Liberación de óxido nítrico en arterias tumorales de pacientes con cáncer colorrectal / Nitric oxide release on tumour arteires form patients with colorectal cancer

INTRODUCCIÓN. El óxido nítrico es un factor liberado por el endotelio vascular que participa en los procesos de formación de tumores porque es capaz de estimular la proliferación celular, fomentar la angiogénesis y regular el flujo sanguíneo tumoral. Además, la dilatación de los vasos sanguíneos tumorales provocada por el NO puede aumentar la eficacia de los tratamientos oncológicos ya que facilita el acceso al tumor de los fármacos antineoplásicos e incrementa la oxigenación de la masa tumoral potenciando los efectos beneficiosos de la radioterapia. MATERIAL Y MÉTODO. Para estudiar si la liberación de NO está alterada en las arterias tumorales, se obtuvieron de 19 pacientes intervenidos quirúrgicamente por cáncer de colon y recto, arterias mesentéricas irrigando el tumor y arterias mesentéricas de una región alejada del tumor, y asimismo se obtuvieron arterias mesentéricas de pacientes intervenidos de diverticulitis (n=4) o enfermedad inflamatoria intestinal (n=3). Los segmentos vasculares se montaron en un sistema de registro de la tensión isométrica y se realizaron curvas de concentraciónrespuesta a la bradikinina, con las arterias previamente contraídas con U46619 en presencia de placebo, del inhibidor de óxido nítrico cintaza L-NAME y del inhibidor de la ciclooxigenasa meclofenamato. RESULTADOS. La relajación a la bradikinina fue similar en los tres grupos de arterias y esta vasodilatación era disminuida en presencia de L-NAME y no se modificaba con meclofenamato. CONCLUSIÓN. La liberación de NO está preservada en las arterias humanas que irrigan los tumores de colon y recto (AU)

INTRODUCTION. Nitric oxide is an endothelium-derived relaxing factor involved in tumour growth because it could regulate celular proliferation, tumour angiogenesis and tumor blood flow. So this relaxation of tumour arteries could enhance medical effects of oncological therapy because facilitates the delivery of anticancer drugs to tumor cells and stimulates oxygenation of tumor tissue increasing the response to radiotherapy. MATERIAL AND METHOD. To study whether release of nitric oxide is altered in tumooir arteries, mesenteric arteries suppying blood flow to colorectal tumor, mesenteric arteries far from said tumor were obtained from 19 patients undergoing colectomy and mesenteric arteries were also obtained from surgical patients with diveticulitis (n=4) or inflammatory bowel disease (n=3). Arteries were prepared for isometric tension recording in an organ bath and were precontrated with U46619. The relaxation produced by bradykinin was recorded in each of these arteries with and without the nitric oxide sinthase inhibitor L-NAME and cyclooxygenase inhibitor meclofenamate. RESULTS. Bradykinin produced a dose-dependent relaxation that was similar in all the three types of artery. This relaxation was reduced with L-NAME and was not modified with meclofenamate. CONCLUSION. Nitric oxide release is preservered in human arteries supplying blood flow to colorectal tumors (AU)

Classification of primary and incisional abdominal wall hernias.

PURPOSE: A classification for primary and incisional abdominal wall hernias is needed to allow comparison of publications and future studies on these hernias. It is important to know whether the populations described in different studies are comparable. METHODS: Several members of the EHS board and some invitees gathered for 2 days to discuss the development of an EHS classification for primary and incisional abdominal wall hernias. RESULTS: To distinguish primary and incisional abdominal wall hernias, a separate classification based on localisation and size as the major risk factors was proposed. Further data are needed to define the optimal size variable for classification of incisional hernias in order to distinguish subgroups with differences in outcome. CONCLUSIONS: A classification for primary abdominal wall hernias and a division into subgroups for incisional abdominal wall hernias, concerning the localisation of the hernia, was formulated.

Starting a new program of split liver transplantation after a low learning curve: a reality in centers with large experience in liver surgery and whole liver transplantation.

BACKGROUND/AIMS: Split liver transplantation (SLT) is nowadays, considered an adequate surgical solution to expand the grafts from the existing pool of cadaveric donors. METHODOLOGY: A total of 897 liver transplantations were performed between 1986 and 2002; 20 were SLTs (2.3%). A 30% were children. RESULTS: Mean follow up of 15.15 months +/- 13.85. Median age was 42.27 +/- 25.65 yrs. Median recipient weight was 52.29 +/- 20.87 Kg. Mean donor weight was 76.1 +/- 13.11. The majority was "in situ" SLT (65%). There was no primary graft dysfunction. Two patients developed biliary complications (none in situ SLT). Early HAT occurred in 2 patients and delayed HAT in one. Four patients were retransplanted but none were performed because of primary graft dysfunction. Five patients died in the hospital. Fifteen patients (75%) survived the postoperative period and 3 patients died during follow-up. Mean patient survival time was 42 months (95% CI: 31-52). Actuarial patient survival was 93.3%, 84.4%, 84.4% at 6 months, 1 year and 3 years. Mean graft survival was 36 months (95% CI: 25-48). Actuarial graft survival was 87%, 72%, 72% at 6, 12, 36 months. Univariate analysis of risk factors for graft loss showed that the type of splitting technique (p=0.019), and the UNOS (1 and 2a) status of the recipient (p=0.001) were significantly associated with graft loss. CONCLUSIONS: In the context of large volume full cadaveric liver transplantation, split liver can provide adequate results (even after a short learning curve) mainly in elective cases and with the in situ technique.

[Effect of endothelin-1 on tumor arteries in patients with colorectal cancer]. / Efecto de la endotelina-1 sobre las arterias tumorales de pacientes con neoplasia colorrectal.

Endothelin-1 is an endothelium-derived vasoconstrictor peptide whose plasma levels are increased in patients with colorectal cancer, and which may be involved in tumor blood flow regulation. To study whether response to this peptide is altered in tumor arteries, mesenteric arteries supplying blood flow to colorectal tumors, and mesenteric arteries far from said tumors were obtained from 13 patients undergoing colectomy; mesenteric arteries were also obtained from patients with diverticulitis (n = 4) or inflammatory bowel disease (n = 3). Arteries were prepared for isometric tension recording in an organ bath, and in this preparation it was found that endothelin-1 induced contraction in all three types of arteries, but that sensitivity to this peptide was greater in arteries supplying blood flow to the tumor than in arteries far from the tumor or arteries from patients without cancer. These results suggest that endothelin-1 may regulate blood flow to colorectal tumors by inducing a greater contraction in tumor-supplying arteries than in non-tumor arteries.

Efecto de la endotelina-1 sobre las arterias tumorales de pacientes con neoplasia colorrectal / No disponible

La endotelina-1 es un péptido vasoconstrictor producido por elendotelio vascular, cuyos niveles plasmáticos están aumentadosen los pacientes con cáncer colorrectal y que puede participar enla regulación del flujo sanguíneo tumoral. Para estudiar si la respuestaa este péptido está alterada en las arterias tumorales, seobtuvieron, de 13 pacientes intervenidos quirúrgicamente porcáncer colorrectal, arterias mesentéricas irrigando el tumor y arteriasmesentéricas de una región alejada del tumor, y asimismo seobtuvieron arterias mesentéricas de pacientes intervenidos por diverticulitis(n = 4) o enfermedad inflamatoria intestinal (n = 3). Lasarterias mesentéricas se montaron en una preparación para el registrode la contracción isométrica en un baño de órganos, encontrándoseque la endotelina-1 producía contracción en los tres tiposde arterias, pero la sensibilidad a este péptido fue mayor enlas arterias irrigando el tumor que en las arterias alejadas del tumoro en las arterias de pacientes sin patología tumoral. Estos resultadosindican que la endotelina-1 puede regular el flujo sanguíneoen los tumores colorrectales, produciendo una mayorvasoconstricción en las arterias que irrigan el tumor que en las arteriasno tumorales

Endothelin-1 is an endothelium-derived vasoconstrictor peptidewhose plasma levels are increased in patients with colorectal cancer,and which may be involved in tumor blood flow regulation.To study whether response to this peptide is altered in tumor arteries,mesenteric arteries supplying blood flow to colorectal tumors,and mesenteric arteries far from said tumors were obtainedfrom 13 patients undergoing colectomy; mesenteric arteries werealso obtained from patients with diverticulitis (n = 4) or inflammatorybowel disease (n = 3). Arteries were prepared for isometrictension recording in an organ bath, and in this preparation it wasfound that endothelin-1 induced contraction in all three types ofarteries, but that sensitivity to this peptide was greater in arteriessupplying blood flow to the tumor than in arteries far from the tumoror arteries from patients without cancer. These results suggestthat endothelin-1 may regulate blood flow to colorectal tumorsby inducing a greater contraction in tumor-supplying arteriesthan in non-tumor arteries

Analysis of CXCL12 3'UTR G>A polymorphism in colorectal cancer.

Colorectal cancer is one of the most prevalent cancers in developed countries. However, the genetic factors influencing its appearance remain far from being fully characterized. Recently, a G>A functional transition mapping the 3' untranslated region of the CXCL12 gene (rs1801157) has been found to be under-represented among rectal cancer patients when compared to colon cancer patients from a Swedish series. Here we present the results from an independent analysis of CXCL12 rs1801157 in a larger CRC series of Spanish origin in order to analyse the robustness of this association within a different European population. No significant difference was observed between controls and colon or rectal cancer patients. We were also unable to find a correlation between rs1801157 and different prognostic markers such as metastasis development or disease-free survival time. The epidemiologic data involving CXCL12 rs1801157 in colorectal cancer risk are discussed.

Neoplasia epitelial sólida quística y papilar del páncreas. Un reto de diagnóstico y tratamiento / Repercussions of chromium picolinate in the protein metabolism based on the age

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Prolapso rectal completo. Resultados clínicos y funcionales con la operación de Delorme / Complete rectal prolapse clinical and functional outcome with Delorme’s procedure

Introducción: hay descritas muchas técnicas quirúrgicas, tantopor vía perineal como abdominal, para el tratamiento del prolapsorectal. El propósito de este trabajo es evaluar los resultadosclínicos y funcionales del procedimiento por vía perineal de Delorme.Pacientes y métodos: se estudiaron 21 pacientes con prolapsorectal completo, entre julio de 2000 y octubre de 2005. Seevaluó la edad, el sexo, el riesgo anestésico y la sintomatologíaacompañante. Las exploraciones complementarias realizadas fueron:colonoscopia, manometría anorrectal previa y posterior a lacirugía y ecografía endoanal de 360°. La operación de Delormefue realizada por el mismo equipo quirúrgico.Resultados: no hubo mortalidad y la morbilidad fue mínima.La tasa de recidiva del prolapso fue de 9,52% con una media deseguimiento de 34 meses. La continencia anal mejoró en un87,5% de los pacientes y no hubo estreñimiento asociado a la cirugía.La estancia media hospitalaria fue de 2 (rango 1-4) días. Enel postoperatorio no hubo dolor en 17 casos y fue escaso en 4. Lasatisfacción con la cirugía fue alta en 16 casos (76,19%), moderadaen 3 (14,28%) y baja en 2 (9,52%).Conclusiones: la operación de Delorme para el tratamientodel prolapso rectal completo tiene una baja morbilidad asociada,mejora la continencia anal, no se asocia con estreñimiento postquirúrgicoy tiene una aceptable tasa de recidiva. La satisfacciónde los pacientes con esta cirugía es alta debido a su gran confortabilidad(anestesia intradural, corta estancia hospitalaria y escasodolor postoperatorio) y óptimos resultados

Introduction: many surgical techniques –both through theperineal and abdominal routes– have been described for the treatmentof rectal prolapse. The aim of this work is to evaluate theclinical and functional outcome with Delorme’s perineal procedure.Patients and methods: twenty-one patients with completerectal prolapse were studied from July 2000 to October 2005.Age, gender, anesthetic risk, and accompanying symptoms wereall assessed. Diagnostic tests performed included: colonoscopy,anorectal manometry before and after surgery, and 360° endoanalultrasonography. Delorme’s procedures were carried outby only one surgical team.Results: no mortality occurred, and morbidity was minimal.Prolapse relapse rate was 9.52% with a mean follow-up of 34months. Anal continence improved in 87.5% of patients, and nosurgery-associated constipation ensued. Mean hospital stay was 2(range 1-4) days. During the postoperative period no pain developedin 17 patients, and 4 patients had mild pain. Satisfactionwith surgery was high in 16 cases (76.19%), moderate in 3(14.28%), and low in 2 (9.52%).Conclusions: Delorme’s procedure for the management ofcomplete rectal prolapse is associated with low morbidity, improvesanal continence, gives rise to no postsurgical constipation, and hasan acceptable relapse rate. Patient satisfaction with this procedure ishigh because of its high comfortability (intradural anesthesia, shorthospital stay, and little postoperative pain) and optimal results

Complete rectal prolapse clinical and functional outcome with Delorme's procedure.

INTRODUCTION: Many surgical techniques -both through the perineal and abdominal routes- have been described for the treatment of rectal prolapse. The aim of this work is to evaluate the clinical and functional outcome with Delorme's perineal procedure. PATIENTS AND METHODS: Twenty-one patients with complete rectal prolapse were studied from July 2000 to October 2005. Age, gender, anesthetic risk, and accompanying symptoms were all assessed. Diagnostic tests performed included: colonoscopy, anorectal manometry before and after surgery, and 360 masculine endoanal ultrasonography. Delorme's procedures were carried out by only one surgical team. RESULTS: No mortality occurred, and morbidity was minimal. Prolapse relapse rate was 9.52% with a mean follow-up of 34 months. Anal continence improved in 87.5% of patients, and no surgery-associated constipation ensued. Mean hospital stay was 2 (range 1-4) days. During the postoperative period no pain developed in 17 patients, and 4 patients had mild pain. Satisfaction with surgery was high in 16 cases (76.19%), moderate in 3 (14.28%), and low in 2 (9.52%). CONCLUSIONS: Delorme's procedure for the management of complete rectal prolapse is associated with low morbidity, improves anal continence, gives rise to no postsurgical constipation, and has an acceptable relapse rate. Patient satisfaction with this procedure is high because of its high comfortability (intradural anesthesia, short hospital stay, and little postoperative pain) and optimal results.

Subcutaneous venous reservoir implant: our experience in 1200 cases.

We present our experience in subcutaneous venous reservoir (SVR) implanting, laying emphasis on the surgical technique, the protocol followed for assessing difficulty, implant care and per- and post-implant complications and their management. Between March 1996 and December 2002 we installed 1200 SVRs on an outpatient basis, with subsequent result follow-up. The reservoir was successfully installed by the standard procedure in 99.33% of cases (1194), while in the remaining six patients (0.67%) the participation of the Intervention Radiology Department was required for correct implantation. Results were excellent with a morbidity of 3.3% and we had to single out two cases of immediate infection (0.16%), nine of tardive infection (over three months); twelve cases of pneumothorax (1%); seven episodes of venous thrombosis (0.58%) and four cases of catheter migration (0.3%). SVR implanting is possible on an outpatient basis but requires strict measures of asepsis and an experienced team and personnel responsible for its handling and maintenance, although there are a small number of complications inherent in the patient's general state.

Angiosarcoma in the small intestine. Apropos of a particular case.

Presentation of a case of small intestine primary angiosarcoma in a 70-year-old male. There is question of an extremely rare tumor in the gastrointestinal tract. Its symptomatology is similar to that of other tumors in the small intestine. An immunohistochemical study is usually essential for its anatomopathological diagnosis. The diagnosis is generally arrived at in its advanced stages, and that makes for a bad prognosis. The bibliography has been revised from this case on.

Pancreatic cancer. Management.

Pancreatic cancer still represents a serious medical concern for which no adequate solution has thus far been found. Surgery is the only appropriate therapy, but has a survival rate of around 30-35% at three years, with an operative mortality below 3% and an operative morbidity approaching 10% of radically resected patients, all of which applies to surgery performed by expert teams in highly experienced sites.

Hernia incisional. Una complicación demasiado frecuente / Incisional hernia. A far too frequent complication

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[Budd-Chiari syndrome: current medical-surgical management]. / Síndrome de Budd-Chiari: manejo médico-quirúrgico actual.

The Budd-Chiari syndrome or obstruction of the hepatic veins and/or suprahepatic inferior vena cava is a rare process, frequently associated with hypercoagulable states. There exist several clinical presentations, being most common the acute and subacute forms and rarely seen the fulminant and chronic forms (cirrhosis or fibrosis associated). We present here a female patient with Budd-Chiari syndrome produced by polycythemia, resolved by mesentericocaval interposition "H" shunt using internal jugular vein, after analyzing the current different modalities of medical-surgical treatment, specially portal system shunts and liver transplantation, related to presentation form.

Management of lower gastrointestinal bleeding in colonic diverticular disease.

AIM: To evaluate the clinical course, diagnostic approach, therapeutic measures and results, in a series of 13 patients with colonic bleeding diverticula. MATERIAL AND METHODS: From 1973 to 1995, 72 patients were admitted with the diagnosis of lower gastroin testinal bleeding. Thirteen presented a colonic diverticula bleeding. Mean age was 65.2 years. Medical history, symptoms, diagnosis, treatment (conservative or surgical) and pathology were recorded. RESULTS: Main bleeding time was 3 days. Eight patients needed blood transfusion. All patients underwent colonoscopic examination and it was diagnostic in every patient. Four patients underwent surgery: one case, because of massive hemorrhage and the other three cases due to bleeding recurrence. Pancolectomy was performed in one patient, ileal resection in another and the other two were treated with a sigmoidectomy and a left hemicolectomy. Pathology analysis corroborated colonic diverticula diagnosis. There was no postoperative mortality. Bleeding recurrence did not occur either in postoperative period or in the follow-up. CONCLUSIONS: Colonic diverticular bleeding usually stops spontaneously, obtaining high rates of preoperative diagnosis with colonoscopy. Less than a third of the cases requires surgical resection.

[Effects of total gastrectomy on the nutritional status]. / Efectos de la gastrectomía total sobre el estado nutricional.

In this study, we have analyzed a series of 88 patients who underwent total gastrectomy followed by two different reconstructive procedures, Roux-en-Y jejunal interposition (57%) and interposition of a jejunal limb between the oesophagus and the duodenum (38%) (Henley procedure). We examined diet, intestinal transit, symptoms of dumping syndrome and body weight curves. Patients with Roux-en-Y reconstruction presented post-prandial sweating more often (48%) than patients with the Henley procedure (21%). Forty percent patients with Roux-en-Y reconstruction suffered post-prandial nausea whereas this finding was not associated with patients after the Henley procedure. The reconstructive method has to be chosen considering the age and general condition of the patient, stage of the neoplasia and its curability. We currently favor Roux-en-Y esophagojejunostomy. However, in selected patients the Henley procedure may prove useful in order to prevent reflux and dumping symptoms.