Evolución de operaciones por enfermedades del intestino proximal y glándulas anexas realizadas en Chile entre 2011 y 2016 / Evolution of surgeries due to diseases of the proximal intestine and anexal glands perfomed in Chile between 2011 and 2016

INTRODUCCIÓN: Los datos sobre número de operaciones realizadas en Chile en patología del intestino proximal y glándulas anexas, han sido cada vez más precisas en los registros estadísticos del MINSAL en los últimos años. OBJETIVO: a) Incorporar datos de otras operaciones no incluidas en reportes previos, b) comparar los resultados de operaciones de alta complejidad reportadas el año 2011 y confrontarlos con los datos del año 2016. MATERIAL Y MÉTODO: En el DEIS (Departamento de Estadística e Información de Salud) se obtuvo el número total de operaciones realizadas en Chile el año 2016 y mortalidad operatoria al momento del egreso de diferentes patologías del intestino proximal y glándulas anexas, siendo la mayoría tumores malignos: cáncer de esófago, estómago, páncreas, hígado y vías biliares intrahepáticas y vesícula biliar. Los resultados se compararon con los obtenidos del año 2011. RESULTADOS: La letalidad anual de cánceres digestivos demostró un alza del cáncer de páncreas e hígado, mientras que se aprecia una baja en el cáncer de esófago y vesícula biliar. Operaciones de patología benigna, como la esofagocardiomiotomía y cirugías antirreflujo laparoscópica no mostraron mortalidad, al igual que el bypass gástrico. La colecistectomía y la gastrectomía vertical laparoscópicas, tuvieron una muy baja mortalidad operatoria. En las intervenciones quirúrgicas por tumores malignos se apreció en todos una disminución de la mortalidad operatoria comparado con el año 2011, aunque no fue estadísticamente significativo. CONCLUSIÓN: El presente estudio muestra un aumento de las operaciones por enfermedades del intestino proximal y glándulas anexas así como una disminución de la mortalidad operatoria el año 2016 comparado con el 2011.

INTRODUCTION: The number of operations performed in Chile due to diseases for the foregut, have been every time more precise and complete in the National Register Data of Statistics in Health (MINSAL), and published in several reports (years 1983, 2005 and 2011). OBJECTIVES: a) to incorporate data of new operations not included before and b) to compare the results of high complex operations reported on 2011 and 2016. MATERIAL AND METHODS: from the DEIS (Department of Statistics and Information of Health) we obtained the total number of operations performed during 2016, and the operative mortality at the time of discharge from the hospital for different diseases of the foregut been the majority malignant tumors: esophageal cancer, gastric cancer, pancreatic cancer, liver and bile ducts carcinoma, and cancer of the gallbladder. The results were compared to dose obtained the year 2011. RESULTS: The annual lethality of digestive malignant tumors showed an increase in pancreatic and liver cancer, while a decrease was observed in patients with esophageal cancer al gallbladder cancer. Operations for benign pathology like esophagomiotomy and laparoscopic antireflux surgery showed no mortality, as well as gastric bypass. Laparoscopic cholecistectomy, and laparoscopic sleeve gastrectomy presented a very low mortality. Surgical procedures for malignant diseases showed a decrease in operative mortality compare to 2011, although not significant. CONCLUSIONS: The present study shows an increase in the operations for foregut diseases performed during 2016 compared with the year 2011, as well as a decrease in operative mortality.

Seis años de experiencia en cirugía digestiva asistida por robot / 6 years of experience with robotic assisted gastrointestinal surgery

Resumen Introducción Desde su aprobación, la cirugía robótica ha crecido como una técnica útil, prometedora y probablemente superior en muchas cirugías. El objetivo de este estudio es exponer y evaluar los resultados de 6 años de experiencia, en cirugía digestiva asistida por robot, utilizada en diferentes procedimientos gastrointestinales, a lo largo de estos años. Material y Método Realizamos una revisión retrospectiva de todos los pacientes consecutivos sometidos a cirugía asistida por robot, realizada por un cirujano digestivo del Departamento de Cirugía Bariátrica y Departamento de Cirugía Robótica de la Clínica Santa María, de Santiago de Chile, entre septiembre de 2011 y mayo de 2017. Resultados Un total de 290 pacientes fueron sometidos a cirugía digestiva asistida por robot durante 6 años. Todos los pacientes fueron operados por el mismo cirujano digestivo. Los procedimientos primarios realizados fueron bypass gástrico en Y-Roux con anastomosis manual, gastrectomía en manga, cirugía revisional bariátrica y no bariátrica, fundoplicatura de Nissen, colecistectomía con puerto único, miotomía de Heller con fundoplicatura de Dor, hernioplastías, y otros casos excepcionales. La mayoría de los procedimientos secundarios fueron colecistectomías, hernioplastías hiatales y adherenciolisis. La estadía hospitalaria promedio fue de 3 días. Se observaron complicaciones postoperatorias en 27 (9,3%) pacientes. De acuerdo a la clasificación de Clavien Dindo, 4 (1,4%) complicaciones fueron Clavien I, 5 (1,7%) Clavien II, 18 (6,2%) Clavien III, 0 Clavien IV, 0 Clavien V. No hubo mortalidad en este grupo. El tiempo total promedio de los procedimientos fue de 76 min. El tiempo quirúrgico promedio fue de 64 min. Conclusión La cirugía digestiva asistida por robot es una técnica confiable y segura, que se puede utilizar para muchas enfermedades.

Background Since its approval, robotic surgery has been growing as a useful, promising and probably superior technique for many surgeries. The aim of this study is to expose and evaluate the results of a 6-year experience, of a single surgeon, with robotic assisted surgery, used for different gastrointestinal procedures throughout this years. Study Design We conducted a retrospective revision of all consecutive robotic assisted gastrointestinal cases performed by a single gastrointestinal laparoscopic surgeon of the Bariatric Surgery Department and Robotics Surgery Department of Clínica Santa María of Santiago, Chile, between September 2011 and May 2017. Results A total of 290 patients underwent robotic gastrointestinal surgery during 6 years. All cases were performed by the same gastrointestinal surgeon. Primary procedures performed were totally hand sewn Roux-en-Y gastric bypass, sleeve gastrectomy, revisional bariatric and non-bariatric surgery, Nissen fundoplication, single port cholecystectomy, Heller myotomy with Dor fundoplication, hernia repairs, and other exceptional cases. A total of 512 procedures were performed in 290 patients. The majority of secondary procedures were cholecystectomies, hiatal hernia repairs and adhesiolysis. Average length of hospital stay was 3 days. Postoperative complications were observed in 27 (9.3%) patients. According to Clavien Dindo classification of surgical complications, 4 (1.4%) complications were Clavien I, 5 (1.7%) Clavien II, 18 (6.2%) Clavien III, 0 Clavien IV, 0 Clavien V. There were no deaths in this group. Mean operative time was 76 minutes. Mean surgical time was 64 minutes. Conclusion Robot assisted upper gastrointestinal surgery is a reliable and effective technique, that can be used in many diseases.

Experiencia inicial con cirugía revisional bariátrica asistida por robot / Initial experience with robotic assisted revisional bariatric surgery

Resumen Introducción La cirugía bariátrica robótica es una técnica novedosa y en desarrollo en Chile. Los procedimientos bariátricos revisionales han aumentado durante los últimos años. No existen publicaciones en nuestro país relacionadas con experiencias en cirugía bariátrica revisional robótica. El objetivo de este estudio es describir la experiencia inicial y los resultados a corto plazo con el uso de la cirugía robótica en estos procedimientos. Material y Métodos Realizamos una revisión retrospectiva de todos los pacientes sometidos a cirugía bariátrica revisional asistida por robot, en Clínica Santa María, de Santiago de Chile. Analizamos las características demográficas, resultados quirúrgicos, morbilidad, mortalidad y tiempo de estadía hospitalaria. Resultados Se realizaron un total de 59 cirugías bariátricas revisionales asistidas por robot, 11 remodelamientos de gastrectomía en manga, 34 bypass gástrico en Y-Roux, 1 remodelamiento del pouch gástrico en un bypass gástrico en Y-Roux, 3 extracciones de banda gástrica ajustable, 1 de ellas con gastrectomía en manga simultánea, 5 instalaciones de banda gástrica ajustable en pacientes con bypass gástrico en Y-Roux, 3 gastrectomías totales, 1 resección de fístula gastro-gástrica y una anastomosis gastroyeyunal. La edad promedio fue de 47,8 años. El Índice de Masa Corporal promedio preoperatorio fue de 33,86 kg/m2. El tiempo quirúrgico promedio fue de 101,63 min. Se observaron complicaciones postoperatorias en 3 pacientes (5,08%). En 2 (3,39%) de ellos, se requirió una reoperación. No hubo fallecidos. El tiempo promedio de estadía hospitalaria fue de 3,6 días. conclusión La cirugía bariátrica revisional asistida por robot es una técnica novedosa, que parece ser segura y efectiva.

Background Robotics in bariatric surgery is a novel development in medical institutions in Chile. Revisional bariatric procedures have increased during the last years. There are no publications in our country related to the initial experience and results in robotic revisional bariatric surgery. The aim of this study is to describe the initial experience and short term outcomes with robotic revisional bariatric surgery. Study Design We conducted a retrospective study of all consecutive robotic revisional bariatric surgeries performed by a single surgeon in Clínica Santa María in Santiago, Chile. We analyzed demographic characteristics and surgical outcomes, morbidity, mortality and length of hospital stay. Results 59 revisional bariatric surgeries were performed, 11 reshaping of sleeve gastrectomy, 34 Roux in Y gastric bypass, 1 pouch reshaping of Roux in Y gastric bypass, 3 extractions of laparoscopic adjustable gastric banding, 1 of them with simultaneous sleeve gastrectomy, 5 laparoscopic adjustable gastric banding to patients with previous Roux in Y gastric bypass, 3 total gastrectomy, 1 resection of gastro-gastric fistula and 1 gastro enteral anastomosis. Mean age was 47.8 years. Average preoperative body mass index was 33.86 kg/m2. Mean surgical time was 101.63 minutes. Postoperative complications were observed in 3 patients (5.08%). In 2 (3.39%) of this patient, reoperation was required. There were no deaths in this group. Average length of hospital stay was 3.6 days. Conclusion Robotic revisional bariatric surgery is a novel technique that appears to be safe and effective.

Effect of spraying of molybdenum and tyrosine on growth, yield and chemical composition of lemon basil plant

This study was conducted to evaluate the effect of foliar application of molybdenum [zero. 50. 100, 200, and 400 ppm] and/or tyrosine as a source of amino acids with levels of zero. 50 and 100 ppm on growth, yield and chemical composition of lemon basil plant at the Experimental Farm of Cultivation and Production of Medicinal and Aromatic Plants Dept. National Research Center. Giza, Egypt, during two successive seasons of 2001 and 2002. Application of the combined treatment [50 ppm molybdenum + 50 ppm tyrosine] resulted in the maximum values of plant height, plant diameter. number of branches, plant fresh weight, plant dry weight, leaves fresh weight, leaves dry weight, flowers fresh weight and Howers dry weight, while the combined treatment of 400 ppm molybdenum resulted in the minimum values for most characters. Interaction between tyrosine and molybdenum decreased hydrocarbonic compounds comparing with control or plants received molybdenum or tyrosine separately. The essential oil was studied with GLC to reveal that the major compounds in all treatment was citral-a, citral-b, humulene and linalool

Clinical prognostic factors in patients with advanced stage of prostate cancer

Objectives: To determine the prognostic factors that could predict patient outcome in patients with advanced stage prostate cancer

Patients and Methods: In this study we retrospectively evaluated the medical record data of 222 patients with advanced stage prostate cancer treated by hormonal therapy [either castration or total androgen blockade [TAB]]. All pre- and post- treatment data records were evaluated with respect to patient age, prostate and tumor size, tumor grade, stage, PSA, alkaline and acid phosphatase and the number of bone lesions. The response to the hormonal treatment was evaluated either early [12 months after treatment] or late [over all follow-up visits until the last visit or death]. Descriptive statistics, student T test, multivariate and Kaplan Meier's curve were used for data analysis

Results: Within 12 months of treatment 70% of the cases showed an improvement with a significant decrease of their pre-treatment values after hormonal therapy. Patient age, tumor stage, the number of bone lesions, serum alkaline and acid phosphatase levels in the pre-treatment data were significantly independent predictors of the overall survival outcome [p= 0.0015, 0.002, 0.001, 0.0002 and 0.028, respectively], while the pre-treatment PSA serum level, tumor grade and the type of hormonal treatment used [either castration or TAB] were no predictors of patient outcome [p= 0.18, 0.82 and 0.47, respectively]. Importantly, the PSA serum level and the number of bone lesions in the first 12 months of patient follow-up were significant predictors of the overall disease survival status [p=0.001 and 0.028, respectively]. The mean follow-up period of alive cases was 39.42 months ranging from 6 - 171 months. Of the 222 cases 110 [51.6%] had overall disease progression during a mean of 59.4 months, while mortality was reported in 118 cases [53.2%] in the course of a mean of 59.9 months

Conclusion: The pre-treatment patient age, tumor stage, serum alkaline and acid phosphatase, as well as the post-treatment PSA level and the number of bone lesions were significant independent predictors of the overall patient outcome in patients with advanced stage prostate cancer. However, a survival analysis in relation to the treatment type did not reveal a statistically significant difference between the outcomes of castration and TAB

Towards positive diagnosis of globus hystericus

17 patients [11 females and 6 males] with the symptom of globus sensation were examined to assess a possible etiologic basis for their symptom. 13 asymptomatic healthy subjects [8 females and 5 males] matched for age and sex were also included as a control group. At the initial assessment, patients and controls underwent a detailed psychometric investigation. Patients were evaluated for other associated symptoms and, in particular, symptoms typifying esophageal motility disorders. They were subjected to thorough physical and otolaryngologic examinations and, thereafter, they underwent upper gastrointestinal endoscopy, barium esophagogram, barium meal, radiograms of the cervical and upper thoracic spines and ultrasonography of the neck structures. Results showed that the symptom was attributed to advanced cervical spondylosis in 2 patients, duodenal ulcer in 2, otitis with mastoiditis in one, rheumatoid arthritis in one, esophageal motility disorders in 7 and it was of psychogenic origin for the remaining 4 patients

HBV serological markers versus clinico-biochmical, and histopathological evidence of activity in the evaluation of cirrhotic patients group A Child's Classification with hematemesis and/or melena

One hundred and five [105] patients with bilhazial hepatic fibrosis and/or cirrhosis fullfiling the criteria of group A child's classification were subjected to thorough clinical examination, biochemical investigation and serological determination of Hepatitis B virus markers. Moreover an upper GIT endoscopy and liver biopsy were done for every patient in the studied group. From the present work hepatitis B serologic markers alone or in combination were present in 86/105[81.9%] of cirrhotic patients group A child's classification The prevalence of each hepatitis B virus serological markers among this group of patients was:HBs AG 18/105 [17.1%], anti-HBs 26/105 [24.8%], anti -HBC IgM 1/105[22.9%] None of the hepatitis Bvirus serological markers was detected in 19/105[18.1%]. HBV serological markers profile of past infection was detected in 21/105 [20%], HBV serological markers profile of chronic current infection in 56/105 [53.3%] and HBV serological markers profile of a recent current infection in 9/105 [8.6%] of cases. Pure bilharzial hepatic fibrosis accounted for 17/105[16.2%] of cases only, mixed cirrhosis for 26/105[24.8%], pure posthepatitic, most likely, due HBV infection in 53/105[50.5%], and undetermined etiology in 9/105[8.6%], of cases. According to the accepted criteria of active cirrhosis, 16.26[61.5%] patients with mixed cirrhosis and 10/53[18.7%] patients with pure cirrhosis showed biochemical and histopathological evidence of active cirrhosis thus we have assured a total incidence of active cirrhosis in 26/105[24.8%] of this group of patients

Decay dynamics of fenvalerate in mentha piperita L and in the resulting oil

A synthetic pyrethroid, fenvalerate [alpha-cyano-3-phenoxy-benzyl alpha-Isopropyl-4-chlorophenylacetate.] was applied to peppermint plants. The residues were determined in peppermint herb and in the resulting oil at different intervals after spraying. Gas-liquid chromatographic analysis was performed on a 5% OV-101 AW/CW with[63] Ni electron capture detection. Fenvalerate recovery was 90% when added at the 5 ppm level. Tracing the residue data are indicated hereafter