Effect of vitamin C administration on neutrophil apoptosis in septic patients after abdominal surgery.

OBJECTIVE: To investigate the effect of parenteral administration of vitamin C on neutrophil apoptosis by determining Fas receptor expression and caspase-3, poly (ADP-ribose) polymerase (PARP), and Bcl-2 levels in neutrophils from septic abdominal surgery patients. STUDY DESIGN: Twenty septic abdominal surgery patients were studied in a prospective, randomized, double-blinded clinical trial. A group of healthy volunteers (n = 10) constituted a reference group for baseline parameter values. The patients were randomly assigned to a vitamin C-treated (n = 10) or placebo-treated (n = 10) group. For a 6-d period from 12 h post-surgery, the vitamin C group received 450 mg/d of the vitamin in 3 doses and the placebo group an identical administration of 5% dextrose. Early-morning peripheral blood samples were obtained daily from 24 h after vitamin C administration until d 6 post-surgery (T1d-T6d). RESULTS: Vitamin C group showed a nonsignificant reduction in Fas (CD95) expression on CD15-positive peripheral blood neutrophils, significantly decreased caspase-3, and PARP levels (caspase-3: T4d: P < 0.05, T5d: P < 0.05, T6d P < 0.01; and PARP: T3d: P < 0.05, T4d: P < 0.05, T6d: P < 0.05), and significantly increased Bcl-2 levels (T3d: P = 0.001) versus placebo group. CONCLUSIONS: Postoperative vitamin C treatment of septic abdominal surgery patients exerts an antiapoptotic effect on peripheral blood neutrophils, reducing caspase-3 and PARP levels, and increasing Bcl-2 levels. However, these antiapoptotic effects are not maintained at all time points.

[Occupational exposure to airborne fungi and bacteria in a household recycled container sorting plant ]. / Exposición laboral a hongos y bacterias ambientales en una planta de selección de residuos de envases.

Several studies have showed an association between the work in waste treatment plants and occupational health problems such as irritation of skin, eyes and mucous membranes, pulmonary diseases, gastrointestinal problems and symptoms of organic dust toxic syndrome (ODTS). These symptoms have been related to bioaerosol exposure. The aim of this study was to investigate the occupational exposure to biological agents in a plant sorting source-separated packages (plastics materials, ferric and non-ferric metals) household waste. Airborne samples were collected with M Air T Millipore sampler. The concentration of total fungi and bacteria and gram-negative bacteria were determined and the most abundant genera were identified. The results shown that the predominant airborne microorganisms were fungi, with counts greater than 12,000 cfu/m(3) and gram-negative bacteria, with a environmental concentration between 1,395 and 5,280 cfu/m(3). In both cases, these concentrations were higher than levels obtained outside of the sorting plant. Among the fungi, the predominant genera were Penicillium and Cladosporium, whereas the predominant genera of gram-negative bacteria were Escherichia, Enterobacter, Klebsiella and Serratia. The present study shows that the workers at sorting source-separated packages (plastics materials, ferric and non-ferric metals) domestic waste plant may be exposed to airborne biological agents, especially fungi and gram-negative bacteria.

[Mirizzi syndrome and gallbladder cancer]. / Síndrome de Mirizzi y cáncer de vesícula.

Mirizzi syndrome (MS) has a low incidence in patients with gallbladder disease. The coexistence of gallbladder cancer seems to be more frequent in patients with MS than in those with gallstones only. We present two patients with MS type II and gallbladder cancer (stages T4N1M0 and T3NxMx). The etiopathogenic mechanisms, diagnostic methods and therapeutic options are discussed.

Síndrome de Mirizzi y cáncer de vesícula / Mirizzi syndrome and gallbladder cancer

El síndrome de Mirizzi (SM) tiene una baja prevalencia en los enfermos con litiasis biliar. La del cáncer de vesícula asociado al SM parece ser muy superior a la que presentan los enfermos con colelitiasis simple. Presentamos a 2 pacientes con SM tipo II y cáncer de vesícula (estadios T4N1M0 y T3NxMx). Se discuten los mecanismos implicados en esta asociación, los métodos diagnósticos y su tratamiento (AU)

Mirizzi syndrome (MS) has a low incidence in patients with gallbladder disease. The coexistence of gallbladder cancer seems to be more frequent in patients with MS than in those with gallstones only. We present two patients with MS type II and gallbladder cancer (stages T4N1M0 and T3NxMx). The etiopathogenic mechanisms, diagnostic methods and therapeutic options are discussed (AU)

Exposición laboral a hongos y bacterias ambientales en una planta de selección de residuos de envases / Occupational exposure to airborne fungi and bacteria in a sorting source-separated packages household waste plant

Distintos estudios han mostrado una asociación entre la actividad laboral enplantas de tratamiento de residuos y la aparición de distintos síntomas en lostrabajadores, como irritación de piel, ojos y membranas mucosas, trastornosgastrointestinales y respiratorios, y el síndrome tóxico por polvo orgánico.Estos síntomas se han asociado con la exposición a bioaerosoles.El objetivo de este trabajo es determinar la exposición laboral a agentesbiológicos en una planta de selección de envases procedentes exclusivamentede la recogida selectiva de residuos sólidos urbanos.Las muestras ambientales se obtuvieron por el método de impactación enplaca con el equipo M Air T de Millipore. Se determinó la concentración dehongos totales, bacterias totales y bacterias gramnegativas y, en cada caso,se identificaron los géneros fúngicos y bacterianos obtenidos.Los microorganismos mayoritarios han sido los hongos, con recuentossuperiores a 12.000 ufc/m3, y las bacterias gramnegativas, que se handeterminado en concentraciones ambientales entre 1.395 y 5.280 ufc/m3.En ambos casos, estas concentraciones han sido muy superiores a lashalladas en la muestra de referencia obtenida en el exterior de la planta.Entre los hongos, los géneros mayoritarios han sido Penicillium yCladosporium, mientras que entre las bacterias gramnegativas se identificaronlos géneros Escherichia, Enterobacter, Klebsiella y Serratia.En conclusión, los trabajadores de una planta de selección de envasesprocedentes de la recogida selectiva de residuos sólidos urbanos puedenestar expuestos a agentes biológicos, especialmente en forma de hongos ybacterias gramnegativas(AU)

Several studies have showed an association between the work in wastetreatment plants and occupational health problems such as irritation of skin,eyes and mucous membranes, pulmonary diseases, gastrointestinal problemsand symptoms of organic dust toxic syndrome (ODTS). These symptoms havebeen related to bioaerosol exposure.The aim of this study was to investigate the occupational exposure tobiological agents in a plant sorting source-separated packages (plasticsmaterials, ferric and non-ferric metals) household waste.Airborne samples were colleted with M Air T Millipore sampler.The concentration of total fungi and bacteria and gram-negative bacteria weredetermined and the most abundant genera were identified.The results shown that the predominant airborne microorganisms were fungi,with counts greater than 12,000 cfu/m3 and gram-negative bacteria, with aenvironmental concentration between 1,395 and 5,280 cfu/m3. In both cases,these concentrations were higher than levels obtained outside of the sortingplant.Among the fungi, the predominant genera were Penicillium and Cladosporium,whereas the predominant genera of gram-negative bacteria were Escherichia,Enterobacter, Klebsiella and Serratia.The present study shows that the workers at sorting source-separatedpackages (plastics materials, ferric and non-ferric metals) domestic wasteplant may be exposed to airborne biological agents, especially fungi andgram-negative bacteria(AU)

Mielinólisis central pontina tras trasplante hepático / Central pontine myelinolysis after liver transplantation

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Hemorragia digestiva e invaginación intestinal por coriocarcinoma intestinal / Gastrointestinal bleeding and intestinal invagination due to intestinal choriocarcinoma

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Surgical options for malignant left-sided colonic obstruction.

PURPOSE: We evaluated the clinical results of different techniques of resection for malignant left-sided colonic obstruction. METHODS: The subjects of this prospective nonrandomized study were 63 consecutive patients who underwent surgery between 1995 and 2000 at a single institution. Patients with nonprimary colonic tumors, lesions located proximally to splenic flexure, peritonitis, perforation, or cecal necrosis were excluded. RESULTS: Segmental colectomy with primary anastomosis (CPA) was performed in 35 patients; with intraoperative colonic irrigation (ICI) in 19, and without ICI in 16. Total or subtotal colectomy (TSC) was performed in 8, and Hartmann's procedure (HP) was performed in 20. There were no differences in age, sex, comorbidity, time of symptoms, preoperative hospital stay, or tumor staging among the groups of patients defined by the different surgical techniques. The overall incidence of postoperative complications was 43%; postoperative mortality, 5%; anastomotic dehiscence, 12%; urgent reoperations, 12%; and readmissions, 5%, without significant differences among the treatment groups. However, the postoperative and total hospital stay were significantly shorter after ICI (P = 0.016 and P = 0.012, respectively). The overall 5-year survival was 42.7%. CONCLUSIONS: We think that segmental colectomy with anastomosis after intraoperative colonic irrigation is the most effective operative treatment for neoplastic left-sided colonic obstructions, considering its safety and cost-effectiveness.

Adenocarcinoma de duodeno / Duodenal adenocarcinoma

Introducción. El adenocarcinoma de duodeno es una neoplasia infrecuente, lo que impide la existencia de grandes series que permitan extraer conclusiones sobre su diagnóstico y su tratamiento. Pacientes y método. Estudio retrospectivo (19992003) de los 5 pacientes diagnosticados de adenocarcinoma duodenal en nuestro servicio. Resultados. La edad media fue de 54 años. El 80% eran varones. Todos presentaron pérdida de peso y dolor abdominal. La localización del tumor fue: segunda (3 casos) y tercera porción (2). A todos los pacientes se les practicó una endoscopia digestiva con biopsia que informó de la presencia de adenocarcinoma. La tomografía computarizada fue la prueba diagnóstica más eficaz. El diagnóstico preoperatorio fue correcto en todos los pacientes. La técnica realizada fue duodenopancreatectomía cefálica (3 casos) y duodenectomía con resección atípica pancreática y hemicolectomía derecha (1 caso). A un paciente con metástasis hepáticas se decidió no practicar intervención quirúrgica. Dos pacientes intervenidos no presentaron ninguna complicación. Los otros presentaron vaciado gástrico lento (1 paciente) y pancreatitis del muñón, que produjo un SIRS que ocasionó el fallecimiento del paciente. La supervivencia de los pacientes intervenidos es de 60, 13 meses y 1 mes, respectivamente. Ninguno ha presentado recidiva de la enfermedad. El paciente no intervenido falleció a los 4 meses. Conclusión. El adenocarcinoma de duodeno es un tumor infrecuente asociado a diversas enfermedades. El tratamiento quirúrgico suele ser una duodenopancreatectomía cefálica. La supervivencia en los pacientes resecados es mejor que la obtenida en los tumores pancreáticos primarios (AU)

Introduction. Duodenal adenocarcinoma is an infrequent neoplasm. Consequently, there are no large series that would allow conclusions to be reached on its diagnosis and treatment. Patients and method. A retrospective study (19992003) of five patients diagnosed with duodenal adenocarcinoma in our service was performed. Results. The mean age was 54 years. Eighty percent were male. All patients showed weight loss and abdominal pain. The tumors were localized in the second portion in three patients and in the third portion in two patients. All patients underwent gastrointestinal endoscopy with biopsy, which revealed adenocarcinoma. The most effective diagnostic test was computed tomography. In all patients, the preoperative diagnosis was correct. The technique performed was cephalic duodenopancreatectomy in three patients and duodenectomy with atypical pancreatic resection and right hemicolectomy in one patient. A decision not to perform surgery was made in one patient with liver metastases. Two patients who underwent surgery showed no complications. The remaining two patients showed slow gastric emptying in one patient and pancreatitis of the stump leading to fatal systemic inflammatory response syndrome in the other. Patient survival was 60, 13 and 1 month respectively. There were no recurrences. The patient who did not undergo surgery died at 4 months. Conclusion. Duodenal adenocarcinoma is an infrequent tumor that is associated with various diseases. Surgical treatment is usually cephalic duodenopancreatectomy. Survival in resected patients is better than that obtained in primary pancreatic tumors (AU)

Pancreatectomía corporocaudal: una misma técnica con variadas indicaciones / Distal pancreatectomy: one technique with several indications

Introducción. La pancreatectomía corporocaudal (PCC) es una técnica que se realiza para diferentes enfermedades pancreáticas. Su frecuencia ha disminuido desde que no se realiza sistemáticamente en la cirugía gástrica oncológica y se ha restringido su uso a pacientes con pancreatitis crónica. Presentamos una serie de enfermos a los que se practicó PCC y debatimos aspectos técnicos y de indicación quirúrgica. Pacientes y método. Estudio retrospectivo realizado entre 1998 y 2003 de los pacientes a los que se ha practicado una PCC clásica con esplenectomía asociada (CIE: 52.52) en nuestro servicio. En dicho período se practicaron 14 PCC. Resultados. La edad media fue de 52,6 años. El 36% era varón (5/14). El diagnóstico fue de tumor quístico mucinoso pancreático en 5 pacientes, tumor neuroendocrino en 3, pancreatitis focal sobre pancreatitis crónica en 2, cáncer de páncreas en 2, traumatismo pancreático por herida con arma blanca en 1 y metástasis pancreática de cáncer renal en 1. La prueba diagnóstica más utilizada fue la tomografía computarizada (TC) abdominal (13/14). La cirugía fue electiva en el 86%. La técnica de cierre del muñón distal se realizó con sutura manual (29%), grapado mecánico (64%) y sutura más grapado (7%). No hemos observado ninguna relación estadística entre el cierre del muñón y el desarrollo de una fístula pancreática. La morbilidad fue del 35% y la mortalidad, nula. La estancia media fue de 18 días. Conclusiones. La PCC es una técnica que se puede realizar sin mortalidad pero con una morbilidad no desdeñable, asociada habitualmente al desarrollo de fístula pancreática. Las indicaciones de PCC han cambiado y en la actualidad se realiza por varias enfermedades pancreáticas cada vez más frecuentes (AU)

Introduction. Distal pancreatectomy (DP) is performed for various pancreatic processes. This procedure has become less frequent since it ceased to be systematically used in oncologic gastric surgery and it is now performed mainly in patients with chronic pancreatitis. We present a series of patients who underwent DP and discuss technical features and surgical indications. Patients and methods. We performed a retrospective study of patients who underwent classical DP with associated splenectomy (CIE: 52.52) in our service from 1998-2003. Fourteen DP were performed during the study period. Results. The mean age was 52.6 years. Thirty-six percent of the patients were male (5/14). Diagnosis was mucinous cystic tumor of the pancreas (5), neuroendocrine tumor (3), focal chronic pancreatitis (2), pancreatic cancer (2), pancreatic injury due to a sharp instrument wound (1), and pancreatic metastases from renal cancer (1). The most frequently used diagnostic procedure was abdominal computerized axial tomography (13/14). Surgery was elective in 86%. The technique used to close the distal stump was manual suture (29%), mechanical stapling (64%) and suture plus stapling (7%). No statistically significant relationship was observed between closure of the stump and the development of pancreatic fistula. Morbidity was 35% and mortality was 0%. The mean length of hospital stay was 18 days. Conclusions. DP can be performed without mortality but morbidity is not inconsiderable and is usually associated with the development of pancreatic fistulas. The indications for DP have changed and currently this procedure is performed for several pancreatic processes that are becoming increasingly frequent (AU)

[Distal pancreatectomy: one technique with several indications]. / Pancreatectomía corporocaudal: una misma técnica con variadas indicaciones.

INTRODUCTION: Distal pancreatectomy (DP) is performed for various pancreatic processes. This procedure has become less frequent since it ceased to be systematically used in oncologic gastric surgery and it is now performed mainly in patients with chronic pancreatitis. We present a series of patients who underwent DP and discuss technical features and surgical indications. PATIENTS AND METHODS: We performed a retrospective study of patients who underwent classical DP with associated splenectomy (CIE: 52.52) in our service from 1998-2003. Fourteen DP were performed during the study period. RESULTS: The mean age was 52.6 years. Thirty-six percent of the patients were male (5/14). Diagnosis was mucinous cystic tumor of the pancreas (5), neuroendocrine tumor (3), focal chronic pancreatitis (2), pancreatic cancer (2), pancreatic injury due to a sharp instrument wound (1), and pancreatic metastases from renal cancer (1). The most frequently used diagnostic procedure was abdominal computerized axial tomography (13/14). Surgery was elective in 86%. The technique used to close the distal stump was manual suture (29%), mechanical stapling (64%) and suture plus stapling (7%). No statistically significant relationship was observed between closure of the stump and the development of pancreatic fistula. Morbidity was 35% and mortality was 0%. The mean length of hospital stay was 18 days. CONCLUSIONS: DP can be performed without mortality but morbidity is not inconsiderable and is usually associated with the development of pancreatic fistulas. The indications for DP have changed and currently this procedure is performed for several pancreatic processes that are becoming increasingly frequent.

[Duodenal adenocarcinoma]. / Adenocarcinoma de duodeno.

INTRODUCTION: Duodenal adenocarcinoma is an infrequent neoplasm. Consequently, there are no large series that would allow conclusions to be reached on its diagnosis and treatment. PATIENTS AND METHOD: A retrospective study (1999-2003) of five patients diagnosed with duodenal adenocarcinoma in our service was performed. RESULTS: The mean age was 54 years. Eighty percent were male. All patients showed weight loss and abdominal pain. The tumors were localized in the second portion in three patients and in the third portion in two patients. All patients underwent gastrointestinal endoscopy with biopsy, which revealed adenocarcinoma. The most effective diagnostic test was computed tomography. In all patients, the preoperative diagnosis was correct. The technique performed was cephalic duodenopancreatectomy in three patients and duodenectomy with atypical pancreatic resection and right hemicolectomy in one patient. A decision not to perform surgery was made in one patient with liver metastases. Two patients who underwent surgery showed no complications. The remaining two patients showed slow gastric emptying in one patient and pancreatitis of the stump leading to fatal systemic inflammatory response syndrome in the other. Patient survival was 60, 13 and 1 month respectively. There were no recurrences. The patient who did not undergo surgery died at 4 months. CONCLUSION: Duodenal adenocarcinoma is an infrequent tumor that is associated with various diseases. Surgical treatment is usually cephalic duodenopancreatectomy. Survival in resected patients is better than that obtained in primary pancreatic tumors.

Resultados de la resección hepática con intención curativa por metástasis de carcinoma colorrectal / Outcome of liver resection with curative intent for metastases from colorectal carcinoma

Introducción. La cirugía es el recurso fundamental en el tratamiento de las metástasis hepáticas de carcinoma colorrectal. Sus resultados dependen de una correcta selección y una morbimortalidad postoperatoria ajustada a los estándares establecidos. Pretendemos valorar nuestros resultados en relación con la morbimortalidad y la supervivencia a largo plazo. Pacientes y método. Estudio prospectivo de una cohorte de pacientes en los que se realizó una resección curativa de metástasis hepáticas de carcinoma colorrectal (tumor primario tratado curativamente, ausencia de enfermedad extrahepática irresecable y resección completa de la enfermedad hepática). En el período 1998-2002 practicamos 40 hepatectomías (5 rerresecciones) en 36 enfermos, con exéresis del tumor primario concomitante en 18 casos. Resultados. En 17 intervenciones (42,5 por ciento) se trataron metástasis múltiples (máximo de 6 lesiones). Se realizaron 14 hepatectomías mayores (35 por ciento), 12 mono o bisegmentectomías (30 por ciento) y 14 resecciones no anatómicas (35 por ciento). Aparecieron complicaciones en el 45 por ciento de los postoperatorios, entre las que destacaban 5 colecciones perihepáticas, 4 derrames pleurales sintomáticos, 3 fístulas biliares, 3 insuficiencias hepáticas, 3 insuficiencias renales y 2 hemoperitoneos. La tasa de reintervenciones fue del 12,5 por ciento y la mortalidad posquirúrgica del 5 por ciento. El 73 por ciento de los pacientes recibió quimioterapia coadyuvante. El seguimiento medio fue de 16,4 meses, con una supervivencia actuarial a los 4 años del 33 por ciento (supervivencia libre de enfermedad del 24,5 por ciento). Conclusiones. Las unidades quirúrgicas que tratan metástasis hepáticas de origen colorrectal deben conocer sus resultados y analizar su adecuación a los estándares establecidos. Nuestros datos resultan adecuados en cuanto a la mortalidad postoperatoria y la supervivencia a largo plazo. El análisis de la morbilidad postoperatoria nos ha permitido detectar áreas de mejora para adecuarlas a los estándares predefinidos (AU)

Signet-ring-cell carcinoma of the Vater's ampulla.

CONTEXT: Most tumors affecting Vater's Ampulla are adenocarcinomas and other histological variants are less frequent. A review of the literature revealed only seven previously reported cases of signet ring cell carcinoma of the ampulla of Vater. The presence of this kind of tumor has no clear histological explanation. Two possible theories have been proposed: the presence of gastric heterotopia in the ampulla of Vater or the existence of a perivaterian duodenal heterotopia of ulcerous etiology as the origin of a signet ring cell tumor which secondarily invades the ampulla of Vater. CASE REPORT: We performed a pancreatoduodenectomy in a 67-year-old woman with a T2N0M0 ampulla tumor. A histologic study revealed a signet ring cell neoplasm. CONCLUSION: Etiology and survival of signet ring cell carcinoma of Vater's ampulla is not well-defined in the literature due to the extreme rarity of this disease. Duodenopancreatectomy with pylorus preservation is the treatment of choice.

Tumores quísticos mucinosos del páncreas / Mucinous cystic tumors of the pancreas

Introducción. Los tumores quísticos del páncreas constituyen un grupo heterogéneo de neoplasias poco frecuentes (representan el 10-15 por ciento de las lesiones quísticas pancreáticas), que incluye los tumores serosos, mucinosos y un grupo miscelánea. El interés ha ido en aumento en los últimos años por su alta tasa de curación y su potencial confusión con afecciones pancreáticas benignas. Métodos. Hemos realizado un estudio retrospectivo sobre los pacientes con diagnóstico de tumor quístico mucinoso de páncreas en nuestro hospital durante los años 1999-2001 y debatimos los métodos diagnósticos y terapéuticos empleados. Resultados. Se trató a 7 pacientes (6 mujeres) con el diagnóstico de tumor quístico mucinoso de páncreas. La media de edad fue 54 años (rango, 32-72). Los métodos diagnósticos utilizados fueron la ecografía y la tomografía computarizada (TC) en los 7 pacientes y la colangiorresonancia y la punción aspiración con aguja fina (PAAF) en 3 de ellos. Todos los pacientes fueron sometidos a tratamiento quirúrgico. El resultado anatomopatológico fue 6 casos de cistoadenoma mucinoso y 1 caso de cistoadenocarcinoma. Conclusiones. Los tumores quísticos de páncreas son neoplasias poco frecuentes. Aparecen con mayor frecuencia en mujeres adultas y se relacionan con el consumo de tabaco y las nitrosaminas. El diagnóstico va a estar basado en la clínica (dolor abdominal, síntomas derivados del efecto masa, pérdida de peso, saciedad precoz, náuseas, vómitos y otros de menor frecuencia) y en los diferentes métodos diagnósticos disponibles, principalmente la TC, si bien son también de gran utilidad la ecografía, la ecoendoscopia, la colangiopancreatografía endoscópica (CPRE), la colangiorresonancia, la tomografía por emisión de positron (PET) y la PAAF guiada porTC. La actitud terapéutica en los tumores mucinosos debe ser quirúrgica ante la imposibilidad de discernir preoperatoriamente la histología definitiva (AU)

Enfermedad de Caroli monolobar asociada a hepatolitiasis / Monolobar caroli´s disease associated with hepatolithiasis

La enfermedad de Caroli es una entidad que se hereda de forma autosómica recesiva y está caracterizada por la dilatación sacular no obstructiva de los grandes conductos biliares intrahepáticos. Puede afectar al hígado globalmente o a un solo lóbulo. Clínicamente, cursa con colangitis de repetición y se puede asociar a hepatolitiasis. La enfermedad monolobar puede resolverse mediante hepatectomía, y la bilobar puede requerir la realización de un trasplante hepático. Presentamos un caso de enfermedad de Caroli monolobar derecha asociada a hepatolitiasis, y debatimos los métodos diagnósticos y terapéuticos (AU)

Rotura de adenoma hepático secundario al consumo de anticonceptivos orales / Rupture of hepatic adenoma secondary to intake of oral contraception

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