¿Es posible predecir la presencia de cáncer colorrectal en el análisis sanguíneo? Método de aproximación probabilística / Is it possible to predict the presence of colorectal cancer in a blood test? A probabilistic approach method

Introducción: la valoración del estado de inmunovigilancia (capacidad del organismo para evitar el desarrollo de neoplasias) en el análisis sanguíneo presenta connotaciones pronósticas de interés en el cáncer colorrectal. Evaluamos un posible carácter predictivo de la enfermedad en el análisis sanguíneo y su cuantificación mediante el diseño de un índice de interacción matemático entre varios parámetros sanguíneos, con capacidad predictiva probabilística de presencia de la enfermedad. Método: estudio casos y controles de análisis comparativo de la distribución de parámetros sanguíneos, sobre 266 pacientes con cáncer colorrectal y 266 pacientes sanos, durante el periodo comprendido entre 2009-2013. Resultados: los sujetos con cáncer colorrectal presentaron, con respecto a los controles, diferencias estadísticamente significativas (p < 0,05) en los niveles de plaquetas, fibrinógeno, leucocitos totales, neutrófilos, índices de inmunovigilancia sistémica (ratio neutrófilo/linfocito y ratio plaqueta/linfocito), hemoglobina, hematocrito y eosinófilos. Estas diferencias permitieron el diseño de un perfil analítico sanguíneo de riesgo de enfermedad, cuantificable mediante la aplicación de una fórmula matemática con capacidad de identificación probabilística de los sujetos con mayor riesgo de presencia de enfermedad (área bajo la curva del espacio ROC = 0,85). Conclusiones: Ante la posible existencia de un carácter predictivo de presencia de cáncer colorrectal en el análisis sanguíneo, mostramos que es posible su cuantificación mediante el diseño de un índice de interacción entre varios parámetros sanguíneos. El diseño y desarrollo de índices de interacción entre parámetros sanguíneos constituye una línea de investigación de interés para el desarrollo y mejora de programas de cribado de la enfermedad (AU)

Introduction: The assessment of the state of immunosurveillance (the ability of the organism to prevent the development of neoplasias) in the blood has prognostic implications of interest in colorectal cancer. We evaluated and quantified a possible predictive character of the disease in a blood test using a mathematical interaction index of several blood parameters. The predictive capacity of the index to detect colorectal cancer was also assessed. Methods: We performed a retrospective case-control study of a comparative analysis of the distribution of blood parameters in 266 patients with colorectal cancer and 266 healthy patients during the period from 2009 to 2013. Results: Statistically significant differences (p < 0.05) were observed between patients with colorectal cancer and the control group in terms of platelet counts, fibrinogen, total leukocytes, neutrophils, systemic immunovigilance indexes (neutrophil to lymphocyte ratio and platelet to lymphocyte ratio), hemoglobin, hematocrit and eosinophil levels. These differences allowed the design of a blood analytical profile that calculates the risk of colorectal cancer. This risk profile can be quantified via a mathematical formula with a probabilistic capacity to identify patients with the highest risk of the presence of colorectal cancer (area under the ROC curve = 0.85). Conclusions: We showed that a colorectal cancer predictive character exists in blood which can be quantified by an interaction index of several blood parameters. The design and development of interaction indexes of blood parameters constitutes an interesting research line for the development and improvement of programs for the screening of colorectal cancer (AU)

Is it possible to predict the presence of colorectal cancer in a blood test? A probabilistic approach method.

INTRODUCTION: The assessment of the state of immunosurveillance (the ability of the organism to prevent the development of neoplasias) in the blood has prognostic implications of interest in colorectal cancer. We evaluated and quantified a possible predictive character of the disease in a blood test using a mathematical interaction index of several blood parameters. The predictive capacity of the index to detect colorectal cancer was also assessed. METHODS: We performed a retrospective case-control study of a comparative analysis of the distribution of blood parameters in 266 patients with colorectal cancer and 266 healthy patients during the period from 2009 to 2013. RESULTS: Statistically significant differences (p < 0.05) were observed between patients with colorectal cancer and the control group in terms of platelet counts, fibrinogen, total leukocytes, neutrophils, systemic immunovigilance indexes (neutrophil to lymphocyte ratio and platelet to lymphocyte ratio), hemoglobin, hematocrit and eosinophil levels. These differences allowed the design of a blood analytical profile that calculates the risk of colorectal cancer. This risk profile can be quantified via a mathematical formula with a probabilistic capacity to identify patients with the highest risk of the presence of colorectal cancer (area under the ROC curve = 0.85). CONCLUSIONS: We showed that a colorectal cancer predictive character exists in blood which can be quantified by an interaction index of several blood parameters. The design and development of interaction indexes of blood parameters constitutes an interesting research line for the development and improvement of programs for the screening of colorectal cancer.

[CUN-BAE formula and biochemical factors as predictive markers of obesity and cardiovascular disease in patients before and after sleeve gastrectomy]. / Fórmula CUN-BAE y factores bioquímicos como marcadores predictivos de obesidad y enfermedad cardiovascular en pacientes pre y post gastrectomía vertical.

INTRODUCTION: Body Mass Index (BMI) is one of the most used parameters in bariatric surgery. However, it does not discriminate the weight associated with adiposity. CUN-BAE formula is an equation that calculates Body Fat Percentage or adiposity, based on easily available values (age, sex and BMI). With this new classification many of the subjects that was considered normal weight or overweight (BMI ≤30 kg/m2) really have a higher adiposity and they have comorbidities associated with obesity. The objective of this study is to evaluate the adiposity by formula CUN-BAE as a predictive marker of cardiovascular risk in morbidly obese patients before and after sleeve gastrectomy. MATERIAL AND METHODS: We performed a retrospective observational study of women that were intervened with sleeve gastrectomy, between 2007 and 2012 at the Universitary General Hospital of Elche. The adiposity was calculated by formula CUN-BAE preoperatively and 12 months after surgery. These values were correlated with different metabolic and cardiovascular risk parameters. RESULTS: 50 women were studied. Preoperatively, the mean BMI was 50.4 ± 7 kg/m2 and adiposity 54.8 ± 3%. One year after surgery, the mean BMI was 27.7 ± 3 and adiposity 39.4 ± 4%. The adiposity was significantly correlated with 3 biochemical factors associated with increased cardiovascular risk (cortisol, vitamin D and ratio TG/HDL). CONCLUSION: Adiposity, according to the formula CUNBAE, and biochemical analysis of predictive factors of obesity together represent useful tools for assessing the risk of cardiovascular disease after sleeve gastrectomy.

Introducción: Introducción: El Índice de Masa Corporal (IMC) es uno de los parámetros más utilizados en cirugía bariátrica. Sin embargo, no discrimina el peso asociado a adiposidad. La fórmula CUN-BAE es una ecuación que permite calcular el Porcentaje de Grasa Corporal (PGC) o adiposidad, basándose en valores fáciles de disponer (edad, sexo e IMC). Con esta nueva clasificación muchos de los sujetos considerados con normopeso o sobrepeso (IMC ≤30 kg/m2) en realidad tienen un PGC alto y presentan comorbilidades asociadas a la obesidad. El objetivo de este estudio es evaluar PGC cuantificado mediante fórmula CUN-BAE como marcador predictivo de riesgo cardiovascular en pacientes obesos mórbidos, antes y después de ser sometidos a Gastrectomía Vertical (GV). Material y métodos: Realizamos un estudio observacional retrospectivo de mujeres intervenidas de GV entre 2007 y 2012 en el Hospital General Universitario de Elche, calculando el PGC mediante la fórmula CUN-BAE de forma preoperatoria y 12 meses tras la intervención. Se correlacionaron estos valores con diferentes parámetros metabólicos y de riesgo cardiovascular. Resultados: Se estudiaron 50 mujeres. Preoperatoriamente, el IMC medio de 50,4 ± 7,4 kg/m2 y PGC del 54,8 ± 3%. Al año de la intervención, el IMC medio era de 27,7 ± 2,6 y el PGC 39,4 ± 3,7%. La PGC se correlacionó significativamente con 3 factores bioquímicos asociados con mayor riesgo cardiovascular (cortisol, vitamina D y cociente TG/HDL). Conclusión: la adiposidad, según la fórmula CUN-BAE, y el análisis de factores bioquímicos predictivos de obesidad, de forma conjunta suponen herramientas útiles para valorar el riesgo de enfermedad cardiovascular, después de GV.

Fórmula CUN-BAE y factores bioquímicos como marcadores predictivos de obesidad y enfermedad cardiovascular en pacientes pre y post gastrectomía vertical / Cun-bae formula and biochemical factors as predictive markers of obesity and cardiovasclar disease in patients before and after sleeve gastrectomy

Introducción: El Índice de Masa Corporal (IMC) es uno de los parámetros más utilizados en cirugía bariátrica. Sin embargo, no discrimina el peso asociado a adiposidad. La fórmula CUN-BAE es una ecuación que permite calcular el Porcentaje de Grasa Corporal (PGC) o adiposidad, basándose en valores fáciles de disponer (edad, sexo e IMC). Con esta nueva clasificación muchos de los sujetos considerados con normopeso o sobrepeso (IMC ≤ 30 kg/m2 ) en realidad tienen un PGC alto y presentan comorbilidades asociadas a la obesidad. El objetivo de este estudio es evaluar PGC cuantificado mediante fórmula CUN-BAE como marcador predictivo de riesgo cardiovascular en pacientes obesos mórbidos, antes y después de ser sometidos a Gastrectomía Vertical (GV). Material y métodos: Realizamos un estudio observacional retrospectivo de mujeres intervenidas de GV entre 2007 y 2012 en el Hospital General Universitario de Elche, calculando el PGC mediante la fórmula CUN-BAE de forma preoperatoria y 12 meses tras la intervención. Se correlacionaron estos valores con diferentes parámetros metabólicos y de riesgo cardiovascular. Resultados: Se estudiaron 50 mujeres. Preoperatoriamente, el IMC medio de 50,4 ± 7,4 kg/m2 y PGC del 54,8 ± 3%. Al año de la intervención, el IMC medio era de 27,7 ± 2,6 y el PGC 39,4 ± 3,7%. La PGC se correlacionó significativamente con 3 factores bioquímicos asociados con mayor riesgo cardiovascular (cortisol, vitamina D y cociente TG/HDL). Conclusión: la adiposidad, según la fórmula CUN-BAE, y el análisis de factores bioquímicos predictivos de obesidad, de forma conjunta suponen herramientas útiles para valorar el riesgo de enfermedad cardiovascular, después de GV (AU)

Introduction: Body Mass Index (BMI) is one of the most used parameters in bariatric surgery. However, it does not discriminate the weight associated with adiposity. CUN- BAE formula is an equation that calculates Body Fat Percentage or adiposity, based on easily available values (age, sex and BMI). With this new classification many of the subjects that was considered normal weight or overweight (BMI ≤ 30 kg/m2 ) really have a higher adiposity and they have comorbidities associated with obesity. The objective of this study is to evaluate the adiposity by formula CUN-BAE as a predictive marker of cardiovascular risk in morbidly obese patients before and after sleeve gastrectomy. Material and methods: We performed a retrospective observational study of women that were intervened with sleeve gastrectomy, between 2007 and 2012 at the Universitary General Hospital of Elche. The adiposity was calculated by formula CUN-BAE preoperatively and 12 months after surgery. These values were correlated with different metabolic and cardiovascular risk parameters. Results: 50 women were studied. Preoperatively, the mean BMI was 50.4 ± 7 kg/m2 and adiposity 54.8 ± 3%. One year after surgery, the mean BMI was 27.7 ± 3 and adiposity 39.4 ± 4%. The adiposity was significantly correlated with 3 biochemical factors associated with increased cardiovascular risk (cortisol, vitamin D and ratio TG/HDL). Conclusion: Adiposity, according to the formula CUNBAE, and biochemical analysis of predictive factors of obesity together represent useful tools for assessing the risk of cardiovascular disease after sleeve gastrectomy (AU)

[Acute renal failure and chronic diarrhea: McKittrick-Wheelock syndrome]. / Insuficiencia renal aguda y diarrea crónica: síndrome de McKittrick-Wheelock.

In 1954, McKittrick and Wheelock described for the first time a syndrome presenting chronic lost of fluid and electrolytes secondary to chronic diarrhea, associated to large rectal villous adenomas. We report a case of a 75-year-old female who presented chronic diarrhea (3 to 4 depositions per day in the last year), accompanied by acute renal failure. In the rectal tact, we objective the presence of a mass of soft consistency with an irregular surface, occupying approximately two thirds of the circumference, at about 3 cm from the anal margin. It was confirmed by the colonoscopy and the patology was informed as villous adenoma, producing chronic diarrhea or McKittrick-Wheelock syndrome. We decide the surgical approach after the normalization of patient's general status and a proctectomy with coloanal anastomosis was performed. We conclude that we must think about this syndrome in aged patients with chronic diarrhea, alterations of the electrolyte balance and presence of renal failure. Surgery treatment after the replacement of water and electrolytes is the unique curative treatment. The absence of this can cause the death of these patients.

Tratamiento laparoscópico de seudoquiste intraabdominal como complicación de catéter ventriculoperitoneal / Laparoscopic treatment of an intra-abdominal pseudo-cyst as a ventriculo-peritoneal catheter complication

No disponible

No disponible

Bazo errante en paciente asintomática / Wandering spleen in an asymptomatic patient

No disponible

No disponible

Leiomiosarcoma anal asociado a síndrome de Lynch / Anal leiomiosarcoma associated to Lynch syndrome

No disponible

Traumatismo abdominal asociado a hernia inguinal y braguero ortopédico / Abdominal injury associated with inguinal hernia and orthopedic truss

No disponible

Aneurisma de arteria mesentérica superior / Aneurysm of the superior mesenteric artery

No disponible

Surgical (close lateral internal sphincterotomy) versus chemical (botulinum toxin) sphincterotomy as treatment of chronic anal fissure.

BACKGROUND AND OBJECTIVE: The aim of this prospective randomized trial was to compare the effectiveness and morbidity of surgical vs chemical sphincterotomy in the treatment of chronic anal fissure after a 3-year follow-up period. PATIENTS AND METHOD: Eighty patients with chronic anal fissure were treated either with close lateral internal sphincterotomy (group 1) or with chemical sphincterotomy with 25 U botulinum toxin injected into the internal sphincter (group 2). RESULTS: Overall healing was 90% in the close sphincterotomy group and 45% in the toxin botulinum group (p < 0.001). There was a group of patients with clinical factors (duration of disease over 12 months and presence of a sentinel pile before treatment) associated with a higher recurrence of anal fissure. Final percentage of incontinence was 5% in the close sphincterotomy group and 0% in the botulinum toxin group (p > 0.05). All incontinent patients were aged more than 50 years. CONCLUSIONS: We recommend surgical sphincterotomy as the first therapeutic approach in patients with clinical factors of recurrence. However, we recommend the use of botulinum toxin in patients older than 50 years or with associated risk factors of incontinence, despite the higher rate of recurrence, since it avoids the greater risk of incontinence seen with surgery.

Surgical (close lateral internal sphincterotomy) versus chemical (botulinum toxin) sphincterotomy as treatment of chronic anal fissure

FUNDAMENTO Y OBJETIVO: Comparar en un estudioprospectivo y aleatorizado la efectividad y morbilidaddel tratamiento con esfinterotomía quirúrgicay toxina botulínica en la fisura anal crónica.PACIENTES Y MÉTODO: Se trató a 80 pacientes confisura anal crónica mediante esfinterotomía lateralinterna cerrada (grupo 1) o esfinterotomíaquímica con la inyección en el esfínter internode 25 U de toxina botulínica (grupo 2).RESULTADOS: La tasa de curación global a los 3años fue del 90% en la esfinterotomía cerrada ydel 45% con la toxina botulínica (p 0.05). Todos los pacientes incontinentestuvieron una edad superior a 50 años.CONCLUSIONES: Recomendamos la esfinterotomíaquirúrgica como la técnica de elección enpacientes con factores de recurrencia. Preferimosla utilización de toxina botulínica en pacientesmayores de 50 años o con factores deriesgo de incontinencia, ya que, a pesar delmayor riesgo de recurrencia, evita el mayorriesgo de incontinencia descrito en la esfinterotomíaquirúrgica

BACKGROUND AND OBJECTIVE: The aim of this prospectiverandomized trial was to compare theeffectiveness and morbidity of surgical vs chemicalsphincterotomy in the treatment of chronicanal fissure after a 3-year follow-up period.PATIENTS AND METHOD: Eighty patients with chronicanal fissure were treated either with close lateralinternal sphincterotomy (group 1) or with chemicalsphincterotomy with 25 U botulinum toxininjected into the internal sphincter (group 2).RESULTS: Overall healing was 90% in the closesphincterotomy group and 45% in the toxinbotulinum group (p 0.05). All incontinentpatients were aged more than 50 years.CONCLUSIONS: We recommend surgical sphincterotomyas the first therapeutic approach in patientswith clinical factors of recurrence. However,we recommend the use of botulinum toxinin patients older than 50 years or with associatedrisk factors of incontinence, despite thehigher rate of recurrence, since it avoids thegreater risk of incontinence seen with surgery

Chromoendoscopic mucosal resection of a gastric dysplasia

La displasia gástrica puede ser seguida y tratada mediante endoscopia. Han sido diversas las técnicas descritas para dicho fin. Se aporta el caso de un paciente varón de 70 años que presentaba anemia, anorexia, debilidad y pérdida de peso. La gastroscopia y la biopsia demostraron la presencia de una displasia gástrica severa, realizándose resección cromoendoscópica de la misma. El paciente se encuentra asintomático un año después, recuperado de la anemia. Uno de los controles endoscópicos recientes reveló la presencia de una displasia leve en el área cercana a la resección previa. Se discuten las ventajas e inconvenientes de esta técnica