Melanoma anorrectal: a propósito de un caso / Anorectal melanoma: a case report

Introducción: El melanoma anorrectal es una neoplasia poco frecuente, que posee mal pronóstico debido a lo avanzado de la enfermedad al momento del diagnóstico, con una sobrevida a los cinco años menor al 10%. A diferencia del melanoma cutáneo, hasta el 87% de los melanomas anorrectales pueden ser amelanocíticos. Suele presentarse con sintomatología inespecífica, principalmente con rectorragia o como hallazgo incidental en colonoscopías. Caso clínico: Paciente sexo femenino de 63 años que presenta rectorragia de 4 meses de evolución. El diagnóstico fue confirmado con biopsia rectal e inmunohistoquímica con marcadores HBM 45 y S100 positivos. Estudio de diseminación resultó negativo. El tratamiento de elección fue la resección abdominoperineal. Conclusiones: Actualmente, no existe una diferencia significativa en la sobrevida en aquellos pacientes que se someten a resección abdominoperineal (Operación de Miles) en relación a aquellos que se les realiza resección local más radioterapia. Es necesario obtener siempre un margen quirúrgico adecuado, sin comprometer severamente la funcionalidad del esfínter anal. (AU)

Introduction: Anorectal melanoma is a rare, highly mlignant tumor due to its lack of early diagnosis, with a poor poor 5-year survival of 10%. About 87% of anorectal melanomas are amelanotic. Patients often present with non-specific symptoms, mainly with rectal bleeding. Case report: The following is a reported case from Felix Bulnes Hospital. A 63-year-old female patient who presented 4-month rectal bleeding. The diagnosis was confirmed with rectal biopsy and immunohistochemistry with expression of HBM 45 and S100 protein. Abdominoperineal resection was the treatment of choice. Conclusion: Patients undergoing radical surgery have no significant survival difference compared to those undergoing local excision with radiation therapy. (AU)

Simulación, ¿una necesidad en el entrenamiento para la cirugía laparoscópica colorrectal? / Simulation, a need in training for colorectal laparoscopic surgery?

Resumen La cirugía laparoscópica colorrectal (CLCR) se realiza desde hace más de dos décadas y a pesar de la amplia evidencia que apoya sus beneficios para los pacientes, su difusión y utilización han sido lentas. Su curva de aprendizaje prolongada es uno de los principales factores restrictivos para su más amplia utilización en la práctica clínica en nuestro país. La realización de esta técnica mínimamente invasiva requiere de habilidades avanzadas y específicas que no necesariamente se adquieren con el aprendizaje de la cirugía tradicional o abierta. El objetivo de este documento es resumir las diferentes estrategias de simulación actualmente disponibles para el entrenamiento en CLCR y la evidencia que avala su implementación en los programas de cirugía colorrectal.

Abstract Laparoscopic colorectal surgery (LCRS) is performed more than two decades ago and despite the wide evidence supporting its benefits for patients, its diffusion and utilization has been slow. Its prolonged learning curve is one of the main restrictive factors for its wider use in clinical practice in our country. The realization of this minimally invasive technique requires advanced and specific skills that are not necessarily acquired with the learning of traditional or open surgery. The objective of this paper is to summarize the different simulation strategies currently available for LCRS training and the evidence supporting its implementation in colorectal surgery programs.

Resultados oncológicos a largo plazo de pacientes sometidos a resección laparoscópica por cáncer de recto / Long term oncological outcomes of patients undergoing laparoscopic resection for rectal cancer

Introducción: En la actualidad hay consenso en la seguridad oncológica en la cirugía laparoscópica para el tratamiento del cáncer de colon, sin embargo, en el cáncer de recto (CR) los resultados a largo plazo, continúan siendo objeto de estudio. El objetivo de este trabajo es analizar la sobrevida a largo plazo en pacientes operados por adenocarcinoma de recto por vía laparoscópica. Material y Métodos: Desde la base de datos prospectiva de cirugía colorrectal laparoscópica se seleccionaron los pacientes operados por CR en el periodo entre octubre 2000 y diciembre 2009. Se excluyó a los pacientes con cáncer colorrectal hereditario. Se analizaron los datos de seguimiento los cuales son obtenidos mediante registros clínicos y datos del registro civil. Se realizó un análisis de sobrevida con el método de Kaplan-Meier. Resultados: En el periodo mencionado, 60 pacientes fueron operados por CR, 2 (3,4%) pacientes fallecieron en el postoperatorio temprano y fueron excluidos en el análisis de sobrevida, por tanto, 58 pacientes fueron incluidos en el seguimiento. El 41% eran sexo femenino y la edad promedio fue de 60 ± 11,6 años. Los tumores se encontraban localizados en el recto superior, medio e inferior en un 28%, 28% y 44% respectivamente. Las cirugías realizadas fueron resección abdominoperineal, resección anterior ultrabaja interesfintérica, resección anterior ultrabaja y resección anterior baja en un 8%, 28%, 5% y 59% de los pacientes, respectivamente. El 50% de los pacientes recibieron neoadyuvancia. Tras la estadificación postoperatoria 4% fueron clasificados estadio 0, 38% estadio I, 17% estadio II, 28% estadio III y 13% estadio IV. El recuento de linfonodos de la pieza operatoria fue de 12,3 en promedio. A un seguimiento de 42,6 meses (r: 17 a 103 meses) la sobrevida global estimada a 5 años es de 85%. Según estadios la sobrevida estimada a 5 años fue de 100% para el estadio 0 y I, 88% para el estadio II, 74% para el estadio III... (TRUNCADO)

Background: Currently there is a consensus in oncological safety for laparoscopic surgery for colon cancer; however, in rectal cancer long term outcomes are still a subject of debate. The aim is to analyze long term survival in patients who underwent laparoscopic surgery for rectal cancer. Material and Methods: From the prospective database of laparoscopic colorectal surgery, we selected patients operated on between October 2000 and December 2009. Patients with hereditary colorectal cancer were excluded. Follow-up data was obtained by medical records and national vital records. Survival was analyzed using the Kaplan-Meier method. Results: In this period, 60 patients were operated on for rectal cancer. Two died in the early postoperative period and were excluded from the analysis; therefore, 58 patients were included in follow-up. Forty-one percent were female and mean age was 60±11.6 years old. Tumors were localized in the upper, mid and lower rectum in 28%, 28% and 44%, respectively. Surgeries performed were abdominoperineal resection, ultra-low intersphincteric resection, ultralow anterior resection and low anterior resection in 8%, 28%, 5% and 59% of patients, respectively. Fifty percent received neoadjuvant treatment. After postoperative staging 4% were classified as stage 0,17% as stage I, 28% as stage II, 28% as stage III, and 13% as stage IV. At a mean 42.6 month follow-up (r: 17-103 months) estimated overall 5-year survival was 85%. When analyzed according to stage, estimated overall 5-year survival was 100% for stages 0 and I, 88% for stage II, 74% for stage III, and 57% for stage IV. Conclusion: Long term survival in patients undergoing laparoscopic surgery for rectal cancer is satisfactory and is within the values reported by international centers.

Gastrectomía extendida en cáncer gástrico: Evaluación de la morbilidad y mortalidad postoperatoria / Complications and mortality of extended gastrectomy for gastric cancer

Background: Extended gastrectomy allows a complete tumor excision in patients with advanced gastric cancer. Aim: To compare the surgical results of extended (ER) and non-extended gastrectomy (NER) among patients with gastric cancer, and determine factors associated with complications and mortality. Material and Methods: Review of medical records of patients with gastric cancer who underwent complete resection between 2002 and 2008 in an oncological hospital. Demographics, patient-related and therapeutic features were compared between groups, and independent factors were established with multivariate analysis. Results: Seventy four patients, (44 men, median age 62 years) underwent an ER and 103 patients, (56 men, median age 61 years) a NER. Specifically, ER included splenectomy alone in 27 patients, splenectomy associated with other procedure in 24, partial esophagectomy in 18, distal pancreatectomy in 13, hemicolectomy in 8, total esophagectomy in 7, partial hepatectomy in 4, and adrenalectomy in 1. Postoperative complications were observed in 19 patients treated with an ER (26 percent) and in 11 patients treated with a NER (11 percent), p < 0.05. Serious complications were higher in patients who underwent an ER compared with NER (6 patients (8 percent) vs. 4 (4 percent), respectively) p < 0.05. In the same way, mortality was higher in patients treated with ER when it was compared with NER (4 patients (5 percent) vs two (2 percent), respectively), p < 0.05. ER and serum albumin levels were independent factors associated to a higher risk of mortality and rate of complications. Conclusions: ER was associated with a higher rate of general and severe complications, and mortality.

[Complications and mortality of extended gastrectomy for gastric cancer]. / Gastrectomía extendida en cáncer gástrico. Evaluación de la morbilidad y mortalidad postoperatoria.

BACKGROUND: Extended gastrectomy allows a complete tumor excision in patients with advanced gastric cancer. AIM: To compare the surgical results of extended (ER) and non-extended gastrectomy (NER) among patients with gastric cancer, and determine factors associated with complications and mortality. MATERIAL AND METHODS: Review of medical records of patients with gastric cancer who underwent complete resection between 2002 and 2008 in an oncological hospital. Demographics, patient-related and therapeutic features were compared between groups, and independent factors were established with multivariate analysis. RESULTS: Seventy four patients, (44 men, median age 62 years) underwent an ER and 103 patients, (56 men, median age 61 years) a NER. Specifically, ER included splenectomy alone in 27 patients, splenectomy associated with other procedure in 24, partial esophagectomy in 18, distal pancreatectomy in 13, hemicolectomy in 8, total esophagectomy in 7, partial hepatectomy in 4, and adrenalectomy in 1. Postoperative complications were observed in 19 patients treated with an ER (26%) and in 11 patients treated with a NER (11%), p < 0.05. Serious complications were higher in patients who underwent an ER compared with NER (6 patients (8%) vs. 4 (4%), respectively) p < 0.05. In the same way, mortality was higher in patients treated with ER when it was compared with NER (4 patients (5%) vs two (2%), respectively), p < 0.05. ER and serum albumin levels were independent factors associated to a higher risk of mortality and rate of complications. CONCLUSIONS: ER was associated with a higher rate of general and severe complications, and mortality.

[Depressive symptoms after an acute myocardial infarction]. / Síntomas depresivos posinfarto al miocardio: detección precoz en una población hospitalizada.

BACKGROUND: Depression after myocardial infarction (MI) is a frequent disorder and it increases the long-term risk of cardiac mortality. AIM: To assess the frequency of depressive symptoms and the history of depression in hospitalized post-MI patients. PATIENTS AND METHODS: During three months, depressive symptoms and history of depression were studied in 47 consecutive patients (mean age 59.8+/-9.5 years, 68% male), admitted for MI to the Barros Luco Trudeau Hospital. The Beck Depression Inventory (BDI) and the Composite International Diagnostic Interview (CIDI 2.1) were used with DSM-IV diagnosis criteria. RESULTS: According to the results obtained using the CIDI, 27,7% of the patients had a history of depression. This occurred in 53,3% of women and 15,6% of men (p <0.01). During the hospitalization, 38.3% of patients had depressive symptoms (BDI > or =17 points), affecting 60% of women and 28,1% of men (p <0.02). In women and patients with history of depression, depressive symptoms tended to be more common and more severe. CONCLUSIONS: Depressive symptoms in post-MI patients are frequent and attending physicians should actively detect them.

Influences of hormone replacement therapy on postmenopausal women's health perceptions.

OBJECTIVE: To assess the beliefs of climacteric women regarding their health, menopause, and hormone replacement therapy (HRT). DESIGN: Medical students asked to interview 526 healthy women, ranging from 40 to 64 years of age, between January and February of 2002. Of that number, 26 (4.9%) declined to participate in the interview. Thus, 500 women were interviewed about their beliefs and perceptions regarding their quality of life and health risks, as well as their opinions on menopause and HRT. RESULTS: The mean age of the sample was 53.3 +/- 6.2 years; 83.4% were postmenopausal, and 18.8% were HRT users. Of the women interviewed, 38.6% believed that their health was good. Although 78.8% thought that cancer is the main cause of death, 64% of them considered themselves to be at high risk for cardiovascular disease and osteoporosis. Most (64%) believed that menopause deteriorates the quality of life and that it increases cardiovascular risk (52.4%) and osteoporosis (72.0%). The HRT users perceived that they had better health status (48.9% v 36.2%, P < 0.02) and smaller cardiovascular risk (54.3% v 66.3%, P < 0.04) than did the nonusers; however, they ignored the preventive effect of estrogens in osteoporosis. CONCLUSIONS: Women believe that menopause deteriorates their health. The HRT users perceived themselves to be healthier and to have a smaller risk for cardiovascular disease.