Necrosis intestinal segmentaria en paciente joven / Segmental intestinal necrosis in a young patient

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Segmental intestinal necrosis in a young patient.

Segmental ischemic colitis is an uncommon disease in young patients, being usually associated to drug abuse, infectious or autoimmune diseases. We present a case that, in spite of a complete diagnostic study, had repeatedly two attacks of intestinal necrosis during his admission.

Spontaneous rupture of a liver hemangioma. A case report.

Spontaneous rupture of a liver hemangioma is a very uncommon disease, but extremely seriousness because it is associated to a 75% of mortality caused by hipovolemic shock. A case of an spontaneous rupture of liver hemangioma, which was previously unknow, is presented.

Rotura espontánea de hemangioma hepático no conocido / Spontaneous rupture of a liver hemangioma. A case report

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Necrosis séptica de miembro inferior secundaria a picadura de araña reclusa parda / Septic limb necrosis, secondary to a brown recluse spider bite

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Nudo del catéter ventrículo-peritoneal con obstrucción y necrosis intestinal: una inusual y grave complicación / Ventriculo-peritoneal catheter knot with obstruction and intestinal necrosis: an unusual and serious complication

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Síndrome de Horner traumático sin lesión vascular / Traumatic Horner syndrome without vascular injury

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Vólvulo gástrico agudo. A propósito de un caso / Acute gastric volvulus: A case report

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Variables relacionadas con la diseminación metastásica axilar en el cáncer de mama con ganglio centinela positivo. Evaluación de modelos predictivos / Factors related to metastatic axillary disease in breast cancer patients with a positive sentinel lymph node. Evaluation of predictive models

Objetivos. Evaluar las variables relacionadas con la diseminación metastásica axilar e intentar validar los diferentes modelos predictivos creados hasta la fecha. Pacientes y método. Realizamos un estudio retrospectivo a lo largo de 10 años. Fueron incluidas todas las pacientes intervenidas de cáncer de mama en nuestro hospital con ganglio centinela positivo. Se recogieron 27 variables clínico/histológicas del tumor y se realizó un análisis uni/multivariante para valorar la relación con la presencia de metástasis en ganglios axilares no centinelas. Se aplicaron los modelos predictivos a nuestra población: MSKCC, Stanford, Tenon, Meretoja unicéntrico y Meretoja multicéntrico y se calculó para cada uno de ellos el área bajo la curva de característica operativa de receptor (ROC). Resultados. Las variables significativas con la diseminación metastásica axilar fueron el IMC, la macrometástasis en el ganglio centinela, la unifocalidad y la extensión extranodal. Ningún modelo predictivo pudo ser validado, pues todos presentan una capacidad discriminativa diagnóstica baja, con áreas bajo la curva menores de 0,7. Conclusiones. Los modelos predictivos de diseminación metastásica axilar en caso de ganglio centinela positivo por sí solos no permiten discriminar aquellas pacientes con afectación metastásica axilar en el ganglio no centinela (AU)

Objectives. To evaluate factors related to metastatic axillary disease and to validate and update the predictive models created to date for metastatic axillary disease. Patients and method. In this retrospective study, we included all patients with a positive sentinel lymph node biopsy who underwent breast cancer surgery in our hospital in the last 10 years. We obtained 27 clinical/histopathological variables for each patient and univariate and multivariate statistical analyses were performed to evaluate the relationship between these variables and the presence of metastases in non-sentinel axillary nodes. We applied the main published predictive models (MSKCC, Stanford, Tenon, Meretoja single-center and multicenter models) to our population. The area under the receiver operating characteristic curve was calculated for each of the models. Results. The variables significantly related to metastatic axillary disease were body mass index, macrometastases in the sentinel lymph node, single-focus, and extranodal spread. None of the predictive models was validated because all of them had low diagnostic discrimination, with areas below the curve lower than 0.7. Conclusions. Predictive models for metastatic axillary disease in patients with a positive sentinel lymph node have low diagnostic accuracy in identifying low risk patients (AU)

Protective ileostomy: complications and mortality associated with its closure.

INTRODUCTION: diverting loop ileostomies are widely used in colorectal surgery to protect low rectal anastomoses. However, they may have various complications, among which are those associated with the subsequent stoma closure. The present study analyses our experience in a series of patients undergoing closure of loop ileostomies. METHOD: retrospective study of all the patients undergoing ileostomy closure at our hospital between 2006-2010. There were 89 patients: 56 males (63%) and 33 females (37%) with a mean age of 55 (38-71) years. The most common indication for ileostomy was protection of a low rectal anastomosis, 81 patients (91%). The waiting time until stoma closure, type and frequency of the complications, length of hospital stay and mortality rate are analysed. RESULTS: waiting time before surgery was 8 (1-25) months. Forty-one patients (45,9%) developed some type of complication, three were reoperated (3.37%) and one patient died (1.12%). The most important complications were intestinal obstruction (32.6%), diarrhoea(6%), surgical wound infection (6%), enterocutaneous fistula (4.5%), rectorrhagia (3.4%) and anastomotic leak (1.12%). The mean length of patient stay was 7.54 (2-23) days. CONCLUSIONS: protective ostomies in low rectal anastomoses have proved to be the only preventive measure for reducing the morbidity and mortality rates for anastomotic leakage. However, creation means subsequent closure, which must not be considered a minor procedure but an operation with possibly significant complications, including death, as has been shown in publications on the subject and in our own series.