Effective and alternative treatment of anastomotic leak after gastrojejunal bypass: endoluminal vacuum therapy.

Anastomotic leak (AL) after with Roux-en-Y gastric bypass (RYGB) has a morbidity rate to 53% and it can be potentially lethal (mortality rate from 0.5 to 10%). In these cases, surgery is usually a challenge, so in recent years minimally invasive endoscopic treatment is gaining ground. Endoluminal vacuum therapy (EVAC) is a promising treatment that is being used in esophagogastric and rectal surgery for the management of AL. We present the case of a patient on his 5th postoperative day of bariatric surgery (RYGB) with an acute abdomen. He was diagnosed of dehiscence of gastrojejunal anastomosis and he needed urgent surgery twice. Subsequently, in control CT, a new anastomotic leak is evidenced. However, given the clinical stability of the patient, it was decided to start EVAC type ESO-Sponge® placed by endoscopy. A total of 4 changes are made every 3-4 days with a total duration of treatment of 15 days. EVAC was removed when the defect presented a 1 mm sized.

Cutaneous metastasis of primitive neuroectodermal lung tumor.

Primary sarcomas of the chest are rare. Although primitive neuroectodermal tumor (PNET) usually develops in the chest wall, it has been described as a primary pulmonary tumor. We present an unusual case of PNET arising in the lung of an 89-year-old man.

Remoción de Enterococcus faecalis después de preparación rotatoria e irrigación con hipoclorito de sodio al 5 por ciento y gluconato de clorhexidina al 2 por ciento con/sin EDTA al 1.7 por ciento / Enterococcus faecalis removal after rotary canal instrumentation and irrigation with 5 percent sodium hypochlorite and 2 percent chlorhexidine gluconate with/without 1.7 percent EDTA

Antecedentes: El Enterococcus faecalis es el microorganismo más relacionado con fracasos endodónticos e infecciones endodónticas recurrentes. Puede sobrevivir, colonizar los túbulos y reinfectar el canal radicular, pues persiste después de la preparación, irrigación e incluso obturación. Objetivo: Comparar la efectividad en la remoción de Enterococcus faecalis con hipoclorito de sodio al 5% y gluconato de clorhexidina al 2% como sustancias irrigadoras con ácido edético (EDTA) al 1,7% y sin ésta, como sustancia quelante. Métodos: Estudio experimental in vitro en el que se realizó una preparación biomecánica rotatoria a 30 premolares extraídos que fueron posteriormente sembrados en agar BHI con las cuatro combinaciones y un grupo control (solución salina). Se midió el crecimiento de E. faecalis por conteo de unidades formadoras de colonias (UFC). Resultados: Se observaron incontables UFC en todas las muestras del grupo control. También mayor cantidad de UFC en los grupos 3 (hipoclorito de sodio al 5% + EDTA al 1,7%) y 4 (gluconato de clorhexidina al 2% + EDTA al 1,7%). Ninguna de las sustancias irrigadoras solas o combinadas con el quelante removió completamente el E. faecalis. Conclusiones: El uso de EDTA al 1,7% disminuyó la efectividad de las sustancias irrigadoras en la remoción del microorganismo. Ambos, hipoclorito de sodio y gluconato de clorhexidina, fueron relativamente efectivos en la remoción de E. faecalis.

Background: Enterococcus faecalis is the oral microorganism that is most related to failure of endodontic therapy and apical recurring infections. It can survive, colonize tubules and reinfect the root canal because it persists after preparation, irrigation and even obturation. Objective: Compare the effectiveness of irrigants 5% sodium hypochlorite and 2% chlorhexidine gluconate with or without the use of 1.7% EDTA as chelate. Methods: This was an in vitro experimental study in which 30 extracted premolar roots were prepared with rotary instruments. Each specimen was irrigated with one of the combinations of substances and cultured in BHI agar. A fourth group consisted of a control with saline solution. E. faecalis growth was measured through counting CFUs. Results: Uncountable CFUs were observed in all samples of the control group. There was a higher amount of CFUs in groups 3 (5% NaOCl + 1.7% EDTA) and 4 (2% Chlorhexidine gluconate + 1.7 EDTA). None of the irrigants with or without chelate completely removed E. faecalis. Conclusions: The use of 1.7 EDTA decreased the effectiveness of the irrigating substances in the removal of the microorganism. Both, sodium hypochlorite and chlorhexidine gluconate were relatively effective removing E. faecalis.

Pancreatic panniculitis.

Pancreatic panniculitis is an uncommon complication of pancreatic disease, most frequently pancreatitis and pancreatic carcinoma. The pathogenesis of the process remains unknown, but possibly the release of pancreatic enzymes may induce permeability of the microcirculation and cause fat necrosis. Clinically, pancreatic panniculitis presents with tender, ill-defined, red-brown nodules in the lower extremities that may ulcerate and drain an oily substance and usually precedes pancreatic disease. The histopathologic picture consists of a mostly lobular panniculitis without vasculitis, with the presence of the typical ghost cells that correspond to necrotic and calcified adipocytes. Treatment should be directed at the underlying pancreatic disease.

Colitis seudomembranosa de origen poco frecuente / Pseudomembranous colitis of unusual origin

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Genetic analysis of the GRM1 gene in human melanoma susceptibility.

Data obtained from a mouse model indicated that the ectopic expression of the Grm1 gene is sufficient for transforming melanocytes and causing malignant melanoma in vivo. In addition, it has also been documented that the GRM1 gene is aberrantly expressed in human melanomas. Here we have performed a genetic association study to elucidate whether the GRM1 gene contributes to human melanoma susceptibility. To carry out this study, we initially genotyped 250 melanoma patients and 329 nonselected and nonrelated controls with three single nucleotide polymorphisms, rs854145, rs362962 and rs6923492, located in the intron 1, intron 4 and exon 10 of the GRM1 gene, respectively. To perform sample genotyping, we used pyrosequencing techniques. Regarding rs854145 and rs6923492, there were no differences in genotypic distribution or allelic frequency between patients and controls. However, we observed (i) a higher frequency of patients carrying the C allele of rs362962 than in controls (OR=1.40, CI=[1.01-1.95], P=0.045), and (ii) that difference became greater in a subgroup of patients with a low level of sun exposure and tumours located on the trunk and extremities (OR=2.10, CI=[1.26-3.51], P=0.0039). To confirm these observations, the sample size of both patient and control groups was increased. In total, 464 patients and 561 controls were genotyped for the rs362962 polymorphism. Only the second observation was confirmed (OR=1.69, CI=[1.16-2.47], P=0.0064). Our results suggest that the GRM1 gene may contribute to melanoma susceptibility in that specific group of patients.

[Treatment of mycosis fungoides with PUVA and bexarotene]. / Tratamiento de micosis fungoide con PUVA más bexaroteno.

INTRODUCTION: The combined use of bexarotene and PUVA is a treatment that is currently being investigated. In this paper, six patients treated with this combination are presented. OBJECTIVES: To assess the efficacy and safety of treatment with PUVA + bexarotene in patients with mycosis fungoides (MF). Patients, material and methods. Six patients diagnosed with MF in different stages, who received three sessions of PUVA treatment a week (initially 2.35 J/cm 2, with progressive increases to a maximum of 23.5 J/cm 2) + bexarotene (initial dose 300 mg/m 2/day, decreasing to 200, 150 or 75 mg/m 2 if signs of toxicity appeared). All received atorvastatin. RESULTS: Stage at the start of treatment: two patients IIb, one patient Ib with B2 blood involvement, two patients Ib, one patient Ia. Five of the six patients responded to the treatment (three full remissions [FR], two partial remissions [PR]). One patient did not respond. In those in whom FR was achieved, the time required for the response was 10, 20 and 24 weeks. All presented with hypertriglyceridemia (maximum 1194 mg/ dL). It was necessary to administer thyroid hormone supplements to four of the patients. Two of them had alterations in the hepatic biochemistry values, and two others presented with alterations in the muscle profile analysis. CONCLUSION: The combination of PUVA and bexarotene is a safe and effective treatment for MF. It will be necessary to await the results of the clinical trials currently underway to see if their combined use is better than treatment with PUVA alone. The response rate (RR) was 86 % (three FR and two PR out of six patients).

Tratamiento de micosis fungoide con PUVA más bexaroteno / Treatment of mycosis fungoides with PUVA and bexarotene

Introducción. La utilización conjunta de bexaroteno y psoraleno y radiación ultravioleta A (PUVA) en la actualidad es un tratamiento en investigación. En el presente trabajo se presentan 6 pacientes tratados con esta combinación. Objetivos. Valorar eficacia y seguridad del tratamiento con PUVA más bexaroteno en pacientes con micosis fungoide. Pacientes, material y métodos. Seis pacientes diagnosticados de micosis fungoide en distintos estadios que han recibido PUVA, tres sesiones semanales (inicio 2,35 J/cm 2, con aumentos progresivos hasta llegar a un máximo de 23,5 J/cm 2) más bexaroteno (dosis inicial, 300 mg/m 2/día, disminuyendo a 200, 150 o 75 mg/m 2 si aparecía toxicidad). Todos los pacientes recibieron atorvastatina. Resultados. Al inicio de tratamiento, 2 pacientes se encontraban en estadio IIb, un paciente en Ib con afectación hemática B2, 2 pacientes en Ib y un paciente en estadio Ia. Cinco de los 6 pacientes respondieron al tratamiento (tres remisiones completas [RC], dos remisiones parciales [RP]). Un paciente no respondió. De los que obtuvieron RC, el tiempo hasta la respuesta fue de 10, 20 y 24 semanas, respectivamente. Todos los pacientes presentaron hipertrigliceridemia (máximo de 1.194 mg/dl). En cuatro de los pacientes fue necesario administrar suplementos de hormona tiroidea. Dos de ellos tuvieron alteraciones de la bioquímica hepática y dos más presentaron alteraciones analíticas del perfil muscular. Conclusión. La combinación de PUVA y bexaroteno es un tratamiento eficaz y seguro para la micosis fungoide. Habrá que esperar a los resultados de los ensayos clínicos en curso para ver si es mejor su uso combinado que el tratamiento con PUVA sola. El índice de respuesta fue del 86 % (3 RC y 2 RP de 6 pacientes)

Introduction. The combined use of bexarotene and PUVA is a treatment that is currently being investigated. In this paper, six patients treated with this combination are presented. Objectives. To assess the efficacy and safety of treatment with PUVA + bexarotene in patients with mycosis fungoides (MF). Patients, material and methods. Six patients diagnosed with MF in different stages, who received three sessions of PUVA treatment a week (initially 2.35 J/cm 2, with progressive increases to a maximum of 23.5 J/cm 2) + bexarotene (initial dose 300 mg/m 2/day, decreasing to 200, 150 or 75 mg/m 2 if signs of toxicity appeared). All received atorvastatin. Results. Stage at the start of treatment: two patients IIb, one patient Ib with B2 blood involvement, two patients Ib, one patient Ia. Five of the six patients responded to the treatment (three full remissions [FR], two partial remissions [PR]). One patient did not respond. In those in whom FR was achieved, the time required for the response was 10, 20 and 24 weeks. All presented with hypertriglyceridemia (maximum 1194 mg/ dL). It was necessary to administer thyroid hormone supplements to four of the patients. Two of them had alterations in the hepatic biochemistry values, and two others presented with alterations in the muscle profile analysis. Conclusion. The combination of PUVA and bexarotene is a safe and effective treatment for MF. It will be necessary to await the results of the clinical trials currently underway to see if their combined use is better than treatment with PUVA alone. The response rate (RR) was 86 % (three FR and two PR out of six patients)