First day postoperative values of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein as complication predictors following gastric oncologic surgery.

INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) level are simple laboratory test parameters that can provide us with information on the inflammatory status of the organism. CRP has been shown to be a predictor of postoperative complications, whereas NLR and PLR have shown greater usefulness in the prognosis of oncologic pathologies. AIM: To evaluate the associations of NLR and PLR with postoperative complications following gastric oncologic surgery and compare them with CRP. MATERIALS AND METHODS: A prospective study was conducted on 66 patients that underwent oncologic gastric surgery, within the time frame of January 2014 and March 2019. The variables analyzed were sociodemographic data, surgical technique, tumor extension, and NLR, PLR, and CRP levels from the first day after surgery, as well as postoperative complications. RESULTS: Seventeen patients (25.8%) presented with grade III-V complications, utilizing the Clavien-Dindo classification system. Mean NLR value was 11.30 and was associated with the appearance of major complications, with statistical significance (p = 0.009). Mean PLR was266.05 and was not significantly associated with complications (p = 0.149). Fifty-four patients had a mean CRP level of 143.24 and it was not related to the appearance of major complications (p = 0.164). CONCLUSIONS: The NLR is a simple and inexpensive parameter, which measured on postoperative day one, predicted the appearance of major postoperative complications in our study sample and appears to be a better predictive parameter than CRP for said complications. Further studies to confirm that trend need to be carried out.

First day postoperative values of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein as complication predictors following gastric oncologic surgery. / Valor del Ratio Neutrófilo-Linfocito, Ratio Plaqueta-Linfocito y Proteína C Reactiva del primer día como predictores de complicaciones postoperatorias tras cirugía oncológica gástrica.

INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) level are simple laboratory test parameters that can provide us with information on the inflammatory status of the organism. CRP has been shown to be a predictor of postoperative complications, whereas NLR and PLR have shown greater usefulness in the prognosis of oncologic pathologies. AIM: To evaluate the associations of NLR and PLR with postoperative complications following gastric oncologic surgery and compare them with CRP. MATERIALS AND METHODS: A prospective study was conducted on 66 patients that underwent oncologic gastric surgery, within the time frame of January 2014 and March 2019. The variables analyzed were sociodemographic data, surgical technique, tumor extension, and NLR, PLR, and CRP levels from the first day after surgery, as well as postoperative complications. RESULTS: Seventeen patients (25.8%) presented with grade III-V complications, utilizing the Clavien-Dindo classification system. Mean NLR value was 11.30 and was associated with the appearance of major complications, with statistical significance (p = 0.009). Mean PLR was 266.05 and was not significantly associated with complications (p = 0.149). Fifty-four patients had a mean CRP level of 143.24 and it was not related to the appearance of major complications (p = 0.164). CONCLUSIONS: The NLR is a simple and inexpensive parameter, which measured on postoperative day one, predicted the appearance of major postoperative complications in our study sample and appears to be a better predictive parameter than CRP for said complications. Further studies to confirm that trend need to be carried out.

Absceso glúteo por finegoldia magna en un paciente diabético / Gluteal Abscess due to Finegoldia Magna in a Patient with Diabetes

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Chronic infrarenal aortic occlusion: predictors of surgical outcome in patients undergoing aortobifemoral bypass reconstruction.

AIM: Chronic infrarenal aortic occlusion is relatively infrequent. Aortobifemoral bypass has been the traditional treatment. The aim of this study is to evaluate the prognostic factors related to long-term survival and patency rates of chronic infrarenal aortic occlusion after aortobifemoral bypass. METHODS: From January 1984 to December 2004, we performed consecutively 278 aortobifemoral for aortoiliac occlusive disease. Of these, 67 (24%) patients, 62 men (92.5%), presented with ischemia due to aortic occlusion. The log-Rank test was used to determine predictors of long-term survival and graft patency in a univariate analysis. With a model of proportional-hazards Cox regression the independent prognostic factors of long-term survival were determined. RESULTS: The postoperative mortality was 8.9%. The estimated cumulative long-term survival for aortic occlusion patients was 56% and 38% at 10 and 20 years, respectively. The estimated cumulative primary patency was 79% at 10 years and 40% at 20 years. The 20-year limb survival rate was 86%. There was no statistical difference in long-term survival and graft patency between TASCIC-D and IRAO. Previous coronary disease (P=0.008) and postoperative complications (P=0.017) significantly decreased the survival of patients. Both variables retained significance on multivariable analysis. The presence of chronic renal failure significantly decreased the patency of the aortobifemoral bypass (P=0.013). CONCLUSION: Aortobifemoral bypass for chronic infrarenal aortic occlusion has an excellent primary patency rate with reasonable morbi-mortality. The presence of concomitant coronary disease and postoperative complications are prognostic factors of long-term survival.

Upper intestinal obstruction due to inverted intraduodenal diverticulum.

Inverted intraduodenal diverticulum is a rare congenital abnormality usually arising near the ampulla of Vater. We describe a case of an inverted duodenal diverticulum in a patient that presented with an upper recurrent intestinal obstruction that required surgery. Recognition of the entity and its anatomic relationships to the ampulla of Vater is essential to the prevention of iatrogenic complications. The inverted intraduodenal diverticulum must be considered in the management of upper intestinal obstruction of unclear origin.

Candida isolation in patients hospitalized on a surgical ward: significance and mortality-related factors.

BACKGROUND: Infections caused by Candida are an emerging pathology on surgical wards. The aim of the present study was to evaluate the incidence, characteristics, and predictive factors of mortality in patients colonized and/or infected by Candida spp. in this setting. METHODS: A consecutive series of 105 patients hospitalized on a general surgery ward between 2000 and 2004 were included, and 118 positive cultures for Candida were identified. The variables age, sex, previous medical history, current disease, anemia, ICU stay, type and localization of the microorganism, need for parenteral nutrition, and transfusions were recorded. The primary outcome was in-hospital mortality. A univariate analysis was performed to determine which of these variables were associated with mortality. With a logistic regression model, independent prognostic factors of mortality were determined. RESULTS: The prevalence of patients colonized and/or infected by Candida on our surgical ward was 0.98% (CI 95%: 0.79-1.17), and the incidence was 49 cases per 1,000 patient-years. Of the 105 patients in this series, 56 were men (53%) and 49 women (47%); the mean age was 63.8 years (SD +/- 15.7). Twelve patients (11.4%) had candidemia. Crude mortality was 23% (24 patients), whereas the mortality attributable to candidemia was 25% (3/12 cases). Anemia (p = 0.001); transfusions (p = 0.003), and an ICU stay (p = 0.002) were associated with mortality. Candidemia was associated with neoplasms (p = 0.02) and the infection caused by Candida parapsilosis (p = 0.04). The only independent factor related to mortality was the anemia (p = 0.028; Odds Ratio: 6.43; 95% CI: 1.23-33.73). CONCLUSIONS: Colonization and/or infection by Candida spp. in non-ICU hospitalized surgical patients implies a relative high mortality. Anemia is an independent factor for mortality.

Mesenteric venous thrombosis. Associated systemic disorders and hypercoagulability status of 21 surgical patients.

BACKGROUND/AIMS: Mesenteric venous thrombosis (MVT) is a rare condition with a challenging diagnosis. The aim of this study was to evaluate its association with systemic diseases and coagulation disorders. METHODOLOGY: Out of 132 patients operated on because of mesenteric ischemia between 1988 and 2002, all patients with a documented MVT were retrospectively recorded. Epidemiological and clinical data, complications and perioperative mortality were analyzed. RESULTS: Twenty-one patients, 10 male and 11 female, had MVT. Mean age was 63.8 years (SD: +/- 20.9). Arterial hypertension (57.1%) was the most prevalent associated condition. Other associated disorders were neoplasms (3 cases), liver cirrhosis (1 case), recurrent pulmonary thromboembolism (1 case), and one or more coagulation disorders (7 cases): lupus anticoagulant (2 cases); factor V Leiden (2 cases); protein S deficiency (3 cases); antithrombin III deficiency (1 case) and disseminated intravascular coagulation (1 case). Perioperative mortality was 33.3% (7 patients). Mean survival at the end of the study was 65.73 months (EE: 13.82). Patients with a coagulation disorder had a higher survival rate than those presenting without it (p = 0.02). CONCLUSIONS: MVT is still a lethal condition with a high morbidity that could be associated to systemic disorders and hypercoagulability syndromes in more than 50% of the cases.

Perforación de intestino delgado por embolia de colesterol / Perforation of the small intestine due to cholesterol embolism

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Pacientes nonagenarios en un servicio de urgencias / Nonagenarian patients in the emergency department

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[Prognostic factors of mortality in elderly patients in the emergency department]. / Factores pronósticos de mortalidad de los ancianos en un servicio de urgencias hospitalario.

BACKGROUND: Increasing attention has been given to the elderly patients in emergency departments. However, prevalence and predictive factors of mortality in geriatric patients in emergency rooms have not been stablished. This study was conducted to analyse predictive factors associated with mortality in patients aged more than 75 years-old. METHODS: Descriptive transversal study. Data from 1003 patients aged over 75 years were recorded: biographic data, past medical history, functional capacity, acute vs chronic diseases, discharge diagnosis, emergency room stay, mortality and their causes. Bivariant and multivariant (logistic regression) analysis were performed in an attempt to establish mortality associated factors. Prevalence odds ratio (OR) and 95% confidence intervals were estimated. RESULTS: 45 patients died (4.7% IC 95%: 3.2 a 5.7). In bivariant analysis age (p = 0.008), previous heart failure (p = 0.008) or renal failure (p = 0.05), functional disability (p < 0.001), mental disorders (p < 0.001), acute diseases (p = 0.01), and the following entities: politraumatism, sepsis, respiratory failure, pneumonia, ileus, acute abdomen, and coronary artery diseases, were associated with mortality. In multivariant analysis were detected as independent prognostic factors: circulatory disorders, coronary artery diseases, sepsis, respiratory failure, and functional disability. CONCLUSIONS: Over 75 years-old patients mortality in emergency departments is more frequently associated with diagnosis of coronary heart disease, respiratory failure, sepsis and functional disability.

Adherencias postoperatorias. Estudio experimental en la rata / Postoperative adhesions: experimental study in rats

Introducción. Las adherencias postoperatorias suponen la primera causa de oclusión intestinal en pacientes operados en el mundo occidental. En su etiopatogenia se han involucrado un gran número de agentes y gestos quirúrgicos, que podrían potenciar la formación de adherencias. Objetivo. Nos propusimos estudiar la influencia de algunos de estos productos de uso habitual en cirugía. Material y método. Fueron intervenidas 130 ratas Sprague- Dawley, divididas en 11 grupos de 12 ratas cada uno, salvo el grupo control, con 10 ratas, en las que se instilaron los siguientes productos: povidona yodada, agua oxigenada, sue ro fisiológico a 37 °C, sangre autóloga, Tissucol®, Trazograf®, malla de Prolene y gasa quirúrgica, y se llevaron a cabo gestos como desperitonización de 1 cm2, manoseo de asas, además del grupo control que consistió en apertura simple y cierre de la cavidad abdominal. Todas las ratas fueron intervenidas mediante incisión de laparotomía media y fueron sacrificadas a los 60 días de esta primera intervención. Se valoraron el número de adherencias, el grosor de las mismas, la separabilidad, la vascularización, así como los órganos implicados en las adherencias, cuya cuantificación permitió definir un índice adherencial individual y para cada grupo de ratas. A continuación se analizó si existían o no diferencias significativas entre los diferentes grupos. Resultados. Se presentaron adherencias en el 63,5 por ciento de los animales intervenidos. Se objetivó que, de manera global, existían diferencias estadísticamente significativas, en cuanto a la presentación de adherencias se refiere, entre los diferentes grupos (p < 0,001). Los grupos que mayormente producían adherencias de un modo significativo fueron los compuestos por los cuerpos extraños y la povidona yodada, que presentaron diferencias estadísticamente significativas, en cuanto al índice adherencial obtenido, prácticamente con cada uno del resto de los grupos estudiados. Conclusiones. Con independencia de que se considere la determinante susceptibilidad individual en la formación adherencial, se recomienda limitar el uso de determinados productos en la cavidad abdominal en función de su potencial adhesiogénico (AU)

Factores pronósticos de mortalidad de los ancianos en un servicio de urgencias hospitalario / Prognostic factors of mortality in elderle patients in the emergency department

Fundamento: Con el progresivo envejecimiento de la población el proceso asistencial del anciano en el servicio de urgencias ha adquirido un creciente interés. No obstante, la mortalidad de la población geriátrica en el servicio de urgencias y sus factores pronósticos han sido poco estudiados. Se analizan los factores relacionados con la mortalidad de los pacientes mayores de 75 años en un servicio de urgencias hospitalario. Pacientes y método: Estudio descriptivo transversal, en el que se estudiaron 1003 pacientes consecutivos con edad superior a 75 años. Se recogieron los datos de filiación, antecedentes personales, capacidad funcional, nivel de patología, diagnóstico de alta, tiempo de estancia y mortalidad así como su causa. Se realizó un análisis bivariante y multivariante (regresión logística) para determinar los factores asociados con la mortalidad. Se utilizó como medida de riesgo la razón de Odds (OR), que se estimó con su IC 95 porciento. Resultados: Fallecieron 45 pacientes (4,7 porciento). En el análisis bivariante la edad (p=0,008), los antecedentes de insuficiencia cardiaca (p=0,008), insuficiencia renal (p=0,05), la incapacidad funcional (p< 0,001), alteraciones mentales (p< 0,001), la patología aguda (p=0,01) y los siguientes cuadros nosológicos: politraumatismo, sepsis, insuficiencia respiratoria, neumonía, ileo intestinal, abdomen agudo y cardiopatía isquémica, se relacionaron con la mortalidad. En el análisis multivariante global se mostraron como factores pronósticos independientes de mortalidad el grupo de enfermedades circulatorias, la cardiopatía isquémica, la sepsis, la insuficiencia respiratoria y el presentar algún grado de incapacidad física. Conclusiones: La mortalidad de los pacientes ancianos en el servicio de urgencias se relaciona fundamentalmente con los diagnósticos de cardiopatía isquémica, insuficiencia respiratoria, sepsis e incapacidad física (AU)

Tumor filodes de mama. Análisis de 22 casos / Phyllodes tumor of the breast. Analysis of 22 cases

Introducción y objetivos. El tumor filodes es una neoplasia infrecuente de la mama cuyo tratamiento, en lo que se refiere a la extensión de la exéresis, es aún objeto de controversia. Se analizan los resultados obtenidos en una serie de pacientes portadoras de esta neoplasia que hemos tenido oportunidad de tratar. Pacientes y método. Entre 1986 y 1997 fueron diagnosticadas y remitidas al servicio de cirugía de nuestro centro 22 pacientes portadoras de tumor filodes de mama. Retrospectivamente, fueron analizados los datos correspondientes a edad, localización y dimensiones del tumor, así como las características histológicas de benignidad o malignidad, el tratamiento efectuado (exéresis local frente a mastectomía) y el período libre de la enfermedad tras la intervención. Resultados. La edad media fue de 48 años (rango, 36-77). El tumor se localizó más frecuentemente en los cuadrantes superoexternos (15 casos) y sus dimensiones eran inferiores a 5 cm en 7 pacientes; entre 5-10 cm en 13 pacientes y mayor de 10 cm en 2 casos. Fueron clasificados como benignos 14 nódulos y como malignos 7 casos, no pudiéndose determinar en un caso. Fueron practicadas 12 exéresis locales (11 benignos y uno maligno) y 10 mastectomías (6 malignos, 3 benignos y uno indeterminado). Solamente una paciente falleció durante el seguimiento, a los 5 meses de habérsele practicado una mastectomía. El carácter de benignidad o malignidad se relacionó con el tamaño (p = 0,03). Sin embargo, no se encontraron diferencias significativas entre la recidiva y la histología y el tratamiento efectuado (tumorectomía frente a mastectomía). Conclusiones. Los tumores filodes de mama, independientemente del tipo de exéresis practicada, presentan un pronóstico bueno a largo plazo. Se hace necesaria la realización de estudios controlados prospectivos para evaluar el tipo de cirugía ideal (AU)