Comparison of phenotypes and outcomes following resection of incidental versus symptomatic pancreatic neuroendocrine tumors

Background and aim: fifty to 70 percent of pancreatic neuroendocrine tumors are diagnosed incidentally. The objective of this study was to compare the phenotype and oncological outcomes of incidental versus symptomatic pancreatic neuroendocrine tumors.Methods: a retrospective study was performed, identifying all incidental and symptomatic tumors resected between 2000 and 2019. Baseline characteristics, symptoms, operative variables and pathological stage were all recorded. Patterns of recurrence and overall and disease-free survival were analyzed in both groups.Results: fifty-one incidental and 45 symptomatic pancreatic tumor resections were performed. Symptomatic tumors were more frequent in females (29 vs 17; p = 0.005) and younger patients (median years; 50 vs 58; p = 0.012) and were detected at a more advanced stage (p = 0.027). There were no differences in location and most resections (n = 49; 51 %) were performed laparoscopically. There were no operative mortalities and 17 (17.7 %) severe complications (≥ IIIb on the Clavien-Dindo classification) were recorded with no differences between the two groups. With a median follow-up of 64.4 months (range 13.5-90), overall survival at five and ten years was 89.7 % and 72.8 % for the non-incidental tumors and 80.9 % and 54.6 % for the incidental tumors (p = ns), respectively. Disease-free survival in both groups (excluding M1a) was 71.2 % and 47.5 %, and 93.7 % and 78.1 %, respectively (p = ns).Conclusions: symptomatic tumors are more frequent in females and present at more advanced pathological stages. There were no significant differences in overall and disease-free survival between the two groups. Resection of incidental tumors ≥ 1.5-2 cm seems advisable, although each case should be assessed on an individual basis. (AU)

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: clinicopathological features and long-term outcomes following a pancreatectomy

Objective: the objective of this study was to analyze the anatomical and clinical features and long-term oncologic outcomes of 25 patients that underwent surgery due to intraductal papillary mucinous neoplasm of the pancreas. Material and methods: patients undergoing surgery for intraductal papillary mucinous neoplasm of the pancreas were identified from a prospective database of pancreatic resections. Demographic data, symptoms, type of surgery and type of lesion (branch type, main duct or mixed) were recorded. The lesions were classified into invasive (high grade dysplasia and carcinoma) and noninvasive (low- or intermediate-grade dysplasia). Postoperative complications were analyzed as well as the pattern of recurrence and disease-free survival at five and ten years. Results: the most common symptoms in the 25 patients (14 males and eleven females) were abdominal pain and weight loss. Eight (32%) cases were diagnosed incidentally. Twelve (48%) of the lesions were of the branch type, three affected the main duct and ten (40%) were mixed. Twelve cephalic duodenopancreatectomies and seven total pancreatectomies were performed; three were central; two, distal; and one, enucleation. Seven cases (32%) had an invasive phenotype. Three patients had locoregional and distant recurrence at six, 16 and 46 months after surgery with a median follow-up of 7.7 years. Disease-free survival at five and ten years for the noninvasive type was 94% and 57% for invasive phenotypes (p < 0.05). Conclusions: intraductal papillary mucinous neoplasm is a heterogeneous entity with well differentiated phenotypes, which requires a tailored strategy and treatment, as established in the current consensus guidelines due to its malignant potential

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Predictors of postoperative complications and readmissions in laparoscopic pancreas resection: Results of a cohort 105 consecutive cases. A retrospective study / Factores predictivos de complicaciones postoperatorias y reingresos en resecciones laparoscópicas de páncreas: resultados en una cohorte de 105 casos consecutivos. Estudio retrospectivo

Introduction: Laparoscopic resection of the pancreas (LRP) has been implemented to a varying degree because it is technically demanding and requires a long learning curve. In the present study we analyze the risk factors for complications and hospital readmissions in a single center study of 105 consecutive LRPs. Methods: We conducted a retrospective study using a prospective database. Data were collected on age, gender, BMI, ASA score, type of surgery, histologic type, operative time, hospital stay, postoperative complications, degree of severity and hospital readmission. Results: The cohort included 105 patients, 63 females and 42 males with a median age and BMI of 58 (53–70) and 25.5 (22,2–27.9) respectively. Eighteen (17%) central pancreatectomies, 5 (4.8%) enucleations, 81 (77.6%) distal pancreatectomies and one total pancreatectomy were performed. Fifty-six patients (53.3%) experienced some type of complication, of which 13 (12.3%) were severe (Clavien-Dindo > IIIb) and 11 (10.5%) patients were readmitted in the first 30 days after surgery. In the univariate analysis, age, male gender, ASA score, central pancreatectomy and operative time were significantly associated with the development of complications (P <0.05). In the multivariate analysis, male gender (OR 7.97; 95% CI 1.08–58.88)), severe complications (OR 59.40; 95% CI, 7.69–458.99), and the development of intrabdominal collections (OR 8.97; 95% CI, 1.28–63.02)) were associated with hospital readmission. Conclusions: Age, male gender, ASA score, operative time and central pancreatectomy are associated with a higher incidence of complications. Male gender, severe complications and intraabdominal collections are associated with more hospital readmissions. (AU)

Introducción: Las resecciones laparoscópicas del páncreas (RLP) tienen un grado de implantación muy heterogéneo debido a su dificultad técnica y a exigir una curva de aprendizaje larga. En el presente trabajo estudiamos los factores de riesgo de las complicaciones y de los reingresos en una serie unicéntrica de 105 RLP. Métodos: Se realizó un estudio retrospectivo. Se recogieron la edad, sexo, índice de masa corporal, el grado ASA, tipo de cirugía, tipo histológico, duración de la intervención, estancia hospitalaria, las complicaciones postoperatorias, grado de gravedad y reingreso. Resultados: La cohorte comprende 105 pacientes, 63 mujeres y 42 varones, con una mediana de edad y IMC, de 58 (53–70) y 25.5 (22.2–25.5) respectivamente. Se realizaron 18 (17%) pancreatectomias centrales, 81 (77%) distales, 5 (4.8%) enucleaciones y una total. 56 (53.3%) pacientes sufrieron alguna complicación, 13 (12.3%) fueron graves (Clavien-Dindo > IIIb) y hubo 11 (10.5%) reingresos. En el análisis univariante, la edad, el sexo masculino, el grado ASA, la pancreatectomía central y el tiempo operatorio se asociaban significativamente con el desarrollo de complicaciones (P < 0.05). En el análisis multivariante, los varones (OR 7.97; 95% IC 1.08–58.8), las complicaciones severas (OR 59.40; 95% IC 7.69–458.9), el desarrollo de colecciones intraabdominales (OR 8.97; 95% IC 1.2–63.0) se asociaban con el reingreso hospitalario. Conclusiones: La edad, el sexo masculino, el grado ASA, la duración de la intervención y la pancreatectomía central se asocian con mayor incidencia de complicaciones. Los varones, las complicaciones graves, las colecciones intraabdominales se asociaban con más reingresos hospitalarios. (AU)

Agenesis of the dorsal pancreas associated with mucinous cysts and chronic calcific non-alcoholic pancreatitis

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Tumores quísticos neuroendocrinos de páncreas (cPNET): revisión sistemática y metaanálisis de series de casos / Cystic pancreatic neuroendocrine tumors (cPNETs): a systematic review and meta-analysis of case series

Los tumores quísticos neuroendocrinos representan entre el 13% de los tumores neuroendocrinos de páncreas. El objetivo del trabajo es realizar una revisión sistemática y un metaanálisis de las series de casos descritas. Se realizó una revisión sistemática hasta septiembre de 2016 mediante una búsqueda en Medline, Scopus y EMBASE con los términos: "cystic pancreatic endocrine neoplasm", "cystic islets tumors" y "cystic islets neoplasms". De 795 citas se seleccionaron 80 estudios que describían 431 pacientes, incluyendo 5 casos propios. El 87,1% (n = 387) eran tumores esporádicos y el 10,3% (n = 40) correspondían a neoplasia endocrina múltiple tipo 1. El 44,6% (n = 135) fueron diagnosticados de forma incidental. La citología mostró una sensibilidad del 78,5%. El 85% (n = 338) eran tumores no funcionantes; y el insulinoma fue el más frecuente entre los funcionantes. Según la estadificación European Neuroendocrine Tumor Society, el 87,8% estaban limitados al páncreas (I-IIb) y el 12,2% eran avanzados (III-IV). La supervivencia libre de enfermedad a los 5 años en estadios (I-IIIa) y en los estadios (IIIb-IV) fue del 91,5% y 54,2% respectivamente; y fue significativamente menor (p = 0,0001) en los tumores funcionantes. En los pacientes con MEN-1 hubo mayor incidencia de funcionantes (62,5%) y multicéntricos (28,1%). Los tumores quísticos neuroendocrinos de páncreas expresan un fenotipo diferente a los tumores endocrinos sólidos, pero tienen un pronóstico similar, tras la resección a excepción de los tumores hereditarios (AU)

Cystic pancreatic neuroendocrine tumors represent 13% of all neuroendocrine tumors. The aim of this study is to analyze the phenotype and biologic behavior of resected cystic neuroendocrine tumors. A systematic review and meta-analysis were conducted until September 2016 using a search in Medline, Scopus, and EMBASE with the terms "cystic pancreatic endocrine neoplasm", "cystic islets tumors" and "cystic islets neoplasms". From the 795 citations recovered 80 studies reporting on 431 patients were selected. 87.1% (n = 387) were sporadic tumors and 10.3% (n = 40) corresponded to multiple endocrine neoplasia endocrine type 1. Were diagnosed incidentally 44.6% (n = 135). Cytology was found to have a sensitivity of 78.5%. Were non-functional tumors 85% (n = 338), and among the functional tumors, insulinoma was the most frequent. According to the European Neuroendocrine Tumor Society staging, 87.8% were limited to the pancreas (I-IIb), and 12.2% were advanced (III-IV). Disease-free survival at 5 years in stages (I-IIIa) and (IIIb-IV) was 91.5% and 54.2%, respectively; and was significantly lower (p = 0.0001) in functional tumors. In patients with multiple endocrine neoplasia there was a higher incidence of functional (62.5%) and multifocal (28.1%) tumors. Disease-free survival at 5 and 10 years was 60%. Cystic pancreatic neuroendocrine tumors exhibit phenotypical characteristics which are different to those of solid neuroendocrine tumors (AU)

Agenesis of the dorsal pancreas: systematic review of a clinical challenge

Background: Agenesis of the dorsal pancreas is a rare malformation. Since 1911 and until 2008, 53 cases have been reported. Several authors have recently described the association of this anomaly with neoplasia of the ventral pancreas, thus we performed a systematic review of the literature from 2008 to 2015. Methods: A systematic review of the Medline and ISI Web of Science Databases from 2008 until 2015 was carried out, and 30 articles which met the inclusion criteria were identified that included a total of 53 patients: 7 children and 46 adults. Conclusions: Although dorsal pancreatic agenesis is a rare malformation, given its association with non-alcoholic pancreatitis and neoplasia of the residual pancreas, physicians should maintain an expectant attitude (AU)

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A single institution’s 21-year experience with surgically resected pancreatic neuroendocrine tumors: an analysis of survival and prognostic factors

Background: Pancreatic neuroendocrine tumors (pNETs) comprise a heterogeneous group of tumors with a varied biological behavior. In the present study, we analyzed the experience of 79 pNETs resected between 1993 and 2015. The pathologic prognostic factors (European Neuroendocrine Tumor Society, ENETS; and AJCC) classification, vascular invasion (VI), proliferation index (ki-67) and the presence of necrosis were retrospectively reviewed. Methods: The clinical data of 79 patients with pNETs who underwent surgery were retrospectively analyzed. Mortality rates and Kaplan-Meier estimates were used to evaluate survival over time for pathologic stages, tumor functionality, and vascular invasion. Cox proportional hazards models were used to calculate the hazard ratio regarding ENETS, AJCC staging, sex, tumor functionality and vascular invasion. Results: The male:female ratio was 40:39. Twenty-one patients (26%) had functional tumors and 58 (73.4%) had nonfunctional tumors, of which 35 (44.3%) were diagnosed incidentally. Seventeen Whipple procedures, 46 distal pancreatectomies (including 26 laparoscopic and 20 open procedures), 8 laparoscopic central pancreatectomies, 1 laparoscopic resection of the uncinated process and 7 enucleations (one laparoscopic) were performed. Vascular invasion and necrosis were observed in 29 of 75 cases (38.6%) and in 16 cases (29%), respectively. The comparison between survivor functions of ENETS staging categories showed statistically significant differences (p = 0.042). Mortality rate was higher in patients with non-functioning tumors compared with hormonally functioning tumors (p = 0.052) and in those with vascular invasion (p = 0.186). Conclusions: In spite of the heterogeneity of pNETs, the ENETS TNM classification efficiently predicts long-term prognosis. The non-functioning tumors and the presence of vascular invasion are associated with poor prognosis (AU)

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Incidental lesions of the pancreas. A clinicopathological study of 100 cases surgically treated

OBJECTIVE: the objective of the present study was to analyze the characteristics of resected incidental lesions of the pancreas. MATERIAL AND METHODS: a retrospective study was performed of pancreatectomies due to incidentalomas between 1995 and 2018. RESULTS: one hundred pancreatectomies were performed due to incidental lesions; 64 (64%) were solid and 36 (36%) were cystic lesions. The cytological analysis agreed with the diagnosis in 67/71 (88.7%) cases. Thirty-six tumors were cystic, 48 were neuroendocrine and 16 were adenocarcinomas. Disease-free survival for patients with cystic, neuroendocrine tumors and adenocarcinomas was 100%, 79% and 57.7% (p < 0.04). CONCLUSION: pancreatic incidentalomas have a heterogeneous phenotype and should be treated in experienced centers

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Cystic tumors of the pancreas. An update of the surgical experience in a single institution

Background: the aim of the present study was to analyze the clinicopathological features of patients undergoing pancreatic surgical resections due to cystic neoplasms of the pancreas. Material and methods: demographic data, form of presentation, radiologic images and location of the tumors within the pancreas were analyzed. Data was also collected on the type of surgery (open/laparoscopic), postoperative complications and their severity and oncologic outcomes. Results: eighty-two pancreatic resections were performed. The mean age of patients was 57 years and 49 (59%) were female. Forty-one tumors (50%) were incidental and the most frequent symptoms in the group of symptomatic patients were abdominal pain (63.4%) and weight loss (36.5%). Thirty-two tumors (39%) were located in the tail of the pancreas, 25 (30.5%) in the head and 20 (24.4%) in the body. Thirty-nine (47.5%) distal pancreatectomies, 16 central, ten duodenal pancreatectomies and one enucleation were performed; 40 (48.5%) were carried out laparoscopically. Mean hospital stay was ten days and eight patients (7%) experienced severe complications, one was a pancreatic fistula. Sixty-six tumors (80.5%) were recorded as non-invasive and 16 (19.5%) as invasive: seven intraductal mucinous papillary tumors, one cystic mucinous tumor, four solid pseudopapillary tumors and four cystic neuroendocrine tumors. There was a median follow-up of 64 months; disease-free survival at five and ten years was 97.4% in the patients with non-invasive tumors and 84.6% and 70.5% in the invasive tumors group (p < 0.01). Conclusions: fifty percent of cystic neoplasms of the pancreas are incidental. Two phenotypes exist, invasive and non-invasive

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Resección totalmente laparoscópica de lesiones sólidas hepáticas: análisis de una serie institucional de 71 casos / Totally laparoscopic resection of solid hepatic lesions: analysis of a single-centre series of 71 cases

Objetivo: Valoración de los resultados de una serie institucional de resecciones de lesiones sólidas hepáticas realizadas mediante abordaje totalmente laparoscópico. Pacientes y método Desde noviembre de 2002 hasta febrero de 2012 hemos realizado 71 resecciones de lesiones sólidas hepáticas con abordaje totalmente laparoscópico: 65 por enfermedad maligna y 6 por enfermedad benigna. Se extirparon 21 hepatocarcinomas, 16 sobre hígado cirrótico. Se realizaron 52 (73,2%) resecciones limitadas, 14 seccionectomías (3 posteriores derechas y 11 laterales izquierdas). Finalmente, 5 resecciones hepáticas mayores: 3 hepatectomías izquierdas y 2 derechas. En 14 casos (19,7%) se asoció algún otro procedimiento quirúrgico (colecistectomía no incluida).Del total, 41 (57,7%) lesiones se localizaron en segmentos anteriores (SA) y 30 (42,3%) en segmentos posterosuperiores (SPS).Resultados Hubo 2 conversiones a cirugía abierta (2,8%).Cinco pacientes requirieron transfusión intraoperatoria (7%). La mediana de estancia fue de 4 días (3-5). Hubo un fallecimiento (1,4%) y una reintervención por fístula de anastomosis esófago-yeyunal. Los márgenes de resección estuvieron libres de tumor en el 100% de los casos. La cirugía asociada supuso un aumento significativo en la tasa de morbilidad (35,7 frente a 7%, p=0,012). Las resecciones en SPS no mostraron diferencias en cuanto a índice de complicaciones (p=0,28), transfusión (p=0,69) o estancia hospitalaria (p=0,44) frente a resecciones de SA. Conclusión El abordaje totalmente laparoscópico es factible y seguro en la resección de lesiones hepáticas sólidas. La cirugía asociada puede suponer un aumento significativo en la tasa de morbilidad. Las resecciones de lesiones localizadas en SPS pueden realizarse con igual seguridad que en SA (AU)

Objective: To assess the results of a single-centre series of solid hepatic lesion resections using a totally laparoscopic approach. Patients and method: A total of 71 solid hepatic lesion resections using a totally laparoscopic approach were performed from November 2002 to February 2012. Of these, 65 were due to malignant disease, and 6 due to benign diseases. A total of 21 hepatocellular carcinomas were removed, 16 on a cirrhotic liver. Limited resections were performed in 52 (73.2%) cases, as well as 14 sectionectomies (3 right posterior and 11 left laterals). Finally, there were 5 major liver resections: 3 left and 2 right hepatectomies. In 14 cases (19.7%) it was combined with some other surgical procedure (cholecystectomy not included). The lesions were located in the anterior segments (SA) in 41 cases (57.7%) and in postero-superior segments (PSS) in 30 cases. Results: There were 2 (2.8%) conversions to open surgery. Five (7%) patients required transfusions during surgery. The median hospital stay was 4 (3-5) days. There was one(1.4%) death, and one patient required further surgery due to esophagojejunal anastomoticleak. The resection margins were tumour-free in 100% of the cases. Combined surgery (..) (AU)

Colgajo de Abbe modificado: Flor de Lys Subcutánea / Fleur D'Lys Abbe Flap

El colgajo de Abbe es un buen recurso para corregir defectos secundarios en fisuras labiales. Al colgajo original se le agregan tres extensiones de tejido celular subcutáneo a manera de de "Flor de Lys", las mismas que al ser rotadas hacia su posición definitiva le confieren mayor volumen a la parte alta del labio superior y la base de la columela, obteniéndose mejores resultados comparados con el colgajo convencional, pudiéndose además realizar otros procedimientos adicionales simultáneamente. Se analiza la técnica en 44 pacientes operados entre 1977 y 1997 tanto en fisuras bilaterales como unilaterales, así como sus ventajas y alcances.

Abbe flap is a good alternative for correction of secondary cleft lip deformities. The origonal abbe flap with the addition of three extensions of subcutaneous celular tissue in a fleur d'Lys pattern, rotating them to its new position will gives more volume, to the uppen lip as well as the columella, giving better results compared to the conventional flap, with the advantage of performing additional corrections at the same time. A study of 44 patients from 1977 to 1997, with bilateral as well as unilateral cleft was done evaluating the benefits of the technique.

Sindactilia de manos, pies, plastía sin injerto de piel / Syndactilia of the feet and Hands, Graftless repair

La sindactilia, de las manos o de los pies, es la malformación congénita mas común con frecuencia se presenta asociada a otras condiciones como la Acrosindactilia, Síndrome de Poland, Apert y otros. Es más frecuente entre los dedos medio y anular. La técnica quirúrgica empleada utiliza para corregirla colgajos tringulares proximales en las comisuras, seguido de dos colgajos triangulares a lo largo de la fusión de los dedos. En cada lado palmar y dorsal, se retira tejido graso para permitir el cierre de los colgajos cruzados sin tensión, evitando el uso de los injertos de piel. Presentamos 10 casos de sindactilia de manos y 5 casos de sindactilia de pies operados entre agosto de 1987 y mayo de 1997. Los resultados obtenidos desde el punto de vista funcional y estético han sido considerados satisfactorios. Describimos las ventajas del procedimiento.

The most frecuent malformation of hands and feet is syndactilia, if often occurs acompanied with other conditions such as Acrosyndactilia, Poland Syndrome, Apert and others. Most frecuently the anular and middle fingers on each dorsal and palmar surfiless, eliminating fat excess the flaps to help closure without tension avoiding the use of skin grafts. We present 10 cases of hand syndactilia and 5 of feet syndactilia, treated between August 1987 and May 1997. Esthetic and functional results are considered satisfactory. We describe the advantages of the procedures.

Reconstrucción de brazo afectado por tumor de células de Merkel, con colgajo gran dorsal pediculado / Latissimus dorsi pedicled flap in arm reconstruction after Merkel cell carcinoma resection

Latissimus dorsi flap is versatile to cover local defects as at distance. The tumor of cells of Merkel is not very frequent and it appears in exposed areas in the sun. Case Report: Patient female 55 years with tumoracion in left arm. Tumoracion is dried up and it is carried out reconstruction of the area with a ipsilateral. Latissimus dorsi flap. Conclusion: The tumor of Merkel involves an extensive area of the left arm, creating a great defect in the resection. Latissimus dorsi flap contributes muscular and cutaneous to cover the great and deep defects. for the reconstruction.

Fisura labial unilateral. Corrección estética primaria / Correction of bilateral cleft lip

La técnica de rotación y avance de Millard se ha constituido en uno de los procedimientos más populares en las últimas décadas por su versatilidad, adaptabilidad incorporándose la reparación nasal primaria, logrando mejores resultados tanto funcionales como estéticos. Revisamos 287 pacientes operados entre 1980 a 1997 de fisuras labiales unilaterales primarias entre completos e incompletos, con asimetría nasal, utilizando el procedimiento de rotación y avance en su diseño externo, añadiendo una amplia disección de los tejidos mucoso, muscular, periostio en algunos casos y piel, logrando cicatrices más aceptables y resultados estéticos y funcionales satisfactorios a mediano y largo plazo. Asimismo reproduciendo las estructuras nasales tanto en la punta como en el ala y piso con mejor simetría y menos posibilidades de cirugía secundaria.

The Millard rotation advancement technique is one of the most popular methods for cleft lip correction. With the addition of the primary cleft nose repair we were able to get good functional and esthetic results. We review 287 cleft lip treated between 1980 and 1997 using the rotation advancement technique with a wide underminig of the mucosal, muscular and periostal layer. Also reproducing the nasal structures in the ala tip an nasal floor with better symetry and less posibilities of secondary surgery.

Fisura palatina: corrección anatómica y funcional / Anatomical and functional cleft palate correction

Pese a la numerosa y extensa cantidad de técnicas y procedimientos, el tratamiento de la fisura palatina aún genera controversia. Realizamos la disección de los planos mucoso nasal, mucoperiostico oral identificado y aislando el pedículo vascular; se realiza la desinserción de los músculos palatinos de su posición vertical oblicua, suturándolos en posición transversal, sin emplear incisiones relajantes laterales, consiguiendo alargar el padalar. La úvula es corregida por una plastía que deja íntegro un lado y le da la apariencia normal. Reportamos 141 pacientes operados entre 1993 y 1996 entre fisuras unilaterales, bilaterales, completas e incompletas y submucosas, las complicaciones obtenidas en esta serie son 6 fístulas pequeñas, 2 sangrados en el post-operatorio inmediato, y 8 casos de insuficiencia velofaringea de diverso grado que se corrigieron con procedimientos secundarios. Casi todos fueron tratados en forma ambulatoria. La conclusión final es que al no dejar áreas cruentas se permite una rápida recuperación, y un crecimiento y desarrollo máxilo facial normal y adecuada fonación.

Despite the many techniques available, the surgical treatment of Cleft Palate remains controversial our technique basically consists in disecting the nasal and oral mucosa as nell as disecting the muscle layer and repositioning into a normal transverse position, through a midline incision, without lateral relaxing incisions. This allows tha palate to lengthen. The uvula is corrected by centralizind one of the two hemi uvula of the original cleft. Reported are 141 patients operated between 1993 and 1996, including unilateral, bilateral and submucus clefts. Complications in these series were: Midline fistula formation in 6 cases, inmediate post-operative bleeding in two and velopharyngeal insuffisiency in 8 cases, all of which were treated secondarily. Almost all cases were treated ambulatory. It is concluded that the technique described produces satisfactory results without interfering with growth and producing good phonation in most cases.

Asociación de marcadores inflamatorios y aterosclerosis subclínica en relación con la edad en sujetos sin enfermedad cardiovascular / Association of age, inflammatory markers and subclinical atherosclerosis in subjects free from cardiovascular disease

FUNDAMENTO Y OBJETIVO: El objetivo de este estudio ha sido examinar si existe una asociación independiente entre parámetros inflamatorios y aterosclerosis subclínica en relación con la edad en sujetos asintomáticos desde el punto de vista cardiovascular. PACIENTES Y MÉTODO: Se han analizado el perfil metabólico y marcadores inflamatorios y de dañoendotelial, como la proteína C reactiva ultrasensible, interleucina 6, fibrinógeno y factor VonWillebrand, así como el engrosamiento íntima-media (EIM) carotídeo, como marcador de aterosclerosissubclínica, en una muestra de 890 sujetos asintomáticos (edad media: 55 años; extremos:20-80 años; un 80% varones), pero con factores de riesgo cardiovascular.RESULTADOS: En el análisis por cuartiles de edad, observamos un aumento de factores de riesgo tradicionales, como glucosa y presión arterial, en sujetos de edad avanzada (61-80 años) respecto a cuartiles de edad inferior (p < 0,01), así como de los parámetros inflamatorios y de daño endotelial (p < 0,001) y del EIM (p < 001). En el análisis multivariante, tras ajustar porlos factores de riesgo, se observó una asociación independiente entre EIM, inflamación y disfunción endotelial en el subgrupo de mayor edad (p < 0,01). CONCLUSIONES: Además de la edad, la inflamación sistémica y el daño vascular se asocian con la aterosclerosis subclínica en sujetos asintomáticos. El fenotipo proinflamatorio asociado a la edad puede predisponer al desarrollo de complicaciones cardiovasculares

BACKGROUND AND OBJECTIVE: We assessed whether an independent association between inflammatory markers and age-related subclinical atherosclerosis could be found in subjects free from cardiovascular disease. PATIENTS AND METHOD: Metabolic parameters, inflammatory and endothelial markers, such as high-sensitivity C-reactive protein, interleukin-6, fibrinogen and von Willebrand factor, as well as the carotid intima-media thickness were assessed in 890 asymptomatic subjects (mean age:55 years; range: 20-80 years; 80% men) with cardiovascular risk factors. RESULTS: Subjects in the upper quartile (age 61-80 years) showed a significant increase of traditional risk factors, particularly arterial pressure and glucose levels (p < 0.01) as compared with lower quartiles. We also found a significant increase in the levels on inflammatory and endothelial markers (p < 0.001) and intima-media thickness (p < 0.001) in older adults. In the multivarate analysis, after adjustment for cardiovascular risk factors, intima-media thicknesswas independently associated with inflammation and endothelial dysfunction in older adults (p< 0.01). CONCLUSIONS: Besides age, systemic inflammation and vascular damage are associated with subclinical atherosclerosis in asymptomatic subjects. The age-related inflammatory profile maypredispose to cardiovascular complications

Normativa de seguridad alimentaria en el ámbito de las Fuerzas Armadas / No disponible

A pesar de la extensa reglamentación, las actuaciones en materia de seguridad alimentaria realizadas por los órganos sanitarios del Ministerio de Defensa no han sido en absoluto reguladas en el ámbito del Estado. Asi, las competencias de inspección sanitaria han sido trasferidas a las Comunidades Autónomas, sin que se tuvieran en cuenta las particularidades y el funcionamiento de los órganos de la Defensa. Con el fin de subsanar esta falta, la Jefatura de Apoyo Veterinario de Inspección General de Sanidad, trabaja actualmente en la redacción de un proyecto del Real Decreto en el que se contempla la figura de una Autoridad Sanitaria competente en materia de Seguridad Alimentaria en el ámbito del Ministerio de Defensa, similar a la que aparece reflejada en la orden Ministerial nº 143/2006 de 30 de noviembre, para la aplicación de la Ley de Sanidad Animal o en la Orden Ministerial nº 87/2004 de 31 de Marzo, sobre la inspección de instalaciones para la prevención y control de la legionelosis (AU)

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Diseño de rotación y avance de Millard modificada a incisiones pequeñas. Estudio comparativo en fisura labial unilateral / Design of rotation and advance of modified Millard to small incisions. Comparative study in unilateral labial fissure

La técnica de rotación y avance es uno de los procedimientos más utilizados, reproduce las estructuras normales y coloca las cicatrices en las líneas naturales. Revisamos 280 pacientes operados entre 1980 a 1999 de fisura labial unilateral primaria completa e incompleta, utilizando las incisiones de rotación y avance. En 195 pacientes se utilizó el diseño original de Millard, cuya incisión medial o de rotación llega hasta la línea media en la raíz de la columela, y la de avance es transversal y llega en algunos casos hasta la raíz de ala nasal. En 85 pacientes operados a partir de 1997, se utilizaron incisiones que siguen la forma de la columna filtral en el lado medial y el borde mucocutáneo en el lado lateral, obteniendo una cicatriz que sigue esta estructura, evitando cicatrices adyacentes. Los resultados obtenidos muestran menores cicatrices en el último grupo de pacientes, se producen mejor las líneas naturales y se conservan las estructuras labionasales intactas. Las complicaciones encontradas fueron asimetrías y retracciones pequeñas en ambos grupos.