Peritoneal tuberculosis mimicking colonic carcinomatosis.

Pulmonary Tuberculosis (TB) has increased in Spain in recent years due to multiple factors. Peritoneal tuberculosis represents the sixth cause of extrapulmonary tuberculosis, accounting for 11% of tuberculosis cases. We report a 28-year-old male from Mali, who arrived at our hospital with an acute abdomen due to intestinal perforation with a computed tomography scan (CT) performed peritoneal tuberculosis mimicking primary carcinomatosis. This presents a diagnostic and therapeutic challenge, since the surgical approach differs in both cases, and the prognosis is very different between them.

Dermatofibrosarcoma protuberans en región perianal: estudio de un caso, revisión y actualización / Perianal dermatofibrosarcoma protuberans: a case report, review and update

El dermatofibrosarcoma protuberans es un sarcoma de bajo grado que típicamente se origina en dermis con extensión local a tejido celular subcutáneo y músculo. Presentamos un dermatofibrosarcoma protuberans perianal en un varón de 41 años que le ocasionaba proctalgia y estreñimiento, y revisamos la literatura científica. El interés del caso reside fundamentalmente en la excepcionalidad de que un dermatofibrosarcoma protuberans se presente en región perianal (solo 2 casos previamente descritos) y en esa línea, en la dificultad del manejo quirúrgico en dicha topografía. El reordenamiento t(17;22)(q22;q13) con el resultado de la fusión génica COL1A1/PDGFß en estos tumores no solo es una característica de utilidad diagnóstica; también, otorga una alternativa terapéutica en casos inoperables o metastásicos con el uso de imatinib

Dermatofibrosarcoma protuberans is a low-grade sarcoma typically originating in the dermis but with local invasion of subcutaneous cell and muscle tissue. We report a case of perianal dermatofibrosarcoma protuberans in a 41-year-old male complaining of anal pain and constipation. To date, only two cases of perianal dermatofibrosarcoma protuberans have been reported. The unusual location hinders surgical treatment. The characteristic translocation t(17;22)(q22;q13) leading to the formation of COL1A1/PDGFß fusion transcripts is not only of diagnostic value but also enables an alternative imatinib-based therapy in inoperable or metastatic cases. The pertinent literature is reviewed

[Perianal dermatofibrosarcoma protuberans: a case report, review and update]. / Dermatofibrosarcoma protuberans en región perianal: estudio de un caso, revisión y actualización.

Dermatofibrosarcoma protuberans is a low-grade sarcoma typically originating in the dermis but with local invasion of subcutaneous cell and muscle tissue. We report a case of perianal dermatofibrosarcoma protuberans in a 41-year-old male complaining of anal pain and constipation. To date, only two cases of perianal dermatofibrosarcoma protuberans have been reported. The unusual location hinders surgical treatment. The characteristic translocation t(17;22)(q22;q13) leading to the formation of COL1A1/PDGFß fusion transcripts is not only of diagnostic value but also enables an alternative imatinib-based therapy in inoperable or metastatic cases. The pertinent literature is reviewed.

Transanal endoscopic microsurgery for the treatment of uncommon rectal lesions. / Microcirugía endoscópica transanal en el tratamiento de lesiones rectales atípicas.

INTRODUCTION: Transanal endoscopic microsurgery (TEM) was developed as a less aggressive alternative treatment for rectal lesions (mainly adenomas and adenocarcinomas). However, its use for other rectal lesions has become more frequent, trying to reduce the morbidity associated with more invasive techniques. The aim of this study is to describe our experience in the use of TEM in other rectal lesions. METHODS: Retrospective and descriptive study including patients operated with TEM (from June 2008 to December 2016) for the treatment of rectal lesions different from adenomas or adenocarcinomas. RESULTS: Among the 138 patients treated by TEM in our department, 10 patients were operated on for rectal lesions other than adenomas or adenocarcinomas. Rectal lesions were 3neuroendocrine tumours, a neuroendocrine tumour metastasis, a rectal stenosis, a cloacogenic polyp, an endometrioma, a retrorrectal tumour, a presacral abscess and a lesion in the rectovaginal septum. Mean operative time was 72min and postoperative stay was 4.2 days. Only one patient needed a reoperation, due to rectal bleeding. CONCLUSIONS: TEM could be a useful tool for the treatment of rectal lesions different from adenomas or adenocarcinomas, potentially decreasing the morbidity associated with more aggressive surgical techniques.

Microcirugía endoscópica transanal en el tratamiento de lesiones rectales atípicas / Transanal endoscopic microsurgery for the treatment of uncommon rectal lesions

Introducción: La microcirugía endoscópica transanal (TEM) se diseña como una alternativa menos agresiva en el tratamiento de lesiones rectales (principalmente adenomas y adenocarcinomas). Sin embargo, su uso se ha ampliado a otras lesiones rectales para intentar disminuir la morbilidad añadida a técnicas más invasivas. El objetivo de este estudio es mostrar nuestra experiencia en el uso de la TEM en el tratamiento de otras lesiones rectales, diferentes de adenomas y adenocarcinomas. Métodos: Estudio retrospectivo descriptivo en el que se incluyen pacientes intervenidos mediante TEM para el tratamiento de lesiones rectales (diferentes a adenomas o adenocarcinomas) desde junio de 2008 hasta diciembre de 2016. Resultados: Entre los 138 pacientes operados mediante TEM en nuestro servicio, 10 fueron tratados por lesiones diferentes a adenomas o adenocarcinomas. Las lesiones rectales fueron 3tumores neuroendocrinos primarios, una metástasis de tumor neuroendocrino, una estenosis rectal, un pólipo cloacogénico, un endometrioma, un tumor retrorrectal, un absceso presacro y una lesión sin filiar en tabique rectovaginal. El tiempo operatorio medio fue de 72 min y la estancia postoperatoria de 4,2 días. Solo un paciente necesitó reintervención por rectorragia. Conclusiones: La aplicación del TEM para el tratamiento de lesiones rectales diferentes a adenomas o adenocarcinomas puede ser una herramienta útil que potencialmente ayude a disminuir la morbilidad asociada a otros tipos de técnicas quirúrgicas más invasivas (AU)

Introduction: Transanal endoscopic microsurgery (TEM) was developed as a less aggressive alternative treatment for rectal lesions (mainly adenomas and adenocarcinomas). However, its use for other rectal lesions has become more frequent, trying to reduce the morbidity associated with more invasive techniques. The aim of this study is to describe our experience in the use of TEM in other rectal lesions. Methods: Retrospective and descriptive study including patients operated with TEM (from June 2008 to December 2016) for the treatment of rectal lesions different from adenomas or adenocarcinomas. Results: Among the 138 patients treated by TEM in our department, 10 patients were operated on for rectal lesions other than adenomas or adenocarcinomas. Rectal lesions were 3neuroendocrine tumours, a neuroendocrine tumour metastasis, a rectal stenosis, a cloacogenic polyp, an endometrioma, a retrorrectal tumour, a presacral abscess and a lesion in the rectovaginal septum. Mean operative time was 72min and postoperative stay was 4.2 days. Only one patient needed a reoperation, due to rectal bleeding. Conclusions: TEM could be a useful tool for the treatment of rectal lesions different from adenomas or adenocarcinomas, potentially decreasing the morbidity associated with more aggressive surgical techniques (AU)

Hemorragia intercostal secundaria a tos persistente en un caso de reagudización de EPOC. Tratamiento selectivo mediante embolización arterial / Intercostal bleeding due to persistent cough in a case of acute exacerbation of COPD. Selective treatment by arterial embolization

No disponible

Empleo de plasma autólogo rico en plaquetas en el tratamiento de fístulas perianales complejas / Using autologous platelet-rich plasma for the treatment of complex fistulas

Objetivo: este estudio tiene como objetivo demostrar la efectividad y seguridad de un gel de fibrina autóloga rico en factores de crecimiento plaquetario para el tratamiento de las fístulas perianales complejas. Material y métodos: estudio epidemiológico prospectivo descriptivo. Se incluyen pacientes que presentan fístula perianal compleja o fístula perianal simple con alteración de la continencia. Se realiza identificación de ambos orificios y del trayecto, legrado del mismo e instilación del Vivostat PRF® en el trayecto hasta observar exceso de material por el OFE. Las variables a analizar son: edad, sexo, uso de setón previo, clínica prevalente, tipo de fístula, complicaciones postoperatorias, cierre de la fístula y alteraciones en la calidad de vida mediante el test sf-36(v2). Resultados: desde enero del 2011 hasta mayo del 2013 se ha intervenido a 23 pacientes, 12 hombres y 11 mujeres, con una media de edad de 49 años y un seguimiento mínimo de 12 meses. Dos abandonaron el estudio. 17 pacientes presentaban fístula transesfinteriana baja; 2, transesfinteriana alta, y 2, interesfinteriana con alteración de la continencia. El síntoma más frecuente es la supuración. Doce pacientes llevaban un setón laxo (62%), de los cuales curaron nueve. De todos los pacientes que hemos intervenido el porcentaje de éxitos es de un 62%. Ningún paciente desarrolló incontinencia después del tratamiento. Sólo dos refieren una peor calidad de vida después de la intervención. Conclusión: este estudio demuestra que hay un claro beneficio con el uso de Vivostat PRF® como tratamiento para las fístulas perianales complejas. Es una técnica altamente reproductible con resultados aceptables y que no produce alteraciones de la continencia (AU)

Objective: This study aims to demonstrate the effectiveness and safety of autologous fibrin gel rich in platelet growth factors for the treatment of complex perianal fistulas. Material and Methods: Prospective epidemiological study. Patients with complex perianal fistula or perianal fistula mere alteration of continence are included. identification of both holes and the journey, curettage of it and instillation of Vivostat PRF® in the way it is done to observe excess material by OFE. The variables analyzed were: age, sex, use of prior Seton clinic prevalent type of fistula, postoperative complications, fistula closure and impaired quality of life using the SF-36 test (v2). Results: From January 2011 to May 2013 have involved 23 patients, 12 men and 11 women, with an average age of 49 years and a minimum follow-up of 12 months. Two dropped out. 17 patients had low transsphincteric fistulas, 2 and 2 high transsphincteric intersphincteric with impaired continence. The most common symptom is the discharge. Twelve patients had a loose seton (62%), of which nine cured. Of all the patients we have operated the success rate is 62%. No patient developed incontinence after treatment. Only two reported a worse quality of life after surgery. Conclusion: This study demonstrates that there is a clear benefit to the use of Vivostat PRF® as a treatment for complex perianal fistulas. It is a highly reproducible technique with acceptable results and does not produce impairment of continence (AU)

Using autologous platelet-rich plasma for the treatment of complex fistulas.

OBJECTIVE: This study aims to demonstrate the effectiveness and safety of autologous fibrin gel rich in platelet growth factors for the treatment of complex perianal fistulas. MATERIAL AND METHODS: Prospective epidemiological study. Patients with complex perianal fistula or perianal fistula mere alteration of continence are included. identification of both holes and the journey, curettage of it and instillation of Vivostat PRF® in the way it is done to observe excess material by OFE. The variables analyzed were: age, sex, use of prior Seton clinic prevalent type of fistula, postoperative complications, fistula closure and impaired quality of life using the SF-36 test (v2). RESULTS: From January 2011 to May 2013 have involved 23 patients, 12 men and 11 women, with an average age of 49 years and a minimum follow-up of 12 months. Two dropped out. 17 patients had low transsphincteric fistulas, 2 and 2 high transsphincteric intersphincteric with impaired continence. The most common symptom is the discharge. Twelve patients had a loose seton (62%), of which nine cured. Of all the patients we have operated the success rate is 62%. No patient developed incontinence after treatment. Only two reported a worse quality of life after surgery. CONCLUSION: This study demonstrates that there is a clear benefit to the use of Vivostat PRF® as a treatment for complex perianal fistulas. It is a highly reproducible technique with acceptable results and does not produce impairment of continence.

¿Qué se investiga en cáncer de recto? / What's new in rectal cancer research

INTRODUCCIÓN: La evidencia clínica tiene más peso en las especialidades médicas que en las quirúrgicas. El cáncer de recto (CR) no es una excepción. En este artículo, nos hemos planteado explorar de forma cuantitativa y cualitativa, qué cuestiones y materias relacionadas con el CR están siendo investigadas en el momento actual y, posteriormente, analizar esta información para conocer qué respuestas podrá darnos la investigación clínica en el futuro. MÉTODOS: La obtención de datos se realizó en abril de 2014 y se basó en 3 fuentes: 2 registros institucionales de ensayos clínicos, -el registro americano (clinicaltrials.gov) y el registro europeo (EU Clinical Trials Register) - y una encuesta realizada a través de la Asociación Española de Coloproctología (AECP). Los estudios obtenidos fueron exportados a una base de datos diseñada especialmente para esta revisión, en la que se incluyeron además una serie de elementos descriptivos que permitieran la catalogación de los estudios. Los resultados de la encuesta AECP fueron analizados de forma separada. RESULTADOS: Hay actualmente en marcha 216 estudios referidos al CR. Dos tercios son fundamentalmente oncológicos. Casi un tercio son quirúrgicos. Las líneas de investigación se centran en la mejora del tratamiento preoperatorio: nuevos fármacos, nuevos esquemas de quimiorradioterapia (generalmente de inducción o consolidación) u optimización de la radioterapia y sus efectos. Los ensayos clínicos quirúrgicos estudian aspectos relacionados con robótica, laparoscopia, estomas, anastomosis bajas, CR distal y tratamiento local. CONCLUSIONES: La mayoría de los estudios actuales sobre CR analizan aspectos relacionados con la quimiorradioterapia y sus efectos. Un tercio se centran en temas especialmente quirúrgicos

INTRODUCTION: Clinical evidence has a more significant role in medical specialties than in surgery. Rectal cancer (CR) is no exception. This paper explores what CR-related subjects are being investigated at the present time in a quantitative and qualitative way and analyzes this information to know what possible answers clinical research could give us in the future. METHODS: The data collection was carried out in April 2014 and was based on 3 sources: 2 institutional clinical trials registries -American (clinicaltrials.gov) and European (EU Clinical Trials Register)- and a survey given to members of the Asociación Española de Coloproctología (AECP). The obtained studies were exported to a database designed especially for this review, which included a number of descriptive elements that would allow the cataloging of the different studies. The AECP survey results were analyzed separately. RESULTS: There are currently 216 clinical trials ongoing related to CR. Two-thirds are primarily conducted by oncologists. Nearly a third are surgical. The research focuses on improving preoperative treatment: new drugs, new schemes of chemo-radiotherapy (usually induction or consolidation schemes) or optimization of radiotherapy and its effects. Surgical clinical trials are related to robotics, laparoscopy, stoma, low colorectal anastomosis, distal CR and local treatment. CONCLUSION: Most of the current clinical trials ongoing on CR are analyzing aspects of chemo-radiotherapy and its effects. A third focus on purely surgical issues

What is being researched in rectal cancer? / ¿Qué se investiga en cáncer de recto?

INTRODUCTION: Clinical evidence has a more significant role in medical specialties than in surgery. Rectal cancer (CR) is no exception. This paper explores what CR-related subjects are being investigated at the present time in a quantitative and qualitative way and analyzes this information to know what possible answers clinical research could give us in the future. METHODS: The data collection was carried out in April 2014 and was based on 3 sources: 2 institutional clinical trials registries -American (clinicaltrials.gov) and European (EU Clinical Trials Register)- and a survey given to members of the Asociación Española de Coloproctología (AECP). The obtained studies were exported to a database designed especially for this review, which included a number of descriptive elements that would allow the cataloging of the different studies. The AECP survey results were analyzed separately. RESULTS: There are currently 216 clinical trials ongoing related to CR. Two-thirds are primarily conducted by oncologists. Nearly a third are surgical. The research focuses on improving preoperative treatment: new drugs, new schemes of chemo-radiotherapy (usually induction or consolidation schemes) or optimization of radiotherapy and its effects. Surgical clinical trials are related to robotics, laparoscopy, stoma, low colorectal anastomosis, distal CR and local treatment. CONCLUSION: Most of the current clinical trials ongoing on CR are analyzing aspects of chemo-radiotherapy and its effects. A third focus on purely surgical issues.

Cirujano 2.0: el reto está en la red / Surgeon 2.0: the challenge is on the Web

En los últimos tiempos hemos visto publicados numerosos artículos y opiniones acerca de cómo internet está cambiando la práctica clínica. En el presente artículo nos centraremos en describir 2 aspectos que creemos fundamentales en la interrelación web 2.0 y Medicina-Cirugía: a) conceptualización de web 2.0 y sus diferencias con las herramientas preexistentes y b) descripción de algunas de las herramientas que bajo la óptica médico-quirúrgica pueden ser de mayor interés para los profesionales, los pacientes y la interacción entre ambos. Ha llegado el momento de subirse al tren 2.0, donde los canales de comunicación entre profesionales y entre estos con los pacientes mejoran a diario las situaciones de enfermedad, facilitan el aprendizaje a partir del contacto con otros médicos y cirujanos, al tiempo que proporcionan un excelente recurso para mantener la salud y conocer la enfermedad y su terapéutica (AU)

Numerous articles and opinions have been published in the last few years on how the Internet is changing clinical practice. In this article we focus on describing 2 aspects that we believe are fundamental in the web 2.0 and Medicine-Surgery inter-relationship: a) web 2.0 conceptualisation and its differences with other pre-existing tools, and b) a description of some of the tools that from a medical-surgical view could be of major interest to the professionals, the patients, and interaction between both. The time has arrived to board train 2.0, where the channels of communication between the professionals, and between them and the patients, are improving disease situations daily, to improve learning through contact with other physicians and surgeons, at the same time providing an excellent resource for maintaining health and to know the disease and its treatment (AU)

[Surgeon 2.0: the challenge is on the Web]. / Cirujano 2.0: el reto está en la red.

Numerous articles and opinions have been published in the last few years on how the Internet is changing clinical practice. In this article we focus on describing 2 aspects that we believe are fundamental in the web 2.0 and Medicine-Surgery inter-relationship: a) web 2.0 conceptualisation and its differences with other pre-existing tools, and b) a description of some of the tools that from a medical-surgical view could be of major interest to the professionals, the patients, and interaction between both. The time has arrived to board train 2.0, where the channels of communication between the professionals, and between them and the patients, are improving disease situations daily, to improve learning through contact with other physicians and surgeons, at the same time providing an excellent resource for maintaining health and to know the disease and its treatment.

Indicaciones y resultados de la microcirugía endoscópica transanal en el tratamiento de los tumores rectales en una serie consecutiva de 52 pacientes / Indications and results of transanal endoscopic microsurgery in the treatment of rectal tumours in a consecutive series of 52 patients

El abordaje abdominal para el tratamiento de los tumores rectales se asocia a una morbilidad considerable. La microcirugía endoscópica transanal (TEM) supone una técnica alternativa, menos invasiva que la cirugía radical, y por tanto, con una menor morbilidad asociada. Además, con una correcta selección de pacientes, la TEM presenta resultados oncológicos equiparables a la cirugía radical. El objetivo de este estudio es revisar nuestros resultados con TEM y discutir sus indicaciones en el tratamiento de los tumores rectales. Pacientes y método Estudio observacional con recogida prospectiva de datos desde junio de 2008 hasta enero de 2011. Las indicaciones de TEM fueron: lesiones benignas rectales no susceptibles de resección mediante colonoscopia; lesiones rectales neoplásicas precoces (T1N0M0) con factores de buen pronóstico; lesiones neoplásicas con estadios más avanzados en pacientes seleccionados (alto riego quirúrgico, negación de cirugía radical o estoma e intención paliativa).Resultados Se realizó resección mediante TEM a 52 pacientes (35 lesiones benignas y 17 malignas). La estancia media hospitalaria ha sido de 4,9 días con una morbilidad asociada del 15,3%. La resección R0 en adenomas y carcinomas fue del 97,1% y 88,8% respectivamente. Durante el seguimiento de 15 (3-31) meses, se ha evidenciado una recidiva de un adenoma que ha vuelto a ser intervenido mediante TEM. Conclusiones La TEM es un procedimiento seguro y efectivo para el tratamiento de lesiones rectales benignas y malignas precoces seleccionadas, asociada a una baja morbilidad. No obstante, se trata de una estrategia terapéutica, basada en un equipo multidisciplinario, fundamentada en una cuidadosa selección de pacientes, una técnica quirúrgica auditada y un estricto protocolo de seguimiento (AU)

Introduction: The abdominal approach for the treatment of rectal tumours is associated with considerable morbidity. Transanal endoscopic microsurgery (TEM) is a technical alternative, and less invasive than radical surgery, and thus, with a lower associated morbidity. Also, with the correct selection of patients, TEM shows similar oncological results to radicalsurgery. The objective of this study is to review our results with TEM and discuss its indications in the treatment of rectal tumours. Patients and method: An observational, retrospective study with prospective collection of data conducted from June 2008 to January 2011. TEM indications were: benign rectaltumours non-resectable using colonoscopy; early malignant rectal tumours (T1N0M0) with good prognostic factors: neoplastic tumours in more advanced stages in selected patients(high surgical risk, refused radical surgery or stoma and palliative care).Results: A resection was performed using TEM on 52 patients (35 benign and 17 malignant tumours). The mean hospital stay was 4.9 days, with an associated morbidity of 15.3%. TheR0 resection in adenomas and carcinomas was 97.1% and 88.8% respectively. During afollow-up of 15 (3-31) months, one recurrence of an adenoma was observed which was reoperated on using TEM. Conclusions: TEM is a safe and effective procedure for the treatment of benign and selected early malignant rectal tumours, and is associated with a low morbidity. However, it is a therapeutic strategy based on a multidisciplinary team, basically with careful selection of patients, a validated technique and a strict follow-up protocol (AU)