Aseguramiento en la indicación quirúrgica. Réplica a: causas de conversión en la cirugía laparoscópica de la enfermedad por reflujo gastroesofágico: análisis de nuestra experiencia (1) / No disponible

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[Preoperative workup to assess indication for laparoscopic treatment in gastroesophageal reflux disease].

INTRODUCTION AND OBJECTIVES: antireflux surgery performed by an experienced surgeon is a maintenance option for patients with well-documented gastroesophageal reflux disease (GERD). Well-documented GERD is difficult to find, as GERD is a multifactorial disease in which the gastroesophageal junction, with its special anatomical and functional components, is important. In order to examine patient preoperative workups, and their indication for surgical treatment in GERD, we retrospectively studied patients who underwent a laparoscopic antireflux procedure. METHODS: preoperative workups in patients from our health care area who underwent a laparoscopic antireflux procedure from December 1997 to February 2007 were retrospectively analyzed. Data related to epidemiological findings, symptoms, morphologic and functional evaluation, medical therapy, and indication for surgical treatment were recorded and statistically analyzed by means of a bivariate test. Differences were significant when the p value was equal to or less than 0.05. RESULTS: 100 patients (50 % female, 51.31 +/- 13.53 years of age) underwent a laparoscopic antireflux surgery after 56.47 +/- 61.33 months with symptoms. Ninety-five percent of patients had an anatomical abnormality. The pH monitoring test diagnosed three quarters of cases. The most frequent indication for GERD treatment was persistent or recurrent esophagitis despite adequate medical treatment (52 cases). CONCLUSIONS: based on our preoperative workup, as described, 100 percent of subjects were well documented and diagnosed with GERD (both non-erosive reflux disease and erosive reflux disease), and their indication for laparoscopic treatment was retrospectively assessed in 94% of cases.

Neumoperitoneo con gas intramural en un segmento entérico / No disponible

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Preoperative workup to assess indication for laparoscopic treatment in gastroesophageal reflux disease

Introducción y objetivos: la cirugía antirreflujo realizadapor un cirujano experto es una opción para el tratamiento demantenimiento para el paciente con enfermedad por reflujo gastroesofágico(ERGE) bien documentada. La “buena documentación”de la ERGE es difícil de llevar a cabo, dado que se trata deuna entidad multifactorial, en la que la unión gastroesofágica, consus condiciones tan especiales tanto anatómicas como funcionales,es determinante. Para evaluar preoperatoriamente tanto eldiagnóstico como la indicación quirúrgica de los pacientes quehan sido intervenidos mediante un procedimiento laparoscópicoantirreflujo en nuestro centro, hemos estudiado retrospectivamentesus historiales clínicos.Métodos: se analizaron retrospectivamente los historiales clínicosde los pacientes de nuestra Área Sanitaria sometidos a unprocedimiento laparoscópico antirreflujo desde diciembre de1997 hasta febrero de 2007. Para evaluar el aseguramiento preoperatorioen el diagnóstico y la indicación quirúrgica, se tomaronlos datos epidemiológicos, la sintomatología, las pruebas diagnósticasrealizadas, tanto morfológicas como funcionales, la terapéuticamédica pautada y la indicación quirúrgica recogida en la historiaclínica de cada uno de los pacientes. La información obtenidafue analizada estadísticamente mediante los test bivariantes. Lasdiferencias obtenidas fueron significativas cuando el valor de p resultóigual o menor a 0,05.Resultados: se estudiaron 100 pacientes (50% mujeres, conuna edad media de 51,31 ± 13,53 años) intervenidos mediantecirugía antirreflujo por vía laparoscópica. Su sintomatología previaduró 56,47 ± 61,33 meses. El 95% de los pacientes presentóuna anormalidad anatómica. La monitorización del pH diagnosticóa 3 cuartas partes de ellos. Y la indicación quirúrgica más frecuenteresultó la recurrencia o persistencia de la esofagitis a pesarde un adecuado tratamiento médico (52 casos).Conclusiones: según los datos recogidos retrospectivamenteen sus historiales clínicos, nuestros pacientes tuvieron un diagnósticopreoperatorio bien documentado (incluyendo tanto el reflujono erosivo como el erosivo) en el 100% de los casos y una indicaciónquirúrgica sólidamente fundamentada en el 94% de ellos

Introduction and objectives: antireflux surgery performedby an experienced surgeon is a maintenance option for patientswith well-documented gastroesophageal reflux disease (GERD).Well-documented GERD is difficult to find, as GERD is a multifactorialdisease in which the gastroesophageal junction, with its specialanatomical and functional components, is important. In orderto examine patient preoperative workups, and their indication forsurgical treatment in GERD, we retrospectively studied patientswho underwent a laparoscopic antireflux procedure.Methods: preoperative workups in patients from our healthcare area who underwent a laparoscopic antireflux procedurefrom December 1997 to February 2007 were retrospectivelyanalyzed. Data related to epidemiological findings, symptoms,morphologic and functional evaluation, medical therapy, and indicationfor surgical treatment were recorded and statistically analyzedby means of a bivariate test. Differences were significantwhen the p value was equal to or less than 0.05.Results: 100 patients (50 % female, 51.31 ± 13.53 years ofage) underwent a laparoscopic antireflux surgery after 56.47 ±61.33 months with symptoms. Ninety-five percent of patientshad an anatomical abnormality. The pH monitoring test diagnosedthree quarters of cases. The most frequent indication forGERD treatment was persistent or recurrent esophagitis despiteadequate medical treatment (52 cases).Conclusions: based on our preoperative workup, as described,100 percent of subjects were well documented and diagnosedwith GERD (both non-erosive reflux disease and erosive refluxdisease), and their indication for laparoscopic treatment was retrospectivelyassessed in 94% of cases

[Effect of ursodeoxycholic acid in an experimental colon cancer model]. / Efecto del ácido ursodeoxicólico en un modelo experimental de cáncer de colon.

AIMS: The present study was designed to examine the effect of ursodeoxycholic acid as chemoprotective agent in experimental colon carcinogenesis in rats. MATERIAL AND METHODS: One hundred and ten 10-week-old, Sprague-Dawley rats were divided into five groups: group A (20), no treatment. Group B (20), receiving daily both ursodeoxycholic acid (UDCA) 4 mg/kg of body weight and ethanol 1.23 g/kg of body weight added to the drinking water from the beginning of the study through 24 weeks. Group C (30), receiving 18 weekly doses of dimethylhydrazine (DMH) 21 mg/kg of body weight subcutaneously from the beginning of the study, with the same doses of UDCA and ethanol as in group B. Group D (20), ethylen-diamin-tetracetic acid solution alone for 18 weeks. Group E (20), receiving the same doses of ethanol plus DMH injections as in group C. All experimental animals were sacrificed after 25-27 weeks. RESULTS: No tumors developed in dimethylhydrazine-free groups. No significant differences in number of tumor-free animals, number of tumors per rat, and macro-microscopic tumor findings were seen between animals in group C and animals in group E. CONCLUSIONS: We concluded that such an ursodeoxycholic acid supplementation did not modify colorectal carcinogenesis using a dynamic DMH-induced model in rats.

Efecto del ácido ursodeoxicólico en un modelo experimental de cáncer de colon / Effect of ursodeoxycholic acid in an experimental colon cancer model

Objetivos: analizar si la administración oral del ácido urso -deo xi cólico previene la aparición y desarrollo de carcinogénesiscolónica en ratas.Material y métodos: ciento diez ratas de la raza “Sprague-Dawley” de 10 semanas de vida, de ambos sexos, fueron divididasen 5 grupos: a) 20 ratas control, sin tratamiento; b) 20 ratas, tratadascon ácido ursodeoxicólico (AUDC), a 4 mg/kg/día, juntocon etanol, a 1,23 g/kg peso al día, añadidos al agua de bebida,desde el principio del estudio y durante 24 semanas; c) 30 ratas,18 dosis semanales, de 21 mg/kg peso de dimetilhidracina(DMH) subcutánea, desde el principio del estudio, junto con lasmismas dosis de etanol y AUDC, que en el grupo B; d) 20 ratas,18 dosis semanales subcutáneas de ácido etilen-diamino-tetracético;y e) 20 ratas, tratadas con las mismas dosis de etanol y lasmismas inyecciones de DMH, que el grupo C. El sacrificio de todoslos animales, se llevó a cabo en las semanas 25-27.Resultados: no aparecieron tumores en ausencia de DMH.No se observaron diferencias significativas en el número de ratasque desarrollaron cáncer de colon, ni en el número de neoplasiaspor rata, ni en los hallazgos macro-microscópicos de los tumores,entre los animales del grupo C y del grupo E.Conclusiones: la administración de ácido ursodeoxicólico, enla dosis y tiempo utilizados no modificó la carcinogénesis colónica,usando un modelo dinámico de administración concomitantede inducción tumoral con DMH en ratas

Aims: the present study was designed to examine the effect ofursodeoxycholic acid as chemoprotective agent in experimentalcolon carcinogenesis in rats.Material and methods: one hundred and ten 10-week-old,Sprague-Dawley rats were divided into five groups: group A (20),no treatment. Group B (20), receiving daily both ursodeoxycholicacid (UDCA) 4 mg/kg of body weight and ethanol 1.23 g/kg ofbody weight added to the drinking water from the beginning ofthe study through 24 weeks. Group C (30), receiving 18 weeklydoses of dimethylhydrazine (DMH) 21 mg/kg of body weight subcutaneouslyfrom the beginning of the study, with the same dosesof UDCA and ethanol as in group B. Group D (20), ethylen-diamin-tetracetic acid solution alone for 18 weeks. Group E (20),receiving the same doses of ethanol plus DMH injections as ingroup C. All experimental animals were sacrificed after 25-27weeks.Results: no tumors developed in dimethylhydrazine-freegroups. No significant differences in number of tumor-free animals,number of tumors per rat, and macro-microscopic tumorfindings were seen between animals in group C and animals ingroup E.Conclusions: we concluded that such an ursodeoxycholicacid supplementation did not modify colorectal carcinogenesis usinga dynamic DMH-induced model in rats

Ictericia secundaria a vólvulo del asa aferente del Billroth-II / Jaundice caused by afferent loop volvulus following Billroth-II gastrectomy

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Evidence-based review versus Points of view

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Peliosis esplénica, una entidad poco frecuente / Splenic peliosis: a rare entity

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Effect of defunctionalization on colon carcinogenesis in the rat.

OBJECTIVE: to examine the effect of fecal absence on experimental colon carcinogenesis in both male and female rats. MATERIAL AND METHODS: a total of 138 10-week-old Sprague-Dawley, male and female rats were divided into five groups: A) 20 rats, no treatment; B) 26 rats, colonic defunctionalization; C) 30 rats, 18 weekly doses of dimethylhydrazine (DMH), 21 mg/kg body weight each, from the beginning of the study; D) 20 rats, ethylen-diamine-tetraacetic acid for 18 weeks; and E) 42 rats, same surgical procedure as rats in group B plus DMH injections at the same doses as rats in group C. Animals were sacrificed after 25-27 weeks. Number of tumors, their location, and pathological findings were all compared between groups. RESULTS: no tumors developed in the dimethylhydrazine-free groups. No differences were obtained either in number of tumors or tumors per rat for group C as compared to group E. Fecal absence was associated with smaller-sized tumors (p = 0.007), greater numbers of non-mucinous tumors (p = 0.00009), better differentiation (p = 0.0054), and lesser penetration into the wall (p = 0.015) for group E as compared to group C. In the dimethylhydrazine group, fecal absence altered the number of tumors developing in males as compared to female rats (p = 0.025). Moreover, this fecal absence showed no inhibitory effect on right colonic tumors (p = 0.0065). CONCLUSIONS: fecal absence alters the DMH-carcinogenic pattern in the defunctionalized colon when using an experimental model in both male and female rats.

Efecto de la desfuncionalización colónica en un modelo experimental de cáncer de colon / Effect of defunctionalization on colon carcinogenesis in the rat

Objetivo: examinar el efecto de la ausencia fecal en la aparicióny desarrollo de la carcinogénesis colónica en ratas de ambossexos.Material y métodos: ciento treinta y ocho ratas “Sprague-Dawley” de 10 semanas de vida, de ambos sexos, divididas en5 grupos: A) 20 ratas, sin tratamiento; B) 26 ratas, con una desfuncionalizacióncolónica; C) 30 ratas, 18 dosis semanales de 21mg/kg peso de dimetilhidracina (DMH) desde el principio del estudio;D) 20 ratas, 18 semanas con ácido etilen-diamino-tetracético;y E) 42 ratas, igual técnica quirúrgica que B, y las mismas inyeccionesque C. El sacrificio tuvo lugar a las 25-27 semanas. Se estudióla incidencia de tumores colorrectales, su localización y loshallazgos anátomo-patológicos, comparando entre grupos.Resultados: la ausencia de carcinógeno no desarrolló tumores.No hubo diferencias significativas entre el número total de tumoresinducidos ni en el promedio de tumores por rata entre lasratas C y las E. La ausencia fecal provocó unos tumores de menortamaño (p = 0,007), los cuales presentaron estirpes más glandulares(p = 0,00009), mejor diferenciadas (p = 0,0054) y menos invasivas(p = 0,015). Así mismo, la ausencia fecal modificó tanto elpredominio natural de los machos sobre las hembras para desarrollarun mayor número de tumores colónicos DMH-inducidos(p = 0,025), como el predominio en el colon derecho de los carcinomasmucinosos DMH-inducidos (p = 0,0065).Conclusiones: la desfuncionalización colónica en ratas provocaen los segmentos desfuncionalizados una alteración de lospatrones de la carcinogénesis DMH-inducida

Objective: to examine the effect of fecal absence on experimentalcolon carcinogenesis in both male and female rats.Material and methods: a total of 138 10-week-old Sprague-Dawley, male and female rats were divided into five groups: A) 20rats, no treatment; B) 26 rats, colonic defunctionalization; C) 30rats, 18 weekly doses of dimethylhydrazine (DMH), 21 mg/kgbody weight each, from the beginning of the study; D) 20 rats,ethylen-diamine-tetraacetic acid for 18 weeks; and E) 42 rats,same surgical procedure as rats in group B plus DMH injections atthe same doses as rats in group C. Animals were sacrificed after25-27 weeks. Number of tumors, their location, and pathologicalfindings were all compared between groups.Results: no tumors developed in the dimethylhydrazine-freegroups. No differences were obtained either in number of tumorsor tumors per rat for group C as compared to group E. Fecal absencewas associated with smaller-sized tumors (p = 0.007),greater numbers of non-mucinous tumors (p = 0.00009), betterdifferentiation (p = 0.0054), and lesser penetration into the wall(p = 0.015) for group E as compared to group C. In the dimethylhydrazinegroup, fecal absence altered the number of tumors developingin males as compared to female rats (p = 0.025). Moreover,this fecal absence showed no inhibitory effect on rightcolonic tumors (p = 0.0065).Conclusions: fecal absence alters the DMH-carcinogenic patternin the defunctionalized colon when using an experimentalmodel in both male and female rats