DPP-4 Levels Are Increased in Subjects with Poor Sleep Quality.

Background: Up to 30% of the population has sleep disturbances, generating a negative health impact, a situation that is often not known and no medical attention is sought. It has been observed that after a total deprivation of sleep, the levels of dipeptidyl peptidase 4 (DPP-4) tend to increase. The aim of this study was to compare serum levels of DPP-4 in healthy subjects, with adequate and poor-quality sleep needing medical/pharmacological treatment. Materials and Methods: Cross-sectional study of subjects scheduled for elective surgery with low cardiometabolic risk. Subjects between 18-70 years of age were included, without previous diagnosed pathology (diabetes mellitus type 2; neoplasm; nephropathy; and liver disease) and major amputations, and who signed informed consent. The study protocol was aproved in the Local Committee for Ethics and Research, number 45-16. Anthropometry was performed (% body fat; waist and neck circumferences), and sleep quality assessment (Pittsburgh Sleep Quality Index [PSQI]) to classify them as worthy or not worthy of medical/pharmacological care. Serum DPP-4 was determined by Enzime Linked Immunosorbent Assay (ELISA). The statistical analysis was done in RStudio Software. Results: Fifty seven subjects (2017-2018) were included, with a combined frequency of overweight/obesity of 66.6% and with abdominal circumference values of 93.2 ± 13.6, higher than that proposed by the International Diabetes Federation. The PSQI was 8.3 ± 4.1, and 56.1% were classified as worthy of medical/pharmacological attention. When comparing the levels of DPP-4, these were higher in this group 2385.0 ± 2082.0 versus not worthy 1716.7 ± 1261.7 pg/mL, being statistically significant (P = 0.035). Conclusions: The elevated levels of DPP-4 in person with poor quality sleep worthy of medical/pharmacological treatment could be an early indicator of metabolic disorders, which need to be evaluated in depth.

DPP-4 as a Possible Biomarker of Inflammation Before Abdominal Surgery for Chronic Pathology: Our Experience with Elective Cholecystectomy.

Background and objectives: Dipeptidyl-Peptidase 4 (DPP-4) is a protein expressed in numerous cells and tissues. Recently it has shown its involvement as a catalyst in the inflammatory response in various pulmonary, autoimmune, intestinal and other pathologies. The objective of this study was to compare the preoperative serum levels of DPP-4 in patients with and without surgical finding of perivesicular inflammation. Materials and methods: a cross-sectional analytical study nested in a prospective cohort, including patients scheduled for elective cholecystectomy, without surgical complications, that were 18-70 years of age, with low cardiovascular risk, without a history of peritonitis, pancreatitis, or jaundice and underwent ERCP protocol, type 2 diabetes mellitus, acute inflammatory (Protein C Reactive < 3 mg/L, leucocytes < 10 1000/mm3), neoplastic, nephrologic or liver disease, the use of anti-inflammatory drugs, steroids and/or antibiotics, the use of pacemakers or metallic implants and without major amputations and whom agreed to participate by providing their informed consent. Ethical and Research register: 45-16. Prior to surgery we compiled anthropometric data and a blood sample to determine the serum levels of DPP-4. The presence of perivesicular inflammation was determined in the surgery. The data was analyzed using the statistical program Rstudio. Results: High BMI values were observed (27.8 ± 6.4); waist circumference (94.7 ± 15.1) and percentage of fat mass (34.7 ± 11.7), showing a cumulative frequency of 65.9% for overweight/obesity. In 27.3% of the interventions, intraoperative perivesicular inflammation findings were reported. The serum levels of DPP-4 were lower in the group of patients with perivesicular inflammation (3947.6 ± 1659.5 vs. 3053.2 ± 1469.6, LC95% of the difference: 160.4-1628.3), being statistically significant (P = 0.018). Conclusions: In the subacute or chronic phases of cholecystitis, there appears to be a constant consumption of DPP-4, which would modulate a better immune response that could be related to the reduction of postoperative complications, so the use of Serum levels of DPP-4 as an early biomarker could improve the diagnostic accuracy of this pathology and the surgical approach.

[Efficacy of modified auriculotherapy for post-operative pain control in patients subjected to laparoscopic cholecystectomy]. / Eficacia de la auriculoterapia modificada como tratamiento para el control del dolor postoperatorio en pacientes intervenidos mediante colecistectomía laparoscópica.

BACKGROUND: The high frequency of post-operative pain in the patients after laparoscopic cholecystectomy has led to the need to use multiple analgesic therapies. These include auriculotherapy, although not very good results have been obtained with the traditional techniques. OBJECTIVE: To evaluate the effectiveness of modified auriculotherapy for post-operative pain control in laparoscopic cholecystectomy patients. MATERIAL AND METHODS: Double-blind controlled clinical trial. Experimental group: Different points ear puncture with xylocaine without needles vs. placebo group. Post-operative visual analogue scale (VAS) at 6, 12, 18, 24, 36, and 48h and rescue doses of analgesics, were measured in both groups. RESULTS: At 6h post-operative, 87% of the auriculotherapy group had a VAS of<4 vs. 48% of placebo group (p = 0.004), and 96 vs. 74% (p = 0.008) at 18hours. At 24, 36 and 48h after surgery there were no differences, and as all of the patients in both groups had a VAS<4, they were discharged to the hospital. CONCLUSIONS: Modified auriculotherapy was better to the conventional analgesics for post-operative pain control in patients subjected to laparoscopic cholecystectomy.

[Video-assisted thoracic surgery diagnosis of mucinous (colloid) lung adenocarcinoma: Case report]. / Diagnóstico de adenocarcinoma mucinoso (coloide) pulmonar por cirugía torácica asistida por video. Reporte de caso.

BACKGROUND: Mucinous colloid lung adenocarcinoma is an uncommon variant of lung carcinomas with similar features to tumours seen in the gastrointestinal tract. To distinguish between these tumours and other mucinous lung tumours, such as mucinous bronchioloalveolar cell carcinomas and metastatic mucinous lesions could be difficult with small biopsy specimens from fine needle aspiration. CLINICAL CASE: The case is described of a 49-year-old female with history of dyspnoea and cough with bloody sputum and weight lose. Thorax axial computed tomography demonstrated a right lower lobe spiculated mass with calcifications. Transthoracic computed tomography- guided fine needle biopsy reported negative results, and the biopsy obtained with video-assisted thoracic surgery was useful for an adequate cytology report of a colloid variant of mucinous lung adenocarcinoma. CONCLUSION: Video-assisted thoracic surgery is an appropriate option for obtaining a larger specimen in those cases where small biopsies are inconclusive for the diagnosis of thoracic pathologies such as malignant tumours.

[Surgical site infection in non-traumatic surgery]. / Infección del sitio operatorio en cirugía abdominal no traumática.

BACKGROUND: Risk factors of surgical site infection (SSI) have been widely studied, such as abdominal surgery, surgical time >2 h, contaminated or dirty surgery, three or more diagnoses at discharge, and ASA classification >II. METHODS: A prospective risk factor study was carried out for SSI in patients who underwent non-traumatic abdominal surgery, comparing an institutional (Secretary of Health) and a private third-level hospital during the period from October 2001 to May 2002. RESULTS: We studied 527 patients with 21 cases (3.98%) of SSI and four deaths due to this cause, 0.75% of the total population and 19% of patients with SSI. The mean age was 47.5 +/- 19.1 years, and there were 195 (37%) males and 332 (63%) females. The incidence of SSI in the private hospital was 2.1% and in the institutional hospital 5%, without statistical significance (p = 0.09). Within the infected group we found 14 superficial infections, 5 deep infections, and 2 infections in the organ or surgical field. Variables included in the models of logistic regression were smoke, blood transfusion, trichotomy, and wound type. CONCLUSIONS: Observed infection incidence was within the expected range. In our study there were no differences between facilities, and SSI incidence is similar to what has previously been reported.

Infección del sitio operatorio en cirugía abdominal no traumática / Surgical site infection in non-traumatic surgery

BACKGROUND: Risk factors of surgical site infection (SSI) have been widely studied, such as abdominal surgery, surgical time >2 h, contaminated or dirty surgery, three or more diagnoses at discharge, and ASA classification >II. METHODS: A prospective risk factor study was carried out for SSI in patients who underwent non-traumatic abdominal surgery, comparing an institutional (Secretary of Health) and a private third-level hospital during the period from October 2001 to May 2002. RESULTS: We studied 527 patients with 21 cases (3.98%) of SSI and four deaths due to this cause, 0.75% of the total population and 19% of patients with SSI. The mean age was 47.5 +/- 19.1 years, and there were 195 (37%) males and 332 (63%) females. The incidence of SSI in the private hospital was 2.1% and in the institutional hospital 5%, without statistical significance (p = 0.09). Within the infected group we found 14 superficial infections, 5 deep infections, and 2 infections in the organ or surgical field. Variables included in the models of logistic regression were smoke, blood transfusion, trichotomy, and wound type. CONCLUSIONS: Observed infection incidence was within the expected range. In our study there were no differences between facilities, and SSI incidence is similar to what has previously been reported.

[Comparison of two forms of nasal and pharyngeal topical anestesia for performing esophageal manometry]. / Comparación de dos formas de anestesia tópica nasal y faríngea para la realización de manometría esofágica.

BACKGROUND: The esophageal manometry (EM) is an invasive procedure that causes nasal pain, pharyngeal pain, and nausea. A topical anesthetic may improve tolerance of the examination. OBJECTIVE: To compare the effectiveness of 10% lidocaine with 20% benzocaine as topical anesthetics in order to reduce discomfort during an EM. MATERIALS AND METHODS: 251 patients who had been prescribed an EM received either lidocaine or benzocaine in the nose and pharynx before inserting the catheter An EM was carried out using the usual pull-trough technique and an observer registered the insertion time of the catheter. Patients assessed the intensity of nasal pain and nausea by means of a visual analog scale. Finally, patients were asked whether, if necessary, they would repeat the study. RESULTS: 127 patients were studied in the lidocaine group and 124 in the benzocaine group. The EM was carried out on all patients without complications. Although benzocaine tended to be the preferred anesthetic, no significant differences were found between the groups in relation to nasal pain, nausea, and insertion time. The percentage of patients with moderate or intense discomfort was significantly less in the benzocaine group (nasal pain 10 vs. 33%, p < 0.001; and nausea 24 vs. 36%, p = 0.05). A similar percentage of patients said they would not agree to having another EM (p = NS). CONCLUSIONS: Both lidocaine and benzocaine are topical anesthetics that can reduce discomfort during an EM. Benzocaine seems to achieve a better effect among more patients submitted to this procedure.

[Usefulness of colonoscopy with biopsy for the study of patients with chronic diarrhea]. / La utilidad de la colonoscopia con toma de biopsias en el estudio de pacientes con diarrea crónica.

BACKGROUND: the endoscopic evaluation of the colonic mucosa complemented with biopsy sampling may be very useful in the study of patients with chronic diarrhea. However its value in daily practice has not been extensively explored. OBJECTIVE: to know the utility of colonoscopy with systematic biopsy sampling in the study of the patients with chronic diarrhea. MATERIAL AND METHODS: patients with chronic diarrhea (loose stools and frequent bowel movements for at least four weeks) were examined with colonoscopy and biopsy sampling for systematic histologic examination; even in patients with a normal-appearing mucosa. Patients with the following were excluded: a diagnosis of HIV infection/AIDS, previous colon surgery, known inflammatory bowel disease, gastrointestinal bleeding, anemia or involuntary weight loss. RESULTS: a total of 109 patients were included (63 females, mean age 52 years). Colonoscopy was normal in 53 cases (49%) and abnormal in 56 (51%). The biopsies showed a specific disease in 31 cases (28%), non-specific changes in 58 (53%) and normal mucosa in 20 (18%). Microscopic colitis (lymphocytic or collagenous colitis) was detected in 12 cases (11%) all of them with a normal colonoscopy. Colonoscopy with systematic biopsy sampling allowed making a specific diagnosis in 31 of patients (28%). CONCLUSIONS: colonoscopy with systematic biopsy sampling is very useful in the study of patients with chronic diarrhea, since it established a specific diagnosis in 28% of the patients and 11% with microscopic colitis, all of them with normal mucosa.

[Prevalence of different groups that comprise endoscopy-negative reflux disease]. / La prevalencia de los diferentes grupos que integran la enfermedad por reflujo con endoscopia negativa.

BACKGROUND DATA: Endoscopic-negative reflux disease (ENRD) is a heterogeneous population. There are few data regarding the prevalenece of each group and subgroups that constitutes ENRD population. OBJECTIVE: To describe the prevalence of the differents groups and subgroups in ENRD. PATIENTS AND METHODS: We studied consecutive patients with frequent heartburn and acid regurgitation with endoscopically normal esophageal mucosa in whom ambulatory 24-h esophageal pH monitoring was performed. According with the pH-testing data and the correlation between symptoms and the acid reflux events, the subjects were classified in two groups: non-erosive gastroesophageal reflux disease (NERD) and functional heartburn. The functional heartburn group was splited in 3 subgroups: asymptomatics during pH-monitoring, hipersensitive esophagus and those with physiologic reflux with negative association between symptoms and acid reflux events. These last subgroup was classified in: minute changes of intra-esophegeal pH (upper than 4, n = 19) and non-acid related stimuli. RESULTS: One hundred and eleven patients with ENRD were classified in NERD (28%, n = 31) and functional heartburn (72%, n = 80). Patients with functional heartburn were classified in asymptomatics during pH-monitoring (11%, n = 12), hipersensitive esophagus (9%, n = 10) and those with physiologic reflux with negative association between symptoms and acid reflux events (52%, n = 58). In these last subgroup 19 (17%) patients were classified as minute changes of intra-esophegeal pH (upper than 4) and 39 (35%) as non-acid related stimuli. CONCLUSIONS: Even most of the patients with ENRD have normal ambulatory pH-test, their symptoms are related with drops of esophageal pH in 26% of the cases. Eleven percent do not have symptoms during ambulatory pH-monitoring.

[Peritoneal coccidioidomycosis]. / Coccidioidomicosis peritoneal.

BACKGROUND: Peritonitis is a very rare condition that has been found on inmunocompromised patients and patients on peritoneal dialysis. OBJECTIVE: To present one case of a patient with chronic abdominal pain that was found to have coccidioidomycosis. CASE PRESENTATION: 50 year old female with 6 months of intermittent abdominal pain referred to right upper quadrant, nausea and vomiting, without fever or jaundice. On physical exam she had pain localized to right upper quadrant. An US was performed and reported a schleroatrophic and litiasic gallbladder. Exploratory laparoscopy was performed, the findings were diffuse lesions in the peritoneal cavity parietal and visceral, some of them were biopsied. A peritoneal coccidioidomycosis was reported and fluconazol treatment was started. Postoperatory evolution was unremarkable at 3 years. CONCLUSION: Coccidioideal peritonitis is a rare disease, most of the patients are asymptomatic and frequently diagnosed while working up other disease.

[Appendiceal tumors. Clinicopathologic review of 5,307 appendectomies]. / Tumores apendiculares. Revisión clínico-patológica de 5,307 apendicectomías.

INTRODUCTION: Appendix tumors are unusual, accounting for 0.4% of all gastrointestinal- tract malignancies. Although rare, the spectrum of malignant disease is complex and has led to confusion with regard to accurate description of the natural history of these tumors. Consequently, many errors in diagnosis and treatment have occurred. OBJECTIVE: Our aim was to analyze incidence and clinic-pathologic behavior of appendiceal tumors. METHODS: Our study type was retrospective, observational, longitudinal, and descriptive, and was conducted at a secondary-care-level hospital. From a single care center, a histopathologic database of 5,307 appendectomies, all appendiceal tumors, was identified and case notes were reviewed. Analysis of clinical presentation, histopathology, operation, and outcome is presented. RESULTS: During a 10-year period (5,307 appendectomies), 31 patients (0.58%) with appendiceal tumors were identified: 11 had carcinoid tumors, 18 benign, and two patients had malignant tumors. Acute appendicitis was the most common presentation (79.1%), and 20.3% were normal appendices. Patients with appendiceal tumor included 23 females and eight males with mean age of 48 years. Ninety seven percent of patients had preoperative diagnosis of acute appendicitis. CONCLUSIONS: Appendiceal tumors are uncommon and most commonly present as acute appendicitis. Macroscopic suspicion during surgery is the most important point to make the best decision.

[Inflammatory pseudotumor of the retroperitoneum]. / Pseudotumor inflamatorio de retroperitoneo.

Inflammatory pseudotumor is a rare, benign lesion of various organs and tissues, characterized by proliferating fibrovascular tissue admixed with inflammatory cells of etiology and pathogenesis that are largely unknown. We report a case of a 55-years-old woman with acute pancreatitis with a retroperitoneal mass in Morrison's space detected by tomography. Aspects concerning incidence, etiology, clinical, and histopathologic characteristics are discussed.

Neurofibromatosis gastrointestinal: una causa poco frecuente de cirugía abdominal / Gastrointestinal neurofibromatosis: an infrequent cause of abdominal surgery

Objetivo: reportar dos casos de neurofibromatosis gastrointestinal que requirieron tratamiento quirúrgico para su resolución. Antecedentes: la neurofibromatosis es una enfermedad congénita que se divide en dos tipos. En la neurofibromatosis tipo 1 o enfermedad de Von Recklinghausen el paciente presenta algunas manifestaciones clásicas de la enfermedad como lesiones dérmicas café con leche, alteraciones óseas y neurofibromas de nervios periféricos y centrales. Hasta 25 por ciento de los pacientes con neurofibromatosis tipo 1 presenta afección gastrointestinal, y los órganos más frecuentemente involucrados son el estómago y el yeyuno. La sintomatología principal de los pacientes con neurofibromatosis gastrointestinal es oclusión intestinal o hemorragia. Método: dos pacientes con neurofibromatosis gastrointestinal que ameritaron manejo quirúrgico para su resolución. Resultados: dos casos de neurofibromatosis gastrointestinal, un paciente tuvo como manifestación clínica hemorragia de tubo digestivo y el segundo paciente oclusión intestinal. Se les realizó laparotomía exploradora teniendo como hallazgos neurofibromatosis gastrointestinal como causa de sus síntomas. Conclusiones: el manejo de la neurofibromatosis gastrointestinal puede requerir tratamiento quirúrgico, y cuando esto se realiza generalmente la recuperación posoperatoria es satisfactoria.

Factores de riesgo en la cirugía colorrectal / Risk factors in colorectal surgery

Objetivo: establecer los factores que aumentan el riesgo de complicaciones en los pacientes con manejo quirúrgico colorrectal. Método y resultados: se realizó un estudio retrospectivo de los pacientes con cirugía colorrectal en el periodo 1986 a 1995. Se incluyeron a 330 pacientes, 207 sin complicaciones (62.7 por ciento) y 123 (37.3 por ciento) con complicaciones. No presentaron diferencias significativas en cuanto al sexo y antecedentes patológicos en cada grupo. Fue más frecuente en el grupo con complicaciones una edad mayor de 50 años, con cirugía de urgencia, leucocitosis 12,000, glucemia preoperatoria 200 mg/dL, creatinina 2.5 g/dL y diagnóstico de enfermedad diverticular complicada. Los procedimientos con mayor riesgo fueron la colectomía subtotal y la cirugía que termina con estomas. Las complicaciones menores fueron infección de herida, de vías urinarias y las mayores, dehiscencia de anastomosis, necrosis del estoma, evisceración y muerte. Conclusiones: de acuerdo a lo establecido en el presente más comúnmente en pacientes mayores de 50 años y con enfermedad concomitantes descompensada en el perioperatorio. Tomando en cuenta los factores de riesgo que se encontraron, la corrección de estos y la vigilancia estrecha del paciente en el perioperatorio, nos brinda una oportunidad de incidir positivamente en el curso natural de la enfermedad