Influence of rescrubbing before laparotomy closure on abdominal wound infection after colorectal cancer surgery: results of a multicenter randomized clinical trial.

OBJECTIVE: To test the hypothesis that strict asepsis in closing wounds following laparotomy reduces the risk for surgical wound infection in elective colorectal cancer surgery. DESIGN: Multicenter randomized clinical trial conducted from June 1, 2009, through June 1, 2010. SETTINGS: Colorectal surgery units of 9 Spanish hospitals. PATIENTS: A total of 969 patients who underwent elective colorectal cancer surgery were eligible for randomization. In closing the laparotomy wound, the patients were randomized to 2 groups: conventional (n=516) and new operation (n=453). In the conventional group, a new set of instruments was used, surgical staff changed their gloves, and the surgical drapes surrounding the laparotomy were covered by a new set of drapes. The new operation group involved removing all drapes, the surgical staff scrubbed again, and a new set of drapes and instruments was used. MAIN OUTCOME MEASURES: Incisional (superficial and deep) surgical site infection 30 days after the operation and risk factors for postoperative wound infections. RESULTS: A total of 146 incisional surgical site infections (15.1%) were diagnosed. Of these, 96 (9.9%) were superficial and 50 (5.1%) were deep infections. On an intent-to-treat basis, significant differences were found between both groups (66 [12.8%] in the conventional group vs 80 [17.7%] in the new operation group [P=.04]). CONCLUSION: This study does not support the use of rescrubbing to reduce the incidence of incisional surgical site infection. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN19463413

Hiperaldosteronismo primario aislado causado por carcinoma córtico-suprarrenal / Primary aldosteronism arising from adrenocortical carcinoma

OBJETIVOS: Presentar el caso de un varón de 39 años con carcinoma córtico-suprarrenal e hiperaldosteronismo primario como única manifestación endocrina. MÉTODO-RESULTADOS: Tras la evaluación hormonal y radiológica completa, se practicó suprarrenalectomía y nefrectomía derecha (pT2pN0M0, estadio II), normalizándose la tensión arterial y las cifras de potasio y aldosterona. El paciente recibió terapia adyuvante con carboplatino y etopósido. Después de un intervalo libre de enfermedad de 15 meses se diagnosticaron metástasis pulmonares, sin recidiva local hasta 5 meses después, momento en que también reapareció hipertensión arterial e hiperaldosteronismo primario. No hubo otras alteraciones endocrinas. Se instauró tratamiento con espironolactona y 5-FU y adriamicina sin respuesta tumoral y el paciente falleció a los 3 años por complicaciones de metástasis endobronquiales. CONCLUSIONES: El carcinoma suprarrenal con hiperaldosteronismo primario aislado es excepcional por lo que no existe gran experiencia en su diagnóstico y tratamiento. Aunque no existen estudios controlados, en estadios localmente avanzados parece razonable la terapia adyuvante con fármacos, como la combinación de cisplatino y etopósido (VP-16), alternativos al mitotano (o,pDDD), pues aunque puede ser útil cuando existe hipercortisolismo su eficacia como agente antitumoral ha sido más discutida (AU)