ABSTRACT
INTRODUCTION AND AIM: Normally, the bile ducts are sterile, but up to 4.2% of healthy persons can present with positive cultures. Certain circumstances favor that situation, such as gallstones or biliary tree manipulation. The aim of the present study was to determine the factors that influence the presence of bacteriobilia, as well as its implications for clinical practice. MATERIALS AND METHODS: A prospective study was conducted on bile cultures from patients that underwent cholecystectomy at our hospital center within the time frame of 2013 to 2015. RESULTS: The study included 196 patients (42.3% women and 57.7% men) that underwent either open or laparoscopic cholecystectomy and in whom bile fluid samples were taken. The clinical, epidemiologic, and laboratory test characteristics of the patients were analyzed, as well as the surgical indication (urgent surgery or programmed surgery). With respect to microbiology, 47% of the bile cultures were positive: 56.5% presented with one microorganism, 25% with two, and 18.5% with three or more. CONCLUSION: Microbiologic bile analysis should not be systematically performed, given that its result is relevant only in cases that present with demonstrated risk factors. However, in those cases, said analysis is essential to establish adequate antibiotic treatment, in relation to activity spectrum and duration, to prevent complications and an increase in microbial resistance.
Subject(s)
Bile/microbiology , Cholecystectomy , Adult , Aged , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
INTRODUCTION AND AIMS: Abdominal ultrasonography is very useful for diagnosing acute appendicitis and has 59-96% sensitivity and 83-98% specificity. The aim of the present study was to determine the diagnostic yield of abdominal ultrasound imaging for acute appendicitis and identify the patient subgroups with the best results. MATERIALS AND METHODS: Patients at a general hospital that underwent appendectomy due to the clinical suspicion of appendicitis, who also had a diagnostic radiologic study, within the time frame of January 2007 to December 2010, were analyzed. Ultrasound studies were considered positive when there were radiologic signs suggestive of acute appendicitis. The sensitivity, specificity, and predictive values of the diagnostic study were determined through the logistic regression method. RESULTS: A total of 646 patients were operated on due to clinical suspicion of acute appendicitis. A diagnostic abdominal ultrasound study was carried out on 383 (59.3%) of those patients, resulting in 79% sensitivity (74-83, 95% CI), 58% specificity (39-75, 95% CI), 95% positive predictive value (92-97, 95% CI), and 20% negative predictive value (13-30, 95% CI). CONCLUSIONS: Abdominal ultrasound imaging in patients with a high suspicion of appendicitis had a mediocre diagnostic yield, but better results could be achieved in different specific subgroups.
Subject(s)
Abdomen/diagnostic imaging , Appendicitis/diagnostic imaging , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Appendectomy , Appendicitis/pathology , Appendicitis/surgery , Female , Humans , Logistic Models , Male , Middle Aged , Retrospective Studies , Sensitivity and Specificity , Ultrasonography , Young AdultABSTRACT
OBJECTIVE: Report our experience in the diagnosis and treatment of Boerhaave syndrome by retrospective study from 1997 to 2013. PATIENTS AND METHODS: A retrospective study was conducted covering the time frame of 1997 to 2013. RESULTS: There were a total of 5 men (71%) and 2 women (29%) and the mean age was 54 years (range: 33-80 years). Diagnosis was made through computed tomography scan in 5 cases (71%) and esophagogram in 2 cases (19%). Six patients (86%) had emergency surgery, whereas one case (14%) was managed conservatively. The surgical technique employed was primary suture and repair in 4 patients (67%) and esophageal resection and subsequent cervical esophagostomy in 2 patients (33%). CONCLUSIONS: Boerhaave's syndrome is a clinically rare entity with an elevated mortality rate. Therefore, a high degree of suspicion is necessary for making the diagnosis and providing early treatment that can result in improved outcome.
Subject(s)
Esophageal Perforation/therapy , Mediastinal Diseases/therapy , Adult , Aged , Aged, 80 and over , Endoscopy, Gastrointestinal , Esophageal Perforation/diagnosis , Esophageal Perforation/surgery , Female , Humans , Male , Mediastinal Diseases/diagnosis , Mediastinal Diseases/surgery , Middle Aged , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The laparoscopic approach to bowel obstruction is still controversial. OBJECTIVE: To evaluate our initial results in the laparoscopic treatment of bowel obstruction. MATERIAL AND METHODS: A retrospective study on patients diagnosed with bowel obstruction that underwent laparoscopic surgery within the time frame of January 2008 to June 30, 2012. The variables employed were: age, sex, occlusion etiology, previous surgeries, clinical progression, pneumoperitoneum creation, use of an auxiliary incision, anesthesia duration, conversion rate, postoperative hospital stay, time needed to tolerate liquids, and complications. RESULTS: Twenty-six patients, 18 women (69.2%) and 8 men (30.8%), with a mean age of 64.35 years (range: 21-92 years) were analyzed. The most frequent obstruction etiology was secondary to adhesions and presented in 12 cases. Nine patients (34.6%) underwent a completely laparoscopic approach and laparoscopy was complemented by an auxiliary incision in another 9 patients (34.6%), resulting in 18 cases (69.2%) of successful laparoscopic approach. Eight patients (30.8%) required conversion to open surgery. The mean anesthesia duration was 95min (range: 55-165min), mean postoperative hospital stay was 6 days (range: 3-72 days), and the mean amount of time needed to tolerate liquids was 3 days (range: 1-10 days). The patients that underwent complete laparoscopic approach presented with shorter hospital stay, they were able to ingest liquids earlier, and they presented with a lower number of postoperative complications; this latter variable was the only one that was statistically significant. CONCLUSIONS: The initial results of our experience were good, although more patients are needed in order to standardize and extend the use of this technique.
Subject(s)
Digestive System Surgical Procedures/methods , Intestinal Obstruction/surgery , Laparoscopy/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Intestinal Obstruction/etiology , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: There is no international consensus on the approach of choice for performing appendectomy. AIMS: To analyze and compare open and laparoscopic approaches in the surgical treatment of acute appendicitis. MATERIAL AND METHODS: A retrospective study was carried out on patients over 14-years-old operated on for suspected acute appendicitis between January 2007 and December 2009. Variables were: age, sex, body mass index, specialized surgeon or resident in training, progression duration, conversion rate, use of drains, abdominal cavity irrigation, macroscopic appearance of the appendix, onset time of anesthesia, ASA classification, postoperative hospital stay, resumption of intake of liquids, and complications. The patients were divided into two groups: laparoscopic approach (LA) and open approach (OA). RESULTS: A total of 533 patients were enrolled (290 LA and 243 OA). Onset time of anesthesia was 75 min (30-190 min) in LA vs 55 min (20-160 min) in OA (p<0,0001). COMPLICATIONS: intraabdominal abscesses in 17 LA cases vs 13 OA cases (p=0,79); surgical wound alterations in 16 LA cases vs 47 OA cases (p=0,0001); incisional hernias in 2 LA cases (1%) vs 10 OA cases (p=0,008). There were no statistically significant differences in postoperative hospital stay (3 days), resumption of intake of liquids (1 day) or readmission rate (8%). CONCLUSIONS: There are fewer surgical wound alterations and incisional hernias with the laparoscopic approach, but there is higher cost, lengthier surgery duration, and a longer learning curve. Our results cannot provide a clear indication for one approach or the other, and therefore each case must be evaluated on an individual basis.
Subject(s)
Appendectomy/methods , Appendicitis/surgery , Laparoscopy/methods , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Anesthesia , Female , Humans , Learning Curve , Length of Stay , Male , Middle Aged , Retrospective Studies , Young AdultSubject(s)
Hirschsprung Disease/diagnosis , Barium Sulfate , Biopsy , Colon, Sigmoid/diagnostic imaging , Constipation/etiology , Contrast Media , Diarrhea/etiology , Feces , Hirschsprung Disease/diagnostic imaging , Hirschsprung Disease/surgery , Humans , Male , Radiography , Rectum/pathology , Young AdultSubject(s)
Humans , Female , Middle Aged , Biopsy/instrumentation , Biopsy/methods , Breast Neoplasms/surgery , Breast Neoplasms , Lymphography/trends , Lymphography , Immunohistochemistry/methods , Immunohistochemistry/trends , Lymph Node Excision/methods , Mammography/trends , Mammography , Ultrasonography, Mammary , Immunohistochemistry , Lymph Node Excision/trends , Lymph Node ExcisionABSTRACT
BACKGROUND: The total number of harvested lymph nodes has been demonstrated to be of prognostic significance for colon cancer. Differences can occur in the total number of harvested lymph nodes between different specialists (surgeons and pathologists). OBJECTIVE: The aim of this study was to analyse if, in our centre, the number of analysed lymph nodes in patients with colon cancer that are classified as pN0 is also related to survival. MATERIAL AND METHODS: A retrospective study was designed, where 148 patients with colon adenocarcinoma (pN0 of TNM classification) who underwent elective surgery between 1 January 1995 and 31 December 2001, with curative intent were included. Three groups were created according to the number of analysed lymph nodes ( < 7, 7-14, > 14 lymph nodes). For survival analysis the Kaplan-Meier and CUSUM curves methods were used. RESULTS: The total number of analysed lymph nodes was 1,493 (mean 10.1 lymph nodes per patient). The rate of 5-years survival was 63.0% in the group with < 7 lymph nodes; 7-14 lymph nodes: 80.6% and those with > 14 lymph nodes: 91.8% (p < 0.01). Prognostic significance was also present for multivariate analysis. CONCLUSION: In our centre, harvesting a larger number of lymph nodes is related to improved rates of 5-years survival for patients with colon cancer staged as pN0. It seems reasonable to recommend obtaining as many lymph nodes as possible, and not to establish a minimum number of lymph nodes to be harvested.
Subject(s)
Adenocarcinoma/surgery , Colonic Neoplasms/surgery , Lymph Nodes/surgery , Adenocarcinoma/pathology , Adult , Aged , Aged, 80 and over , Colonic Neoplasms/pathology , Female , Humans , Kaplan-Meier Estimate , Lymph Nodes/pathology , Lymphatic Metastasis , Male , Middle Aged , Multivariate Analysis , Prognosis , Retrospective Studies , Survival RateABSTRACT
Introducción: el número total de ganglios analizados ha demostradosu influencia pronóstica en el cáncer de colon. Puedenexistir grandes diferencias en el número de ganglios obtenidos pordiferentes especialistas (cirujanos y anatomopatólogos).Objetivo: el objetivo del presente estudio fue analizar si, ennuestro medio, el número de ganglios analizados en pacientes concáncer de colon clasificados como pN0 se relaciona también conla supervivencia.Material y métodos: estudio retrospectivo, con inclusión de148 pacientes con adenocarcinoma de colon (pN0 de la clasificaciónTNM) intervenidos de forma programada con intención curativaentre 1 de enero de 1995 y 31 de diciembre de 2001. Se establecieron3 grupos según el número de ganglios analizados (< 7,7-14, > 14 ganglios). Para el análisis de la supervivencia se utilizaronel método de Kaplan Meier y las gráficas CUSUM.Resultados: el número total de ganglios analizados fue 1.493(media 10,1 ganglios por paciente). La supervivencia a 5 años fuedel 63,0% en el grupo con < 7 ganglios; del 80,6% en el grupocon 7-14; y del 91,8% en el grupo con > 14 ganglios analizados(p < 0,01). La influencia pronóstica se mantuvo en el análisis multivariante.Conclusión: en nuestro medio, la obtención de un mayor númerode ganglios analizados se relaciona con una mayor supervivenciaa los 5 años en pacientes con cáncer de colon clasificadoscomo pN0. Parece razonable recomendar la obtención de tantosganglios como sea posible en este tipo de cirugía y no recomendarun número mínimo de ganglios que se deberían analizar(AU)
Background: the total number of harvested lymph nodeshas been demonstrated to be of prognostic significance forcolon cancer. Differences can occur in the total number of harvestedlymph nodes between different specialists (surgeons andpathologists).Objective: the aim of this study was to analyse if, in our centre,the number of analysed lymph nodes in patients with coloncancer that are classified as pN0 is also related to survival.Material and methods: a retrospective study was designed,where 148 patients with colon adenocarcinoma (pN0 of TNMclassification) who underwent elective surgery between 1 January1995 and 31 December 2001, with curative intent were included.Three groups were created according to the number of analysedlymph nodes (< 7, 7-14, > 14 lymph nodes). For survival analysisthe Kaplan-Meier and CUSUM curves methods were used.Results: the total number of analysed lymph nodes was1,493 (mean 10.1 lymph nodes per patient). The rate of 5-years survival was 63.0% in the group with < 7 lymph nodes;7-14 lymph nodes: 80.6% and those with > 14 lymph nodes:91.8% (p < 0.01). Prognostic significance was also present formultivariate analysis.Conclusion: in our centre, harvesting a larger number oflymph nodes is related to improved rates of 5-years survival forpatients with colon cancer staged as pN0. It seems reasonableto recommend obtaining as many lymph nodes as possible, andnot to establish a minimum number of lymph nodes to be harvested(AU)
