[Relation between preoperative prognostic Onodera's Index and postsurgery complications in the R0 gastric carcinoma resection]. / Relación entre el índice de Onodera pre-operatorio y las complicaciones post-cirugía R0 en el cáncer de estómago.

BACKGROUND: It has been postulated in the Asian literature that a low prognostic nutritional index (OI) could be associated with a higher rate of complications following radical gastric cancer surgery, but there is a lack of data concerning western countries. The aim is to analyze the relationship between a low preoperative OI and the frequency and severity of surgical complications in R0 gastric cancer resection. PATIENTS AND METHODS: In the present article, 124 cases of gastric cancer with R0 resection were reviewed. An OI <45 was considered pathologically low. The complication rate was compared between both groups: OI <45 vs OI =45. A multivariate analysis was performed adjusting for: age > 68 years, ASA score, preoperative hemoglobin level <12 g/dL, pTNM stage, administration of neoadyuvant therapy and type of gastrectomy. The relationship between a PNI<45 and the severity of complications graded according to the Clavien-Dindo classification was determined. RESULTS: We registered mild complications in 11.3% of cases, severe complications in 9.7% and a mortality rate of 2.4%. Patients with a OI <45 showed a higher complication rate: 37.7% versus 12.7% [odds ratio (OR) = 4.17; CI95% = (1.71 - 10.20 p = 0.001)], confirmed by multivariate analysis: [OR = 4.17; CI95% = (1.54 - 11.30); p = 0.005]. Patients with OI <45 had more severe complication-exitus: 20.8% versus 5.6% [OR = 4.39; CI95% = (1.31 - 14.68); p = 0.011]. CONCLUSIONS: We confirmed that patients with a low preoperative OI show a higher independent risk of complications after a R0 gastric cancer resection in a western country as well. Complications, in these cases with OI <45, registered a significantly higher severity grade.

Relación entre el índice de Onodera pre-operatorio y las complicaciones post-cirugía R0 en el cáncer de estómago / Relation between preoperative prognostic Onodera’s Index and postsurgery complications in the R0 gastric carcinoma resection

Fundamento: En publicaciones asiáticas se postula que un Índice de Onodera (IO) bajo puede asociarse con una mayor frecuencia de complicaciones post-resección radical del cáncer gástrico, careciendo de resultados en áreas occidentales. En el presente trabajo se analiza la relación entre un IO pre-operatorio bajo con la frecuencia y la gravedad de las complicaciones post-cirugía R0 en el cáncer gástrico. Pacientes y métodos: Se revisaron 124 tumores gástricos con resección R0. Considerando patológicamente bajo un IO <45, estudiamos la frecuencia de complicaciones entre los grupos con IO menor y ≥45. En el análisis multivariante incluimos como variables de ajuste la edad mayor de 68 años, puntuación ASA, hemoglobina pre-operatoria menor de 12 g/dL, estadio pTNM, infiltración serosa, invasión ganglionar y tipo de gastrectomía realizada. Determinamos la relación entre IO <45 y la frecuencia y gravedad de las complicaciones, según la clasificación de Clavien-Dindo modificada. Resultados: Se registraron complicaciones leves en un 11,3%; graves 9,7% y exitus 2,4%. Los pacientes con IO <45 presentaron mayor frecuencia de complicaciones: 37,7% versus 12,7% [ odds ratio (OR) = 4,17; IC 95% = (1,71-10,20); p = 0,001], confirmada en el análisis multivariante: [OR = 4,17; IC 95% = (1,54-11,30); p = 0,005]. Los pacientes con IO <45 tuvieron más complicaciones graves-exitus: 20,8% versus 5,6% [OR = 4,39; IC 95% = (1,31-14,68); p = 0,011]. Conclusiones: También en un país occidental, los pacientes con IO pre-operatorio bajo (<45) muestran un mayor riesgo independiente de presentar complicaciones tras la resección R0 del carcinoma gástrico. Adicionalmente, las complicaciones registradas en los casos con IO <45, muestran una significativa mayor gravedad (AU)

Background: It has been postulated in the Asian literature that a low prognostic nutritional index (OI) could be associated with a higher rate of complications following radical gastric cancer surgery, but there is a lack of data concerning western countries. The aim is to analyze the relationship between a low preoperative OI and the frequency and severity of surgical complications in R0 gastric cancer resection. Patients and methods: In the present article, 124 cases of gastric cancer with R0 resection were reviewed. An OI <45 was considered pathologically low. The complication rate was compared between both groups: OI <45 vs OI ≥45. A multivariate analysis was performed adjusting for: age > 68 years, ASA score, preoperative hemoglobin level <12 g/dL, pTNM stage, administration of neoadyuvant therapy and type of gastrectomy. The relationship between a PNI<45 and the severity of complications graded according to the Clavien-Dindo classification was determined. Results: We registered mild complications in 11.3% of cases, severe complications in 9.7% and a mortality rate of 2.4%. Patients with a OI <45 showed a higher complication rate: 37.7% versus 12.7% [odds ratio (OR) = 4.17; CI95% = (1.71 - 10.20 p = 0.001)], confirmed by multivariate analysis: [OR = 4.17; CI95% = (1.54 - 11.30); p = 0.005]. Patients with OI <45 had more severe complication-exitus: 20.8% versus 5.6% [OR = 4.39; CI95% = (1.31 - 14.68); p = 0.011]. Conclusions: We confirmed that patients with a low preoperative OI show a higher independent risk of complications after a R0 gastric cancer resection in a western country as well. Complications, in these cases with OI <45, registered a significantly higher severity grade (AU)

[Predictive pre-treatment value of the Prognostic Nutritional Index on survival in gastric carcinoma]. / Valor predictivo pre-tratamiento del Índice Pronóstico Nutricional sobre la supervivencia del carcinoma gástrico.

BACKGROUND: The Prognostic Nutritional Index (PNI) combines the values of circulating lymphocytes and serum albumin and, in the Asian literature; it has been related with the prognosis following R0 resection of gastric cancer. No results are available in Western countries. We study the possible independent prognostic value, at the moment of the tumour's diagnosis, of PNI on survival. PATIENTS AND METHODS: We review 234 consecutive gastric carcinomas, calculating global survival and tumour-specific survival. We considered pre-treatment PNI values of < 40 to be pathological. We carried out a univariate and multivariate analysis of cases of survival according to PNI, including the following adjustment variables: age > 70 years, ASA anaesthetic at the time of diagnosis, size of the neoplasia > 5cm, macroscopic type, undifferentiated degree and TNM clinical stage through echoendoscopy and/or CAT. RESULTS: The univariate analysis registered greater global and specific survival in cases with PNI ≥ 40 versus PNI < 40: [HR = 2.28; CI 95% = (1.60-3.26); p< 0.001] and [HR = 2.35; CI 95% = (1.63-3.39); p< 0.001], respectively. The multivariate analysis confirmed a better independent prognosis in cases with OI ≥ 40: global survival: [HR = 1.48; CI 95% = (1.02-2.16); p = 0.040], specific survival: [HR = 1.51; CI 95% = (1.03-2.23); p = 0.036]. CONCLUSIONS: At the moment of diagnosis of gastric cancer and including all registered cases, a PNI ≥ 40 is accompanied by a signifi-cantly greater global and tumour-specific survival. In our series, this better prognosis is independent of the patient's age group, his/her ASA classification, the size and degree of differentiation of the neoplasia and its TNM clinical stage.

Valor predictivo pre-tratamiento del Índice Pronóstico Nutricional sobre la supervivencia del carcinoma gástrico / Predictive pre-treatment value of the Prognostic Nutritional Index on survival in gastric carcinoma

Fundamento: El Índice Pronóstico nutricional (IPN) combina los valores de los linfocitos circulantes y la albúmina sérica y, en la literatura asiática, se le ha relacionado con el pronóstico tras la resección R0 del cáncer gástrico, sin disponer de resultados en países occidentales. Estudiamos, en el momento del diagnóstico del tumor, el posible valor pronóstico independiente del IPN, sobre la supervivencia. Pacientes y Métodos: Revisamos 234 carcinomas gástricos consecutivos, determinando la supervivencia global y la específica por el tumor. Consideramos patológicos los valores del IPN pre-tratamiento < 40. Realizamos un análisis univariante y multivariante de las supervivencias según el IPN, incluyendo las siguientes variables de ajuste: edad > 70 años, ASA anestésico al diagnóstico, tamaño de la neoplasia > 5 cm, tipo macroscópico infiltrante, grado indiferenciado y estadificación clínica TNM mediante ecoendoscopia y/o TAC. Resultados: El análisis univariante registró una mayor supervivencia global y específica en los casos con IPN ≥ 40 versus IPN < 40: [HR = 2,28; IC 95% = (1,60-3,26); p< 0,001] y [HR = 2,35; IC 95% = (1,63-3,39); p< 0,001], respectivamente. El análisis multivariante confirmó un mejor pronóstico independiente en los casos con IO ≥ 40: supervivencia global: [HR = 1,48; IC 95% = (1,02-2,16); p = 0,040], supervivencia específica: [HR = 1,51; IC 95% = (1,03-2,23); p = 0,036]. Conclusiones: En el momento del diagnóstico del cáncer gástrico e incluyendo la totalidad de los casos registrados, un IPN ≥ 40 se acompaña de una supervivencia global y específica por el tumor significativamente mayor. En nuestra serie, este mejor pronóstico es independiente del grupo de edad del paciente, de su clasificación ASA, del tamaño y grado de diferenciación de la neoplasia y de su estadificación clínica TN (AU)

Background: The Prognostic Nutritional Index (PNI) combines the values of circulating lymphocytes and serum albumin and, in the Asian literature; it has been related with the prognosis following R0 resection of gastric cancer. No results are available in Western countries. We study the possible independent prognostic value, at the moment of the tumour's diagnosis, of PNI on survival. Patients and methods: We review 234 consecutive gastric carcinomas, calculating global survival and tumour-specific survival. We considered pre-treatment PNI values of < 40 to be pathological. We carried out a univariate and multivariate analysis of cases of survival according to PNI, including the following adjustment variables: age > 70 years, ASA anaesthetic at the time of diagnosis, size of the neoplasia > 5cm, macroscopic type, undifferentiated degree and TNM clinical stage through echoendoscopy and/or CAT. Results: The univariate analysis registered greater global and specific survival in cases with PNI ≥ 40 versus PNI < 40: [HR = 2.28; CI 95% = (1.60-3.26); p< 0.001] and [HR = 2.35; CI 95% = (1.63-3.39); p< 0.001], respectively. The multivariate analysis confirmed a better independent prognosis in cases with OI ≥ 40: global survival: [HR = 1.48; CI 95% = (1.02-2.16); p = 0.040], specific survival: [HR = 1.51; CI 95% = (1.03-2.23); p = 0.036]. Conclusions: At the moment of diagnosis of gastric cancer and including all registered cases, a PNI ≥ 40 is accompanied by a significantly greater global and tumour-specific survival. In our series, this better prognosis is independent of the patient's age group, his/her ASA classification, the size and degree of differentiation of the neoplasia and its TNM clinical stage (AU)

[Prognostic value of Onodera's index in colorectal cancer survival]. / Valor pronóstico del índice de Onodera en la supervivencia del cáncer colorrectal.

BACKGROUND: Onodera's prognostic nutritional index (OPNI), which is calculated using total lymphocyte count and serum albumin level, has been used as a marker of nutritional status, with its potential prognostic value in colorectal cancer having recently been postulated in Japan and China. There is still no data on the predictive value of OPNI in a Western population. PATIENTS AND METHODS: A consecutive case series of 207 patients scheduled for colorectal cancer resection with curative intent was reviewed. Pre-treatment OPNI was calculated using the formula: [10 x serum albumin (g/dl) + 0.005 x lymphocytes/mm²]. OPNI values under 40 were considered low. Univariate and multivariate analysis were performed on survival curves, comparing cases with OPNI values less than, equal to or greater than 40 (Cox model, stepwise), in the overall series and in pTNM stage II. RESULTS: The median for clinical follow-up was 81 months (interquartile range 60-96). Twenty-six patients (12.6%) had a low OPNI (≤ 40). In the multivariate analysis, patients with low OPNI showed less favourable survival curves, both in the overall series: [p <0.001; HR = 3.16; 95% CI = 1.67-5.94] and in the 78 cases in pTNM stage II: [p <0.004; HR = 4.36; 95% CI = 1.61-11.76]. CONCLUSIONS: A low pre-treatment OPNI (<40) has an independent, unfavourable predictive value on survival in European patients with resected colorectal cancer, both in the overall series and in pTNM stage II.

Valor pronóstico del índice de Onodera en la supervivencia del cáncer colorrectal / Prognostic value of Onodera’s index in colorectal cancer survival

Fundamento: El índice de Onodera (IO) combina los valores de los linfocitos circulantes y de la albúmina sérica y se ha utilizado como marcador del estado nutricional, postulándose recientemente en Japón y China su posible valor pronóstico en el cáncer colorrectal. Todavía no disponemos de datos sobre el valor predictivo del IO en una población occidental. Pacientes y métodos: Se revisaron 207 cánceres colorrectales resecados programada y consecutivamente, con intención curativa. Se calculó el IO pre-tratamiento mediante la fórmula: [10 x albúmina sérica (g/dl) + 0,005 x cifra de linfocitos circulantes/mm²]. Consideramos bajos los valores de IO menores de 40. Se efectuó un análisis univariable y multivariable de las curvas de supervivencia entre los casos con valores de IO menores, iguales o mayores de 40 (modelo de Cox, stepwise), todo ello en la serie global y en el estadio pTNM II. Resultados: El seguimiento clínico tuvo una mediana de 81 meses (rango intercuartílico 60-96). Veintiséis pacientes (12,6%) presentaron un IO bajo (≤ 40). En el análisis multivariable, los pacientes con IO bajo mostraron unas curvas de supervivencia más desfavorables, tanto en la serie global: [p < 0,001; HR = 3,16; IC 95% = 1,67-5,94)] como en los 78 casos en estadio pTNM II: [p < 0,004; HR = 4,36; IC 95% = 1,61-11,76)]. Conclusiones: También en pacientes europeos, un índice de Onodera pre-tratamiento bajo (< 40) tiene un valor predictivo independiente y desfavorable sobre la supervivencia en el cáncer colorrectal resecado, tanto en la serie global como en el estadio pTNM II (AU)

Background: Onodera's prognostic nutritional index (OPNI), which is calculated using total lymphocyte count and serum albumin level, has been used as a marker of nutritional status, with its potential prognostic value in colorectal cancer having recently been postulated in Japan and China. There is still no data on the predictive value of OPNI in a Western population. Patients and methods: A consecutive case series of 207 patients scheduled for colorectal cancer resection with curative intent was reviewed. Pre-treatment OPNI was calculated using the formula: [10 x serum albumin (g/dl) + 0.005 x lymphocytes/mm²]. OPNI values under 40 were considered low. Univariate and multivariate analysis were performed on survival curves, comparing cases with OPNI values less than, equal to or greater than 40 (Cox model, stepwise), in the overall series and in pTNM stage II. Results: The median for clinical follow-up was 81 months (interquartile range 60-96). Twenty-six patients (12.6%) had a low OPNI (≤ 40). In the multivariate analysis, patients with low OPNI showed less favourable survival curves, both in the overall series: [p <0.001; HR = 3.16; 95% CI = 1.67-5.94] and in the 78 cases in pTNM stage II: [p <0.004; HR = 4.36; 95% CI = 1.61-11.76]. Conclusions: A low pre-treatment OPNI (<40) has an independent, unfavourable predictive value on survival in European patients with resected colorectal cancer, both in the overall series and in pTNM stage II (AU)

Endoscopic localization of colorectal cancer: study of its accuracy and possible error factors.

INTRODUCTION: accurate preoperative localization of colorectal cancer (CRC) is very important, with a wide range of published error rates. AIMS: to determine accuracy of endoscopic localization of CRC in comparison with preoperative computed tomography (CT). To analyse variables that could be associated with a wrong endoscopic localization. PATIENTS AND METHODS: endoscopic and CT localization of a series of CRC without previous surgery were reviewed. We studied the concordance between endoscopic and radiologic localization against operative findings comparing accuracy of endoscopy and CT. We analysed the frequency of wrong endoscopic diagnoses with regard to a series of patient, endoscopy and tumor variables. RESULTS: two hundred thirty seven CRC in 223 patients were studied. Concordance with surgical localization was: colonoscopy = 0.87 and CT = 0.69. Endoscopic localization accuracy was:91.1%; CT: 76.2%: p = 0.00001; OR = 3.22 (1.82-5.72). Obstructive cancer presented a higher rate of wrong localization: 18 vs. 5.7% in non-obstructive tumors (p = 0.0034; OR = 3.65 (1.35-9.96). Endoscopic localization mistakes varied depending on tumor location, being more frequent in descending colon: 36.3%, p = 0.014; OR = 6.23 (1.38-26.87) and cecum: 23.1%, p = 0.007; OR = 3.92 (1.20-12.43). CONCLUSIONS: endoscopic accuracy for CRC localization was very high and significantly better than CT accuracy. Obstructive tumor and those located in the descending colon or cecum wereassociated with a significant increase of the error risk of CRC endoscopic localization.

Expresión tisular de proteínas reparadoras e infiltración linfocítica tumoral: significado pronóstico en el carcinoma colorrectal resecado / Tissular expression of mismatch repair proteins and tumour lymphocytic infiltration: prognostic significance in resected colorectal carcinoma

Fundamento. En el cáncer colorrectal se discute la posible relación entre la expresión patológica de proteínas reparadoras (EPPR) y la infiltración linfocítica tumoral (ILT), así como el posible efecto pronóstico de ambos factores. Material y métodos. Se han revisado 243 cánceres colorrectales, resecados consecutivamente. Estudiamos inmunohistoquímicamente la EPPR de MLH1, MSH2 y MSH6. La ITL se valoró mediante la tinción de CD3 en el epitelio tumoral. Comparamos la mortalidad y progresión tumoral post-operatoria entre los casos con y sin EPPR y con y sin ITL. Adicionalmente estudiamos la mortalidad y progresión tumoral entre los casos EPPR (+), según presentaran o no ITL. Resultados. El 13,6% tumores expresaron EPPR (+) y el25,5% ITL (+). El seguimiento fue: 73,8±34,6 meses. La frecuencia de ITL (+) resultó similar entre tumores EPPR (+):27,3% y EPPR (-): 25,2% (p = 0,80). Los casos EPPR (+) mostraron menor mortalidad: 12,1% versus 23,3% (p = 0,15) y menor progresión tumoral: 21,2% versus 29% (p = 0,35). Las neoplasias ITL (+) tuvieron menor mortalidad: 9,7% versus26% [p = 0,007; OR = 3,27(1,25-9,05)] y progresión tumoral: 12,9% versus 33,1% [p = 0,002; OR = 3,35 (1,42-8,15)]. Los 9 tumores EPPR (+) e ILT (+) no presentaron mortalidad ni progresión tumoral, frente a una mortalidad: 16,7% y progresión: 29,2% de los 24 casos EPPR (+) e ITL (-) p = 0,19 y p= 0,07 respectivamente. Conclusiones. No se ha encontrado relación entre EPPR e ITL, con tasas muy similares de ILT (+) entre casos con y sin EPPR. La ILT (+) mostró un efecto pronóstico favorable superior a la EPPR (+). La combinación de ILT (+) e EPPR (+) parece tener un efecto protector acumulativo, aunque su escasa frecuencia resta significación al hallazgo(AU)

Background. In colorectal cancer there is discussion about the possible relation between the mismatch repair protein expression (MMRPE) and tumour lymphocytic infiltration(TLI), as well as the possible prognostic effect of both factors. Methods. A review was made of 243 colorectal cancers, consecutively resected. We made an immunohystochemical study of the MMRPE of MLH1, MSH2 and MSH6. The TLI was evaluated through CD3 staining in the tumoural epithelium. We compared mortality and post-operative tumoural progression amongst the cases with and without MMRPE and with and without TLI. Additionally, we studied mortality and tumoural progression amongst MMRPE (+) cases, according to whether or not they presented TLI. Results. Thirteen point six percent of the tumours expressed MMRPE (+) and 25.5% TLI (+). The follow-up was: 73.8±34.6 months. The frequency of TLI (+) turned out to be similar between MMRPE (+) tumours: 27.3% and MMRPE (-): 25.2% (p = 0.80). The MMRPE (+) cases showed less mortality: 12.1%versus 23.3% (p = 0.15) and less tumoural progression: 21.2%versus 29% (p = 0.35). The ITL neoplasias (+) had a lower mortality: 9.7% versus 26% [p = 0.007; OR = 3.27(1.25-9.05)]and tumoural progression: 12.9% versus 33.1% [p = 0.002; OR = 3.35 (1.42-8.15)]. The 9 MMRPE (+) and ILT (+) tumours did not present mortality or tumoural progression, against a mortality: 16.7% and progression: 29.2% of the 24 MMRPE (+) and TLI (-) cases p = 0.19 and p = 0.07 respectively. Conclusions. No relation was found between MMRPE and TLI, with very similar rates of TLI (+) between cases with and without MMRPE. The TLI (+) showed a favourable prognostic effect higher than that of the MMRPE (+). The combination of TLI (+) and MMRPE (+) seems to have an accumulative protective effect, although its limited frequency reduces the significance of the finding(AU)

Long-term follow-up of 1,000 patients cured of Helicobacter pylori infection following an episode of peptic ulcer bleeding.

OBJECTIVES: To evaluate the effect of Helicobacter pylori (H. pylori) eradication on ulcer bleeding recurrence in a prospective, long-term study including 1,000 patients. METHODS: Patients with peptic ulcer bleeding were prospectively included. Prior non-steroidal anti-inflammatory drug (NSAID) use was not considered exclusion criteria. H. pylori infection was confirmed by rapid urease test, histology, or (13)C-urea breath test. Several eradication therapies were used. Subsequently, ranitidine 150 mg o.d. was administered until eradication was confirmed by (13)C-urea breath test 8 weeks after completing therapy. Patients with therapy failure received a second, third, or fourth course of eradication therapy. Patients with eradication success did not receive maintenance anti-ulcer therapy and were controlled yearly with a repeat breath test. NSAID use was not permitted during follow-up. RESULTS: Thousand patients were followed up for at least 12 months, with a total of 3,253 patient-years of follow-up. Mean age 56 years, 75% males, 41% previous NSAID users. In all, 69% had duodenal ulcer, 27% gastric ulcer, and 4% pyloric ulcer. Recurrence of bleeding was demonstrated in three patients at 1 year (which occurred after NSAID use in two cases, and after H. pylori reinfection in another one), and in two more patients at 2 years (one after NSAID use and another after H. pylori reinfection). The cumulative incidence of rebleeding was 0.5% (95% confidence interval, 0.16-1.16%), and the incidence rate of rebleeding was 0.15% (0.05-0.36%) per patient-year of follow up. CONCLUSION: Peptic ulcer rebleeding virtually does not occur in patients with complicated ulcers after H. pylori eradication. Maintenance anti-ulcer (antisecretory) therapy is not necessary if eradication is achieved. However, NSAID intake or H. pylori reinfection may exceptionally cause rebleeding in H. pylori-eradicated patients.

[Tissue expression of mismatch repair proteins and tumor lymphocytic infiltration: prognostic significance in resected colorectal carcinoma]. / Expresión tisular de proteínas reparadoras e infiltración linfocítica tumoral: significado pronóstico en el carcinoma colorrectal resecado.

BACKGROUND: In colorectal cancer there is discussion about the possible relation between the mismatch repair protein expression (MMRPE) and tumour lymphocytic infiltration (TLI), as well as the possible prognostic effect of both factors. METHODS: A review was made of 243 colorectal cancers, consecutively resected. We made an immunohystochemical study of the MMRPE of MLH1, MSH2 and MSH6. The TLI was evaluated through CD3 staining in the tumoural epithelium. We compared mortality and post-operative tumoural progression amongst the cases with and without MMRPE and with and without TLI. Additionally, we studied mortality and tumoural progression amongst MMRPE (+) cases, according to whether or not they presented TLI. RESULTS: Thirteen point six percent of the tumours expressed MMRPE (+) and 25.5% TLI (+). The follow-up was: 73.8±34.6 months. The frequency of TLI (+) turned out to be similar between MMRPE (+) tumours: 27.3% and MMRPE (-): 25.2% (p = 0.80). The MMRPE (+) cases showed less mortality: 12.1% versus 23.3% (p = 0.15) and less tumoural progression: 21.2% versus 29% (p = 0.35). The ITL neoplasias (+) had a lower mortality: 9.7% versus 26% [p = 0.007; OR = 3.27(1.25-9.05)] and tumoural progression: 12.9% versus 33.1% [p = 0.002; OR = 3.35 (1.42-8.15)]. The 9 MMRPE (+) and ILT (+) tumours did not present mortality or tumoural progression, against a mortality: 16.7% and progression: 29.2% of the 24 MMRPE (+) and TLI (-) cases p = 0.19 and p = 0.07 respectively. CONCLUSIONS: No relation was found between MMRPE and TLI, with very similar rates of TLI (+) between cases with and without MMRPE. The LTI (+) showed a favourable prognostic effect higher than that of the MMRPE (+). The combination of LTI (+) and MMRPE (+) seems to have an accumulative protective effect, although its limited frequency reduces the significance of the finding.

Estudio de las lesiones neoplásicas metacrónicas en el carcinoma colorrectal / Study of colorectal metachronous neoplastic lesions

Fundamento. Analizar la frecuencia y las características delas lesiones neoplásicas metacrónicas, carcinomas y adenomas,tras la resección de un cáncer colo-rectal (CCR).Pacientes y métodos. Revisamos 382 CCR operados y seguidosmediante colonoscopias completas en dos hospitalesde nuestra comunidad. Analizamos las lesiones metacrónicasregistradas valorando su localización, momento deldiagnóstico, histología, número y tamaño. Estudiamos lafrecuencia de adenomas de aparición precoz (12 meses),comparando su tamaño con respecto al resto de lesiones.Resultados. La mediana de seguimiento fue de 48 meses (12-112), con 2,74±1,47 colonoscopias/caso. Diagnosticamos 7cánceres metacrónicos (1,8%), 4 de ellos en estadio I. La medianade tiempo hasta su diagnóstico fue de 24 meses (13-54).Registramos adenomas metacrónicos en 162 casos (42,4%),sin diferencias entre los dos hospitales: 42,1% vs. 43,8%(p=0,88). Un 6,3% de los pacientes presentaron adenomasavanzados. En 164 casos en que el primer control se efectuó alos 12 meses, la incidencia de adenomas fue del 24%. Los adenomasfueron mayoritariamente únicos (60,8%) y menores de5 mm (68,5%). En un 55,5% de los casos con pólipos, algunotenía una localización proximal. El diagnóstico se realizó enla 1ª exploración (56,2%), 2ª (27,8%) ó 3ª (9%). La mediana detiempo hasta el diagnóstico fue de 21 meses (12-112) para eladenoma simple y de 35 (12-112) para el avanzado.Conclusiones. Nuestro seguimiento permitió aplicar untratamiento teóricamente curativo en la mayoría de los carcinomasmetacrónicos diagnosticados. La alta incidenciade adenomas y su frecuente localización proximal hacennecesario un seguimiento con colonoscopias completas,que debería iniciarse al año de la operación y podría pasara ser menos estricto tras tres exploraciones consecutivassin pólipos(AU)

Background. To analyse the frequency and characteristicsof metachronous neoplastic lesions, carcinomas and adenomas,following resection of colorectal cancer.Patients and methods. We reviewed 382 patients subjectedto CCR operations and followed up through completecolonoscopies in two hospitals in our province. We analysedthe metachronous lesions registered, evaluating theirlocalisation, time of diagnosis, histology, number and size.We studied the frequency of early adenomas (12 months),comparing their size with the rest of the lesions.Results. The average follow-up was 48 months (12-112), with2.74±1.47 colonoscopies/case. We diagnosed 7 metachronouscancers (1.8%), 4 of them in stage I. The average time untiltheir diagnosis was 24 months (13-54). We registered metachronousadenomas in 162 cases (42.4%), without differencesbetween the two hospitals: 42.1% vs. 43.8% (p=0.88). Six pointthree percent of the patients presented advanced adenomas.In 164 cases where the control was carried out after 12 months,the incidence of adenomas was 24%. In the majority ofcases, the adenomas were sole (60.8%) and smaller than 5mm (68.5%). In 55.5% of the cases with polyps, some had aproximal localisation. Diagnosis was made on the 1st exploration(56.2%), the 2nd (27.8%) or the 3rd (9%). Average time untildiagnosis was 21 months (12-112) for simple adenoma and 35(12-112) for advanced adenoma.Conclusions. Our follow up made it possible to apply atheoretically curative treatment in the majority of the metachronouscarcinomas diagnosed. The high incidence ofadenomas and the frequent proximal localisation make afollow up with complete colonoscopies necessary, whichmust be started one year after the surgery and can becomeless strict following three consecutive explorations withoutpolyps(AU)

[Incidence and characteristics of eosinophilic esophagitis in adults]. / Incidencia y características de la esofagitis eosinofílica (EE) en adultos.

Eosinophilic esophagitis (EE) is a disease characterised by the infiltration of esophageal mucous by eosinophils, whose incidence in adults seems to have been increasing in recent years, in a way that is similar to what is occurring with other diseases of a probable immunoallergic aetiology. It predominates in young adults and is mainly expressed by dysphagia and esophageal food impactation. Treatment is based on eliminating the allergen that is potentially involved and the administration of corticoids. This article offers a retrospective review of EE cases diagnosed in the Hospital de Navarra between January 2002 and August 2008, with 25 patients found, which represents an incidence of 2.13 cases/105 inhabitants/year. Seventy-two percent of our patients showed dysphagia and 52% a history of food bolus impaction, with endoscopic alterations found in 23 of the 25 cases. Out of 24 patients studied, 76% showed an alimentary allergy or neumoallergens, which supports the immunoallergic basis of the disease and the need for an allergy exam in all patients with EE. The majority of our patients (22 out of 24 evaluated) presented a good clinical response to treatment, which was based on avoiding exposure to the potentially involved allergen and/or the administration of corticoids (topical or systemic) and/or the administration of proton pump inhibitors.

Incidencia y características de la esofagitis eosinofílica (EE) en adultos / Incidence and characteristics of eosinophilic esophagitis in adults

La esofagitis eosinofílica (EE) es una enfermedadcaracterizada por la infiltración de la mucosa del esófagopor eosinófilos, cuya incidencia en adultos pareceestar aumentando en los últimos años, de forma similara lo que ocurre en otras enfermedades de probable etiologíainmunoalérgica. Predomina en varones jóvenes yse manifiesta principalmente por disfagia e impactaciónalimentaria. Su tratamiento se basa en eliminar elalérgeno potencialmente implicado y la administraciónde corticoides.En el presente trabajo se revisan retrospectivamentelos casos de EE diagnosticados en el Hospital de Navarraentre enero de 2002 y agosto de 2008, encontrándose25 pacientes, lo que supone una incidencia de 2,13casos/105 habitantes/año. Un 72% de nuestros pacientespresentaban disfagia y un 52% historia de impactacióndel bolo alimentario, encontrándose alteracionesendoscópicas en 23 de los 25 casos. De 24 pacientesestudiados, un 76% manifestaban alergia alimentariao a neumoalérgenos, lo que apoya el fondo inmunoalérgicode la enfermedad y la necesidad de un estudioalergológico en todos las pacientes con EE. La mayoríade nuestros pacientes (22 de 24 valorados) presentaronbuena respuesta clínica al tratamiento, que se basó enevitar la exposición al alergeno potencialmente implicadoy/o la administración de corticoides (tópicos osistémicos) y/o la administración de inhibidores de la bomba de protones(AU)

Eosinophilic esophagitis (EE) is a disease characterisedby the infiltration of esophageal mucosa by eosinophils,whose incidence in adults seems to have beenincreasing in recent years, in a way that is similar towhat is occurring with other diseases of a probable immunoallergicaetiology. It predominates in young adultsand is mainly expressed by dysphagia and esophagealfood impactation. Treatment is based on eliminatingthe allergen that is potentially involved and the administrationof corticoids.This article offers a retrospective review of EEcases diagnosed in the Hospital de Navarra betweenJanuary 2002 and August 2008, with 25 patients found,which represents an incidence of 2.13 cases/105 inhabitants/year. Seventy-two percent of our patients showeddysphagia and 52% a history of food bolus impaction,with endoscopic alterations found in 23 of the 25 cases.Out of 24 patients studied, 76% showed an alimentaryallergy or to neumoallergens, which supports the immunoallergicbasis of the disease and the need for anallergy exam in all patients with EE. The majority of ourpatients (22 out of 24 evaluated) presented a good clinicalresponse to treatment, which was based on avoidingexposure to the potentially involved allergen and/or theadministration of corticoids (topical or systemic) and/or the administration of proton pump inhibitors(AU)

[Study of colorectal metachronous neoplastic lesions]. / Estudio de las lesiones neoplásicas metacrónicas en el carcinoma colorrectal.

BACKGROUND: To analyse the frequency and characteristics of metachronous neoplastic lesions, carcinomas and adenomas, following resection of colorectal cancer. PATIENTS AND METHODS: We reviewed 382 patients subjected to RCC operations and followed up through complete colonoscopies in two hospitals in our province. We analysed the metachronous lesions registered, evaluating their localisation, time of diagnosis, histology, number and size. We studied the frequency of early adenomas (12 months), comparing their size with the rest of the lesions. RESULTS: The average follow-up was 48 months (12-112), with 2.74+/-1.47 colonoscopies/case. We diagnosed 7 metachronous cancers (1.8%), 4 of them in stage I. The average time until their diagnosis was 24 months (13-54). We registered metachronous adenomas in 162 cases (42.4%), without differences between the two hospitals: 42.1% vs. 43.8% (p=0.88). Six point three percent of the patients presented advanced adenomas. In 164 cases where the control was carried out after 12 months, the incidence of adenomas was 24%. In the majority of cases, the adenomas were sole (60.8%) and smaller than 5 mm (68.5%). In 55.5% of the cases with polyps, some had a proximal localisation. Diagnosis was made on the 1st exploration (56.2%), the 2nd (27.8%) or the 3rd (9%). Average time until diagnosis was 21 months (12-112) for simple adenoma and 35 (12-112) for advanced adenoma. CONCLUSIONS: Our follow up made it possible to apply a theoretically curative treatment in the majority of the metachronous carcinomas diagnosed. The high incidence of adenomas and the frequent proximal localisation make a follow up with complete colonoscopies necessary, which must be started one year after the operation and can become less strict following three consecutive explorations without polyps.

[Study of frequency, distribution and diagnostic performance in synchronic neoplastic lesions of colorectal carcinoma]. / Estudio de la frecuencia, distribución y rendimiento diagnóstico en las lesiones neoplásicas sincrónicas del carcinoma colo-rectal.

AIM: To analyse the frequency, characteristics and diagnosis of synchronic neoplastic lesions in colorectal cancer. METHODS: A review was carried out of 384 colorectal cancers, diagnosed through complete colonoscopy and resected. The synchronic cancers and the characteristics of the adenomas were determined: number, size, histological type, dysplasia, as well as their localisation in the colon and with respect to the carcinoma. RESULTS: Twenty-eight synchronic cancers were found (7.3% of the total); 8 developed tumours and 20 malignant polyps. In 54.4% of the cases there was a synchronic adenoma. In patients with synchronic lesions, 43% showed an advanced adenoma. Twenty percent of the synchronic polyps found were proximal to the splenic flexure; 41% were distal and 38% had both localisations. Fifty-nine point one percent of the patients had some adenoma proximal to the cancer, with criteria of advanced adenoma in 13.9%. The distribution of the adenomas was more uniformly spread in the cancers with a proximal localisation (p = 0.038). Seventeen percent of the distal cancers presented synchronic lesions with a proximal colon localisation exclusively. Partial endoscopies would diagnose the distal cancers, but would omit a synchronic adenoma in 42.3% of the sigmoidoscopies and 40% of the short colonoscopies. CONCLUSIONS: High rates of carcinoma and synchronic adenomas were registered. We underline the high index of advanced adenomas and the frequency of synchronic lesions proximal to the cancer, which is why incomplete colonoscopies, although allowing the diagnosis of the distal cancer, omit a high percentage of synchronic adenomas, including advanced lesions. All of this confirms the need to perform a complete pre-, intra- and post operational colonoscopy in resectable colorectal cancer.

[Synchronous neoplastic lesions in colorectal cancer. An analysis of possible risk factors favouring presentation]. / Lesiones neoplásicas sincrónicas en el cáncer colorectal. Análisis de posibles factores que favorezcan su presentación.

AIM: few data have been published regarding the causes of synchronous lesions in patients with colorectal cancer. The aim of our study was to identify potential factors that might be implicated in the development of multicentric lesions, since this knowledge could be useful for tailored follow-up once initial synchronous lesions have been removed. METHODS: we retrospectively reviewed 382 colorectal cancer cases diagnosed by total colonoscopy and histological study of surgical specimens. We divided our population into 2 groups, based on whether they had synchronous lesions or otherwise. Several data related to personal and family history, habits, symptoms, and tumor characteristics were assessed. Univariate and multivariate statistical analyses were performed. RESULTS: 208 (54.5%) patients had synchronous adenomas and 28 (7.3%) had synchronous cancer. A multivariate analysis showed that the following parameters were consistently related to the presence of multicentric lesions--male gender: OR = 1.97; CI = 1.13-3.45; p = 0.017; age = 59 years: OR = 2.57; CI = 1.54-4.29; p < 0.001; personal history of colonic adenomas: OR = 3.04; CI = 1.04-8.85; p = 0.042; and obstructive tumors: OR = 0.48; CI = 0.27-0.85; p = 0.012. CONCLUSION: our results show that several parameters that are easy to measure could be considered risk factors for the development of multicentric lesions. These factors need to be confirmed with follow-up studies analyzing their role in patients with and without metachronic lesions once all synchronous lesions have been removed.

Estudio de la frecuencia, distribución y rendimiento diagnóstico en las lesiones neoplásicas sincrónicas del carcinoma colo-rectal / Study of frequency, distribution and diagnostic performance in synchronic neoplastic lesions of colorectal carcinoma

Objetivo: Analizar la frecuencia, características y el diagnóstico de las lesiones neoplásicas sincrónicas en el cáncer colo-rectal. Material y métodos: Se han revisado 384 cánceres colorectales, diagnosticados mediante colonoscopia completa y resecados. Se ha determinado los cánceres sincrónicos y las características de los adenomas: número, tamaño, tipo histológico,displasia, así como su localización en el colon y respecto al carcinoma. Resultados: Se han encontrado 28 cánceres sincrónicos (7,3% del global): 8 tumores desarrollados y 20 pólipos malignizados. El 54,4% de los casos tenía algún adenoma sincrónico. En los pacientes con lesiones sincrónicas, un 43% presentaba un adenoma avanzado. El 20% de los pólipos sincrónicos encontrados fueron proximales al ángulo esplénico; distales el 41% y con ambas localizaciones el 38%. El 59,1% de los pacientes tenía algún adenoma proximal con respecto al cáncer, con criterios de adenoma avanzado en el 13,9%. La distribución de los adenomas estuvo más uniformemente repartida en los cánceres de localización proximal (p = 0,038). Un 17% de los cánceres distales presentó lesiones sincrónicas localizadas exclusivamente en colon proximal. Las endoscopias parciales diagnosticarían los cánceres distales, pero omitirían un adenoma sincrónico en el 42,3% de las sigmoidoscopias y en el 40% de las colonoscopias cortas. Conclusiones: Se registraron unas elevadas tasas de carcinoma y adenomas sincrónicos. Destacamos el alto índice de adenomas avanzados y la frecuencia de lesiones sincrónicas proximales al cáncer, por lo que las colonoscopias incompletas, aunque permitan el diagnóstico del cáncer distal, omiten un alto porcentaje de adenomas sincrónicos, incluyendo lesiones avanzadas. Todo ello confirma la necesidad de efectuar una colonoscopia completa pre, intra o post-quirúrgica en el cáncer colo-rectal resecable (AU)

Aim: To analyse the frequency, characteristics and diagnosis of synchronic neoplastic lesions in colorectal cancer. Methods: A review was carried out of 384 colorectal cancers, diagnosed through complete colonoscopy and resected. The synchronic cancers and the characteristics of the adenomas were determined: number, size, histological type, dysplasia, as well as their localisation in the colon and with respect to the carcinoma. Results: Twenty-eight synchronic cancers were found (7.3% of the total); 8 developed tumours and 20 malignant polyps. In 54.4% of the cases there was a synchronic adenoma. In patients with synchronic lesions, 43% showed an advanced adenoma. Twenty percent of the synchronic polyps found were proximal to the splenic flexure; 41% were distal and 38% had both localisations. Fifty-nine point one percent of the patients had some adenoma proximal to the cancer, with criteria of advanced adenoma in 13.9%. The distribution of the adenomas was more uniformly spread in the cancers with a proximal localisation (p = 0.038). Seventeen percent of the distal cancers presented synchronic lesions with a proximal colon localization exclusively. Partial endoscopies would diagnose the distal cancers, but would omit a synchronic adenoma in 42.3% of the sigmoidoscopies and 40% of the short colonoscopies. Conclusions: High rates of carcinoma and synchronic adenomas were registered. We underline the high index of advanced adenomas and the frequency of synchronic lesions proximal to the cancer, which is why incomplete colonoscopies, although allowing the diagnosis of the distal cancer, omit a high percentage of synchronic adenomas, including advanced lesions. All of this confirms the need to perform a complete pre-, intra- and post operational colonoscopy in resectable colorectal cancer (AU)

[The role of endoscopic ultrasonography in the etiological evaluation of idiopathic acute pancreatitis]. / Papel de la ecoendoscopia en el estudio etiológico de la pancreatitis aguda idiopática.

Up to 30% of patients with acute pancreatitis are diagnosed of idiopathic acute pancreatitis after an initial evaluation including a complete clinical history, physical examination, analysis with calcium and triglycerides determination, and at least one transabdominal ultrasonography. Unexplained pancreatitis represents a diagnostic challenge, although after different explorations a cause is found in the majority of these patients. During the last years endosonography has proved to be a low morbidity exploration very useful in the evaluation of patients with this entity. In this article we review the role of endosonography in the etiologic study of patients with idiopathic acute pancreatitis.

Lesiones neoplásicas sincrónicas en el cáncer colorrectal. Análisis de posibles factores que favorezcan su presentación / No disponible

Objetivo: en el cáncer colorrectal son poco conocidas las causasdel frecuente desarrollo de lesiones neoplásicas sincrónicas.Pretendemos identificar posibles factores que pudieran influir enla multicentricidad lesional. Su conocimiento sería útil para, tras eltratamiento de las lesiones iniciales, optimizar el seguimiento enlos pacientes que los presentaran.Pacientes y métodos: estudiamos retrospectivamente 382cánceres colorrectales diagnosticados mediante colonoscopiacompleta y estudio de la pieza quirúrgica. Comparamos una seriede parámetros referentes a los antecedentes personales y familiares,hábitos, datos clínicos y del tumor entre los grupos con y sinlesiones neoplásicas sincrónicas, mediante análisis estadístico univariabley multivariable.Resultados: doscientos ocho (54,5%) pacientes presentaronadenomas sincrónicos y 28 (7,3%) carcinoma sincrónico. En el análisismultivariable el sexo masculino: OR = 1,97; IC = 1,13-3,45,p = 0,017; la edad superior a 59 años: OR = 2,57; IC = 1,54-4,29,p < 0,001; el antecedente personal de pólipo colónico: OR = 3,04,IC = 1,04-8,85, p = 0,042 y el carácter obstructivo del cáncer:OR = 0,48; IC = 0,27-0,85, p = 0,012 se asocian significativamentecon la multicentricidad lesional.Conclusión: en los enfermos con cáncer colorrectal, nuestroestudio muestra una serie de parámetros, de fácil determinación,que podrían comportarse como factores de riesgo para el desarrollode multicentricidad lesional. Estos factores deberán confirmarsemediante un estudio de seguimiento, analizando su comportamientoentre los pacientes que presenten o no lesionesmetacrónicas tras la limpieza quirúrgico-endoscópica inicial

Aim: few data have been published regarding the causes ofsynchronous lesions in patients with colorectal cancer. The aim ofour study was to identify potential factors that might be implicatedin the development of multicentric lesions, since this knowledgecould be useful for tailored follow-up once initial synchronous lesionshave been removed.Methods: we retrospectively reviewed 382 colorectal cancercases diagnosed by total colonoscopy and histological study ofsurgical specimens. We divided our population into 2 groups,based on whether they had synchronous lesions or otherwise.Several data related to personal and family history, habits, symptoms,and tumor characteristics were assessed. Univariate andmultivariate statistical analyses were performed.Results: 208 (54.5%) patients had synchronous adenomasand 28 (7.3%) had synchronous cancer. A multivariate analysisshowed that the following parameters were consistently relatedto the presence of multicentric lesions –male gender: OR = 1.97;CI = 1.13-3.45; p = 0.017; age >= 59 years: OR = 2.57;CI = 1.54-4.29; p < 0.001; personal history of colonic adenomas:OR = 3.04; CI = 1.04-8.85; p = 0.042; and obstructive tumors:OR = 0.48; CI = 0.27-0.85; p = 0.012 .Conclusion: our results show that several parameters that areeasy to measure could be considered risk factors for the developmentof multicentric lesions. These factors need to be confirmedwith follow-up studies analyzing their role in patients with andwithout metachronic lesions once all synchronous lesions havebeen removed