Evaluación de la grelina plasmática tras aplicación de neuroestimulación percutánea del dermatoma T6 en el tratamiento de la obesidad / Plasma ghrelin levels after percutaneous electrical nerve stimulation of dermatome T6 for the treatment of obesity

Introducción: Los pacientes con obesidad, con frecuencia, tienen dificultad para adherirse a una dieta baja en calorías durante largos períodos de tiempo. Una de las causas del fracaso dietético es la sensación continua de hambre. La grelina es un péptido orexígeno, secretado por células enterocromafines del fundus gástrico. El objetivo de este estudio fue analizar las variaciones de los valores plasmáticos de grelina tras PENS del dermatoma T6 asociado a dieta hipocalórica, así como la modificación del apetito y la pérdida de peso, comparándolo con un grupo control en el que solo se pautó una dieta hipocalórica. Material y métodos: Realizamos un estudio prospectivo no aleatorizado, incluyendo 20 pacientes sometidos a PENS del dermatoma T6, asociado a dieta hipocalórica, como tratamiento previo a ser sometidos a una técnica de cirugía bariátrica y con el fin de reducir peso (grupo 1), y 20 pacientes a los que se les pautó exclusivamente dieta hipocalórica previa a la intervención quirúrgica (grupo 2). En el grupo 1 se analizaron los niveles de grelina plasmática en 5 momentos diferentes del procedimiento: antes de realizar la primera sesión de PENS (muestra 1a), al finalizar la primera sesión de PENS (muestra 1b), antes de realizar la última sesión de PENS (muestra 2a), al finalizar la última sesión de PENS (muestra 2b) y un mes después de haber finalizado el tratamiento (muestra 3). En el grupo 2 se obtuvieron solo 2 muestras, antes de comenzar la dieta (muestra 1) y tras 12 semanas de dieta (muestra 2). Resultados: Tras 12 semanas de tratamiento se observó una pérdida de IMC del 8,42 ± 2,6% en el grupo 1 y del 1,32 ± 0,98% en el grupo 2 (p = 0,007). En el grupo 1 se apreció un descenso significativo de los valores de grelina entre las muestras 1a y 2a, y entre las muestras 1a y 3. En el grupo 2 se observó un aumento no significativo de los niveles de grelina entre las muestras 1 y 2. Conclusión: El PENS del dermatoma T6 se asoció con una disminución en los valores de grelina plasmática. Esta terapia, asociada a una dieta hipocalórica, consigue una pérdida de IMC superior al 8% en 12 semanas de tratamiento

Introduction: Obese patients often find it difficult to adhere to long-term low-calorie diets. One of the reasons for dietary failure is the permanent feeling of hunger. Ghrelin is an orexigenic hormone, secreted by enterochromaffin cells in the gastric fundus. The aim of this study was to analyze changes in plasma ghrelin levels after PENS of dermatome T6 associated to a low-calorie diet, as well as changes in appetite and weight loss, as compared to a control group on a low-calorie alone. Material and methods: A prospective, non-randomized study was conducted including 20 patients who underwent PENS of dermatome T6 associated to a low-calorie diet before undergoing bariatric surgery to lose weight (Group 1), and 20 patients who were only prescribed a low-calorie diet before surgery (Group 2). In Group 1, plasma ghrelin levels were measured at 5 timepoints: before the first PENS session (Sample 1a); after the first PENS session (Sample 1b); before the last PENS session (Sample 2a); after the last PENS session (Sample 2b); and one month after treatment completion (Sample 3). In Group 2, only two samples were collected: before the start of the diet (Sample 1) and after 12 weeks of diet (Sample 2). Results: After 12 weeks of treatment, BMI decreases of 8.42% ± 2.6% and 1.32% ± 0.98% were seen in Group 1 and Group 2 respectively (p = 0.007). A significant decrease was seen in ghrelin levels between samples 1a and 2a, and between samples 1a and 3. In Group 2, a non-significant increase was seen in ghrelin levels. Conclusion: PENS of dermatome T6 was associated to decreased plasma ghrelin levels. This therapy, associated to a low-calorie diet, achieves a BMI reduction greater than 8% after 12 weeks of treatment

Plasma ghrelin levels after percutaneous electrical nerve stimulation of dermatome T6 for the treatment of obesity. / Evaluación de la grelina plasmática tras aplicación de neuroestimulación percutánea del dermatoma T6 en el tratamiento de la obesidad.

INTRODUCTION: Obese patients often find it difficult to adhere to long-term low-calorie diets. One of the reasons for dietary failure is the permanent feeling of hunger. Ghrelin is an orexigenic hormone, secreted by enterochromaffin cells in the gastric fundus. The aim of this study was to analyze changes in plasma ghrelin levels after PENS of dermatome T6 associated to a low-calorie diet, as well as changes in appetite and weight loss, as compared to a control group on a low-calorie alone. MATERIAL AND METHODS: A prospective, non-randomized study was conducted including 20 patients who underwent PENS of dermatome T6 associated to a low-calorie diet before undergoing bariatric surgery to lose weight (Group 1), and 20 patients who were only prescribed a low-calorie diet before surgery (Group 2). In Group 1, plasma ghrelin levels were measured at 5 timepoints: before the first PENS session (Sample 1a); after the first PENS session (Sample 1b); before the last PENS session (Sample 2a); after the last PENS session (Sample 2b); and one month after treatment completion (Sample 3). In Group 2, only two samples were collected: before the start of the diet (Sample 1) and after 12 weeks of diet (Sample 2). RESULTS: After 12 weeks of treatment, BMI decreases of 8.42%±2.6% and 1.32%±0.98% were seen in Group 1 and Group 2 respectively (p=0.007). A significant decrease was seen in ghrelin levels between samples 1a and 2a, and between samples 1a and 3. In Group 2, a non-significant increase was seen in ghrelin levels. CONCLUSION: PENS of dermatome T6 was associated to decreased plasma ghrelin levels. This therapy, associated to a low-calorie diet, achieves a BMI reduction greater than 8% after 12 weeks of treatment.

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.

[Not Available]. / Valoración del riesgo cardiovascular después de gastrectomía vertical: comparativa del IMC, la adiposidad, el índice de Framingham y el índice aterogénico como marcadores del éxito de la cirugía.

Introducción y objetivo: el IMC puede resultar engañoso para ciertas complexiones corporales, por lo que se han propuesto otros parámetros como la adiposidad (calculada a través de fórmula CUN-BAE,) el índice de Framingham de riesgo cardiovascular (IF) y el índice aterogénico (IA) (rCT/HDL-c) como predictores de riesgo cardiovascular. Se propone comparar estos factores como marcadores de éxito terapéutico tras cirugía en pacientes obesos sometidos a gastrectomía vertical laparoscópica (GVL) como procedimiento de cirugía bariátrica.Material y métodos: realizamos un estudio observacional prospectivo de pacientes sometidos a GVL y con un periodo de seguimiento mínimo de 1 año. Analizamos la evolución de IMC, adiposidad, IF e IA.Resultados: analizamos 140 pacientes. El IMC preoperatorio fue de 49,1 kg/m2, con una adiposidad del 54,8%, un IF 7,54% y un IA de 4,2. A los 12 meses el IMC era de 28,4 kg/m2, con una adiposidad del 39,4%, un IF del 3,7% y un IA de 1,64. En función de estos resultados, a los 12 meses el IMC medio está en rango de sobrepeso, la adiposidad en niveles de obesidad (obesidad: > 25% en hombres y > 35% en mujeres), el IF en rango de riesgo cardiovascular bajo (< 5%) y el IA dentro del rango de normalidad (< 3). Correlacionando estos parámetros observamos que el IMC se correlaciona con la adiposidad tanto en valores preoperatorios (Pearson 0,486; p = 0,004), posoperatorios (Pearson 0,957; p < 0,001), como en la diferencia entre ambos (Pearson 0,606; p = 0,017), lo cual es lógico, porque el IMC se incluye en la fórmula CUN-BAE para el cálculo de la adiposidad. En los valores posoperatorios se objetiva una correlación de la adiposidad con el IF (Pearson 0,814, p = 0,036) y con el IA (Pearson 0,517; p = 0,049). En los valores preoperatorios no se objetivan dichas correlaciones. El IMC no se correlacionó con la adiposidad.Conclusión: la adiposidad se correlaciona con índices de riesgo cardiovascular, como el índice de Framingham o el índice aterogénico, pero solo en las determinaciones posoperatorias. Estos elementos suponen herramientas útiles para valorar la disminución del riesgo de enfermedad cardiovascular después de cirugía bariátrica.

Valoración del riesgo cardiovascular después de gastrectomía vertical: comparativa del IMC, la adiposidad, el índice de Framingham y el índice aterogénico como marcadores del éxito de la cirugía / Assessment of cardiovascular risk after sleeve gastrectomy: comparative of BMI, adiposity, Framingham and atherogenic index as markers of success of surgery

Introducción y objetivo: el IMC puede resultar engañoso para ciertas complexiones corporales, por lo que se han propuesto otros parámetros como la adiposidad (calculada a través de fórmula CUN-BAE, el índice de Framingham de riesgo cardiovascular (IF) y el índice aterogénico (IA) (rCT/HDL-c) como predictores de riesgo cardiovascular. Se propone comparar estos factores como marcadores de éxito terapéutico tras cirugía en pacientes obesos sometidos a gastrectomía vertical laparoscópica (GVL) como procedimiento de cirugía bariátrica. Material y métodos: realizamos un estudio observacional prospectivo de pacientes sometidos a GVL y con un periodo de seguimiento mínimo de 1 año. Analizamos la evolución de IMC, adiposidad, IF e IA. Resultados: analizamos 140 pacientes. El IMC preoperatorio fue de 49,1 kg/m2 , con una adiposidad del 54,8%, un IF 7,54% y un IA de 4,2. A los 12 meses el IMC era de 28,4 kg/m2 , con una adiposidad del 39,4%, un IF del 3,7% y un IA de 1,64. En función de estos resultados, a los 12 meses el IMC medio está en rango de sobrepeso, la adiposidad en niveles de obesidad (obesidad: > 25% en hombres y > 35% en mujeres), el IF en rango de riesgo cardiovascular bajo (< 5%) y el IA dentro del rango de normalidad (< 3). Correlacionando estos parámetros observamos que el IMC se correlaciona con la adiposidad tanto en valores preoperatorios (Pearson 0,486; p = 0,004), posoperatorios (Pearson 0,957; p < 0,001), como en la diferencia entre ambos (Pearson 0,606; p = 0,017), lo cual es lógico, porque el IMC se incluye en la fórmula CUN-BAE para el cálculo de la adiposidad. En los valores posoperatorios se objetiva una correlación de la adiposidad con el IF (Pearson 0,814, p = 0,036) y con el IA (Pearson 0,517; p = 0,049). En los valores preoperatorios no se objetivan dichas correlaciones. El IMC no se correlacionó con la adiposidad. Conclusión: la adiposidad se correlaciona con índices de riesgo cardiovascular, como el índice de Framingham o el índice aterogénico, pero solo en las determinaciones posoperatorias. Estos elementos suponen herramientas útiles para valorar la disminución del riesgo de enfermedad cardiovascular después de cirugía bariátrica (AU)

Introduction and objective: BMI can be misleading for certain body constitutions, for this reason other parameters have been proposed as predictors of cardiovascular risk, among them the adiposity (calculated through CUNBAE formula) the Framingham Index and the Atherogenic Index (TC-r/HDL-c.) We propose to compare these factors as markers of success after sleeve gastrectomy as bariatric surgery procedure for obese patients. Material and methods: We performed a prospective observational study of patients undergoing to a sleeve gastrectomy and with a minimum follow-up period of 1 year. We analyze the evolution of BMI, adiposity, the Framingham Index & the Atherogenic Index. Results: We analyzed 140 patients. Preoperative BMI was 49.1 kg/m2 , with a 54.8% for adiposity. The Framingham value was 7.54% and Atherogenic Index: 4.2. At 12 months BMI was 28.4 kg/m2 and adiposity percentage 39.4%. At the same time, the Framingham was 3.7% and Atherogenic Index: 1.64. Analyzing these data, after 12 months from surgery, the mean of BMI is in range of overweight, the adiposity is classifi ed as obesity (> 25% in men and > 35% in women), the Framingham range describes a low cardiovascular risk (< 5%) and the Atherogenic Index is located in the normal range (< 3). Correlating these parameters we observed that BMI is correlated with adiposity at preoperative values (Pearson 0.486; p = 0.004), postoperative (Pearson 0.957; p < 0.001), and the difference between them (Pearson 0.606; p = 0.017). This is logical, because the BMI is included in the formula for calculating the adiposity (by CUNBAE formula.) In the postoperative values correlated the adiposity with Framingham value (Pearson 0.814, p = 0.036) and with the atherogenic risk (p = 0.049, 0.517 Pearson.) In preoperative values, these correlations are not objectified. BMI was not correlated with adiposity. Conclusion: The adiposity correlates better with cardiovascular risk indices, such as the Framingham Index or the Atherogenic Index, but only in the postoperative values. These elements represent useful tools for assessing the decreased risk of cardiovascular disease after bariatric surgery (AU)

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.

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.

Anastomic leak in colorectal cancer surgery. Development of a diagnostic index (DIACOLE).

BACKGROUND: We have obtained a diagnostic score (DIACOLE) in order to detect anastomotic leakage in the postoperative period of colorectal cancer surgery. METHODS: Systematic review to identify any symptoms and clinical or analytical signs associated with anastomotic leakage after colorectal cancer surgery and a meta-analysis of each of these factors. The DIACOLE score encompasses all factors that reached statistical significance in their respective meta-analyses. The value of each factor in the score was determined depending the Napierian logarithm of the odds ratios. The index was validated using collected data at our institution. RESULTS: We identified 13 potential signs and symptoms of anastomotic leakage to elaborate the DIACOLE score. The predictive power of the DIACOLE was validated in a case-control study, resulting in an Area Under Curve (AUC) of 0.911 and a 95% confidence interval. These values were considered indicative of a very good diagnostic score. CONCLUSIONS: If DIACOLE score is > 3.065, a blood count and re-evaluating the score daily are recommended. If the DIACOLE>5.436, a radiological test is advised. We have developed free software to obtain DIACOLE value.

Effect of Peritoneal Lavage with Clindamycin-Gentamicin Solution during Elective Colorectal Cancer Surgery on the Oncologic Outcome.

BACKGROUND: Antibiotics combined with lavage have demonstrated a reduction in the bacterial contamination and decreases surgical site infection (SSI) rate. SSI leads to an immunocompromised situation, as immunologic defense is focused on controlling the septic focus, leaving unattended the neoplasm. It has been described that SSI may result in a worse oncologic outcome. The aim of this study is to evaluate prospectively the effect of peritoneal lavage with clindamycin and gentamicin on the oncologic outcome of colorectal tumors. METHODS: A randomized study of patients with diagnosis of colorectal neoplasms and undergoing elective surgery was performed at our institutions between January and September 2011. Patients were randomly assigned into two groups: Those undergoing an intra-abdominal lavage with normal saline (Group 1) and those undergoing an intra-abdominal lavage with a gentamicin-clindamycin solution (Group 2). Recurrence, global survival, and disease-free survival were investigated. RESULTS: One hundred and four patients were analyzed, with 52 in each group. After a minimum follow-up of 42 mo, mean disease-free survival was 37.2 ± 14.2 mo in Group 1 and 25.8 ± 16.3 mo in Group 2 (mean difference 11.4; confidence interval (CI) 95% (2.2-25.1); p = 0.009). Mean global survival was 44.2 ± 11.9 mo in Group 1 and 34.1 ± 14.1 mo in Group 2 (mean difference 10.1; CI 95% (2.2-18);p = 0.016). CONCLUSION: The intra-peritoneal lavage with gentamicin and clindamycin increases the disease-free and global survival colorectal tumors.

La neuroestimulación eléctrica percutánea del dermatoma T7 mejora el perfil glucémico en pacientes obesos y diabéticos tipo 2. Estudio clínico aleatorizado / Percutaneous electric neurostimulation of dermatome T7 improves glycemic profile in obese and type 2 diabetic patients. A randomized clinical study

INTRODUCCIÓN: La secreción endocrina pancreática está regulada por el sistema nervioso autónomo. El sistema parasimpático estimula la producción de insulina por las células beta e inhibe la liberación adrenérgica por el sistema nervioso simpático. El objetivo del presente estudio es evaluar el efecto de la neuroestimulación percutánea (PENS) del dermatoma T7, creándose un reflejo somato-autonómico, cuya vía eferente serán las ramas del nervio vago que estimulan específicamente el páncreas. Se analizará el efecto de este tratamiento sobre la glucemia, la secreción de insulina y la resistencia a la acción de la insulina. MÉTODOS: Estudio prospectivo aleatorizado en el que se incluyeron pacientes con Índice Masa Corporal ≥ 30 kg/m2 y diagnóstico de diabetes mellitus en tratamiento con metformina. Los pacientes fueron aleatorizados en 2 grupos: pacientes sometidos a PENS del dermatoma T7 (12 sesiones de 30 min semanales) asociado a dieta de 1.200 Kcal/día (grupo 1) y pacientes que seguían una dieta de 1.200 Kcal/día exclusivamente (grupo 2). A todos los pacientes se les realizó una analítica sanguínea en ayunas antes de empezar el tratamiento y a los 7 días de finalizarlo. RESULTADOS: Se incluyeron 60 pacientes: 30 pacientes en cada grupo. Al finalizar el tratamiento en el grupo 1 se observa un descenso significativo en la glucemia (descenso medio de 62,1 mg/dl; p = 0,024) y en el HOMA (descenso medio 1,37; p = 0,014). En el grupo 2 no se observan diferencias significativas en los valores pre y postratamiento. CONCLUSIÓN: La PENS del dermatoma T7 asociada a dieta de 1.200 Kcal/día produce una mayor reducción de la glucemia y de la resistencia insulínica que la obtenida solo mediante dieta tras 3 meses de tratamiento

INTRODUCTION: Endocrine pancreatic segregation is regulated by the autonomic nervous system. The parasympathetic system stimulates insulin production by the beta cells and inhibits the adrenergic discharge by the sympathetic nervous system. The aim of this study was to evaluate the effect of percutaneous neurostimulation (PENS) of dermatome T7, generating a somato-autonomic reflex, whose efferent pathway are the vagal branches that specifically stimulate the pancreas. The effect of this treatment on glycemia, insulin secretion and insulin resistance was investigated. METHODS: A prospective randomized clinical trial was performed. Patients with Body Mass Index ≥ 30 kg/m2 and diagnosis of diabetes mellitus treated with Metformin were included. Patients were divided into 2 groups: Patients undergoing PENS of dermatome T7 (12 sessions of 30 minutes weekly) associated with a 1,200 Kcal/day diet (Group 1) and patients following only a 1,200 Kcal/day diet (Group 2). All the patients underwent a blood sample extraction before the treatment and 7 days after finishing it. RESULTS: 60 patients were included: 30 in each group. After finishing the treatment, in Group 1 a significant decrease in glycemia (Mean decrease of 62,1 mg/dl; P = .024) and HOMA (Mean decrease 1.37;P = .014) was observed. In Group 2, no significant differences between pre and post-treatment values were observed. CONCLUSION: PENS of dermatome T7 associated with a 1,200 Kcal/day diet achieves a greater reduction in glycemia and insulin resistance than with diet exclusively after 3 months of treatment

Effect of Lavage with Gentamicin vs. Clindamycin vs. Physiologic Saline on Drainage Discharge of the Axillary Surgical Bed after Lymph Node Dissection.

BACKGROUND: To date, without placement of a drain, seroma formation cannot be avoided after axillary lymph node dissection (ALND). The purpose of this study was to evaluate the effect on drainage volume of pre-closure axillary lavage with physiologic saline, gentamicin solution, or clindamycin solution. METHODS: A randomized study was performed between January 2013 and October 2014. Inclusion criteria were a diagnosis of breast neoplasm and plans to undergo an elective ALND because of axillary metastases. The patients were randomized into three groups: Two lavages with 500 mL of physiologic saline (Group 1), lavage with 500 mL of saline followed by lavage with 500 mL of a 240-mg gentamicin solution (Group 2), and lavage with 500 mL of saline followed by lavage with 500 mL of a 600-mg clindamycin solution (Group 3). RESULTS: A total of 51 patients were included. The mean number of days with a drain in place was 7.1±3 in Group 1, 4.1±1.2 in Group 2, and 6.4±2.1 in Group 3 (p<0.001). Total drainage volume before tube removal was 435.3±220.1 mL in Group 1, 155.2±82.4 mL in Group 2, and 352.3±212.9 mL in Group 3 (p=0.03). In a pairwise analysis, irrigation with gentamicin solution achieved a lower drainage volume and a reduction in the number of days of drainage maintenance compared with the other two groups. CONCLUSION: The post-operative output of the axillary drain is substantially lower in patients undergoing lavage of the surgical bed with a gentamicin solution than in patients undergoing lavage with physiologic saline or clindamycin solution.

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.

Efecto de los patrones de conducta alimentaria y de la pérdida de peso preoperatoria sobre los resultados a corto y medio plazo en pérdida de peso tras gastrectomía vertical laparoscópica / Effect of preoperative eating patterns and preoperative weight loss on the short- and mid-term weight loss results of sleeve gastrectomy

INTRODUCCIÓN: En la gastrectomía vertical, la pérdida de peso depende directamente de la adherencia a la dieta postoperatoria. El objetivo de este estudio es evaluar el efecto de los patrones alimentarios preoperatorios y de la adherencia a la dieta pautada antes de la cirugía, sobre la pérdida de peso a corto y medio plazo. MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo de todos los pacientes obesos mórbidos intervenidos mediante una gastrectomía vertical laparoscópica como procedimiento bariátrico entre 2008 y 2012. Se evaluaron los hábitos alimentarios preoperatorios de los pacientes y se registró la pérdida de peso pre- y postoperatoria a los 12 y 24 meses de la cirugía. RESULTADOS: Se incluyó a 50 pacientes en el estudio con un IMC preoperatorio medio de 51,2 + 7,9 kg/m2. Todos los pacientes presentaban un patrón alimentario de grandes comedores. Además, el 44% de los pacientes presentaba un patrón de picoteador, el 40% reconocían ingesta abundante de dulces y el 48% tomaban refrescos «light» como bebida en las comidas. El porcentaje de exceso de peso perdido (PEP) medio preoperatorio fue de 13,4% (rango 10-31,4%). Al año el PEP era de 83,7% y a los 2 años, de 82,4%. La pérdida de peso y el PEP preoperatorios mostraron una correlación directa con la pérdida obtenida a los 12 y 24 meses. El PEP medio a los 12 y 24 meses fue significativamente peor en pacientes picoteadores, tomadores de dulces y bebedores de refrescos «light». CONCLUSIÓN: La pérdida de peso preoperatoria se correlaciona con la pérdida de peso al año y a los 2 años. Aquellos pacientes, que además de grandes comedores, también son picoteadores, tomadores de dulces o de bebidas «light», logran una menor pérdida de peso

INTRODUCTION: Weight loss depends directly on the adhesion to the postoperative diet in patients undergoing a sleeve gastrectomy. The aim of this study is to evaluate the effect of different preoperative feeding patterns and the adhesion to a preoperative diet on short and mid- term postoperative weight loss. MATERIAL AND METHODS: A prospective study of all morbidly obese patients undergoing a laparoscopic sleeve gastrectomy as a bariatric procedure between 2008 and 2012 was performed. Preoperative feeding patterns and weight loss, preoperatively and postoperatively at 12 and 24 months, were evaluated. RESULTS: A total of 50 patients were included, with a mean preoperative BMI of 51,2 + 7,9 kg/m2. All the patients presented a feeding pattern of big eaters, 44% of snackers, 40% of sweet eaters and 48% reported regular ingestion of «light» soft drinks. Mean preoperative excess weight loss (EWL) was 13,4% (range 10-31,4%). At 12 months mean EWL was 83,7% and at 24 months 82,4%. Pre and postoperative EWL showed a direct correlation at 12 and 24 months. Mean EWL was significantly lower in snackers, sweet eaters and those drinking «light» soft drinks regularly. CONCLUSION: Preoperative weight loss correlates directly with postoperative weight loss at 1 and 2 years. Snackers, sweet eaters and «light» soft drink consumers, associated with a big eater pattern, achieve a significantly lower postoperative weight loss

Percutaneous electric neurostimulation of dermatome T7 improves glycemic profile in obese and type 2 diabetic patients. A randomized clinical study.

INTRODUCTION: Endocrine pancreatic segregation is regulated by the autonomic nervous system. The parasympathetic system stimulates insulin production by the beta cells and inhibits the adrenergic discharge by the sympathetic nervous system. The aim of this study was to evaluate the effect of percutaneous neurostimulation (PENS) of dermatome T7, generating a somato-autonomic reflex, whose efferent pathway are the vagal branches that specifically stimulate the pancreas. The effect of this treatment on glycemia, insulin secretion and insulin resistance was investigated. METHODS: A prospective randomized clinical trial was performed. Patients with Body Mass Index>30kg/m(2) and diagnosis of diabetes mellitus treated with Metformin were included. Patients were divided into 2 groups: Patients undergoing PENS of dermatome T7 (12 sessions of 30minutes weekly) associated with a 1,200 Kcal/day diet (Group 1) and patients following only a 1,200Kcal/day diet (Group 2). All the patients underwent a blood sample extraction before the treatment and 7 days after finishing it. RESULTS: 60 patients were included: 30 in each group. After finishing the treatment, in Group 1 a significant decrease in glycemia (Mean decrease of 62,1mg/dl; P=.024) and HOMA (Mean decrease 1.37; P=.014) was observed. In Group 2, no significant differences between pre and post-treatment values were observed. CONCLUSION: PENS of dermatome T7 associated with a 1,200Kcal/day diet achieves a greater reduction in glycemia and insulin resistance than with diet exclusively after 3 months of treatment.

Técnica de «stent in stent» en la hiperplasia benigna del esófago. Complicaciones y tratamiento del manejo de las fístulas tras gastrectomía vertical / “Stent in stent” technique for oesophageal benign hyperplasia. Complications and treatment of fistulas after sleeve gastrectomy

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Dolor anal crónico idiopático. Evaluación de los resultados diagnóstico-terapéuticos en una unidad de referencia de coloproctología / Chronic idiopathic anal pain. Results of a diagnostic-therapeutic protocol in a colorectal referral unit

INTRODUCCIÓN: En la actualidad, el dolor anal crónico idiopático (DACI) sigue siendo un diagnóstico de exclusión, cuyo estudio y manejo permanece carente de un protocolo estandarizado. El objetivo del presente estudio es evaluar los resultados obtenidos con el protocolo diagnóstico-terapéutico establecido en nuestro servicio. MATERIAL Y MÉTODOS: Realizamos un estudio retrospectivo de los pacientes diagnosticados de DACI en la Unidad de Coloproctología del Hospital General Universitario de Elche entre 2005 y 2011. RESULTADOS: Se evaluó a 57 pacientes, remitidos con el diagnóstico de dolor anal crónico (DAC) por trastornos funcionales anorrectales (TFAR). Tras la aplicación del protocolo diagnóstico establecido, se llegó a un diagnóstico en 43 casos (75%), incluyendo 22 casos de síndrome del periné descendente, 12 de proctalgia fugax, 2 de neuritis pudenda, 7 de coccigodinia; en 14 casos se realizó un diagnóstico de exclusión de DACI.Entre las medidas terapéuticas empleadas en los pacientes con DACI, el biofeedback combinado con medidas conservadoras mejoró la sintomatología en el 43% de los casos, valorándose la neuroestimulación de raíces sacras en pacientes resistentes a otros tratamientos. CONCLUSIÓN: Mediante una protocolizada anamnesis, exploración física y con ayuda de pruebas complementarias pudo especificarse el diagnóstico de DAC por TFAR, reduciéndose el diagnóstico de exclusión de DACI al 25% de los casos. Las medidas conservadoras junto con el biofeedback consiguieron una mejoría de los síntomas en más del 40% de los casos de DACI. En el resto de pacientes debe valorarse de forma individualizada la neuroestimulación de raíces sacras

INTRODUCTION: Chronic idiopathic anal pain (CIAP) remains a diagnosis of exclusion. Its study and management still lack a standardized protocol. The aim of this study is to evaluate the results obtained with the diagnostic-therapeutic protocol established in our service. MATERIAL AND METHODS: We performed a retrospective study of patients diagnosed with CIAP at the Colorectal Unit of the General University Hospital of Elche, between 2005 and 2011.ResultsWe evaluated 57 patients with a diagnosis of chronic anal pain for functional anorectal disease (FAD). After the application of our diagnostic protocol, final diagnosis of chronic anal pain (CAP) was achieved in 43 cases (75%), including 22 cases of descending perineum syndrome, 12 of proctalgia fugax, 2 of pudendal neuritis and 7 of coccydynia. In 14 patients exclusion diagnosis of CIAP was established. Among the therapies used on patients with CIAP, biofeedback combined with conservative measures improved symptoms in 43% of the cases. Sacral nerve stimulation was assessed in patients who did not respond to other treatments. CONCLUSION: Through proper anamnesis, physical examination and complementary tests, a specific diagnosis of the cause of CAP by FAD can be achieved, reducing exclusion diagnosis of CIAP to 25% of cases. Conservative measures combined with biofeedback achieved an improvement in pain in more than 40% of the cases of CIAP in our study. Sacral nerve stimulation can be considered as a treatment option in refractory cases

Taponamiento quirúrgico con polímero de celulosa oxidada en paciente conhemosuccus pancreaticus / Exceptional use of a surgical oxidized cellulose polymer taponade in a patient with hemosuccus pancreaticus

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Effect of preoperative eating patterns and preoperative weight loss on the short- and mid-term weight loss results of sleeve gastrectomy.

INTRODUCTION: Weight loss depends directly on the adhesion to the postoperative diet in patients undergoing a sleeve gastrectomy. The aim of this study is to evaluate the effect of different preoperative feeding patterns and the adhesion to a preoperative diet on short and mid- term postoperative weight loss. MATERIAL AND METHODS: A prospective study of all morbidly obese patients undergoing a laparoscopic sleeve gastrectomy as a bariatric procedure between 2008 and 2012 was performed. Preoperative feeding patterns and weight loss, preoperatively and postoperatively at 12 and 24 months, were evaluated. RESULTS: A total of 50 patients were included, with a mean preoperative BMI of 51,2+7,9 kg/m(2). All the patients presented a feeding pattern of big eaters, 44% of snackers, 40% of sweet eaters and 48% reported regular ingestion of «light¼ soft drinks. Mean preoperative excess weight loss (EWL) was 13,4% (range 10-31,4%). At 12 months mean EWL was 83,7% and at 24 months 82,4%. Pre and postoperative EWL showed a direct correlation at 12 and 24 months. Mean EWL was significantly lower in snackers, sweet eaters and those drinking «light¼ soft drinks regularly. CONCLUSION: Preoperative weight loss correlates directly with postoperative weight loss at 1 and 2 years. Snackers, sweet eaters and «light¼ soft drink consumers, associated with a big eater pattern, achieve a significantly lower postoperative weight loss.