Gastrina: hormona de múltiples funciones / Gastrin: multifunctional hormone

Gastrin is a polypeptide hormone secreted primarily by G cells of the gastric antrum. Its main function is the regulation of gastric acidity, through the release of histamine, which ultimately acts on the parietal cell. There are a number of pathological conditions characterized by persistent hypergastrinemia will cause various effects, from peptic disease to cancer. Most research points to clarify their involvement in processes of proliferation of different cell types and thus to find a treatment for cancer. Intermediates molecules have been described for the metabolism of gastrin, which also possess the property of stimulating the proliferation of various cell lines and participated in processes of cell migration and invasion. Using molecular bioengineering has been able to modify the original molecule to create receptor antagonist and thus able to address some of the associated diseases. Much of this hormone, described over a century ago, is still unknown (AU)

Obesidad mórbida asociada a quiste broncogénico y leiomioma subcardial que simula GIST: caso clínico / Morbid obesity, esophageal bronchogenic cyst and subcardial leiomioma: report of one case

Gastric wall diseases are found in approximately of 1 percent of the patients submitted to bariatric surgery. Half of these are leiomiomas. Esophageal bronchogenic cysts are exceptional We report a 57 years old female with morbid obesity, a bronchogenic esophageal cyst and subcardial leiomioma. The preoperative study and intraoperative biopsy, suggested the presence of a gastrointestinal stromal tumor (GIST), but the definitive pathological study did not confirm its presence. A total gastrectomy was performed, with an uneventful postoperative course.

La patología intramural gástrica tiene una frecuencia menor al 1 por ciento, en cirugía gástrica. Alrededor del 50 por ciento corresponden a leiomiomas. Los quistes broncogénicos tienen origen embriológico y son excepcionales, y la mayor parte de los reportes corresponden a pacientes pediátricos. Se presenta un caso clínico de paciente portadora de Obesidad mórbida (IMC = 52), asociado a lesión subcardial que simula GIST, cuyo estudio histopatológico resultó ser un quiste esofágico de origen broncogénico de 40 mm, asociado a leiomioma subcardial de 10 mm. Fue sometida a gastrectomía total más anastomosis esófago-yeyunal en Y de Roux, con asa de 180 cm. No presentó morbi-mortalidad postoperatoria. Se discuten los métodos de estudio preoperatorio y las alternativas terapéuticas. No hemos encontrado en la literatura otro caso de asociación de estas raras patologías.

Riesgo perioperatorio del bypass gástrico reseccional en pacientes con obesidad mórbida: Estudio prospectivo de 684 pacientes / Perioperative risk among morbid obese patients subjected to gastric bypass

Background: Bariatric surgery is a complex procedure not exempt of complications. Aim: To assess mortality and complications of excisional gastric bypass among morbidly obese subjects. Material and methods: Prospective analysis of 684 morbid obese patients (age range 14-70 years, 525 females) subjected to an excisional gastric bypass. Major postoperative complications and mortality were registered. Results: Mean body mass index (BMI) of the subjects was 43.7 kg/m2. One hundred sixty two patients had a BMI between 35 and 39.9 kg/m2, 419 had a BMI between 40 and 49.9 kg/m2 and 103 had a BMI over 50 kg/m2. Two patients with a BMI of 52 and 56 kg/m2 respectively, died in the postoperative period (0.3%). Thirty six patients had major complications. Anastomotic fistula was the most common complication in 12 patients (1.7%). Fourteen patients required a new operation due to complications. None of these died. The mean operative volume of the surgical team was 124 patients per year. Conclusions: Excisional gastric bypass has a low rate of mortality and complications, if the surgical team operates a large volume of patients.

Resecabilidad y mortalidad operatoria de la gastrectomía subtotal y total en pacientes con cáncer gástrico avanzado, entre 1969 y 2004 / Evolution of resectability and mortality rates of total and subtotal gastrectomy for gastric cancer

Background: The only curative treatment for gastric cancer is its surgical excision associated to a lymph node dissection. Aim: To study the evolution of resectability and operative mortality of total and subtotal gastrectomy for gastric cancer, in a period of 35 years. Material and methods: Review of medical records of 3000 patients with gastric cancer, operated between 1969 and 2004. Resectability and mortality of total and subtotal gastrectomy was compared in four successive periods (1969 to 1979, 1980 to 1989, 1990 to 1999 and 2000 to 2004). Results: In the four periods there was a steady and significant increase in resectability rate from 49 to 85%. Mortality of total and subtotal gastrectomy decreased significantly from 17 to 2% and from 25 to 1%, respectively. Conclusions: Resectability and mortality rates of total and subtotal gastrectomy have improved with time. Probably a better pre and postoperative care and the experience of the surgical team have an influence in this favorable change.