[Outcome of surgery for Crohn's colitis. Review of 28 cases]. / Colitis de Crohn: resultados del tratamiento quirúrgico y evolución alejada.

BACKGROUND: Exclusive involvement of the colon or rectum in Crohn's disease, called Crohn's colitis, (CC) occurs in about 25% of these patients. AIM: To analyze early surgical results and long-term outcomes of patients undergoing surgery for CC. MATERIAL AND METHODS: Review of a prospective database, identifying patients with Crohn's disease operated between 2003 and 2015 and excluding those with ileocecal disease. We analyzed demographic data, pre and postoperative pharmacological treatment, operations, morbidity and the need for a second bowel resection at follow-up. RESULTS: We reviewed data from 28 patients aged 17 to 72 years (15 men). Twenty-seven (96.4%) had previous pharmacological treatment, 11 received monoclonal antibodies. The most common indications for surgical treatment were failure of medical treatment in 15 cases, acute severe colitis in 12 and anemia/malnutrition in eight. Total colectomy was performed in 17 (61%) patients, proctocolectomy in 8 (29%) and segmental colectomies in 3 (11%). Sixteen (57%) were operated laparoscopically. Major postoperative complications were observed in 5 (18%). Four needed a reintervention. There was no operative mortality. During a 55 months median follow-up of 27 patients, seven (26%) required a second bowel resection, one of them for recurrence. Nineteen (70%) patients had an ostomy, which was permanent in 11. Fifteen patients are without medical treatment. CONCLUSIONS: Most of the reviewed patients required total colectomy for the control of the disease with a low surgical morbidity. Two-thirds required an ileostomy, which became permanent in half of them.

Colitis de Crohn: resultados del tratamiento quirúrgico y evolución alejada / Outcome of surgery for Crohn's colitis: review of 28 cases

Background: Exclusive involvement of the colon or rectum in Crohn's disease, called Crohn's colitis, (CC) occurs in about 25% of these patients. Aim: To analyze early surgical results and long-term outcomes of patients undergoing surgery for CC. Material and Methods: Review of a prospective database, identifying patients with Crohn's disease operated between 2003 and 2015 and excluding those with ileocecal disease. We analyzed demographic data, pre and postoperative pharmacological treatment, operations, morbidity and the need for a second bowel resection at follow-up. Results: We reviewed data from 28 patients aged 17 to 72 years (15 men). Twenty-seven (96.4%) had previous pharmacological treatment, 11 received monoclonal antibodies. The most common indications for surgical treatment were failure of medical treatment in 15 cases, acute severe colitis in 12 and anemia/malnutrition in eight. Total colectomy was performed in 17 (61%) patients, proctocolectomy in 8 (29%) and segmental colectomies in 3 (11%). Sixteen (57%) were operated laparoscopically. Major postoperative complications were observed in 5 (18%). Four needed a reintervention. There was no operative mortality. During a 55 months median follow-up of 27 patients, seven (26%) required a second bowel resection, one of them for recurrence. Nineteen (70%) patients had an ostomy, which was permanent in 11. Fifteen patients are without medical treatment. Conclusions: Most of the reviewed patients required total colectomy for the control of the disease with a low surgical morbidity. Two-thirds required an ileostomy, which became permanent in half of them.

Nuevas emulsiones lipídicas enriquecidas con omega-3: beneficios reales en nutrición parenteral / New lipid emulsions enriched with omega-3: Is there a real benefit on parenteral nutrition?

Total parenteral nutrition allows nutritional supports for patients who are not able to receive oral intake or enteral nutrition. Fatty acids are administrated as lipid emulsions and a lower inflammatory cytokine level has been described after administration of Omega-3. This could be a benefit for critical patients by a potential antiinflamatory and immunomodulation effect. Also, for patients with respiratory distress syndrome, the lower cytokine effect may directly affect pulmonary vessels by vasodilatation and consequently improve respiratory function. Different studies have shown positive clinical outcomes after Omega-3 administration, while other studies have failed to demonstrate significant results. Mechanisms involved with this possible immunomodulation by fish oil are well known, although further research is necessary to clarify the clinical relevance of these mechanisms.

La nutrición parenteral es la técnica de soporte nutricional por vía endovenosa a pacientes que no pueden alimentarse por vía enteral u oral. El aporte de lípidos se realiza a través de emulsiones lipídicas, que poseen diferentes ácidos grasos. Se ha descrito que la administración de ácidos grasos Omega-3 determina una disminución de citoquinas proinflamatorias a nivel plasmático, lo cual supondría beneficios en los pacientes críticos mediante una posible modulación de la respuesta inflamatoria e inmunológica. Además, en los pacientes con distress respiratorio agudo, la disminución de citoquinas proinflamatorias ejercería un efecto directo sobre el lecho vascular pulmonar estableciendo una mejoría de la función respiratoria. Los estudios clínicos son contradictorios respecto a si la suplementación con Omega-3 se asocia con resultados clínicos favorables en forma significativa. Existe gran avance en el conocimiento de los mecanismos involucrados en la posible inmunomodulación que se le atribuye al aceite de pescado, pero futuras investigaciones son necesarias para elucidar la relevancia clínica de estos mecanismos.

[Serial transverse enteroplasty for short bowel syndrome. Case report]. / Enteroplastía transversa seriada como alternativa en el tratamiento del síndrome de intestino corto. Caso clínico.

Among patients with short bowel syndrome, surgical small intestine lengthening techniques are employed to increase the absorptive surface. Among these, serial transverse enteroplasty involves transecting the bowel transversally, preserving the blood supply of the small intestine and creating a longer segment of bowel. We report a 51-year-old woman with a short bowel syndrome and multiple hospital admissions for complications. She was subjected to a serial transverse enteroplasty, increasing small intestinal length from 140 to 180 cm. During the postoperative period, she presented intra abdominal blood collections and a septic episode with bacterial endocarditis. One month after the operation, total parenteral nutrition was discontinued and nutritional and fluid balances were achieved using exclusively the oral route. During the ambulatory follow up, the patient continues with exclusive oral feeding and five bowel movements per day.

Enteroplastía transversa seriada como alternativa en el tratamiento del síndrome de intestino corto: caso clínico / Serial transverse enteroplasty for short bowel syndrome: case report

Among patients with short bowel syndrome, surgical small intestine lengthening techniques are employed to increase the absorptive surface. Among these, serial transverse enteroplasty involves transecting the bowel transversally, preserving the blood supply of the small intestine and creating a longer segment of bowel. We report a 51-year-old woman with a short bowel syndrome and multiple hospital admissions for complications. She was subjected to a serial transverse enteroplasty, increasing small intestinal length from 140 to 180 cm. During the postoperative period, she presented intra abdominal blood collections and a septic episode with bacterial endocarditis. One month after the operation, total parenteral nutrition was discontinued and nutritional and fuid balances were achieved using exclusively the oral route. During the ambulatory follow up, the patient continues with exclusive oral feeding and fve bowel movements per day.

Propuesta y fundamentos para una norma de manejo quirúrgico del paciente obeso: Año 2004 / A proposal of guidelines for surgical management of obesity

Obesity is a chronic disease with an increasing prevalence in all groups of age, and is associated to increased general mortality and cardiovascular risk. The multidisciplinary non surgical approach must be the treatment of choice for obese subjects. However, the results of such approach among subjects with severe or morbid obesity, are unsatisfactory. In this group of patients, bariatric surgery and specifically gastric bypass achieves good long term results, maintaining a low body mass index, reducing complications and improving quality of life. Considering the widespread practice of bariatric surgery in Chile, the Nutrition Unit of the Ministry of Health formed a task force to propose update guidelines for the surgical treatment of obesity. These guidelines were proposed after a thorough literature review and discussion with groups that practice bariatric surgery using defined protocols. This document provides a summarized version of the guidelines. The first section discusses the background for bariatric surgery and the second part give specific recommendations for patient management and the formation of reference centers for surgical management of obesity.

Mecanismos de contaminación de las fórmulas para nutrición enteral / Mechanisms of contamination of formulas for enteral nutrition

Una de las complicaciones más frecuentes de la nutrición enteral es la contaminación de las fórmulas. El objetivo de este trabajo fue evaluar la frecuencia y los mecanismo por los cuales se produce la contaminación en las fórmulas enterales. Se evaluaron dos tipos de fórmulas, una en polvo y la otra líquida estéril, con contenedores reutilizados y estériles. Los resultados demuestran que el mecanismo más importante de contaminación se produce en la central de fórmulas por la manipulación o por el uso de utensilios contaminados. La utilización de contenedores reutilizados contribuye a la contaminación, pero en un menor grado. Las bajadas de los contenedores tienen altos porcentajes de contaminación, superiores al 85 por ciento y no se modifican con el uso de material estéril. Probablemente exista también un mecanismo de contaminación retrógrado

Nutrición enteral en crisis grave de colitis ulcerosa: efectividad nutricional y tolerancia digestiva / Enteral nutrition in severe ulcerative colitis: safety, tolerance and nutritional efficiency

Backgrounds and aims: Total parenteral nutrition (TPN) has been traditionally used as an adjunctive therapy in severe ulcerative colitis patients. We performed a prospective study to ascertain the safety, nutritional efficiency, tolerance and costs of total enteral nutrition in this situation. Methods: After 48 hours of intensive medical treatment, severe ulcerative colitis patients initiated enteral feeding with a polymeric formula. The formula concentration and volume were increased daily. Results: 17 patients (7 women, 10 men; age 36,8ñ12,8 years) with a mean clinical activity score of 15,6ñ1,5 were included. In 14 patients (82,4percent) enteral nutrition was well tolerated, attaining in 11 of them more than 80percent of the caloric requirements by day 4. In 3 cases we observed vomiting and bloating. Prealbumin levels improved significantly from 11,1ñ3,4 mg/dl to 22,7ñ6,8 mg/dl (p= 0.002) at the end of enteral nutrition (11,8ñ4,7 days). Albumin and other nutritional parameters did not change. Conclusions: Total enteral nutrition could be considered a safe and well tolerated nutritional support in these patients. Although albumin and other nutritional parameters did not change during the study period, the increase in prealbumin levels suggests a favourable anabolic effect of total enteral nutrition

Déficit de hormona de crecimiento en pacientes con insuficiencia cardíaca crónica / Growth hormone deficiency in patients with chronic cardiac failure

Nine patients, aged 49 to 76 years old, 7 male, were studied. Seven had an idiopathic dilated cardiomyopathy and 2 a coronary heart disease. All had a stable cardiac failure, in functional capacity II or III and were receiving digoxin, furosemide and potassium supplements. Thyroid hormone levels, basal and exercise growth hormone and IGF-1 levels were measured and compared with reference values for American populations. Left ventricular ejection fraction was measured with an isotopic technique and nutritional status using anthropometry and indirect calorimetry. Anthropometric measures, basal and postprandial oxygen consumption were within normal limits. Thyroid hormone levels were normal. During maximal exercise, growth hormone levels were 2.56ñ4.1 ng/ml and IGF-1 levels were 0.56ñ0.61 mU/ml. These values were significantly lower than expected for age and sex. These patients with chronic cardiac failure have lower than normal growth hormone and IGF-1 levels

Ciprofibrato: nueva terapia farmacológica en la hipertrigliceridemia / Ciprofibrate: a new pharmacologic agent for treatment of hypertriglyceridemia

En 16 hombres portadores de dislipidemia IIb, excluyendodiabéticos y otras patologías graves, evaluamos prospectivamente el efecto en colesterol total, colesterol LDL, colesterol HDL y triglicéridos del ciprofibrato. Después de cuatro semanas con régimen adecuado y sin hipolipemiantes, se les indicaron 100 mg/día en dosis única si mantenían colesterol total o triglicéridos superiores a 200 mg/dL. Se reevaluaron a los 30 y 60 días, duplicando la dosis de ciprofibrato si persistía el colesterol total o los triglicéridos mayores a 200 mg/dL. Con 100 mg de ciprofibrato observamos disminución significativa de colesterol total (promedio ñ D.S. 258 ñ 36 a 228 ñ 28 mg/dL, p<0,002); colesterol LDL (192 ñ 47 a 156 ñ 26 mg/dL, p<0,005); triglicéridos (219 ñ 89 a 142 ñ 50 mg/dL, p<0,001) y elevación de colesterol HDL (35 ñ 7 a 43 ñ 6 mg/dL, p<0,001). Al duplicar la dosis de ciprofibrato en 12 pacientes, no se observó un efecto mayor. Ningún pacinete presentó efctos adversos que pudieran ser atribuidos al medicamento