values over 761 pg/ml were associated with shorter patient survival. The mean overall survival time for patients with serum VEGF levels higher than 761 pg/ml was 7 ± 2.99 months (95 % CI 1.14-12.86) while for patients with serum VEGF levels of less than 761 pg/ml was 21.18 ± 2.88 (95 % CI 15.54-26.83) The mean disease-specific survival time for patients with serum VEGF levels higher than 761 pg/ml was 6.25 ± 2.53 months (95 % CI 1.29-11.21) while for patients with serum VEGF levels of less than 761 pg/ml was 27.57 ± 3.45 (95 % CI 20.80-34.35). Multivariate analysis identified preoperative serum VEGF levels as an independent prognostic factor (HR = 0.144; p = 0.03). CONCLUSIONS: Serum VEGF levels decreased after the completion of treatment in patients with resected tumours, suggesting VEGF tracking may be useful in monitoring progression. Preoperative measurement of serum VEGF may help us identify patients with a poor prognosis (AU)

Implicaciones clínicas de la determinación histológica de los micrornas en el cáncer colorrectal / Clinical implication of histological determination of micrornas in colorectal cancer

Los microRNAs son estructuras moleculares con actividad post-transcripcional que están implicados en la regulación de la expresión genética. Diversos estudios ponen de manifiesto la participación de los microRNAs con distintas funciones fisiológicas, así como con el proceso de la oncogénesis. La expresión de los microRNAs puede verse alterada en las neoplasias por su interacción bien con los genes supresores de tumores, bien con los oncogenes. Se ha llevado a cabo una revisión bibliográfica en PubMed acerca de la evidencia publicada sobre la determinación histológica de los microRNAs y la relación existente con el diagnóstico y el pronóstico del cáncer colorrectal. A pesar de ser preciso nuevos estudios clínicos que especifiquen la relación de los microRNAs con el cáncer colorrectal, se ha evidenciado una relación de estas estructuras con el diagnóstico y pronóstico de esta neoplasia (AU)

MicroRNAs are short non-coding RNA molecules involved in the regulation of gene expression. Several studies demonstrate the involvement of microRNAs with different physiological functions and oncogenesis. The expression of microRNAs may be altered in tumors by their interaction with tumor suppressor genes or with oncogenes. A literature review in PubMed was made about the evidence on the histological determination of microRNAs and the relationship with the diagnosis and prognosis of colorectal cancer. Although further clinical studies focusing on serum microRNAs are required to determine the relationship of microRNAs in colorectal cancer, the relationship of these structures with the diagnosis and prognosis of this neoplasm has been shown (AU)

Microrna-21 y cáncer colorrectal / Microrna - 21 and colorectal cancer

Introducción. Los microRNAs son estructuras moleculares con actividad post-transcripcional que están implicados en la regulación de la expresión genética. Diversos estudios ponen de manifiesto la participación de los microRNAs con distintas funciones fisiológicas, así como con el proceso de la oncogénesis. La expresión de los microRNAs puede verse alterada en las neoplasias por su interacción bien con los genes supresores de tumores, bien con los oncogenes. Discusión. Llevamos a cabo una revisión de la literatura sobre el microRNA-21, poniendo de manifiesto la evidencia existenteentre el microRNA-21 y la enfermedad neoplásica, de forma especial con el cáncer colorrectal. Conclusiones. El estado actual de los microRNAs hace necesario continuar con la investigación existente entre la etiopatogenia de las neoplasias y los microRNAs. El conocimiento de la verdadera implicación de los microRNAs en la fisiopatología de la enfermedad neoplásica, permitirá ampliar las supuestas aplicaciones clínicas del miR-21 no sólo a la determinación del pronóstico del cáncer colorrectal, sino también desde el punto de vista diagnóstico al poder diferenciar las lesiones de la mucosa colónica (AU)

Introduction. MicroRNAs are molecular structures with post-transcriptional activity, involved in the gene expression regulation. Several studies have demonstrated the involvement of microRNAs in different physiological functions, as well as in the oncogenesis process. The expression of microRNAs may be altered in the tumors by either interaction with tumor suppressor genes or oncogenes. Discussion. A review of the medical literature on microRNA-21 has been conducted, showing the evidence between microRNA-21 and neoplastic disease, specially with colorectal cancer. Conclusion. The current status of microRNAs makes necessary to continue the investigation of the pathogenesis of cancer and microRNAs. The knowledge of the involvement of microRNAs in the pathophysiology of neoplastic disease, will allow to extend the supposed clinical applications of miR-21 not only to the determination of the prognosis of colorectal cancer, but also for the differential diagnosis of processes of colonic mucosae (AU)

Adrenalectomía y cirugía mayor ambulatoria. ¿Es posible? / No disponible

Objetivo: El propósito de nuestro estudio fue determinar la factibilidad y seguridad de un programa de adrenalectomía laparoscópica (AL) en régimen ambulatorio (CMA) en el Hospital General de Ciudad Real (HGCR).Material y método: Realizamos una revisión retrospectiva de las adrenalectomías realizadas en el HGCR desde enero de 2006a junio de 2008. La morbilidad y las características de las mas asadrenales extirpadas fueron evaluadas, al igual que la estancia hospitalaria y las complicaciones postoperatorias para ver si podrían haber sido incluidos en un programa de CMA según estrictoscriterios de selección. Resultados: Se realizaron 16 adrenalectomías durante esteperiodo; 12 por vía laparoscópica. Aplicando los criterios de Gill para cirugía ambulatoria, el grupo de candidatos consistiría en 6 pacientes que presentaban las siguientes características: la edad media fue de 51,67 años (44-65), 3 eran funcionantes y 3 incidentalomas. El ratio izquierdas/derechas fue 2:1. El tamaño tumoral medio fue de 3,75 cm (1-5 cm). En todos los casos se practicó AL transperitoneal lateral con tiempo operatorio medio de 83 minutos(30-150 minutos). No se registraron complicaciones postoperatorias. La estancia media fue de 2,83 días (2-3 días), con requerimientos de analgesia oral habitual durante 1-3 días. Conclusión: Nuestros resultados muestran que aplicando estrictos criterios de selección, es seguro y factible iniciar un programa ambulatorio de adrenalectomías por cirujanos expertos en técnicas laparoscópicas avanzadas, con alta satisfacción y nula morbilidad. Aún se necesitan estudios controlados que propicien criterios adecuados para unos resultados óptimos (AU)

Objective: The purpose of our study was to determine the feasibility and safety of a program for laparoscopic adrenalectomy(LA), on an ambulatory basis, at the General Hospital of Ciudad Real (HGCR).Material and method: A retrospective study was undertaken from January 2006 to June 2008. Co-morbidity and characteristics of the adrenal masses to be excised were assessed, as well as hospital length of stay and postoperative complications, to see whether they could have been included in an outpatient program according to strict selection criteria. Results: During the study period 16 adrenalectomies were performed at our institution; 12 of them by laparoscopy. Applying Gill’s criteria for outpatient surgery, the group of candidates consisted of 6 patients who met the following characteristics: mean age was 51.67 years (44-65), 3 tumours were functioning and the other 3 incidental findings. The ratio left/right was 2:1.The mean tumour size was 3.75 cm (1-5 cm). All cases underwent a lateral transperitoneal LA approach, the mean operative time was 83 minutes (30-150). No postoperative complications occurred.The average length of stay was 2.83 days (2-3), with regularoral analgesia requirements for 1-3 days.Conclusion: Our results show that, by applying strict selectioncriteria, it would be safe and feasible to under go an ambulatory program of adrenalectomy by experienced surgeons in advanced laparoscopic techniques, achieving high patients’ satisfaction and no morbidity. Controlled studies are still required to provide appropriate criteria for optimal results (AU)

Poliquistosis renal complicada simulando una colecistitis aguda / Complicated polycistyc kidney disesase simulating an acute cholecystitis

La poliquistosis renal dominante del adulto, aunque es la enfermedad hereditaria más frecuente en la población española, presenta una prevalencia muy baja. Los síntomas iniciales son generalmente inespecíficos y difíciles de detectar por el médico. El método de elección para el diagnóstico de la enfermedad, cuando esta es asintomática, es la ecografía. Presentamos un caso clínico poco frecuente, en el cual el diagnóstico de poliquistosis renal complicada se realiza de forma incidental durante el estudio de un cuadro que simulaba una colecistitis aguda. Queremos resaltar la importancia que tienen una anamnesis detallada y metodológica en el diagnóstico precoz de esta enfermedad (AU)

Adult polycystic kidney disease, although it is the most common hereditary disease in the Spanish population, has very low prevalence. Initial symptoms are usually nonspecific and difficult to detect by the physician. The ultrasonography is the method of choice for diagnosing when the disease is asymptomatic. We report a rare clinical case in which complicated polycystic kidney disease was diagnosed by chance during the study of a simulated acute cholecystitis. We emphasize the importance of making a detailed and methodological medical history for the early diagnosis of this disease (AU)

Investigación en la Unidad de Cirugía Mayor Ambulatoria / No disponible

Fundamento: El concepto de la Cirugía Mayor Ambulatoria(CMA) presenta fundamentalmente un enfoque terapéutico, existiendo la posibilidad en el contexto de este modelo asistencial de efectuar procesos de investigación. El objetivo que se pretende es analizar la utilización de la unidad de CMA como modelo referencial para la realización de estudios clínicos, por lo que se presenta una revisión descriptiva de las comunicaciones más recientes a los congresos de Cirugía Mayor Ambulatoria. Métodos: Estudio descriptivo de las comunicaciones a las Reuniones Nacionales e Internacionales durante los años 2007 y2008, contabilizándose las comunicaciones orales y de tipo póster que describían un estudio prospectivo o retrospectivo. Resultados: Se revisaron las comunicaciones pertenecientes al 7th International Congress of Ambulatory Surgery (IAAS), VII Congreso Nacional de Cirugía Mayor Ambulatoria y VII Simposio de la Asociación Española de Cirugía Mayor Ambulatoria. Se revisaron un total de 503 comunicaciones deslindadas en: 51 estudios prospectivos (10,12%) y 57 estudios retrospectivos (11,33%).Conclusiones: Aun cuando la realización de procesos de investigación resulta perfectamente compatible con determinados modelos organizativos asistenciales como la CMA, se constata una marcada infrautilización de este tipo de organización sanitaria en relación con las actividades investigadoras (AU)

Background: The Ambulatory Surgical Unit has an essentially therapeutic approach, although it is possible, within this organizational model, to develop investigation procedures. The purpose of this study is to analyze the use of the ambulatory surgical unit for the development of clinical studies, so we undertook a descriptive study of the papers sent to the most recent congresses on ambulatory surgery.Methods: A descriptive study of the papers sent to the national and international meetings of 2007-2008, including oral communications and posters describing a prospective or retrospective study. Results: We checked the communications sent to the IAAS7th International Congress of Ambulatory Surgery, VII Congreso Nacional de Cirugía Mayor Ambulatoria and VII Simposio de la Asociación Española de Cirugía Mayor Ambulatoria. Were viewed 503 communications, of which 51 were prospective studies (10.12%) and 57 retrospective studies (11.33%).Conclusions: Although investigation studies are perfectly compatible with certain organizational models of care such as the ambulatory surgical unit, there is a marked under-utilization of this type of health organization in connection with investigation activitie (AU)