Non-antibiotic treatment of uncomplicated acute diverticulitis is applicable and safe in our environment. A prospective multicenter study

Introduction: acute diverticulitis is one of the most frequent underlying causes behind individuals attending the Emergency Room with abdominal pain. The most widespread therapy for acute uncomplicated diverticulitis includes outpatient treatment with antibiotics; however, several publications indicate that patients can also be successfully treated without antibiotics. The results of the implementation of this more recent protocol in two hospitals in Madrid are presented. Methods: an observational prospective study was performed. Participants were patients diagnosed with uncomplicated acute diverticulitis at two hospitals in Madrid, Hospital Universitario de Torrejón and Hospital Universitario Puerta de Hierro Majadahonda, between December 2018 and August 2021, treated on an outpatient basis without antibiotic therapy. The study group was compared with a control group, composed of patients diagnosed with uncomplicated acute diverticulitis and treated with outpatient antibiotic therapy at Hospital Universitario Puerta de Hierro between March 2015 and March 2018. Results: three hundred and sixty-one patients were included, 182 in the study group and 179 in the control group. Diverticulitis was persistent in 19 patients (10.4 %) in the study group, who were not treated with antibiotics, and in five patients (2.8 %) in the control group, treated with outpatient antibiotic therapy (p = 0.004). Recurrences occurred in 23 patients (12.6 %) in the study group, and in 53 patients (29.6 %) in the control group (p < 0.0001). The analysis of the complications found no significant differences between both groups (p = 0.109). No urgent surgical intervention or mortality was recorded in the study group. Conclusions: in our environment, symptomatic non-antibiotic treatment of uncomplicated acute diverticulitis cases is safe, without showing a higher rate of complications. Although, there seems to be a worse initial symptom control. (AU)

Non-antibiotic treatment of uncomplicated acute diverticulitis is applicable and safe in our environment. A prospective multicenter study.

INTRODUCTION: Acute diverticulitis is one of the most frequent underlying causes behind individuals attending the Emergency Department with abdominal pain. The most widespread therapy for acute uncomplicated diverticulitis includes outpatient treatment with antibiotics; however, several publications indicate that patients can also be successfully treated without antibiotics. The results of the implementation of this more recent protocol in two hospitals in Madrid are presented. METHODS: An observational prospective study was performed. Participants were patients diagnosed with AUD at two hospitals in Madrid, the University Hospital of Torrejón and the Puerta de Hierro Majadahonda University Hospital, between December 2018 and August 2021, treated on an outpatient basis without antibiotic therapy. The study group was compared with a control group, composed of patients diagnosed with acute uncomplicated diverticulitis and treated with outpatient antibiotic therapy at the Puerta de Hierro University Hospital between March 2015 and March 2018. RESULTS: 361 patients were included, 182 in the study group and 179 in the control group. Diverticulitis was persistent in 19 patients (10.4%) in the study group, who were not treated with antibiotics, and in 5 patients (2.8%) in the control group, treated with outpatient antibiotic therapy (p=0.004). Recurrences occurred in 23 patients (12.6%) in the study group, and in 53 patients (29.6%) in the control group (p<0.0001). The analysis of the complications found no significant differences between both groups, p=0.109. No urgent surgical intervention or mortality was recorded in the study group. CONCLUSIONS: In our environment, symptomatic non-antibiotic treatment of AUD cases is safe, without showing a higher rate of complications. Although, there seems to be a worse initial symptom control.

Neoadjuvant immunotherapy for dMMR/MSI-H locally advanced rectal cancer: The future new standard approach?

INTRODUCTION: This is a review of the evidence from studies of the efficacy and tolerability of neoadjuvant immunotherapy for mismatch repair-deficient (dMMR) or microsatellite instability-high (MSI-H) Locally Advanced Rectal Cancer (LARC). METHODS: For this review, we searched EMBASE and MEDLINE until 22 September 2022. The terms used in the search included mismatch repair-deficient, microsatellite instability, rectal cancer, neoadjuvant and immunotherapy. RESULTS: A total of 92 studies were obtained but only 9 were selected for the final analysis (one prospective and eight retrospective studies), including less than 20 patients per study. Neoadjuvant immunotherapy provides overall response rates of 100% (with and completed clinical response between 40 and 100%). CONCLUSION: Our review discusses completed prospective and retrospective studies, ongoing clinical trials, and the clinical practice of using neoadjuvant immunotherapy for MSI-H/dMMR LARC. The promising results obtained, would open the door to exploring other alternatives for these patients, offering the possibility of avoiding chemoradiation therapy and surgery in the future.

Adenocarcinoma de colon pobremente diferenciado con diferenciación rabdoide: un diagnóstico anatomopatológico extremadamente infrecuente / Poorly differentiated colonic adenocarcinoma showing rhabdoid feature: An extremely unusual anatomopathological diagnosis

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[Gastric adenocarcinoma in Zinsser-Cole-Engman syndrome]. / Adenocarcinoma gástrico en el síndrome de Zinsser-Cole-Engman.

Zinsser-Cole-Engman syndrome is a congenital dyskeratosis that produces cutaneus and hematologic alterations and, in 5% of patients, gastrointestinal neoplasms. We report the case of a 37-year-old man with this syndrome who was diagnosed with gastric adenocarcinoma. This case provides an example of the management that should be followed with these patients in order to identify neoplasms at stages in which treatment is curative.

Adenocarcinoma gástrico en el síndrome de Zinsser-Cole-Engman / Gastric adenocarcinoma in Zinsser-Cole-Engman syndrome

El síndrome de Zinsser-Cole-Engman es una disqueratosis congénita que causa alteraciones cutáneas, hematológicas y, en un 5% de los casos, neoplasias digestivas. Presentamos el caso de un varón de 37 años afectado de este síndrome en cuya evolución se diagnosticó un adenocarcinoma gástrico. Este caso es un ejemplo de cómo se debería manejar a estos pacientes para identificar neoplasias en estadios en los que el tratamiento es curativo (AU)

Zinsser-Cole-Engman syndrome is a congenital dyskeratosis that produces cutaneus and hematologic alterations and, in 5% of patients, gastrointestinal neoplasms. We report the case of a 37-year-old man with this syndrome who was diagnosed with gastric adenocarcinoma. This case provides an example of the management that should be followed with these patients in order to identify neoplasms at stages in which treatment is curative (AU)