ABSTRACT
Procalcitonin (PCT) and C-Reactive Protein (CRP) are acute-phase reactants that indicate the presence and severity of an infection. The aim of this study was to verify the utility of CRP and PCT as tools for early diagnosis of anastomotic leakage (AL) in patients undergoing elective colorectal surgery. A prospective observational study including 95 patients undergoing elective colorectal surgery with anastomosis, where patients were divided into two groups according to whether or not AL happened. Different variables were compared using a uni- and multivariate analyses to identify the risk factors for AL. Receiver Operating Characteristic (ROC) curves were added to establish a cut-off point for CRP and PCT. The inflammatory marker levels were analysed in other complications different from AL. AL was detected in 11 patients (14%), 7 required an emergency reoperation. The overall morbidity rate was 42.1% and the mortality was 3.2%. In the univariate study, increased CRP on days 3 and 5, male sex and intraoperative complications were significantly associated with AL. In the multivariate study, CRP on day 5 was the only factor related to AL. AUC at ROC curves showed that CRP results ≥ 15.3 mg/dL on day 3 and 9.1 mg/dL on day 5 were predictors of AL. Normal CRP and PCT values had a high negative predictive value. CRP on postoperative day 5 is a reliable marker for early detection of anastomotic leakage in colorectal surgery. Both CRP and PCT on days 3 and 5 have a high negative predictive value.Trial registration: The study has been registered at ClinicalTrials.gov. Code: NCT04632446.
Subject(s)
Anastomotic Leak , Colorectal Surgery , Anastomotic Leak/diagnosis , Biomarkers , Colorectal Surgery/adverse effects , Early Diagnosis , Humans , Male , Predictive Value of Tests , ProcalcitoninABSTRACT
No disponible
Subject(s)
Humans , Male , Young Adult , Neuroblastoma/surgery , Retroperitoneal Neoplasms/surgery , Neuroblastoma/pathology , Retroperitoneal Neoplasms/pathology , Tomography, X-Ray Computed , Adrenal Glands/pathologyABSTRACT
OBJECTIVE: To develop risk-adjusted models for two quality indicators addressing surgical site infection (SSI) in clean and colorectal surgery, to be used for benchmarking and quality improvement in the Spanish National Health System. STUDY DESIGN: A literature review was undertaken to identify candidate adjustment variables. The candidate variables were revised by clinical experts to confirm their clinical relevance to SSI; experts also offered additional candidate variables that were not identified in the literature review. Two risk-adjustment models were developed using multiple logistic regression thus allowing calculation of the adjusted indicator rates. DATA SOURCE: The two SSI indicators, with their corresponding risk-adjustment models, were calculated from administrative databases obtained from nine public hospitals. A dataset was obtained from a 10-year period (2006-2015), and it included data from 21 571 clean surgery patients and 6325 colorectal surgery patients. ANALYSIS METHODS: Risk-adjustment regression models were constructed using Spanish National Health System data. Models were analysed so as to prevent overfitting, then tested for calibration and discrimination and finally bootstrapped. RESULTS: Ten adjustment variables were identified for clean surgery SSI, and 23 for colorectal surgery SSI. The final adjustment models showed fair calibration (Hosmer-Lemeshow: clean surgery χ2 = 6.56, P = 0.58; colorectal surgery χ2 = 6.69, P = 0.57) and discrimination (area under receiver operating characteristic [ROC] curve: clean surgery 0.72, 95% confidence interval [CI] 0.67-0.77; colorectal surgery 0.62, 95% CI 0.60-0.65). CONCLUSIONS: The proposed risk-adjustment models can be used to explain patient-based differences among healthcare providers. They can be used to adjust the two proposed SSI indicators.
Subject(s)
Colorectal Surgery , Surgical Wound Infection , Colorectal Surgery/adverse effects , Humans , Logistic Models , Retrospective Studies , Risk Adjustment , Risk Factors , Surgical Wound Infection/epidemiologyABSTRACT
INTRODUCTION: Diagnosis of colorectal cancer (CRC) based on clinical symptoms is usually established in its advanced stages. One strategy for reducing mortality is the early detection and removal of preneoplastic and initial neoplastic lesions, even before the first symptoms appear, by means of population-based screening campaigns. The aim of the present study is to determine whether CRC diagnosed via a screening campaign has more favourable histopathological prognostic factors than when diagnosed in the symptomatic phase. MATERIAL AND METHODS: The prospective study of all the patients undergoing programmed CRC surgery at the JM Morales Meseguer Hospital (Spain) is between 2004 and 2010. The patients were divided into two groups: one diagnosed from clinical symptoms and one through a screening campaign. The following factors were compared: tumour size; degree of tumour invasion of the wall; lymph node, perineural and lymphovascular involvement; tumour stage; and grade of differentiation. RESULTS: Compared to the symptomatic group, the screen-detected patients had smaller-sized tumours (lesions of less than 5 cm in 84 vs 69.55%, p < 0.001), a lower degree of colorectal wall invasion (T0-1 in 36 vs 9.02%, p < 0.001), less lymph node involvement (N0 in 72 vs 58.76%, p > 0.05), less vascular invasion (7.20 vs 15.22%, p = 0.79) and less perineural invasion (6.4 vs 20.70%, p < 0.001). The TNM staging in the screening group was lower than in the symptomatic group (stage 0-1 in 50.40 vs 18.58%, p < 0.001). CONCLUSIONS: CRC diagnosed through a population-based screening programme presents more favourable histopathological characteristics than that diagnosed from the appearance of symptoms.
Subject(s)
Colorectal Neoplasms/diagnosis , Early Detection of Cancer , Mass Screening , Aged , Aged, 80 and over , Colorectal Neoplasms/pathology , Female , Humans , Informed Consent , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , PrognosisABSTRACT
INTRODUCTION: Population-based screening programmes for colorectal cancer (CRC) allow an early diagnosis, even before the onset of symptoms, but there are few studies and none in Spain on the influence they have on patient survival. The aim of the present study is to show that patients receiving surgery for CRC following diagnosis via a screening programme have a higher survival and disease-free survival rate than those diagnosed in the symptomatic stage. MATERIAL AND METHODS: Prospective study of all the patients undergoing programmed surgery for CRC at the JM Morales Meseguer Hospital in Murcia (Spain) between 2004 and 2010. The patients were divided into two groups: (a) those diagnosed through screening (125 cases); and (b) those diagnosed in the symptomatic stage (565 cases). Survival and disease-free survival were analysed and compared for both groups using the Mantel method. RESULTS: The screen-detected CRC patients show a higher rate of survival (86.3% versus 72.1% at 5 years, p<0.05) and a lower rate of tumour recurrence (73.4% versus 88.3% at 5 years, p<0.05). CONCLUSIONS: Population-based screening for CRC is an effective strategic measure for reducing mortality specific to this neoplasia.
Subject(s)
Colorectal Neoplasms/diagnosis , Mass Screening/methods , Aged , Colorectal Neoplasms/mortality , Early Detection of Cancer/methods , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Prospective StudiesABSTRACT
Chyle leak following axillary lymph node clearance is a rare yet important complication. The treatment of postoperative chyle fistula still remains unclear. Conservative management is the first line of treatment. It includes axillary drains on continuous suction, pressure dressings, bed rest, and nutritional modifications. The use of somatostatin analogue is well documented as a treatment for chylous fistulas after neck surgery. We present a case of chylous fistula after axillary surgery resolved with the use of octreotide.
ABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Adenocarcinoma/diagnosis , Appendiceal Neoplasms/complications , Appendiceal Neoplasms/surgery , Appendiceal Neoplasms , Colectomy/methods , Appendix/pathology , Appendix/surgery , AppendixABSTRACT
Adenocarcinoid tumour of the appendix is a rare entity characterised by the presence of a double component (neuroendocrine and glandular). It originates in the neuroendocrine cells of the appendicular mucosa. A preoperative diagnosis of a primary appendiceal tumour is uncommon and more so one suggesting an adenocarcinoid pathology. Optimal treatment is debated between a simple appendectomy and a more extensive resection, which occasionally includes hysterectomy and bilateral ovariectomy. Our aim is to report this rare entity and conduct a review of the literature on the different treatment options.
Subject(s)
Adenocarcinoma/surgery , Appendiceal Neoplasms/surgery , Appendix/surgery , Adenocarcinoma/pathology , Appendectomy , Appendiceal Neoplasms/pathology , Appendix/pathology , Colectomy , Female , Humans , Middle AgedABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Tomography, X-Ray Computed/methods , Hamartoma/diagnosis , Brunner Glands/pathology , Duodenal Neoplasms/diagnosis , Gastroscopy , Gastrointestinal Hemorrhage/etiologySubject(s)
Duodenal Diseases/diagnosis , Hamartoma/diagnosis , Brunner Glands , Humans , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Marjolin's ulcer is defined as the appearance of a neoplasm within a chronic wound. The most common histological type is squamous. A total of 2 cases treated in our hospital are presented. CLINICAL CASE: Case 1. A 71 year old man who presented with redness and suppuration from the wounds he had in his right foot after an electric shock 40 years earlier. The radiology showed involvement of the 4° and 5° metatarsal. Supracondylar amputation was performed, showing a well-differentiated invasive squamous cell carcinoma. CASE 2: A 56 year old male, paraplegic for 20 years. He was treated due to an infected right heel ulcer, with partial improvement, but the ulcers persisted. Biopsy was performed, reporting as epidermoid carcinoma. Infracondylar amputation was performed. The diagnosis was a well-differentiated squamous cell carcinoma infiltrating the dermis. CONCLUSION: The prevalence of Marjolin's ulcer is 1.3-2.2% of all ulcers. Diagnosis is difficult, so biopsy is recommended on any suspicious lesion or ulcer that has received conservative treatment for one month without improvement, although this time limit is not clear. The treatment is the surgery. Local excision with a margin of an inch is enough. If the ulcer is extensive, amputation is required. Survival is estimated between 66 and 80% at 2 years, with recurrence rates of 23%. Unfavourable factors are poor tumour differentiation and metástasis, appearing in 20% of cases.
Subject(s)
Burns, Electric/complications , Carcinoma, Squamous Cell/etiology , Foot Injuries/complications , Foot Ulcer/etiology , Skin Neoplasms/etiology , Aged , Amputation, Surgical , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/surgery , Diabetic Foot , Foot Ulcer/epidemiology , Foot Ulcer/surgery , Hospital Units , Humans , Male , Mexico/epidemiology , Paraplegia/complications , Prognosis , Retrospective Studies , Skin Neoplasms/diagnosis , Skin Neoplasms/epidemiology , Skin Neoplasms/surgeryABSTRACT
BACKGROUND: Endometriosis is a relatively common disease among women with child-bearing potential, and rare before puberty or following menopause. It consists of the presence of hormone-responsive endometrium outside the endometrial cavity. CASE REPORT: We report the case of a patient with a rectal lesion, initially approached as a primary rectal malignancy, where histopathology eventually revealed an adenocarcinoma arising from endometrial tissue in the colonic wall. DISCUSSION: Endometriosis has an estimated rated of 10-20%. Sites may be split up into two larger categories - gonadal and extragonadal. The frequency of extragonadal endometriosis in the bowel is estimated to involve 3%-37% of women with pelvic endometriosis, and most lesions are found in the sigmoid colon and rectum. The malignant transformation of endometriotic lesions is estimated between 0.3% and 1% of cases. The gold standard in the diagnosis of intestinal endometriosis is exploratory laparotomy and the pathological study of specimens. Adjuvant radiotherapy and chemotherapy, although used for some patients, have not proven effective.
Subject(s)
Adenocarcinoma/pathology , Cell Transformation, Neoplastic , Colonic Diseases/pathology , Endometriosis/pathology , Precancerous Conditions/pathology , Rectal Neoplasms/pathology , Female , Humans , Middle AgedABSTRACT
INTRODUCCIÓN: la endometriosis es una patología relativamente frecuente en mujeres en edad fértil y poco prevalerte en mujeres prepúberes o postmenopáusicas. CASO CLÍNICO: presentamos el caso clínico de una mujer de 57 años, con antecedentes de histerectomía y doble anexectomía por endometriosis ovárica, diagnosticada de neoplasia de recto T3N1. Se realizó neoadyuvancia preoperatoria y resección anterior baja, sin complicaciones. La anatomía patológica describía infiltración de la pared rectal por adenocarcinoma pobremente diferenciado de origen ginecológico. DISCUSIÓN: la endometriosis tiene una prevalencia estimada del 10-20% y su lugar de aparición puede ser variado, tanto gonadal como extragonadal. La frecuencia de endometriosis extragonadal de localización intestinal se estima en un 3-37% de mujeres con endometriosis pélvica, y de estas la mayoría se localizan en colon sigmoide y recto. La transformación maligna de un foco de endometriosis se estima entre el 0,3 y el 1%. El gold estándar para el diagnóstico es la resección y estudio histológico. La radioterapia y quimioterapia adyuvante todavía no ha demostrado su clara utilidad
BACKGROUND: Endometriosis is a relatively common disease among women with child-bearing potential, and rare before puberty or following menopause. It consists of the presence of hormone-responsive endometrium outside the endometrial cavity. CASE REPORT: We report the case of a patient with a rectal lesion, initially approached as a primary rectal malignancy, where histopathology eventually revealed an adenocarcinoma arising from endometrial tissue in the colonic wall. DISCUSSION: Endometriosis has an estimated rated of 10-20%. Sites may be split up into two larger categories - gonadal and extragonadal. The frequency of extragonadal endometriosis in the bowel is estimated to involve 3%-37% of women with pelvic endometriosis, and most lesions are found in the sigmoid colon and rectum. The malignant transformation of endometriotic lesions is estimated between 0.3% and 1% of cases. The gold standard in the diagnosis of intestinal endometriosis is exploratory laparotomy and the pathological study of specimens. Adjuvant radiotherapy and chemotherapy, although used for some patients, have not proven effective
Subject(s)
Female , Humans , Middle Aged , Endometriosis/pathology , Rectal Neoplasms/pathology , Postoperative Complications/diagnosis , Chemotherapy, Adjuvant , Rectal Neoplasms/surgeryABSTRACT
No disponible
