Relación entre cambios en hemoglobina glucosilada y mejora de la composición corporal en pacientes con obesidad mórbida tras gastrectomía tubular laparoscópica / Relationship between changes in hemoglobin glycosilated and improvement of body composition in patients with morbid obesity after tubular laparoscopic gastrectomy

Introducción y objetivo: El objetivo de nuestro estudio es analizar la posible relación entre los cambios en el perfil glucémico y los parámetros de composición corporal en pacientes con obesidad mórbida tras gastrectomía tubular laparoscópica. Material y métodos: Se realiza un estudio observacional prospectivo de cohortes donde el tamaño muestral es de 69 pacientes. Las variables analizadas son peso corporal, glucemia, hemoglobina glucosilada, lipoprotein high density, lipoprotein low density, triglicéridos y circunferencia cintura y cadera. Para llevar a cabo el objetivo de este estudio se ha utilizado un análisis de la variancia de medidas repetidas (ANOVA) y un posterior análisis de correlación a través del test de Pearson. Resultados: Tras el análisis estadístico se han encontrado una reducción significativa del peso tras la cirugía p < 0,001, una reducción significativa de la hemoglobina glucosilada entre los valores preintervención y a los 6 meses de la cirugía (p<0,036) y un descenso significativo de los perímetros de cintura y cadera (p< 0,001). No existieron diferencias significativas en el resto de variables estudiadas. En el análisis de correlación, se encontró una correlación positiva significativa entre el cambio en concentración de hemoglobina glucosilada y perímetro de cadera (p=0,047; r=0,237), a menor diámetro de cadera, menor concentración de hemoglobina glucosilada. Conclusiones: La gastrectomía tubular laparoscópica se muestra como una técnica efectiva para el tratamiento de pacientes obesos mórbidos con diabetes mellitus tipo 2. La reducción en el perímetro de cadera está relacionada con la reducción de hemoglobina glucosilada a los 6 meses de la intervención

Background and objective: The objective of our study is to analyze the possible relationship between changes in glycemic profile and body composition parameters in morbid obesity patients after tubular laparoscopic gastrectomy. Material and methods: A prospective observational cohort study with 69 patients was performed. The variables analyzed were body weight, blood glucose, hemoglobin, glycosylated, high density lipoprotein, low density lipoprotein, triglycerides, and waist and hip circumference. An analysis of variance of repeated measurements (ANOVA) and a correlation analysis through the Pearson test were carried out. Results: A significant reduction in weight (p<.001 after surgery) and in glycosylated hemoglobin (p<.036) and waist hip (p<.001) were found at 6 months after surgery. There was no significant difference in the rest of the variables studied. In correlation analysis, a significant positive correlation was found between the change in concentration of hemoglobin glycosylated and hip circumference (p=.047; r=0.237), the smaller the hip circumference, the lower the concentration of glycosylated hemoglobin. Conclusions: Tubular laparoscopic gastrectomy is an effective technique for the treatment of morbidly obese patients with type 2 diabetes mellitus. The reduction in the perimeter of hip is related to glycosylated hemoglobin reduction 6 months after intervention

Relationship between changes in hemoglobin glycosilated and improvement of body composition in patients with morbid obesity after tubular laparoscopic gastrectomy. / Relación entre cambios en hemoglobina glucosilada y mejora de la composición corporal en pacientes con obesidad mórbida tras gastrectomía tubular laparoscópica.

BACKGROUND AND OBJECTIVE: The objective of our study is to analyze the possible relationship between changes in glycemic profile and body composition parameters in morbid obesity patients after tubular laparoscopic gastrectomy. MATERIAL AND METHODS: A prospective observational cohort study with 69 patients was performed. The variables analyzed were body weight, blood glucose, hemoglobin, glycosylated, high density lipoprotein, low density lipoprotein, triglycerides, and waist and hip circumference. An analysis of variance of repeated measurements (ANOVA) and a correlation analysis through the Pearson test were carried out. RESULTS: A significant reduction in weight (p<.001 after surgery) and in glycosylated hemoglobin (p<.036) and waist hip (p<.001) were found at 6 months after surgery. There was no significant difference in the rest of the variables studied. In correlation analysis, a significant positive correlation was found between the change in concentration of hemoglobin glycosylated and hip circumference (p=.047; r=0.237), the smaller the hip circumference, the lower the concentration of glycosylated hemoglobin. CONCLUSIONS: Tubular laparoscopic gastrectomy is an effective technique for the treatment of morbidly obese patients with type 2 diabetes mellitus. The reduction in the perimeter of hip is related to glycosylated hemoglobin reduction 6 months after intervention.

Duodenectomía parcial como opción terapéutica de un tumor del estroma gastrointestinal duodenal múltiple, asociado a neurofibromatosis tipo 1 / Partial duodenectomy as a therapeutic option in multiple duodenal gastrointestinal stromal tumour associated with neurofibromatosis type 1

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Localización atípica de tumor glómico en el hígado / Atypical location of a glomus tumor in the liver

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Colecistitis aguda por Listeria monocytogenes en paciente inmunocompetente / Listeria monocytogenes cholecystitis in an immunocompetent patient

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Leiomioma de esófago con intensa captación de18fluorodeoxiglucosa en la tomografía por emisión de positrones-tomografía computarizada / Oesophageal leiomyoma with intense uptake in positron tomography with 18Fluorodeoxyglucose and computed tomography

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Recurrence of liver metastases from colorectal cancer and repeat liver resection.

OBJECTIVE: The purpose of this study was to assess the resectability and effectiveness of repeat hepatectomy for relapsing liver metastases of colorectal origin in terms of morbidity, mortality, overall survival, and disease-free survival. METHODS: A retrospective study was performed on a prospective cohort of patients with colorectal liver metastases who underwent repeat surgery at Hospital Universitario San Cecilio, Granada (Spain), from March 2003 to June 2013. Primary outcome variables included survival and morbidity within 30 days post-surgery. RESULTS: A total of 147 patients with colorectal liver metastases underwent surgical excision during the study period; 61 patients had liver recurrence, and 34 of these received repeat surgery. The overall survival rate at 5 and 10 years for resected patients (n=27/34) was 48% and 48%. Mean hospital stay was 8.9 ± 3.5 days, morbidity was 9%, and mortality was 0%. CONCLUSION: Repeat liver resection for colorectal liver metastases is a safe, effective surgical procedure whose results are similar to those obtained after initial liver resection.

Recurrencia de la cirugía de las metástasis hepáticas de cáncer colorrectal y repetición de la resección / Recurrence of liver metastases from colorectal cancer and repeat liver resection

OBJETIVO: el objetivo de este estudio es evaluar la resecabilidad efectividad de las rehepatectomías en metástasis hepáticas de origen colorrectal recidivadas en términos de morbimortalidad, supervivencia global y libre de enfermedad. MÉTODOS: se realizó un estudio retrospectivo de una cohorte prospectiva de pacientes con metástasis hepáticas de origen colorrectal con cirugía de repetición en el Hospital Universitario San Cecilio de Granada de marzo de 2003 hasta junio de 2013. Las variables principales de resultado fueron la supervivencia y la morbilidad antes de los 30 días del postoperatorio. RESULTADOS: un total de 147 pacientes con metástasis hepáticas de origen colorrectal se sometieron a la extirpación quirúrgica durante el periodo de estudio; 61 pacientes presentaron una recidiva hepática de los cuales 34 se sometieron a una cirugía de repetición. La tasa global de supervivencia a 5 y 10 años para los pacientes resecados fue del 48 y el 48%. La estancia media hospitalaria fue de 8,9 ± 3,5 días, la morbilidad del 9% y la mortalidad del 0%. CONCLUSIÓN: las resecciones hepáticas repetidas para las metástasis hepáticas de origen colorrectal constituyen una operación segura y eficaz, con resultados similares a los obtenidos tras una primera resección hepática

OBJECTIVE: The purpose of this study was to assess the resectability and effectiveness of repeat hepatectomy for relapsing liver metastases of colorectal origin in terms of morbidity, mortality, overall survival, and disease-free survival. METHODS: A retrospective study was performed on a prospective cohort of patients with colorectal liver metastases who underwent repeat surgery at Hospital Universitario San Cecilio, Granada (Spain), from March 2003 to June 2013. Primary outcome variables included survival and morbidity within 30 days post-surgery. RESULTS: A total of 147 patients with colorectal liver metastases underwent surgical excision during the study period; 61 patients had liver recurrence, and 34 of these received repeat surgery. The overall survival rate at 5 and 10 years for resected patients (n=27/34) was 48% and 48%. Mean hospital stay was 8.9 ± 3.5 days, morbidity was 9%, and mortality was 0%. CONCLUSION: Repeat liver resection for colorectal liver metastases is a safe, effective surgical procedure whose results are similar to those obtained after initial liver resection

Tumor desmoplásico de células redondas pequeñas peritoneal. Una entidad infrecuente con un mal pronóstico / Desmoplastic small-round-cell tumor of the peritoneum: An uncommon entity with poor prognosis

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[Acute abdomen due to complicated intramural duodenal haematoma. Report of a case and review of the literature]. / Abdomen agudo por hematoma duodenal intramural complicado. Presentación de un caso y revisión en la literatura.

BACKGROUND: Intramural duodenal haematoma is a rare entity that usually occurs in the context of patients with coagulation disorders. A minimum percentage is related to processes such as pancreatitis and pancreatic tumours. CLINICAL CASE: The case is presented of a 45 year-old male with a history of chronic pancreatitis secondary to alcoholism. He was seen in the emergency room due to abdominal pain, accompanied by toxic syndrome. The abdominal computed tomography reported increased concentric duodenal wall thickness, in the second and third portion. After oesophageal-gastro-duodenoscopy, he presented with haemorrhagic shock. He had emergency surgery, finding a hemoperitoneum, duodenopancreatic tumour with intense inflammatory component, as well a small bowel perforation of third duodenal portion. A cephalic duodenopancreatectomy was performed with pyloric preservation and reconstruction with Roux-Y. DISCUSSION: Treatment of a duodenal haematoma is nasogastric decompression, blood transfusion and correction of coagulation abnormalities. Surgery is indicated in the cases in which there is no improvement after 2 weeks of treatment, or there is suspicion of malignancy or major complications arise. CONCLUSIONS: Duodenal intramural haematoma secondary to chronic pancreatitis is rare, although the diagnosis should be made with imaging and, if suspected, start conservative treatment and surgery only in complicated cases.

Tratamiento conservador de la perforación duodenal tras realización de colangiopancreatografía retrógrada endoscópica terapéutica / Conservative treatment of duodenal perforation after therapeutic endoscopic retrograde cholangiopancreatography

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El empalamiento inguinal como reto diagnóstico y terapéutico para el médico y cirujano de urgencias / Inguinal impalement; diagnostic and therapeutic challenge for emergency medical and surgeon

Introducción: el objetivo de este trabajo es presentar un caso de empalamiento a través de la región inguinal. Las heridas por empalamiento son infrecuentes y, en ocasiones, de extrema gravedad, necesitan de una actuación rápida del personal médico de urgencias y del cirujano. Caso clínico: se presenta el caso de un varón de 40 años que sufrió un accidente laboral con empalamiento de un hierro de ferralla a través de la región inguinal derecha, el cuerpo extraño penetró en la cavidad abdominal. Se expone ampliamente el caso clínico, así como los procedimientos realizados en el diagnóstico y el tratamiento de este tipo de lesiones. Conclusiones: las heridas por empalamiento son infrecuentes y suponen un reto para el personal médico que atiende al afectado desde el primer momento, tanto por lo complejas que pueden ser, como por la necesidad de una actuación rápida, sin poder conocer a priori, en muchas de las situaciones, la extensión verdadera de las lesiones, que se evidenciará durante el posible acto operatorio(AU)

Introduction: the objective of this paper was to present a case of impalement through the inguinal region. The impalement injuries are infrequent and sometimes extremely serious. These injuries require prompt action of the emergency medical personnel and surgeon. Clinical case: a forty-year old man, who had an occupational accident resulting in impalement of an iron rebar through the right inguinal region and penetrating abdominal cavity. The clinical case and the procedures performed in the diagnosis and treatment of these injuries were presented in detail. Conclusions: The impalement injuries are rare and represent a challenge to the medical staff that treat the patient from the very beginning, because they can be very complex and require fast action and treatment. In many cases, the real dimension and severity of lesions at first is unknown and can only be assessed during surgery(AU)

Hepatitis fulminante por virus del herpes simple en paciente inmunocompetente. Diagnóstico diferencial con colecistitis aguda / Fulminant hepatitis due to herpes simplex virus in an immunocompetent patient. Differential diagnosis with acute cholecystitis

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Pancreatitis del surco en el diagnóstico diferencial del adenocarcinoma de páncreas / Groove pancreatitis in the differential diagnosis of pancreatic adenocarcinoma

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