Surgical indication for right hemicolectomy in goblet cell adenocarcinoma of the appendix.

We have read with interest the article by Pérez Montiel CA et al., in which goblet cell adenocarcinoma (GCA) is described as a cause of acute appendicitis. Although the article is brilliant in terms of histopathological description of the appendiceal GCA, the surgical indication for right hemicolectomy should be analyzed in depth due to the great controversy that exists in the scientific literature.

Detección y control del cáncer de cuello uterino en mujeres de 35 a 44 años en Ecuador / Detection and control of cervical cancer in women aged 35 to 44 yearsin Ecuador

INTRODUCCIÓN: El cáncer de cuello uterino es un problema de salud pública que se origina en las células que recubren el cuello del útero, cuya etiología se relaciona frecuentemente con el virus del Papiloma Humano. Esta patología solo se presenta en las mujeres, siendo el segundo más común entre las tipologías de cáncer; su aparición puede ser prevenible mediante el control y la detección oportuna. OBJETIVO: Determinar el nivel de control y detección de cáncer cérvico-uterino que tienen las mujeres de 35 a 44 años. METODOLOGÍA: La investigación es cuantitativa, descriptiva y de corte transversal. La muestra fue de 267 mujeres de 35 a 44 años. Se aplicó una encuesta virtual de manera voluntaria y aleatoria a la población femenina de dichas edades, en la cual se establecieron preguntas categorizadas en: Conocimiento general, Control y Detección, éstas nos ayudarán a comprobar el grado de información, control y detección del cáncer cérvico-uterino que tenga dicha población. RESULTADOS: El porcentaje general varía de acuerdo a las categorías de las encuestas empleadas, a partir de las cuales se refleja que el 52,8% tiene conocimiento acerca de los métodos de control y detección del cáncer cérvico-uterino, el 44,3% no ha recibido información acerca del tema y, el 2,9% tiene un conocimiento incompleto. CONCLUSIÓN: El cáncer cérvico-uterino afecta con mayor frecuencia a las mujeres sexualmente activas dentro del rango de edad de 35 y 44 años, siendo la falta de información de la población femenina y la ausencia de controles sanitarios algunos de los factores que predisponen a una alta incidencia y prevalencia de la morbi ­mortalidad a causa de esta patología.

INTRODUCTION: Cervical cancer is a public health problem that originates in the cells lining the cervix, whose etiology is often associated with the Human Papillomavirus. This pathology only occurs in women, being the second most common among cancer typologies; its appearance can be preventable through control and timely detection. OBJECTIVE: To determine the level of control and detection of cervical-uterine cancer in women aged 35 to 44. METHODOLOGY: The research is quantitative, descriptive and cross-sectional. The sample was 267 women aged 35 to 44 years. A voluntary and random virtual survey was applied to the female population of these ages, in which questions categorized in: General knowledge, Control and Detection were established, these will help us to verify the degree of information, control and detection of cervical-uterine cancer in that population. RESULTS: The percentage varies according to the categories of surveys used, showing that 50.3 per cent have knowledge of methods for the control and detection of cervical-uterine cancer, 41.1 per cent have not received information on the subject and 8.6% have incomplete knowledge. CONCLUSIONS: Cervical-uterine cancer most often affects sexually active women in the 35-44 age range, The lack of information from the female population and the absence of health controls are some of the factors that predispose to a high incidence and prevalence of morbidity -mortality due to this pathology.

Sueño: conceptos generales y su relación con la calidad de vida / Sleep: general concepts and their relationship with quality of life

El desarrollo de la medicina del sueño ha experimentado notables avances por contribuciones provenientes tanto de las ciencias básicas como de los estudios clínicos, destacando una relación positiva entre la preservación de un sueño normal y un amplio espectro de beneficios en diferentes indicadores de salud individual y de la población. Un adecuado conocimiento de los postulados y mecanismos fisiológicos del sueño actualmente más aceptados a escala molecular, celular y sistémica, permiten desarrollar conceptos objetivos que otorgan mayor solidez a la evaluación del sueño. La etapificación del sueño, su arquitectura, variables de continuidad del mismo, asícomo el índice de microdespertares, entre otros, tienen una aplicación clínica directa: se pueden describir y utilizar rangos normales de parámetros polisomnográficos con sus características a lo largo de la edad, y variantes cronotípicas individuales. De este modo, se espera seguir avanzando tanto en el temprano y correcto diagnóstico como en una mejor toma de decisiones médicas.Muy probablemente, debido a la función integradora del sueño, es que este juega un rol tan crucial en la salud, avalado por un cuerpo de evidencia que muestra un importante impacto beneficioso de un sueño sano en la calidad de vida, morbilidad y la prevención primaria de enfermedades muy variadas

The development of sleep medicine has experienced notable advances due to contributions from both basic science and clinical studies, highlighting a positive relationship between the preservation of normal sleep and a wide spectrum of benefits in different indicators of individual and population health.An adequate knowledge of the currently more accepted physiological postulates and mechanisms of sleep, on a molecular, cellular and systemic scale, allows the development of objective concepts that give greater solidity to sleep assessment. Sleep staging, architecture, and continuity variables such as the microarousal index, among others, have direct clinical applications: normal ranges of polysomnographic parameters can be described and used with their characteristics throughout age and individual chronotype variants. In this way, it is further advances are expected both in early and correct diagnosis and in better medical treatments.Evidence supports the crucial role sleep plays in overall health. Most likely due to its integrative function, healthy sleep has an important beneficial impact on quality of life, morbidity and primary prevention of a wide variety of diseases

Concentraciones plasmáticas de fragmento N-terminal del propéptido natriurético auricular plasmático en pacientes con preeclampsia y embarazadas normotensas sanas / Plasmatic levels of N-terminal pro-atrial natriuretic peptide in preeclamptic patients and healthy normotensive pregnant women

Fundamento y objetivo: Comparar las concentraciones plasmáticas del fragmento N-terminal del propéptido natriurético auricular en pacientes con preeclampsia y embarazadas normotensas sanas. Métodos: Se realizó un estudio de casos y controles con 180 embarazadas en el Hospital Central Dr. Urquinaona, de Maracaibo (Venezuela), que incluyó 90 pacientes con preeclampsia (grupo A; casos) y un grupo de control seleccionado por tener una edad y un índice de masa corporal similares al grupo A, el cual consistió en 90 embarazadas normotensas sanas (grupo B; controles). Las muestras de sangre se tomaron una hora después del ingreso y antes de la administración de cualquier medicamento en el grupo A para determinar las concentraciones plasmáticas del fragmento N-terminal del propéptido natriurético auricular y otros parámetros de laboratorio. Resultados: Las concentraciones plasmáticas del fragmento N-terminal del propéptido natriurético auricular entre las pacientes del grupo A (media 1,01 [DE 0,26] pg/ml) mostraron diferencias significativas comparadas con las pacientes del grupo B (media 0,55 [DE 0,07] pg/ml; p<0,001). No se observaron correlaciones significativas con los valores de presión arterial sistólica y diastólica en las pacientes con preeclampsia (p=ns). Un valor de corte de 0,66ng/ml presentó un valor por debajo de la curva de 0,93, una sensibilidad del 87,8%, una especificidad del 83,3%, un valor predictivo positivo del 84,0% y un valor predictivo negativo del 87,2%, con una exactitud diagnóstica del 85,6%. Conclusión: Las pacientes con preeclampsia presentaron concentraciones plasmáticas significativamente más altas del fragmento N-terminal del propéptido natriurético auricular al compararlo con embarazadas normotensas sanas, con altos valores predictivos para el diagnóstico

Background and objective: To compare plasma N-terminal pro-atrial natriuretic peptide concentrations in preeclamptic patients and healthy normotensive pregnant women. Methods: A cases-controls study was done with 180 patients at Hospital Central Dr. Urquinaona, Maracaibo, Venezuela, that included 90 preeclamptic patients (group A; cases) and 90 healthy normotensive pregnant women selected with the same age and body mass index similar to group A (group B; controls). Blood samples were collected one hour after admission and prior to administration of any medication in group A to determine plasma N-terminal pro-atrial natriuretic peptide and other laboratory parameters. Results: Plasma N-terminal pro-atrial natriuretic peptide concentrations in group A (mean 1.01 [0.26] pg/mL) showed a significant difference when compared with patients in group B (mean 0.55 [0.07] pg/mL; P<.001]. There was no significant correlation with systolic and diastolic blood pressure values in preeclamptic patients (P=ns). A cut-off value of 0.66ng/mL had an area under the curve of 0.93, sensitivity of 87.8%, specificity of 83.3%, a positive predictive value of 84.0% and a negative predictive value of 87.2%, with a diagnostic accuracy of 85.6%. Conclusion: Preeclamptic patients have significantly higher concentrations of plasma N-terminal pro-atrial natriuretic peptide compared with healthy normotensive pregnant women, with high predictive values for diagnosis

Procalcitonin and C-reactive protein as early markers of anastomotic leak after laparoscopic colorectal surgery within an enhanced recovery after surgery (ERAS) program.

BACKGROUND: C-reactive protein (CRP) and procalcitonin (PCT) have been described as good predictors of anastomotic leak after colorectal surgery, obtaining the highest diagnostic accuracy on the 5th postoperative day. However, if an enhanced recovery after surgery (ERAS) program is performed, early predictors are needed in order to ensure a safe and early discharge. The aim of this study was to investigate the efficacy of CRP, PCT, and white blood cell (WBC) count determined on first postoperative days, in predicting septic complications, especially anastomotic leak, after laparoscopic colorectal surgery performed within an ERAS program. METHODS: We conducted a prospective study including 134 patients who underwent laparoscopic colorectal surgery within an ERAS program between 2015 and 2017. The primary endpoint investigated was anastomotic leak. CRP, PCT, and WBC count were determined in the blood sample extracted on postoperative day 1 (POD 1), POD 2 and POD 3. RESULTS: Anastomotic leak (AL) was detected in 6 patients (4.5%). Serum levels of CRP and PCT, but not WBC, determined on POD 1, POD 2, and POD 3 were significantly higher in patients who had AL in the postoperative course. Using ROC analysis, the best AUC of the CRP and PCT levels was on POD 3 (0.837 and 0.947, respectively). A CRP cutoff level at 163 mg/l yielded 85% sensitivity, 80% specificity, and 99% negative predictive value (NPV). A PCT cutoff level at 2.5 ng/ml achieved 85% sensitivity, 95% specificity, 44% positive predictive value, and 99% NPV. CONCLUSIONS: CRP and PCT are relevant markers for detecting postoperative AL after laparoscopic colorectal surgery. Furthermore, they can ensure an early discharge with a low probability of AL when an ERAS program is performed.

Resultados de la encuesta nacional sobre el tratamiento de la fisura anal crónica en los hospitales españoles / Results of the national survey on the treatment of chronic anal fissure in Spanish hospitals

Introducción: El tratamiento de la fisura anal crónica (FAC) difiere en función del profesional. Para plantear un consenso, sería conveniente conocer el estado actual a nivel nacional. El objetivo del presente estudio es conocer la situación actual del manejo de la FAC en los hospitales españoles. Métodos: Estudio descriptivo, con datos de encuestas a cirujanos de la Asociación Española de Coloproctología en las que se han recogido datos de la comunidad autónoma, tipo de hospital y categoría profesional, opinión sobre el manejo de la FAC en general y relativa a 3 casos clínicos específicos. Resultados: Se ha recibido respuesta de 152 cirujanos. Las medidas farmacológicas constituyen el primer escalón terapéutico (93,38%). En paciente con hipertonía y sin factores de riesgo de incontinencia fecal (IF), el 55,9% emplea medidas higiénico-dietéticas asociadas a pomada de nitroglicerina (MHG + NTG). El segundo escalón lo constituiría la esfinterotomía lateral interna (ELI) (43,4%). En paciente con factores de riesgo de IF, se utiliza MHG + NTG (75,7%) y en caso de fracaso, ELI previa ecografía y/o manometría. En paciente joven con hipertonía inexplorable y proctalgia incapacitante sin factores de riesgo de IF, se trataría con MHG + NTG (55,9%) y si fracasa, ELI (46,1%). Conclusiones: El manejo de la FAC en España presenta similitudes con las recomendaciones que realizan las guías internacionales. Sin embargo, se observan algunas diferencias incluso desde las primeras opciones de tratamiento (AU)

Introduction: The treatment of chronic anal fissure (FAC) differs depending on the professional. To come to a consensus, the current situation in Spain should be studied. The aim of this study is to evaluate the current situation of the management of FAC in Spanish hospitals. Methods: Descriptive study, with data from a survey of surgeons of the Spanish Association of Coloproctology. Data was collected according to the doctor's autonomous community, type of hospital and professional category; FAC management data and 3 clinical cases. Results: Response was obtained from 152 surgeons. Pharmacological measures stand out as the first therapeutic step (93.38%). In patients with hypertonia and with no risk factors for fecal incontinence (FI), 55.9% use hygienic-dietary measures associated with nitroglycerin ointment (MHG + NTG). The second step is internal lateral sphincterotomy (ELI) (43.4%). MHG + NTG (75.7%) is used in patients with FI risk factors and in case of failure, ELI is used with a prior ultrasound and/or manometry. In young patients with unexplained hypertonia and incapacitating proctalgia with no risk factors for FI, MHG + NTG (55.9%) is used and, if it is not successful, they are treated with ELI (46.1%). Conclusions: The management of FAC in Spain shows similarities with the international guideline suggestions. Nevertheless, some differences can be seen from the first stages of treatment (AU)

Results of the national survey on the treatment of chronic anal fissure in Spanish hospitals. / Resultados de la encuesta nacional sobre el tratamiento de la fisura anal crónica en los hospitales españoles.

INTRODUCTION: The treatment of chronic anal fissure (FAC) differs depending on the professional. To come to a consensus, the current situation in Spain should be studied. The aim of this study is to evaluate the current situation of the management of FAC in Spanish hospitals. METHODS: Descriptive study, with data from a survey of surgeons of the Spanish Association of Coloproctology. Data was collected according to the doctor's autonomous community, type of hospital and professional category; FAC management data and 3 clinical cases. RESULTS: Response was obtained from 152 surgeons. Pharmacological measures stand out as the first therapeutic step (93.38%). In patients with hypertonia and with no risk factors for fecal incontinence (FI), 55.9% use hygienic-dietary measures associated with nitroglycerin ointment (MHG+NTG). The second step is internal lateral sphincterotomy (ELI) (43.4%). MHG+NTG (75.7%) is used in patients with FI risk factors and in case of failure, ELI is used with a prior ultrasound and/or manometry. In young patients with unexplained hypertonia and incapacitating proctalgia with no risk factors for FI, MHG+NTG (55.9%) is used and, if it is not successful, they are treated with ELI (46.1%). CONCLUSIONS: The management of FAC in Spain shows similarities with the international guideline suggestions. Nevertheless, some differences can be seen from the first stages of treatment.

Plasmatic levels of N-terminal pro-atrial natriuretic peptide in preeclamptic patients and healthy normotensive pregnant women. / Concentraciones plasmáticas de fragmento N-terminal del propéptido natriurético auricular plasmático en pacientes con preeclampsia y embarazadas normotensas sanas.

BACKGROUND AND OBJECTIVE: To compare plasma N-terminal pro-atrial natriuretic peptide concentrations in preeclamptic patients and healthy normotensive pregnant women. METHODS: A cases-controls study was done with 180 patients at Hospital Central Dr. Urquinaona, Maracaibo, Venezuela, that included 90 preeclamptic patients (group A; cases) and 90 healthy normotensive pregnant women selected with the same age and body mass index similar to group A (group B; controls). Blood samples were collected one hour after admission and prior to administration of any medication in group A to determine plasma N-terminal pro-atrial natriuretic peptide and other laboratory parameters. RESULTS: Plasma N-terminal pro-atrial natriuretic peptide concentrations in group A (mean 1.01 [0.26] pg/mL) showed a significant difference when compared with patients in group B (mean 0.55 [0.07] pg/mL; P<.001]. There was no significant correlation with systolic and diastolic blood pressure values in preeclamptic patients (P=ns). A cut-off value of 0.66ng/mL had an area under the curve of 0.93, sensitivity of 87.8%, specificity of 83.3%, a positive predictive value of 84.0% and a negative predictive value of 87.2%, with a diagnostic accuracy of 85.6%. CONCLUSION: Preeclamptic patients have significantly higher concentrations of plasma N-terminal pro-atrial natriuretic peptide compared with healthy normotensive pregnant women, with high predictive values for diagnosis.

Encefalitis por anticuerpos antirreceptores de N-metil-aspartato debida a teratoma quístico ovárico / Anti-N-methyl-D-aspartate-receptor encephalitis due to ovarian teratoma

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Células progenitoras endoteliales en el embarazo normal y la preeclampsia / Endothelial progenitor cells in normal pregnancy and preeclampsia

El embarazo es un reto para el sistema cardiovascular materno, necesitando de adaptación sistémica y marcados cambios locales en el útero. La adaptación cardiovascular materna al embarazo involucra una respuesta fisiológica compleja a la presencia de un feto en crecimiento, incluyendo alteraciones de las células endoteliales vasculares que contribuyen a la marcada disminución de la resistencia vascular sistémica. El descubrimiento de las células progenitoras endoteliales ha generado un considerable interés en el campo de la biología vascular. Estas células pueden ser movilizadas hacia la circulación por factores de crecimiento y pueden apoyar la salud del endotelio vascular por varios mecanismos. Estas células se originan de una población de células mononucleares circulantes y tienen la capacidad de formar nuevos vasos y contribuyen a la reparación vascular. Patologías del embarazo, como la preeclampsia, incrementan el riesgo de complicaciones y están asociadas con disfunción endotelial.

Pregnancy is a challenge to the maternal vascular system, requiring systemic adaptation and pronounced local changes in the uterus. The maternal cardiovascular adaptation to pregnancy involves a complex physiologic response to the presence of the growing fetus, including alterations in maternal vascular endothelial cells that contribute to a profound fall in total systemic vascular resistance. The discovery of endothelial progenitor cells has generated considerable interest in the field of vascular biology. These cells can be mobilized into the circulation by growth factors and can then support the health of the vascular endothelium by several mechanisms. These cells arise from a population of circulating mononuclear cells and have the capacity to form new blood vessels and contribute to vascular repair. Diseases of pregnancy, such as preeclampsia, increase the risk of complications and are associated with endothelial dysfunction.

Exosomas placentarios y preeclampsia / Placental exosomes and preeclampsia

El éxito del embarazo se asocia con una correcta placentación, esencial para el crecimiento y desarrollo del feto. El sincitiotrofoblasto en el embarazo normal produce y secreta una variedad de elementos necesarios para lograr este objetivo, entre ellos, los exosomas placentarios. Estos llevan proteínas citoplasmáticas y ligadas a la membrana y ácidos nucleicos que pueden reprogramar a las células receptoras. Dependiendo de sus interacciones con el sistema inmune pueden dividirse en inmuno-estimulantes o inmuno-supresores. La producción y secreción de exosomas placentarios inmunosupresores provoca un efecto protector en la unidad feto-placentaria. Aquellos aislados del plasma materno son activos in vitro y se incorporan a las células diana por endocitosis. Su efecto está regulado por factores que incluyen tensión de oxígeno y se correlaciona con la perfusión placentaria. La preeclampsia es un síndrome caracterizado una disminución del flujo sanguíneo útero-placentario asociado a una invasión trofoblástica alterada que puede conducir a hipoxia placentaria y disfunción endotelial, liberando materiales nocivos en la circulación, lo que ocasiona daños en la función endotelial. Se han reportado cambios en la liberación, concentración en plasma materno, composición y actividad de exosomas placentarios en asociación con la preeclampsia. En esta revisión se analiza el origen de los exosomas placentarios y cómo podrían estar involucrados en la fisiopatología de la preeclampsia.

The success of pregnancy is associated with a correct placentation that is essential for the growth and development of the fetus. In a normal pregnancy, the syncytiotrophoblast produces and secretes a variety of elements necessary to achieve this goal, among them placental exosomes. These carry cytoplasmic and membrane-bound proteins and nucleic acids that can reprogram the receptor cells. Depending on their interactions with the immune system, they can be divided into immunostimulants or immunosuppressants. The production and secretion of immunosuppressive placental exosomes causes a protective effect on the fetal­placental unit. Those isolated from maternal plasma are active in vitro and are incorporated into the target cells by endocytosis. Their effect, regulated by factors that include oxygen tension, correlates with placental perfusion. Preeclampsia is a syndrome characterized by a decrease in uteroplacental blood flow associated with an altered trophoblastic invasion that can lead to placental hypoxia and endothelial dysfunction, releasing harmful materials into the circulation and causing damage to endothelial function. Reports have associated changes in the release, concentration in maternal plasma, composition, and activity of placental exosomes with preeclampsia. In this review, we analyze the origin of placental exosomes and how they might be involved in the pathophysiology of preeclampsia.

Marcadores clínicos, biofísicos y bioquímicos para la predicción de preeclampsia / Clinical, biophysical and biochemical markers for preeclampsia prediction

La preeclampsia es una causa importante de morbilidad y mortalidad materna alrededor del mundo. La incidencia de preeclampsia ha aumentado en la última década, lo cual ha sido atribuido a varios factores. A pesar de las décadas de investigación de esta condición, la capacidad de los clínicos para predecir antes de la aparición de los síntomas no ha mejorado en forma significativa. Ninguna prueba de predicción en solitario ha logrado la aceptación generalizada en la práctica clínica. Las combinaciones de marcadores bioquímicos y ecográficos mejoran la predicción temprana de la preeclampsia. La pesquisa con una combinación de factores de riesgo maternos, Doppler de las arterias uterinas, presión arterial media, concentraciones plasmáticas de proteína A relacionada al embarazo y factor de crecimiento placentario, puede identificar cerca de195% de los casos de preeclampsia de aparición temprana. En forma interesante, la creciente investigación ha revelado los nombres de algunas bio-moléculas importantes que pueden tener un papel importante en la vasculogénesis de la placentación temprana. Existen preguntas si un único grupo de parámetros puede diagnosticar un síndrome que es complejo. En esta revisión, se examina la fisiopatología subyacente de la preeclampsia y se analiza los potenciales marcadores clínicos, biofísicos y bioquímicos para la predicción temprana.

Preeclampsia is a major cause of maternal morbidity and mortality worldwide. The incidence of preeclampsia has increased in the past decade, which has been attributed to various predisposing factors. Despite decades of research into the condition, the ability of clinicians to predict it prior to the onset of symptoms has not improved significantly. No single screening test has gained widespread acceptance into clinical practice. Combinations of biochemical and ultrasonographic markers improve the performance of early prediction of preeclampsia. Screening with a combination of maternal risk factors, uterine artery Doppler, mean arterial pressure, maternal serum pregnancy associated plasma protein-A, and placental growth factor can identify about 95% of cases of early onset preeclampsia. Interestingly, intense research has unveiled the names of some important biomolecules which play an influential role in the vasculogenesis of the early placenta. Question remains whether a single set of parameters can diagnose such a complex syndrome. In this review, we will examine the pathophysiology underlying preeclampsia and examine potential clinical, biological and biophysical markers for early prediction.

Outpatient treatment in uncomplicated acute diverticulitis: 5-year experience.

BACKGROUND/AIMS: Most cases of diverticular inflammation are mild and require only medical treatment with liquid diet and antibiotics. Until recently, this treatment required admission to hospitals, which consequently entailed costs. In most cases, treatment was conservative, and less than a quarter of patients admitted actually underwent surgery. In the last year, the outpatient treatment of these patients with uncomplicated diverticulitis has proven effective and safe. The aim of the present study was to describe our experience after 5 years of outpatient treatment with oral antibiotics. MATERIALS AND METHODS: We conducted a retrospective revision study between January 2010 and December 2014. We included all patients admitted to the Emergency Department of the University General Hospital of Elche with a diagnosis of uncomplicated acute diverticulitis based on medical history, physical examination and abdominopelvic computed tomography (CT) scanning. Outpatient treatment consisted of oral antibiotics for 10 days (metronidazole 500 mg/8 h and ciprofloxacin 500 mg/12 h), a liquid diet and oral analgesics (acetaminophen 1 g/6 h). RESULTS: During the period from January 2010 to December 2014, 224 patients were treated on an outpatient basis at a success rate of over 92%. Only 18 patients (8%) required admission after outpatient treatment. CONCLUSION: Outpatient treatment of uncomplicated acute diverticulitis was demonstrated to be safe and effective.

Enhanced recovery care after colorectal surgery in elderly patients. Compliance and outcomes of a multicenter study from the Spanish working group on ERAS.

PURPOSE: ERAS (enhanced recovery after surgery) programs have proven to reduce morbidity and hospital stay in colorectal surgery. However, the feasibility of these programs in elderly patients has been questioned. The aim of this study is to assess the implementation and outcomes of an ERAS program for colorectal cancer in elderly patients. METHODS: This is a multicenter observational study of a cohort of elderly patients undergoing colorectal surgery within an ERAS program. A total of 188 consecutive patients over 70 years who underwent elective colorectal surgery within an ERAS program at three institutions during a 2-year period were included. The compliance with the ERAS protocol interventions was measure. Complications were evaluated according to Clavien-Dindo classification. Data on length of stay and readmission rates were analyzed. RESULTS: Early intake and early mobilization were the most successfully carried out interventions. There was a global compliance rate of 56 % of patients for whom compliance was achieved with all measured interventions. The median hospital length of stay was 6 days. Almost 60 % of patients had no complications, 24 % had minor complications while 13 % had major complications; of them, 8 % patients were reoperated. The readmission rate was 6.4 %. CONCLUSIONS: ERAS after colorectal surgery in elderly patients presents as safe and feasible based on good reported outcomes of compliance rates, complications, readmissions, and needs for reoperation.

Perioperative Standard Oral Nutrition Supplements Versus Immunonutrition in Patients Undergoing Colorectal Resection in an Enhanced Recovery (ERAS) Protocol: A Multicenter Randomized Clinical Trial (SONVI Study).

To compare immunonutrition versus standard high calorie nutrition in patients undergoing elective colorectal resection within an Enhanced Recovery After Surgery (ERAS) program.Despite progress in recent years in the surgical management of patients with colorectal cancer (ERAS programs), postoperative complications are frequent. Nutritional supplements enriched with immunonutrients have recently been introduced into clinical practice. However, the extent to which the combination of ERAS protocols and immunonutrition benefits patients undergoing colorectal cancer surgery is unknown.The SONVI study is a prospective, multicenter, randomized trial with 2 parallel treatment groups receiving either the study product (an immune-enhancing feed) or the control supplement (a hypercaloric hypernitrogenous supplement) for 7 days before colorectal resection and 5 days postoperatively.A total of 264 patients were randomized. At baseline, both groups were comparable in regards to age, sex, surgical risk, comorbidity, and analytical and nutritional parameters. The median length of the postoperative hospital stay was 5 days with no differences between the groups. A decrease in the total number of complications was observed in the immunonutrition group compared with the control group, primarily due to a significant decrease in infectious complications (23.8% vs. 10.7%, P = 0.0007). Of the infectious complications, wound infection differed significantly between the groups (16.4% vs. 5.7%, P = 0.0008). Other infectious complications were lower in the immunonutrition group but were not statistically significantly different.The implementation of ERAS protocols including immunonutrient-enriched supplements reduces the complications of patients undergoing colorectal resection.This study is registered with ClinicalTrial.gov: NCT02393976.

Perioperative immunonutrition in normo-nourished patients undergoing laparoscopic colorectal resection.

OBJECTIVE: To determine whether the joint implementation of immunonutrition and a laparoscopic approach improves morbidity, mortality, and length of stay (LOS) compared with dietary advice. BACKGROUND: Despite progress in recent years in the surgical management of patients with colorectal cancer, postoperative complications are frequent. Nutritional supplements enriched with immunonutrients have recently been introduced into clinical practice. However, the immunonutrition benefits in patients undergoing colorectal laparoscopic surgery are unknown. METHODS: This study was a prospective, randomized trial with two parallel treatment groups receiving an immune-enhancing dietary supplement for 7 days before colorectal resection and 5 days postoperatively or dietary advice. RESULTS: A total of 128 patients were randomized. At baseline, both groups were comparable with respect to age, sex, surgical risk, comorbidities, and analytical and nutritional parameters. The median postoperative LOS was 5 days and was not significantly different between the groups. Wound infection differed significantly between the groups (11.50 vs. 0.00 %, p = 0.006). No other differences between the groups were identified. CONCLUSIONS: The joint use of laparoscopy and supplementation with immunonutrients reduces surgical wound infection in patients undergoing colorectal surgery. TRIAL REGISTRATION: This study is registered with ClinicalTrial.gov : NCT0239396.

C-Reactive Protein and Procalcitonin as Early Markers of Septic Complications after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients Within an Enhanced Recovery After Surgery Program.

BACKGROUND: The performance of most bariatric procedures within an Enhanced Recovery After Surgery (ERAS) programs has resulted in considerable advantages, including a reduction in the length of hospital stay to 2 to 3 days. However, some postoperative complications can appear after the patient has been discharged. The aim of this study was to investigate the efficacy of various acute-phase parameters determined 24 and 48 hours after laparoscopic sleeve gastrectomy (LSG) as bariatric procedure, for predicting septic complications, such a surgical site infection (SSI), in the postoperative course. STUDY DESIGN: A prospective study of 115 morbidly obese patients who underwent LSG within an ERAS program between 2012 and 2015 was conducted. Blood analysis was performed 24 and 48 hours after surgery. Acute-phase parameters (C-reactive protein [CRP], procalcitonin, and fibrinogen) and WBC count were investigated. RESULTS: Septic complications were observed in 13 patients (11.3%). Using receiver operating characteristic analysis at 24 hours postoperatively, a cutoff level of CRP at 70 mg/L achieved 85% sensitivity and 90% specificity for predicting SSI, and a cutoff level of procalcitonin at 0.2 ng/mL achieved 70% sensitivity and 90% specificity. At 48 hours postoperatively, a cutoff level of CRP at 150 mg/L and procalcitonin at 0.95 ng/mL achieved 100% sensitivity and 100% specificity for predicting SSI. CONCLUSIONS: The use of CRP and procalcitonin in the first day and especially in the second day postoperative can predict septic complications after LSG. This is most useful for patients within an ERAS program who will be discharged early.

Tumor regression and survival after perioperative MAGIC-style chemotherapy in carcinoma of the stomach and gastroesophageal junction.

BACKGROUND: We assessed the effectiveness of perioperative MAGIC-style chemotherapy in our series focused on the tumor regression grade and survival rate. METHODS: We conducted a retrospective study of 53 patients following a perioperative regimen of epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/X). Forty-four (83 %) neoplasias were located in the stomach and 9 (17 %) were located at the esophagogastric junction. Perioperative chemotherapy completion, resection, TNM staging, the tumor regression grade (Becker's classification) and survival were analyzed. RESULTS: Forty-five patients (85 %) completed the 3 preoperative cycles. R0 resection was achieved in 42 (79 %) patients. Thirty-five (66 %) patients completed the 3 postoperative cycles. Nine carcinomas (17 %) were considered major responders after preoperative chemotherapy. With multivariate analysis, only completion of perioperative chemotherapy (HR: 0.25; 95%CI: 0.08 - 0.79; p = 0.019) was identified as an independent prognostic factor for disease-specific survival. However, the protective effect of perioperative therapy was lost in patients with ypT3-4 and more than 4 positive lymph nodes (HR: 1.16; 95%CI: 1.02 - 1.32; p = 0.029). The tumor regression grade (major vs minor responders) was at the limit of significance only with univariate analysis. The 5-year overall and disease-specific survival rates were 18 % and 22 % respectively. CONCLUSIONS: The percentage of major responder tumors after preoperative chemotherapy was low. Completion of perioperative ECF/X chemotherapy may benefit patients with gastric carcinomas that do not invade the subserosa with few positive lymph nodes.