Barrett's esophagus and esophageal cancer after sleeve gastrectomy. Myth or reality?

Sleeve gastrectomy has become the most performed bariatric surgery technique in the world. This bariatric technique has been related to the appearance of gastroesophageal reflux and recently with de novo Barrett's esophagus. It is not clear that this leads to an increased incidence of esophageal adenocarcinoma. In this review we analyze the current scientific literature to try to answer the true incidence of Barrett's esophagus and adenocarcinoma after sleeve gastrectomy, and whether these data should make us change the indications for this technique.

Aprendizaje basado en la simulación: valoración de los objetivos docentes en un programa de abdomen agudo y oclusión intestinal en cirugía general / Simulation-based learning: assessment of the teaching objectives in a program of acute abdomen and intestinal occlusion in general surgery, in medicine degree students

Introducción y objetivo: Analizar el logro de los objetivos docentes desarrollados durante el escenario de los casos de simulación a través de la valoración del profesor, los participantes observadores y quien realiza la propia simulación. Sujetos y métodos: Estudio observacional, prospectivo, descriptivo y unicéntrico, realizado con estudiantes de tercer curso de Medicina de la Universitat Autònoma de Barcelona. Se evalúan los objetivos docentes para cada caso clínico simulado por parte de los estudiantes que realizan la simulación, los observadores y el profesor. La evaluación numérica sigue una escala de tipo escala visual analógica y la categórica los clasifica en conseguidos, parcialmente conseguidos y no conseguidos. El estado nervioso y la comodidad de los alumnos también se evalúan numéricamente. Resultados: Se ha registrado la valoración de los objetivos de 929 participantes. La evaluación de los objetivos tiene un valor medio superior a 7 para cada uno de ellos. Existe una diferencia de 1,5-2 puntos en la valoración media entre el primer caso y el último, y no hay ningún alumno que no consiga los objetivos en el último caso. Se describe un estado de nervios alrededor de 4,5 y de comodidad alrededor de 7, sin diferencias entre los distintos evaluadores. Conclusiones: El logro de los objetivos se consigue de forma notable. Entre el primer caso y el último existe una significativa diferencia en el grado de obtención de los objetivos. No hay una relación entre el estado emocional de los participantes y la consecución de los objetivos.(AU)

Introduction and aim: To analyze the achievement of the educational objectives developed during the scenario of the simulation cases through the assessment of the teacher, the observer participants and the person who performs the simulation itself. Subjects and methods: Observational, prospective, descriptive and single-center study, carried out with 3rd year Medicine students at the Universitat Autònoma de Barcelona. The teaching objectives for each simulated clinical case are evaluated by the students who carry out the simulation, the observers and the teacher. The numerical evaluation follows a VAS-type scale and the categorical one classifies them as achieved, partially achieved and not achieved. The nervous state and comfort of the students are also evaluated numerically. Results: The evaluation of the objectives of 929 participants has been registered. The evaluation of the objectives has an average value greater than 7 for each one of them. There is a difference of 1.5-2 points in the average assessment between the first case and the last, with no student not achieving the objectives in the last case. A state of nerves around 4.5 and comfort around 7 is described, with no differences between the different evaluators. Conclusions: The achievement of the objectives is achieved in a remarkable way. Between the first case and the last, there is a significant difference in the degree of achievement of the objectives. There is no relationship between the emotional state of the participants and the achievement of the objectives.(AU)

Consecuencias de la toma de decisiones terapéuticas con base en el resultado del FAST en pacientes politraumáticos con fractura pélvica / Consequencies of therapeutic decision-making based on FAST results in trauma patients with pelvic fracture

Introducción: La exactitud del FAST disminuye notablemente en los pacientes politraumáticos con fractura pélvica. El objetivo es analizar las consecuencias de tomar decisiones terapéuticas basadas en el resultado del FAST en los pacientes politraumáticos con fractura de pelvis. Métodos: Estudio descriptivo de pacientes con politraumatismos mayores de 16 años que han ingresado en el área de críticos o que han fallecido previamente, con fractura pélvica. El resultado del FAST ha sido comparado con un valor realmente positivo o negativo según el resultado de la laparotomía o de la tomografía computarizada.Resultados: En 13 años, se ha incluido a 263 pacientes politraumáticos con fractura pélvica (ISS medio de 31; mortalidad 19%). El FAST tenía una sensibilidad del 65,2%, una especificidad del 69%, una tasa de falsos negativos del 34,8% y una tasa de falsos positivos del 30,9%. Los pacientes hemodinámicamente inestables tenían el doble de mortalidad que los pacientes estables (27% vs. 14%, p <0,05). Los pacientes con un FAST positivo tenían mayor mortalidad que los pacientes con FAST negativo (43% vs. 26%); 4 de 10 pacientes hemodinámicamente inestables con un FAST falsamente positivo que se sometieron a laparotomía exploradora innecesaria murieron por shock hipovolémico. La mortalidad se redujo del 60 al 20% asociando un packing preperitoneal. Conclusiones: La reducida eficacia del FAST en pacientes con fractura de pelvis nos obliga a cuestionarnos las consecuencias de la toma de decisiones terapéuticas con base en sus resultados. Los pacientes con FAST falsamente positivo tienen una mortalidad mayor, que se puede reducir aplicando un packing preperitoneal. (AU)

Introduction: FAST is essential to decide if trauma patients need laparotomy, but has a notably decrease in accuracy in patients with pelvic fracture. Our objective is to analyze the consequences of therapeutic decision-making based on the FAST results in trauma patients with pelvic fracture. Methods: Descriptive study that includes trauma patients older than 16 with a pelvic fracture admitted to the critical care area or who were fallecimiento. FAST result was compared with a true positive or negative value according to the results of laparotomy or abdominal CT. We recorded diagnosis and treatment of each injury and resolution of the case, detailing the cause of death, among all variables. Results: Over the 13–year period, we included 263 trauma patients with pelvic fracture, with a mean ISS of 31 and mortality of 19%. FAST had a sensitivity of 65.2%, specificity of 69%, false negative rate of 34.8% and false positive rate of 30.9%. Hemodynamically unstable patients died twice as many stable patients (27% vs. 14%, p <0.05). Patients with positive FAST died more than negative FAST (43% vs. 26%); and 4 of 10 hemodynamically unstable patients who underwent non therapeutic laparotomy after presenting a false positive FAST died from hypovolemic shock. The mortality rate fell from 60% to 20% when preperitoneal packing was performed before angio-embolization of the pelvis. Conclusion: FAST has low accuracy in polytraumatized patients with pelvic fracture. Patients with false positive FAST have higher mortality, which can be reduce notably applying a preperitoneal packing. (AU)

Consequencies of therapeutic decision-making based on FAST results in trauma patients with pelvic fracture.

INTRODUCTION: FAST is essential to decide whether trauma patients need laparotomy, but it has a notable decrease in accuracy in patients with pelvic fracture. Our objective is to analyze the consequences of therapeutic decision-making based on the FAST results in trauma patients with pelvic fracture. METHODS: Descriptive study that includes trauma patients older than 16 with a pelvic fracture admitted to the critical care area or who died. The FAST result was compared with a true positive or negative value according to the results of laparotomy or abdominal CT. We recorded diagnosis and treatment of each injury and resolution of the case, detailing the cause of death, among all variables. RESULTS: Over the 13-year period, we included 263 trauma patients with pelvic fracture, with a mean ISS of 31 and mortality of 19%. FAST had a sensitivity of 65.2%, specificity of 69%, false negative rate of 34.8% and false positive rate of 30.9%. Hemodynamically unstable patients died twice as many stable patients (27% vs 14%, P < .05). Patients with positive FAST died more than negative FAST (43% vs 26%); and 4 out of 10 hemodynamically unstable patients who underwent non-therapeutic laparotomy after presenting a false positive FAST died from hypovolemic shock. The mortality rate fell from 60% to 20% when preperitoneal packing was performed before angio-embolization of the pelvis. CONCLUSION: FAST has low accuracy in polytraumatized patients with pelvic fracture. Patients with false positive FAST have higher mortality, which can be reduced notably by applying preperitoneal packing.

Pruebas diagnósticas empleadas en la estadificación preoperatoria del cáncer de la unión esofagogástrica: rendimiento y recomendaciones basadas en la evidencia / Diagnostic tests for preoperative staging of esophagogastric junction tumors: performance and evidence-based recomendations

La estadificación clínica preoperatoria es crítica para seleccionar aquellos pacientes cuya enfermedad está localizada y se podrá beneficiar de una cirugía con intención curativa. Idealmente, dicha estadificación debería predecir la invasión tumoral, la afectación linfática y las metástasis a distancia. Con el cTNM podemos seleccionar aquellos pacientes a los que podremos ofrecer una resección endoscópica, una cirugía radical o evitarla en aquellos con metástasis a distancia. Para el diagnóstico inicial de los adenocarcinomas de la unión esofagogástrica se requiere una endoscopia con biopsias. Para la estadificación clínica: TC toracoabdominopélvico, ultrasonografía endoscópica y la PET o la PET-TC. Otras exploraciones de utilidad son: tránsito baritado, resección endoscópica de la mucosa o disección endoscópica de la submucosa (para valoración de estadios iniciales) y la laparoscopia de estadificación. Una vez establecida la resecabilidad del tumor deberá valorarse la operabilidad del mismo en función del estado del paciente

Preoperative clinical staging is critical to select those patients whose disease is localized and may benefit from surgery with curative intent. Ideally, such staging should predict tumor invasion, lymphatic involvement and distant metastases. With the cTNM, we are able to select patients who could benefit from endoscopic resection, radical surgery or less radical treatment in patients with distant metastasis. The initial diagnosis of adenocarcinomas of the esophagogastric junction requires endoscopy with biopsies. For clinical staging, thoracoabdominal-pelvic CT scan, endoscopic ultrasound and PET or PET/CT are used. Other useful explorations are: barium swallow, endoscopic mucosal resection or endoscopic submucosal dissection (for assessment in initial stages) and staging laparoscopy. Once the resectability of the tumor has been established, the operability of the tumor should be assessed according to the patient's condition

Diagnostic tests for preoperative staging of esophagogastric junction tumors: performance and evidence-based recomendations. / Pruebas diagnósticas empleadas en la estadificación preoperatoria del cáncer de la unión esofagogástrica: rendimiento y recomendaciones basadas en la evidencia.

Preoperative clinical staging is critical to select those patients whose disease is localized and may benefit from surgery with curative intent. Ideally, such staging should predict tumor invasion, lymphatic involvement and distant metastases. With the cTNM, we are able to select patients who could benefit from endoscopic resection, radical surgery or less radical treatment in patients with distant metastasis. The initial diagnosis of adenocarcinomas of the esophagogastric junction requires endoscopy with biopsies. For clinical staging, thoracoabdominal-pelvic CT scan, endoscopic ultrasound and PET or PET/CT are used. Other useful explorations are: barium swallow, endoscopic mucosal resection or endoscopic submucosal dissection (for assessment in initial stages) and staging laparoscopy. Once the resectability of the tumor has been established, the operability of the tumor should be assessed according to the patient's condition.

Deciduosis apendicular como causa de abdomen agudo / Appendicular Deciduosis as a Cause of Acute Abdomen

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Libro informático del residente de cirugía: un paso adelante / Surgical electronic logbook: a step forward

INTRODUCCIÓN: El libro informático del residente quirúrgico (LIRQ) tiene por objetivos: simplificar el registro de la actividad formativa de los residentes quirúrgicos y permitir obtener informes fiables y detallados sobre la misma, para su evaluación. MÉTODOS: El LIRQ es una base de datos única y compartida. Los residentes registran de manera prospectiva sus actividades, en 3 bloques: quirúrgico, científico y docente. Permite acceder a informes de la actividad registrada, actualizados al momento. RESULTADOS: Periodo de estudio, usando el LIRQ: Entre junio de 2011 y mayo de 2013. Se registraron un total de 4.255 cirugías y 11.907 procedimientos quirúrgicos. Por otro lado, cada residente registró 250 cirugías por año y 700 procedimientos quirúrgicos por año. La actividad quirúrgica como cirujano principal que se desarrolla el primer año de residencia es, principalmente, en cirugía urgente (68,01%) y por vía laparotómica (97,73%), mientras que durante el quinto año de residencia se desarrolla un 51,27% en cirugía programada y se utiliza la vía laparoscópica en un 23,10% de los casos. Durante este periodo, los residentes participaron en un total de 11 publicaciones científicas, 75 presentaciones en congresos y 69 actividades de formación continuada. CONCLUSIONES: El LIRQ es una herramienta útil que simplifica el registro y análisis de los datos sobre la actividad quirúrgica y científica de los residentes. Constituye un paso adelante en la evaluación de la formación de los residentes quirúrgicos, sin embargo, es solo un paso intermedio en el camino del desarrollo de un registro español de mayor envergadura

INTRODUCTION: The surgical electronic logbook (surgical e-logbook) aims to: simplify registration of the training activities of surgical residents, and to obtain reliable and detailed reports about these activities for resident evaluation. METHODS: The surgical e-logbook is a unique and shared database. Residents prospectively record their activities in 3 areas: surgical, scientific and teaching. We can access activity reports that are constantly updated. RESULTS: Study period using the surgical e-logbook: Between June 2011 and May 2013. Number of surgeries reported: 4,255. Number of surgical procedures reported: 11,907. Number of surgeries per resident per year reported: 250. Number of surgical procedures per resident per year reported: 700. Surgical activity as a primary surgeon during the first year of residency is primarily in emergency surgery (68,01%) and by laparotomy (97,73%), while during the fifth year of residency 51,27% is performed in elective surgery and laparoscopy is used in 23,10% of cases. During this period, residents participated in a total of 11 scientific publications, 75 conference presentations and 69 continuing education activities. CONCLUSIONS: The surgical e-logbook is a useful tool that simplifies the recording and analysis of data about surgical and scientific activities of the residents. It is a step forward in the evaluation of the training of surgical residents, however, is only an intermediate step towards the development of a larger Spanish registry

Isquemia mesentérica aguda: utilidad de las técnicas de revascularización endovascular / Acute mesenteric ischemia: Utility of endovascular techniques

INTRODUCCIÓN: La isquemia mesentérica aguda (IMA) presenta una elevada mortalidad. El diagnóstico y el tratamiento precoces son claves. En nuestro centro aplicamos un protocolo terapéutico que incluye la radiología vascular intervencionista (RVI) en pacientes con IMA sin irritación peritoneal. El objetivo de este estudio fue evaluar el uso de la RVI conjuntamente con la cirugía convencional en el manejo de la IMA de intestino delgado potencialmente reversible diagnosticada mediante tomografía computarizada vascular (angio-TC). MÉTODOS: Estudio observacional, retrospectivo y descriptivo, donde se valora el manejo diagnóstico y terapéutico de la IMA en 2 períodos (antes y después de la aplicación de un protocolo que incluye la RVI) entre 2009 y 2013. El diagnóstico de elección es mediante angio-TC, ante la sospecha clínico-analítica. RESULTADOS: Nuestra serie incluye a 73 pacientes diagnosticados de IMA mediante angio-TC (45: 2009-2011; 28: 2012-2013). La leucocitosis es frecuente (82%), siendo menos frecuente la lactacidemia (47% vs. 53%). Hay 49 pacientes con IMA y exploración abdominal normal. En el 51% se realizó cirugía de resección intestinal (supervivencia 44%); 18%: revascularización mediante RVI (supervivencia 67%); 31%: tratamiento paliativo (supervivencia 0%). El 33% de los pacientes sometidos a RVI como primera línea precisaron de cirugía de rescate (resección intestinal). La mortalidad global es del 67% (2009-2011) vs. 62% (2012-2013). CONCLUSIONES: Desde la aplicación del protocolo ha aumentado la indicación de RVI para tratar a pacientes sin irritación peritoneal, objetivando una disminución de la mortalidad global. En nuestra experiencia, la aplicación de RVI en casos de IMA sin irritación peritoneal al diagnóstico puede incrementar la supervivencia

INTRODUCTION: Acute mesenteric ischemia (AMI) has a high mortality. Early diagnosis and treatment are very important. In our institution there is a therapeutic protocol that includes endovascular techniques (ET) in patients with AMI without peritoneal irritation at diagnosis. The aim of this study was to evaluate the use of ET in conjunction with conventional surgery in the management of potentially reversible IMA diagnosed by computed tomography (CT-angiography). METHODS: Observational, descriptive and retrospective study that evaluated the use of ET in patients with AMI (arterial origin) in 2 periods (before and after the application of a protocol that includes ET), between 2009-2013. All patients were diagnosed by a CT-angiography, as the diagnostic technique of choice, because of the clinical and analytical suspicion. RESULTS: Our series included 73 patients with IMA diagnosed by CT-angiography (45: 2009-2011; 28: 2012-2013). Leukocytosis was common (82%), high lactate levels are less frequent (47% vs. 53%). There were 49 patients with IMA without peritoneal irritation. In 51% bowel resection surgery was performed (44% survival); 18%: revascularization by ET (survival 67%); 31%: palliative treatment (0% survival). 33% of patients undergoing first-line RVI needed a surgical rescue (bowel resection). The overall mortality was 67% (2009-2011) vs. 62% (2012-2013). CONCLUSIONS: Since the protocol application, there is a higher indication of ET in patients with AMI without peritoneal irritation, showing a decreased mortality. With ET application, there is a higher survival in these patients. In our experience, the use of ET in cases of AMI without peritoneal irritation at diagnosis, may increase survival

Acute mesenteric ischemia: Utility of endovascular techniques.

INTRODUCTION: Acute mesenteric ischemia (AMI) has a high mortality. Early diagnosis and treatment are very important. In our institution there is a therapeutic protocol that includes endovascular techniques (ET) in patients with AMI without peritoneal irritation at diagnosis. The aim of this study was to evaluate the use of ET in conjunction with conventional surgery in the management of potentially reversible IMA diagnosed by computed tomography (CT-angiography). METHODS: Observational, descriptive and retrospective study that evaluated the use of ET in patients with AMI (arterial origin) in 2 periods (before and after the application of a protocol that includes ET), between 2009-2013. All patients were diagnosed by a CT-angiography, as the diagnostic technique of choice, because of the clinical and analytical suspicion. RESULTS: Our series included 73 patients with IMA diagnosed by CT-angiography (45: 2009-2011; 28: 2012-2013). Leukocytosis was common (82%), high lactate levels are less frequent (47% vs. 53%). There were 49 patients with IMA without peritoneal irritation. In 51% bowel resection surgery was performed (44% survival); 18%: revascularization by ET (survival 67%); 31%: palliative treatment (0% survival). 33% of patients undergoing first-line RVI needed a surgical rescue (bowel resection). The overall mortality was 67% (2009-2011) vs. 62% (2012-2013). CONCLUSIONS: Since the protocol application, there is a higher indication of ET in patients with AMI without peritoneal irritation, showing a decreased mortality. With ET application, there is a higher survival in these patients. In our experience, the use of ET in cases of AMI without peritoneal irritation at diagnosis, may increase survival.

Surgical electronic logbook: A step forward.

INTRODUCTION: The surgical electronic logbook (surgical e-logbook) aims to: simplify registration of the training activities of surgical residents, and to obtain reliable and detailed reports about these activities for resident evaluation. METHODS: The surgical e-logbook is a unique and shared database. Residents prospectively record their activities in 3 areas: surgical, scientific and teaching. We can access activity reports that are constantly updated. RESULTS: Study period using the surgical e-logbook: Between June 2011 and May 2013. Number of surgeries reported: 4,255. Number of surgical procedures reported: 11,907. Number of surgeries per resident per year reported: 250. Number of surgical procedures per resident per year reported: 700. Surgical activity as a primary surgeon during the first year of residency is primarily in emergency surgery (68,01%) and by laparotomy (97,73%), while during the fifth year of residency 51,27% is performed in elective surgery and laparoscopy is used in 23,10% of cases. During this period, residents participated in a total of 11 scientific publications, 75 conference presentations and 69 continuing education activities. CONCLUSIONS: The surgical e-logbook is a useful tool that simplifies the recording and analysis of data about surgical and scientific activities of the residents. It is a step forward in the evaluation of the training of surgical residents, however, is only an intermediate step towards the development of a larger Spanish registry.

Validación de un modelo de riesgo de evisceración / Validation of abdominal wound dehiscence's risk model

INTRODUCCIÓN: Nuestro trabajo pretende valorar la utilidad del modelo de riesgo de evisceración desarrollado por van Ramshorst et al., y una modificación del mismo, para predecir el riesgo de evisceración entre pacientes operados por laparotomía media. MATERIAL Y MÉTODOS: Estudio observacional, longitudinal y retrospectivo. Muestra: pacientes operados por laparotomía media en la Corporación Sanitaria y Universitaria Parc Taulí (Barcelona), entre el 1 de enero y el 30 de junio del 2010. Variable dependiente: evisceración. Variables independientes principales: los scores de riesgo global y preoperatorio (excluye variables postoperatorias), y las probabilidades de evisceración global y preoperatoria. RESULTADOS: Muestra: 176 pacientes. Eviscerados: 15 (8,5%). La media del score global de riesgo del grupo Evisceración: 4,97 (IC95%: 4,15-5,79) es mayor que la del grupo No evisceración: 3,41 (IC95%: 3,20-3,62), siendo esta diferencia estadísticamente significativa (p < 0,001). La media del score preoperatorio de riesgo del grupo Evisceración: 3,27 (IC95%: 2,69-3,84) es mayor que la del grupo No evisceración: 2,77 (IC95%: 2,64-2,89), siendo esta diferencia estadísticamente significativa (p < 0,05). El score global de riesgo (área bajo la curva ROC: 0,79) tiene mayor capacidad predictiva que el score preoperatorio de riesgo (área bajo la curva ROC: 0,64). DISCUSIÓN: La utilidad del modelo de riesgo desarrollado por van Ramshorst et al. para predecir el riesgo de evisceración, durante el preopeatorio, entre pacientes operados por laparotomía media es limitada. La utilización del score preoperatorio requiere ajustes para mejorar su rendimiento pronóstico

INTRODUCTION: The aim of this study is to determine the usefulness of the risk model developed by van Ramshorst et al., and a modification of the same, to predict the abdominal wound dehiscence's risk in patients who underwent midline laparotomy incisions. MATERIALS AND METHODS: Observational longitudinal retrospective study. Sample: Patients who underwent midline laparotomy incisions in the General and Digestive Surgery Department of the Sabadell's Hospital-Parc Taulí's Health and University Corporation-Barcelona, between January 1, 2010 and June 30, 2010. Dependent variable: Abdominal wound dehiscence. Independent variables: Global risk score, preoperative risk score (postoperative variables were excluded), global and preoperative probabilities of developing abdominal wound dehiscence. RESULTS: Sample: 176 patients. Patients with abdominal wound dehiscence: 15 (8.5%). The global risk score of abdominal wound dehiscence group (mean: 4.97; IC 95%: 4.15-5.79) was better than the global risk score of No abdominal wound dehiscence group (mean: 3.41; IC 95%: 3.20-3.62). This difference is statistically significant (P<.001). The preoperative risk score of abdominal wound dehiscence group (mean: 3.27; IC 95%: 2.69-3.84) was better than the preoperative risk score of No abdominal wound dehiscence group (mean: 2.77; IC 95%: 2.64-2.89), also a statistically significant difference (P<.05). The global risk score (area under the ROC curve: 0.79) has better accuracy than the preoperative risk score (area under the ROC curve: 0.64). CONCLUSION: The risk model developed by van Ramshorst et al. to predict the abdominal wound dehiscence's risk in the preoperative phase has a limited usefulness. Additional refinements in the preoperative risk score are needed to improve its accuracy

[Validation of abdominal wound dehiscence's risk model]. / Validación de un modelo de riesgo de evisceración.

INTRODUCTION: The aim of this study is to determine the usefulness of the risk model developed by van Ramshorst et al., and a modification of the same, to predict the abdominal wound dehiscence's risk in patients who underwent midline laparotomy incisions. MATERIALS AND METHODS: Observational longitudinal retrospective study. SAMPLE: Patients who underwent midline laparotomy incisions in the General and Digestive Surgery Department of the Sabadell's Hospital-Parc Taulí's Health and University Corporation-Barcelona, between January 1, 2010 and June 30, 2010. Dependent variable: Abdominal wound dehiscence. INDEPENDENT VARIABLES: Global risk score, preoperative risk score (postoperative variables were excluded), global and preoperative probabilities of developing abdominal wound dehiscence. SAMPLE: 176 patients. Patients with abdominal wound dehiscence: 15 (8.5%). The global risk score of abdominal wound dehiscence group (mean: 4.97; IC 95%: 4.15-5.79) was better than the global risk score of No abdominal wound dehiscence group (mean: 3.41; IC 95%: 3.20-3.62). This difference is statistically significant (P<.001). The preoperative risk score of abdominal wound dehiscence group (mean: 3.27; IC 95%: 2.69-3.84) was better than the preoperative risk score of No abdominal wound dehiscence group (mean: 2.77; IC 95%: 2.64-2.89), also a statistically significant difference (P<.05). The global risk score (area under the ROC curve: 0.79) has better accuracy than the preoperative risk score (area under the ROC curve: 0.64). CONCLUSION: The risk model developed by van Ramshorst et al. to predict the abdominal wound dehiscence's risk in the preoperative phase has a limited usefulness. Additional refinements in the preoperative risk score are needed to improve its accuracy.

Medición del ácido láctico en pacientes politraumatizados y su utilidad como factor predictor de mortalidad y fallo multiorgánico / Measurement of lactic acid in multiple injury patients and its usefulness as a predictor of multiorgan failure and mortality

Introducción La utilización del ácido láctico como marcador de hipoperfusión oculta y su relación con el fracaso multiorgánico (FMO) y/o la mortalidad están sujetas a debate. Material y método Estudio prospectivo incluyendo pacientes politraumatizados mayores de 16a ingresados en el área de críticos. Se registra el ácido láctico inicial y a las 24h del traumatismo relacionándolo con la morbimortalidad de los pacientes. Resultados Se incluyen en el estudio 342 pacientes con un injury severity score medio de 24,1. Los pacientes que sobreviven tienen un ácido láctico inicial y a las 24h del traumatismo de 27,8 y 17,9 (valores normales inferiores a 22mg/dl), elevándose a 36,5 y 40,2 en los que mueren. No existen diferencias entre el ácido láctico inicial en los pacientes con y sin FMO, elevándose a las 24h en los que presentan FMO (17,8 vs 26,7).Los pacientes con un ácido láctico que empeora o se mantiene patológico en 24h tienen mayor mortalidad que cuando se mantiene bien o mejora (25%-17,1% vs 6,3%-0,8%), aumentando también el porcentaje de pacientes con FMO (40,6%-32,8% vs 14,9%-11,1%).En pacientes hemodinámicamente estables, también existe mayor mortalidad cuando el ácido láctico empeora o se mantiene patológico en las primeras 24h (23,8%-19,2% vs 8,8%-0%), así como mayor porcentaje de FMO (38,1%-26,9% vs 10,9%-7,6%).Conclusiones La evolución del ácido láctico en las primeras 24h del politraumatismo tiene relación con la mortalidad y el FMO, incluso cuando el paciente está hemodinámicamente estable (AU)

Introduction The use of lactic acid as marker of occult hyperfusion and its relationship with multiorgan failure (MOF) and/or mortality is a subject of debate. Material and method A prospective study was conducted on multiple injury patients over 16 years of age in critical care areas. The lactic acid was measured at the beginning and at 24hours of the trauma and associating it with the patient morbidity and mortality. Results A total of 342 patients, with a mean injury severity score of 24.1, were included. The patients who survived had an initial, and 24hours after the trauma, lactic acid of 27.8mg/dl and 17.9mg/dl, respectively, (normal values less than 22mg/dl), increasing to 36.5mg/dl and 40.2mg/dl, respectively, in those who died. There were no differences between the initial lactic acid in patients with and without MOF, being increased at 24hours in those who had MOF (17.8 vs 26.7).The patients with a lactic acid that got worse or remained abnormal at 24hours had a higher mortality than those in which it remained the same or improved (25% - 17.1% vs 6.3% - 0.8%), with the percentage of patients with MOF also increasing (40.6% - 32.8% vs 14.9% - 11.1%).In haemodynamically stable patients, there was also a higher mortality when the lactic acid got worse or remained abnormal in the first 24hours (23.8% - 19.2% vs 8.8% - 0%), as well as a higher percentage of MOF (38.1% - 26.9% vs 10.9% - 7.6%).Conclusions The lactic acid results in the first 24hours of the multiple injury patient are associated with mortality and MOF, even when the patient is haemodynamically stable (AU)

[Measurement of lactic acid in multiple injury patients and its usefulness as a predictor of multiorgan failure and mortality]. / Medición del ácido láctico en pacientes politraumatizados y su utilidad como factor predictor de mortalidad y fallo multiorgánico.

INTRODUCTION: The use of lactic acid as marker of occult hyperfusion and its relationship with multiorgan failure (MOF) and/or mortality is a subject of debate. MATERIAL AND METHOD: A prospective study was conducted on multiple injury patients over 16 years of age in critical care areas. The lactic acid was measured at the beginning and at 24 hours of the trauma and associating it with the patient morbidity and mortality. RESULTS: A total of 342 patients, with a mean injury severity score of 24.1, were included. The patients who survived had an initial, and 24 hours after the trauma, lactic acid of 27.8 mg/dl and 17.9 mg/dl, respectively, (normal values less than 22 mg/dl), increasing to 36.5mg/dl and 40.2mg/dl, respectively, in those who died. There were no differences between the initial lactic acid in patients with and without MOF, being increased at 24 hours in those who had MOF (17.8 vs 26.7). The patients with a lactic acid that got worse or remained abnormal at 24 hours had a higher mortality than those in which it remained the same or improved (25% - 17.1% vs 6.3% - 0.8%), with the percentage of patients with MOF also increasing (40.6% - 32.8% vs 14.9% - 11.1%). In haemodynamically stable patients, there was also a higher mortality when the lactic acid got worse or remained abnormal in the first 24 hours (23.8% - 19.2% vs 8.8% - 0%), as well as a higher percentage of MOF (38.1% - 26.9% vs 10.9% - 7.6%). CONCLUSIONS: The lactic acid results in the first 24 hours of the multiple injury patient are associated with mortality and MOF, even when the patient is haemodynamically stable.

Abscesos esplénicos múltiples / Multiple splenic abscesses

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Gastrointestinal stromal tumors: experience in 49 patients.

INTRODUCTION: Gastrointestinal stromal tumours (GIST) are mesenchymal tumours of the digestive tract originated in the interstitial cells of Cajal. They express the tyrosine kinase c-kit (CD117) activity receptor. Mutations in this receptor cause neoplastic development. Curative treatment continues to be radical resection of the tumour and is resistant to commonly employed chemotherapy regimens. Imatinib mesilate is a drug that inhibits c-kit activity expressed by GIST and its activity in these tumours has been demonstrated. MATERIAL AND METHODS: Retrospective study of all cases of leiomyoma, leiomyosarcoma, schwannoma, and stromal or mesenchymal tumors from 1989 to July 2004. C-kit and CD34 proteins were detected at immunohistochemical study in addition to the usual markers for mesenchymal tumours. RESULTS: 49 GISTs were diagnosed, 26 males and 23 females (mean age 64.1). Symptoms were digestive tract bleeding (n = 13), abdominal pain (n = 13), intestinal occlusion (n = 4) and others. The lesion was located in small bowel (n = 22), stomach (n = 19), rectum (n = 3), peritoneum (n = 2), esophagus (n = 1), omentum (n = 1), and retroperitoneum (n = 1). Forty-three of the 49 patients underwent surgery; radical resection was performed in 37 (75.5%) and palliative surgery in the other six (16.2%). Two of the patients that did not undergo surgery received chemotherapy. At the time of study, 28 (57.14%) patients remained alive, 23 (46.9%) of whom were disease- free and five (10.2%) were not. Nineteen (38.7%) patients died. CONCLUSIONS: The results of our series are similar to the others published. Before the year 2001, surgery was the only successful option for the GIST. Surgical resection continues being the best treatment to definitively cure this disease. Imatinib is used to treat not only resectable tumours, but even to allow the possibility to make a subsequent rescue surgery. On the other hand, Imatinib is used in the treatment of the metastatic disease.

Gastrointestinal stromal tumors: experience in 49 patients

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Introduction. Gastrointestinal stromal tumours(GIST) are mesenchymal tumours of the digestivetract originated in the interstitial cells of Cajal. Theyexpress the tyrosine kinase c-kit (CD117) activityreceptor. Mutations in this receptor cause neoplasticdevelopment. Curative treatment continues to beradical resection of the tumour and is resistant tocommonly employed chemotherapy regimens. Imatinibmesilate is a drug that inhibits c-kit activityexpressed by GIST and its activity in these tumourshas been demonstrated.Material and methods. Retrospective study of allcases of leiomyoma, leiomyosarcoma, schwannoma,and stromal or mesenchymal tumors from 1989to July 2004. C-kit and CD34 proteins were detectedat immunohistochemical study in addition to theusual markers for mesenchymal tumours.Results. 49 GISTs were diagnosed, 26 males and 23females (mean age 64.1). Symptoms were digestivetractbleeding (n = 13), abdominal pain (n = 13), intestinalocclusion (n = 4) and others. The lesion waslocated in small bowel (n = 22), stomach (n = 19),rectum (n = 3), peritoneum (n = 2), esophagus (n = 1),omentum (n = 1), and retroperitoneum (n = 1).Forty-three of the 49 patients underwent surgery;radical resection was performed in 37 (75.5%) andpalliative surgery in the other six (16.2%). Two ofthe patients that did not undergo surgery receivedchemotherapy. At the time of study, 28 (57.14%) patientsremained alive, 23 (46.9%) of whom were disease-free and five (10.2%) were not. Nineteen (38.7%)patients died.Conclusions. The results of our series are similar tothe others published. Before the year 2001, surgerywas the only successful option for the GIST. Surgicalresection continues being the best treatmentto definitively cure this disease. Imatinib is used totreat not only resectable tumours, but even to allowthe possibility to make a subsequent rescue surgery.On the other hand, Imatinib is used in the treatmentof the metastatic disease