Outcome of the treatment of hydronephrosis due to congenital ureteropelvic stenosis according to age at surgery.

BACKGROUND: Congenital kidney and urinary tract anomalies are the most common cause of chronic kidney disease in the first three decades of life. Stenosis of the ureteropelvic junction may cause dilation of the collecting system in the fetal kidney. This study aimed to determine hydronephrosis due to congenital ureteropelvic stenosis treatment outcome according to the age of the intervention. METHODS: We conducted a retrospective descriptive study that included pediatric patients with hydronephrosis secondary to ureteropelvic junction stenosis operated by the Anderson-Hynes open pyeloplasty method from 2010 to 2016. Patients were divided into two groups: group A, children < 1 year of age, and group B, children > 1 year of age. We analyzed ultrasonographic parameters, renal function, and clinical data. Inferential statistics were used with the Mann-Whitney U-test and X2 test. Intra-group data were assessed with the Wilcoxon test. RESULTS: We included 52 patients: group A (n = 16, 30%) and group B (n = 36, 70%). The male sex predominated, and mainly the left renal unit. The most important surgical finding was stenotic segment. The median right glomerular filtration rate was 24.1 mL/min (19.0-34.5) pre-surgical and 38.2 mL/min (35.9-41.09) post-surgical in group A (p = 0.028), and 28.4 mL/min (18.5-35.0) pre-surgical and 37 mL/min (35.7-46.0) post-surgical in group B (p = 0.003). The median left glomerular filtration rate was 30 mL/min (21.4-39.0) pre-surgical and 40.0 mL/min (37.7-44.6) post-surgical in group A (p = 0.005) and 18.4 mL/min (14.2-29.2) pre-surgical and 37 mL/min (33.1-38.5) post-surgical in group B (p < 0.001). CONCLUSIONS: Correction of ureteropelvic stenosis before one year of age results in better renal function than a later correction.

INTRODUCCIÓN: Las anormalidades congénitas del riñón y del tracto urinario son la causa más frecuente de enfermedad renal crónica en las primeras décadas de la vida. La estenosis de la unión ureteropiélica puede ocasionar restricción del flujo urinario desde la pelvis renal hacia el uréter, y es la causa más común de dilatación del sistema colector en el riñón fetal. El objetivo de este estudio fue determinar los resultados del tratamiento de la hidronefrosis por estenosis ureteropiélica congénita según la edad de la intervención. MÉTODOS: Se llevó a cabo un estudio retrospectivo descriptivo incluyendo pacientes pediátricos con hidronefrosis secundaria a estenosis de la unión ureteropiélica sometidos a pieloplastia abierta de Anderson-Hynes en el periodo 2010-2016. Se formaron dos grupos: A, pacientes < 1 año, y B, pacientes > 1 año. Se analizaron parámetros clínicos, ecosonográficos y de función renal. Se utilizó estadística inferencial con las pruebas U de Mann Whitney, χ2 y Wilcoxon. RESULTADOS: Se incluyeron 52 pacientes: 16 en el grupo A (30%) y 36 en el grupo B (70%). Predominó el sexo masculino, y principalmente la unidad renal izquierda. El hallazgo quirúrgico más importante fue el segmento estenótico. La mediana de la tasa de filtración glomerular derecha prequirúrgica fue de 24.1 ml/min (19.0-34.5) y la posquirúrgica fue de 38.2 ml/min (35.9-41.09) en el grupo A (p = 0.028), frente a 28.4 ml/min (18.5-35.0) y 37 ml/min (35.7-46.0), respectivamente, en el grupo B (p = 0.003). La mediana de la tasa de filtración glomerular izquierda prequirúrgica fue de 30 ml/min (21.4-39.0) y la posquirúrgica fue de 40.0 ml/min (37.7-44.6) en el grupo A (p = 0.005), frente a 18.4 ml/min (14.2-29.2) y 37 ml/min (33.1-38.5), respectivamente, en el grupo B (p < 0.001). CONCLUSIONES: La corrección de la estenosis ureteropiélica antes de 1 año de edad resulta en una mejor función renal que la corrección tardía.

Cytogenetic markers and their spatial distribution in a population living in proximity to areas sprayed with pesticides.

Human populations are in contact with potentially toxic substances in varying amounts, if the exposure is work-related or direct, generally the amount of toxin is usually greater than if the exposure is environmental through the drifts that occur. It was proposed to determine the existence of genotoxic damage evaluated through Chromosomal Aberrations and Micronuclei assays and their spatial distribution pattern, as well as the possible relationship between that damage and the values found in biochemical biomarkers, in groups of individuals environmental exposure (respiratory exposure) to mixtures of pesticides, in the province of Córdoba-Argentina. Biochemical and hematological determinations were made in each samples. The results reveal that the monitoring of human populations through the analysis of cytogenetic markers enabled the detection of direct damage in man caused by polluting substances and the results were obtained rapidly. The disadvantage of this type of study is the inability to estimate the degree of exposure.

Comité de Ética Asistencial (CEA) del Hospital Regional de Talca, en pandemia COVID-19 / Care Ethics Committee (CEA) of Talca Regional Hospital, in COVID-19 pandemic

The healthcare ethics committee of the Regional Hospital of Talca, shares with the hospital community, ethical considerations in medical-clinical decisions, in the context of the COVID 19 pandemic. Focus attention on the person, with dignified treatment, with the center in quality and proportional to the individual condition, within the framework of protected teamwork, and that everyone is responsible for mutual care. The considerations of admission to critical units of complicated patients, with principles of caring over healing, without abandoning those who require assistance. Resources are scarce and must be protected, people must not be discriminated against, age is a precedent that must be considered, given the chances of survival, without going beyond the limitations to the therapeutic effort, which must be shared with the treating medical team and of the hospital ethics committee if required. A dignified death is an element to be considered with respect for the person, their families and the community.

Impact of residual nodal involvement after complete tumor response in patients undergoing neoadjuvant (chemo)radiotherapy for rectal cancer.

BACKGROUND: The management of patients with a complete clinical response after neoadjuvant therapy for rectal adenocarcinoma is controversial. Those who advocate for resection point out the inaccuracy of N-staging with current imaging modalities. The objective of this study is to determine the impact of residual nodal involvement after complete tumor regression after neoadjuvant (chemo)radiotherapy. METHODS: The 2004 to 2014 National Cancer Database was queried for patients undergoing proctectomy for nonmetastatic rectal adenocarcinoma who had received neoadjuvant (chemo)radiotherapy and with ypT0 on final pathology. Patients were grouped based on pathologic nodal stage: ypT0N- and ypT0N+. The main outcome was 5-year overall survival. RESULTS: There were 5,156 patients with ypT0N- and 527 with ypT0N+. Mean lymph node harvest was similar (ypT0N- 12.2 nodes [standard deviation 9.1] vs ypT0N+ 11.6 nodes [standard deviation 10.3]; P = .086). Patients with ypT0N+ were more likely to have had clinically involved nodes (P < .001) and earlier clinical T-stage (P = .002). Overall survival at 5 years was less for patients with ypT0N+ (80% vs 86%, log-rank P = .014). ypT0N+ was independently associated with worse overall survival (hazard ratio 1.74, 95% confidence interval 1.33-2.28). CONCLUSION: Residual nodal involvement despite complete tumor regression was associated with worse 5-year overall survival compared to complete pathologic response. Additional therapy should be considered in the presence of complete clinical tumor regression after neoadjuvant (chemo)radiotherapy.

Intraoperative radiotherapy with the Intrabeam® device for the treatment of resectable pancreatic adenocarcinoma. / Radioterapia intraoperatoria con Intrabeam® para el tratamiento del adenocarcinoma de páncreas resecable.

INTRODUCTION: The application of intraoperative radiation therapy to the tumor bed after resection of pancreatic cancer has been shown to be beneficial in the local control of the disease. The objective of this study was to evaluate the preliminary outcomes after the application of a single intraoperative dose to the tumor bed with a new intraoperative radiotherapy device (Intrabeam®) in terms of viability, safety and short-term results. METHODS: We studied 5 patients who underwent pancreaticoduodenectomy for resectable pancreatic cancer in which a radiotherapy boost (5Gy) was intraoperatively applied to the tumoral bed using the portable Intrabeam® device, a low-energy point-source X-ray. Postoperative complications, hospital stay and mortality, recurrences and short-term survival were analyzed. RESULTS: Mean patient age was 68 years. All patients had a T3-stage tumor and one of them N1. In 3 patients, R0 resection was performed, while R1 resection was conducted in 2. Perioperative mortality was 0%. The only complications included delayed gastric emptying and postoperative hemorrhage. There were no pancreatic fistulas. During follow-up (mean: 11.2 months), there was a relapse in the patient who had undergone R1 resection. CONCLUSIONS: The application of radiotherapy with the Intrabeam® device in selected patients has not resulted in increased perioperative morbidity or mortality; therefore, this is a safe procedure for the treatment of resectable cancer.

Radioterapia intraoperatoria con Intrabeam(R) para el tratamiento del adenocarcinoma de páncreas resecable / Intraoperative radiotherapy with the Intrabeam(R) device for the treatment of resectable pancreatic adenocarcinoma

INTRODUCCIÓN: La aplicación de radioterapia intraoperatoria en el lecho tumoral tras la resección de un cáncer de páncreas ha demostrado ser beneficiosa en el control local de la enfermedad. El objetivo de este estudio fue valorar los resultados iniciales obtenidos tras la aplicación de una nueva modalidad de radioterapia intraoperatoria (Intrabeam(R)) en términos de viabilidad, seguridad y resultados a corto plazo. MÉTODOS: Se estudiaron 5 pacientes sometidos a duodenopancreatectomía cefálica por cáncer de páncreas resecable, en los que se aplicó intraoperatoriamente un boost de radioterapia (5Gy) en el lecho tumoral mediante la utilización del dispositivo portátil Intrabeam(R), fuente puntual de rayos X de baja energía. Se analizaron las complicaciones, estancia y mortalidad postoperatorias, recidivas y superviviencia a corto plazo. RESULTADOS: La edad media fue de 68 años. Todos los pacientes presentaban un estadio tumoral T3 y uno de ellos N1. En 3 pacientes se realizó una resección R0 y en 2 casos resultó ser una resección R1. La mortalidad peroperatoria fue del 0%. Solo se presentaron como complicaciones un retraso en el vaciamiento gástrico y una hemorragia postoperatoria. No hubo fístulas pancreáticas. Durante el seguimiento (media: 11,2 meses) se constató una recidiva en el paciente en el que se había practicado una resección R1. CONCLUSIONES: La aplicación de radioterapia con el dispositivo Intrabeam(R) en pacientes seleccionados no ha supuesto un aumento de la morbimortalidad peroperatoria, mostrándose como un procedimiento seguro en el tratamiento del cáncer resecable

INTRODUCTION: The application of intraoperative radiation therapy to the tumor bed after resection of pancreatic cancer has been shown to be beneficial in the local control of the disease. The objective of this study was to evaluate the preliminary outcomes after the application of a single intraoperative dose to the tumor bed with a new intraoperative radiotherapy device (Intrabeam(R)) in terms of viability, safety and short-term results. METHODS: We studied 5 patients who underwent pancreaticoduodenectomy for resectable pancreatic cancer in which a radiotherapy boost (5Gy) was intraoperatively applied to the tumoral bed using the portable Intrabeam(R) device, a low-energy point-source X-ray. Postoperative complications, hospital stay and mortality, recurrences and short-term survival were analyzed. RESULTS: Mean patient age was 68 years. All patients had a T3-stage tumor and one of them N1. In 3 patients, R0 resection was performed, while R1 resection was conducted in 2. Perioperative mortality was 0%. The only complications included delayed gastric emptying and postoperative hemorrhage. There were no pancreatic fistulas. During follow-up (mean: 11.2 months), there was a relapse in the patient who had undergone R1 resection. CONCLUSIONS: The application of radiotherapy with the Intrabeam (R) device in selected patients has not resulted in increased perioperative morbidity or mortality; therefore, this is a safe procedure for the treatment of resectable cancer

Invaginación gastroduodenal secundaria a lipoma submucoso gástrico tratado con exéresis transgástrica laparoscópica / Gastroduodenal invagination secondary to gastric submucosal lipoma treated by laparoscopic transgastric excision

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Evaluación del nivel de daño en el material genético de niños de la provincia de Córdoba expuestos a plaguicidas / Assessment of the level of damage to the genetic material of children exposed to pesticides in the province of Córdoba

Introducción. En las últimas décadas, numerosos autores han investigado acerca de los daños genotóxicos producidos por la exposición a sustancias químicas, aunque no existen para Argentina reportes de estudios que analicen dichos efectos en los niños. El objetivo de este trabajo fue determinar la frecuencia de micronúcleos en células exfoliadas de la mucosa bucal en niños de plantas urbanas con exposición ambiental (por inhalación) y compararla con la frecuencia de micronúcleos en niños que habitan en plantas urbanas alejadas de zonas donde se pulveriza. Población y métodos. Se estudiaron cincuenta niños que habitan la localidad de Marcos Juárez (Córdoba), ubicados a diferentes distancias de exposición a la aplicación de productos plaguicidas, y veinticinco niños de la ciudad de Río Cuarto (Córdoba), considerados no expuestos a dichos productos, y se aplicó el ensayo de micronúcleos en células de la mucosa bucal. Resultados. Se encontró diferencia significativa entre los expuestos a menos de quinientos metros con respecto al grupo de niños no expuestos. El 40% de los individuos expuestos sufren algún tipo de afección persistente, que se podría asociar a la exposición crónica a plaguicidas. Conclusiones. Los resultados obtenidos permiten indicar que existe una exposición a sustancias genotóxicas en un grupo de niños con relación al otro y poner de manifiesto la relevancia del ensayo de micronúcleos en la mucosa bucal para el biomonitoreo genético y la vigilancia en salud pública. El ensayo utilizado detecta un nivel de daño que todavía es reversible.(AU)

Introduction. In the past decades, several authors have investigated the genotoxicity caused by exposure to chemicals, but there are no reports on studies analyzing such effects on children in Argentina. The objective of this study was to establish the micronucleus frequency in exfoliated buccal mucosa cells in children from urban areas with environmental exposure (through inhalation) and to compare it with the micronucleus frequency in children from urban regions far from areas subjected to spraying. Population and Methods. Fifty children living in the town of Marcos Juárez (Córdoba) at different distances from pesticide spraying areas and twenty-five children from the city of Río Cuarto (Córdoba), who are considered not exposed to pesticides, were studied; the micronucleus assay in buccal mucosa cells was used. Results. A significant difference was observed between exposed children living less than 500 m from areas subjected to spraying and those who were not exposed. Forty percent of exposed children suffer some type of persistent condition, which may be associated with chronic exposure to pesticides. Conclusions. Results indicate that genotoxicity is present in a group of children compared to the other one, and highlight the importance of the micronucleus assay in buccal mucosa cells for genetic biomonitoring and public health surveillance. This assay is capable of detecting a level of damage that can be reversible.(AU)

Evaluación del nivel de daño en el material genético de niños de la provincia de Córdoba expuestos a plaguicidas / Assessment of the level of damage to the genetic material of children exposed to pesticides in the province of Córdoba

Introducción. En las últimas décadas, numerosos autores han investigado acerca de los daños genotóxicos producidos por la exposición a sustancias químicas, aunque no existen para Argentina reportes de estudios que analicen dichos efectos en los niños. El objetivo de este trabajo fue determinar la frecuencia de micronúcleos en células exfoliadas de la mucosa bucal en niños de plantas urbanas con exposición ambiental (por inhalación) y compararla con la frecuencia de micronúcleos en niños que habitan en plantas urbanas alejadas de zonas donde se pulveriza. Población y métodos. Se estudiaron cincuenta niños que habitan la localidad de Marcos Juárez (Córdoba), ubicados a diferentes distancias de exposición a la aplicación de productos plaguicidas, y veinticinco niños de la ciudad de Río Cuarto (Córdoba), considerados no expuestos a dichos productos, y se aplicó el ensayo de micronúcleos en células de la mucosa bucal. Resultados. Se encontró diferencia significativa entre los expuestos a menos de quinientos metros con respecto al grupo de niños no expuestos. El 40% de los individuos expuestos sufren algún tipo de afección persistente, que se podría asociar a la exposición crónica a plaguicidas. Conclusiones. Los resultados obtenidos permiten indicar que existe una exposición a sustancias genotóxicas en un grupo de niños con relación al otro y poner de manifiesto la relevancia del ensayo de micronúcleos en la mucosa bucal para el biomonitoreo genético y la vigilancia en salud pública. El ensayo utilizado detecta un nivel de daño que todavía es reversible.

Introduction. In the past decades, several authors have investigated the genotoxicity caused by exposure to chemicals, but there are no reports on studies analyzing such effects on children in Argentina. The objective of this study was to establish the micronucleus frequency in exfoliated buccal mucosa cells in children from urban areas with environmental exposure (through inhalation) and to compare it with the micronucleus frequency in children from urban regions far from areas subjected to spraying. Population and Methods. Fifty children living in the town of Marcos Juárez (Córdoba) at different distances from pesticide spraying areas and twenty-five children from the city of Río Cuarto (Córdoba), who are considered not exposed to pesticides, were studied; the micronucleus assay in buccal mucosa cells was used. Results. A significant difference was observed between exposed children living less than 500 m from areas subjected to spraying and those who were not exposed. Forty percent of exposed children suffer some type of persistent condition, which may be associated with chronic exposure to pesticides. Conclusions. Results indicate that genotoxicity is present in a group of children compared to the other one, and highlight the importance of the micronucleus assay in buccal mucosa cells for genetic biomonitoring and public health surveillance. This assay is capable of detecting a level of damage that can be reversible.

Assessment of the level of damage to the genetic material of children exposed to pesticides in the province of Córdoba.

INTRODUCTION: In the past decades, several authors have investigated the genotoxicity caused by exposure to chemicals, but there are no reports on studies analyzing such effects on children in Argentina. The objective of this study was to establish the micronucleus frequency in exfoliated buccal mucosa cells in children from urban areas with environmental exposure (through inhalation) and to compare it with the micronucleus frequency in children from urban regions far from areas subjected to spraying. POPULATION AND METHODS: Fifty children living in the town of Marcos Juárez (Córdoba) at different distances from pesticide spraying areas and twenty-five children from the city of Río Cuarto (Córdoba), who are considered not exposed to pesticides, were studied; the micronucleus assay in buccal mucosa cells was used. RESULTS: A significant difference was observed between exposed children living less than 500 m from areas subjected to spraying and those who were not exposed. Forty percent of exposed children suffer some type of persistent condition, which may be associated with chronic exposure to pesticides. CONCLUSIONS: Results indicate that genotoxicity is present in a group of children compared to the other one, and highlight the importance of the micronucleus assay in buccal mucosa cells for genetic biomonitoring and public health surveillance. This assay is capable of detecting a level of damage that can be reversible.

Evolution of the crashworthiness and aggressivity of the Spanish car fleet.

This paper investigates the relationship between a passenger car's year of registration and its crashworthiness and aggressivity in real-world crashes. Crashworthiness is defined as the ability of a car to protect its own occupants, and has been evaluated in single and two-car crashes. Aggressivity is defined as the ability to protect users travelling in other vehicles, and has been evaluated only in two-car crashes. The dependent variable is defined as the proportion of injured drivers who are killed or seriously injured; following previous research, we refer to this magnitude as injury severity. A decrease in the injury severity of a driver is interpreted as an improvement in the crashworthiness of their car; similarly, a decrease in the injury severity of the opponent driver is regarded as an improvement in aggressivity. Data have been extracted from the Spanish Road Accident Database, which contains information on every accident registered by the police in which at least one person was injured. Two types of regression models have been used: logistic regression models in single-car crashes, and generalised estimating equations (GEE) models in two-car crashes. GEE allow to take account of the correlation between the injury severities of drivers involved in the same crash. The independent variables considered have been: year of registration of the subject car (crashworthiness component), year of registration of the opponent car (aggressivity component), and several factors related to road, driver and environment. Our models confirm that crashworthiness has largely improved in two-car crashes: when crashing into the average opponent car, drivers of cars registered before 1985 have a significantly higher probability of being killed or seriously injured than drivers of cars registered in 2000-2005 (odds ratio: 1.80; 95% confidence interval: 1.61; 2.01). In single-car crashes, the improvement in crashworthiness is very slight (odds ratio: 1.04; 95% confidence interval: 0.93; 1.16). On the other hand, we have also found a significant worsening in aggressivity in two-car crashes: the driver of the average car has a significantly lower probability of being killed or seriously injured when crashing into a car registered before 1985, than when crashing into a car registered in 2000-2005 (odds ratio: 0.52; 95% confidence interval: 0.45; 0.60). Our results are consistent with a large amount of previous research that has reported significant improvements in the protection of car occupants. They also add to some recent studies that have found a worsening in the aggressivity of modern cars. This trend may be reflecting the impact of differences in masses and travel speeds, as well as the influence of consumer choices. The precise reasons have to be investigated. Also, the causes have to be found for so large a discrepancy between crashworthiness in single and two-car crashes.

Quasi-induced exposure: the choice of exposure metrics.

The quasi-induced exposure method is widely used to estimate exposure and risks of different groups of drivers and vehicles. Essentially, this method assumes that non-at-fault or passive parties in two-vehicle collisions represent a random sample of the populations on the road. Most previous works have used the whole sample of collisions to estimate exposure. There has been some concern about possible biases in quasi-induced estimates. In this paper, we argue that (1) biases are mainly due to differences in accident avoidance abilities, speeds and injury risks, and (2) because the influence of these three factors on the probability of being non-at-fault is not the same for every crash type, differences may arise among non-at-fault populations, in which case some crash types would provide a more accurate estimate of exposure than others. We explore the direction of biases due to speed, accident avoidance ability and injury risk in four accident types: accidents between vehicles travelling on different lanes in two-way, two-lane undivided roads; accidents between vehicles travelling on different lanes on multilane roads; intersection accidents; and accidents between vehicles travelling on the same lane. Our analysis shows that more research would be needed concerning the effect of speed on head-on crashes on undivided roads, and crashes on multilane roads.

[Predictive factors of massive intestinal necrosis in acute mesenteric ischemia]. / Factores predictivos de necrosis masiva intestinal en la isquemia mesentérica aguda.

INTRODUCTION: Suspicion of intestinal necrosis in patients with mesenteric ischemia is mandatory in surgery. Many patients develop massive necrosis after open surgery. However, in some frail, elderly patients, preoperative prediction of massive intestinal necrosis could avoid an unnecessary laparotomy. The aim of this study was to assess predictive factors of massive intestinal necrosis in acute mesenteric ischemia. PATIENTS AND METHOD: We retrospectively evaluated a consecutive sample of 155 patients, 88 men and 67 women, with a mean age of 71.9 years (SD +/- 13.6), who underwent surgery for acute mesenteric ischemia in our institution from 1990 to 2004. Age, sex, clinical features, laboratory findings, and delay to surgery were recorded and assessed as possible risk factors for massive intestinal necrosis. A logistic regression model was used to identify independent prognostic factors. RESULTS: Of the 155 patients, massive intestinal necrosis was recorded in 48 (31%; 95% CI: 23.4-38.6). A statistically significant association was found between massive intestinal necrosis and age (p = 0.04), previous digoxin use (p = 0.01), shock (p = 0.009), hemoconcentration (hemoglobin levels > 16 g/dL) (p = 0.02), hyperamylasemia (p < 0.001), acidosis (p = 0.012), and alkalosis (p = 0.048). Multiple stepwise logistic regression analysis identified three independent prognostic factors that were significantly associated with a higher risk of massive intestinal necrosis: shock (OR = 3.4; 95% CI: 1.1-10), hemoconcentration (OR = 6; 95% CI: 1.6-22.8), and hyperamylasemia (OR = 4.2; 95% CI: 1.5-12.2). CONCLUSIONS: Massive intestinal necrosis can be observed in at least 25% of patients undergoing surgery for acute mesenteric ischemia. Within the limitations of a retrospective study, the variables of shock, hemoconcentration and elevated serum amylase levels may be considered as independent predictive factors of fatal necrosis of the bowel.

Factores predictivos de necrosis masiva intestinal en la isquemia mesentérica aguda / Predictive factors of massive intestinal necrosis in acute mesenteric ischemia

Introducción. La sospecha de necrosis intestinal en un paciente con isquemia mesentérica es indicación absoluta de cirugía. Una vez realizada la laparotomía, muchos pacientes presentan necrosis masiva. En un determinado tipo de pacientes, muy ancianos y debilitados, su reconocimiento preoperatorio podría evitar la laparotomía. Presentamos un estudio que analiza los factores preoperatorios relacionados con necrosis masiva. Pacientes y método. Se estudió retrospectivamente a 155 pacientes, 88 varones y 67 mujeres, con una media de edad de 71,9 ± 13,6 (intervalo de confianza [IC] del 95%, 69,7-74) años, intervenidos quirúrgicamente por isquemia mesentérica entre 1990 y 2004 en nuestra institución. Se recogieron las variables demográficas, antecedentes personales, síntomas clínicos, tiempo de espera y hallazgos de laboratorio y se analizó si se relacionaban o no con necrosis masiva intestinal. Para identificar los factores pronósticos independientes se utilizó un modelo de regresión logística. Resultados. De los 155 pacientes, 48 (31%) presentaron necrosis masiva (IC del 95%, 23,4-38,6). Se relacionaron con la necrosis masiva las variables edad (p = 0,04), ingesta previa de digoxina (p = 0,01), shock (p = 0,009), hemoconcentración (Hb > 16 g%; p = 0,02), hiperamilasemia (p 16 g/dl (OR = 6; IC del 95%, 1,6-22,8) e hiperamilasemia (OR = 4,2; IC del 95%, 1,5-12,2). Conclusiones. Entre los pacientes intervenidos por isquemia mesentérica, como mínimo un 25% presenta necrosis masiva. Con las limitaciones propias de un estudio retrospectivo, se puede concluir que la tríada shock, hemoconcentración e hiperamilasemia constituye un buen predictor de necrosis masiva (AU)

Introduction. Suspicion of intestinal necrosis in patients with mesenteric ischemia is mandatory in surgery. Many patients develop massive necrosis after open surgery. However, in some frail, elderly patients, preoperative prediction of massive intestinal necrosis could avoid an unnecessary laparotomy. The aim of this study was to assess predictive factors of massive intestinal necrosis in acute mesenteric ischemia. Patients and method. We retrospectively evaluated a consecutive sample of 155 patients, 88 men and 67 women, with a mean age of 71.9 years (SD ± 13.6), who underwent surgery for acute mesenteric ischemia in our institution from 1990 to 2004. Age, sex, clinical features, laboratory findings, and delay to surgery were recorded and assessed as possible risk factors for massive intestinal necrosis. A logistic regression model was used to identify independent prognostic factors. Results. Of the 155 patients, massive intestinal necrosis was recorded in 48 (31%; 95% CI: 23.4-38.6). A statistically significant association was found between massive intestinal necrosis and age (p = 0.04), previous digoxin use (p = 0.01), shock (p = 0.009), hemoconcentration (hemoglobin levels > 16 g/dL) (p = 0.02), hyperamylasemia (p < 0.001), acidosis (p = 0.012), and alkalosis (p = 0.048). Multiple stepwise logistic regression analysis identified three independent prognostic factors that were significantly associated with a higher risk of massive intestinal necrosis: shock (OR = 3.4; 95% CI: 1.1-10), hemoconcentration (OR = 6; 95% CI: 1.6-22.8), and hyperamylasemia (OR = 4.2; 95% CI: 1.5-12.2). Conclusions. Massive intestinal necrosis can be observed in at least 25% of patients undergoing surgery for acute mesenteric ischemia. Within the limitations of a retrospective study, the variables of shock, hemoconcentration and elevated serum amylase levels may be considered as independent predictive factors of fatal necrosis of the bowel (AU)

Analysis of the factors related to the decision of restoring intestinal continuity after Hartmann's procedure.

BACKGROUND AND AIMS: Hartmann's operation is widely used for the surgical treatment of complicated left colonic disease. However, many patients never undergo reanastomosis. This study analyzes the factors related to the decision of restoring intestinal continuity. MATERIALS AND METHODS: Between 1997 and 2004, 162 patients underwent Hartmann's operation in our institution. Age, sex, anesthetic risk evaluation (ASA score), underlying disorder (neoplastic vs non-neoplastic), prevalence of colonic reconstruction, as well as postoperative length of hospital stay, perioperative mortality and complications due to the latter procedure were analyzed. Long-term survival was also recorded. RESULTS: Patients' mean age was 68.7 years (SD +/- 14.9); 104 were men (64.2%) and 58 were women (35.8%). Hartmann's operation mortality was 20.4%. Forty-two colonic continuity restorations were performed (25.9%). Mean time until reconstruction procedure was 13.3 months. There were no deaths (mortality 0%), but 23 cases suffered complications (54.8%). No suture dehiscence was observed. Estimated probability of being alive 1, 3, and 5 years after the initial operation was 64.1, 50.4, and 44.3%, respectively. Significant univariate predictors of reversal were male sex (p = 0.003), non-neoplastic disorder (p = 0.004), younger age (p = 0.001) and lower anesthetic risk (p = 0.009). In the multivariate analysis, independent predictive factors were age (OR: 0.94; 95% CI: 0.91-0.98), non-neoplastic disorder (OR: 0.16; 95% CI: 0.05-0.45), and lower anesthetic risk (OR: 0.22; 95% CI: 0.08-0.58). CONCLUSIONS: Hartmann's procedure implies a high mortality and a low percentage of restoration of intestinal continuity. In selected patients, closure of Hartmann's colostomy is a safe procedure, but has a significant morbidity.

Cirugía de la isquemia mesentérica aguda en pacientes octogenarios / Surgery for acute mesenteric ischemia in octogenarians

Introducción: la isquemia mesentérica conlleva una alta mortalidad, especialmente en los pacientes ancianos. En este estudio se compara los resultados de la cirugía de la isquemia mesentérica en octogenarios con los de los no octogenarios. Material y métodos: se estudió a 132 pacientes intervenidos consecutivamente por isquemia mesentérica entre 1988 y 2002 en un servicio de cirugía general. Se establecieron 2 grupos en función de la edad: 80 o más años y menores de 80 años. Se analizó en cada grupo el sexo, la presentación del cuadro en forma de shock y la etiología de la isquemia, así como diferencias entre ambos grupos en cuanto a mortalidad inmediata por isquemia masiva, mortalidad operatoria, estancia y supervivencia a largo plazo, mediante un seguimiento predefinido. Resultados: la población octogenaria fue de 35 pacientes, 17 varones y 18 mujeres (edad media ± desviación estándar, 85,4 ± 4,3 años). Los menores de 80 años fueron 97, 56 varones y 41 mujeres (edad media, 67,1 ± 12,6 años). Ambos grupos fueron similares en cuanto al sexo, cuadro de shock al inicio y etiología de la isquemia. No se encontraron diferencias estadísticamente significativas en cuanto a mortalidad inmediata por isquemia masiva (el 40,0% octogenarios, el 26,8% no octogenarios), así como en mortalidad operatoria (el 74,3% octogenarios, el 61,9% no octogenarios). Tampoco se encontraron diferencias estadísticamente significativas en cuanto a supervivencia global, supervivencia a largo plazo tras ser dado de alta el paciente y estancia mediana. Conclusiones: se ha de considerar la cirugía de la isquemia mesentérica en el paciente mayor de 80 años una opción terapéutica válida en pacientes seleccionados

Introduction and objective: acute mesenteric ischemia carries high mortality, especially in old patients. The present study compared the results of surgery in octogenarian patients with those in non-octogenarian patients. Material and methods: one-hundred and thirty-two consecutive patients who underwent surgery for acute mesenteric ischemia between 1988 and 2002 in our general surgery department were studied. Patients were divided into two groups based on age: those aged 80 years old or older and those aged less than 80 years old. Gender, shock as the initial clinical presentation and the etiology of the ischemia were evaluated. Early mortality due to massive intestinal ischemia, operative mortality, length of hospital stay, and overall and long-term survival were recorded and analysed in both groups through a follow-up analysis. Results: the octogenarian group comprised 35 patients (17 men and 18 women) with a mean age of 85.4 ± 4.3 years). The non-octogenarian group included 97 patients (56 men and 41 women), with a mean age of 67.1 ± 12.6 years. Both groups were similar in sex, initial clinical presentation as shock, and ischemic etiology. There were no statistically significant differences between octogenarian and non-octogenarian patients with regard to immediate mortality due to massive ischemia (40.0% in the octogenarian group versus 26.8% in the non-octogenarian group), or in operative mortality (74.3% versus 61.9%, respectively). Likewise, overall survival, long-term survival, and median length of hospital stay showed no statistically significant differences between the two groups. Conclusions: surgical treatment for acute mesenteric ischemia should be considered a valid therapeutic option in octogenarian patients

Músculo pectoral tercero / Tertius pectoralis muscle

Se presenta una variación muscular, poco frecuente, de un fascículo independiente del músculo pectoral mayor, con origen en el tórax e inserción en el miembro superior. El fascículo muscular, de presentación bilateral, denominado músculo pectoral tercero, ha sido encontrado en dos individuos adultos, de sexo masculino, disecados durante las clases de anatomía topográfica, en la Facultad de Medicina de la Universidad de La Frontera