Consecuencias de la lesión de Dieulafoy en cirugía gástrica / Consequences of a Dieulafoy’s lesion in gastric surgery

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Consequences of a Dieulafoy's lesion in gastric surgery.

In relation to the articles published in this journal by Valdivielso-Cortázar and Relea-Pérez, we have recently operated a patient who presented a digestive hemorrhage in immediate postoperative period due to Dieulafoy´s lesion at the mechanical gastrojejunal anastomosis.

[Long-term adverse effects on bladder filling phase in males submitted to the pelvic radiotherapy]. / EFECTOS ADVERSOS A LARGO PLAZO DE LA FASE DE LLENAGO VESICAL EN VARONES TRATADOS CON RADIOTERAPIA PÈLVICA.

OBJECTIVE: To describe and quantify the long-term adverse effects on filling phase of lower urinary tract function in males submitted to radiotherapy. METHODS: We performed a retrospective comparative study on a cohort of 99 men undergoing EBRT a mean of 4.7 years before for clinically localized prostate, rectum or colon neoplasia, and another cohort formed by 97 men over 50 years who did not undergo radiotherapy. RESULTS: Cystometric bladder capacity and bladder capacity at first voiding desire were significantly lower in the radiotherapy group. Univariate analysis showed that the radiotherapy group evinced a risk to present a diminished compliance of 3.5 times more and 9.3 times more to find stress urinary incontinence, but we did not found increased risk for detrusor overactivity. In multivariate analysis the history of radical surgery acted as a confounding factor in the risk of stress urinary incontinence, but not to suffer diminished bladder compliance. CONCLUSIONS: The main long-term adverse effect of pelvic radiotherapy on male bladder function during filling is the increased risk of low bladder compliance.

Efectos adversos a largo plazo de la fase de llenado vesical en varones tratados con radioterapia pélvica / Long-term adverse effects on bladder filling phase in males submitted to the pelvic radiotherapy

INTRODUCCIÓN: Los efectos adversos de la radioterapia externa RT sobre la función del tracto urinario inferior de los varones están pobremente estudiados. OBJETIVO: Estudiar y cuantificar los efectos a largo plazo sobre la fase de llenado en varones tratados con radioterapia. MÉTODOS: Estudio comparativo retrospectivo de una cohorte de 99 varones tratados con radioterapia externa, realizada con una media de 4,7 años antes del inicio del estudio. Los pacientes estudiados fueron sometidos a radioterapia como tratamiento del cáncer de próstata localizado, tumor de colon y tumor de recto. Se utilizó como grupo control una cohorte de 97 hombres mayores de 50 años que no habían sido sometidos a tratamiento radioterápico. RESULTADOS: La capacidad vesical cistomanométrica y en el momento del primer deseo miccional fueron significativamente menores en el grupo tratado con radioterapia. El análisis univariante mostró una disminución de la acomodación vesical 3,5 veces mayor en el grupo tratado con radioterapia y un aumento del riesgo para desarrollar incontinencia de esfuerzo de 9,3 veces. No se encontraron diferencias en el riesgo de hiperactividad del detrusor. En el análisis multivariante la existencia de antecedentes de cirugía radical pelviana fue un factor de confusión para el desarrollo de incontinencia urinaria de esfuerzo, no siéndolo para la disminución de la acomodación vesical. CONCLUSIONES: El principal efecto adverso que se produce a largo plazo después del tratamiento con radioterapia pélvica es la disminución de la acomodación vesical durante la fase de llenado. El tratamiento con RT adyuvante produce alteraciones urinarias a largo plazo

OBJECTIVE: To describe and quantify the long-term adverse effects on filling phase of lower urinary tract function in males submitted to radiotherapy. METHODS: We performed a retrospective comparative study on a cohort of 99 men undergoing EBRT a mean of 4.7 years before for clinically localized prostate, rectum or colon neoplasia, and another cohort formed by 97 men over 50 years who did not undergo radiotherapy. RESULTS: Cystometric bladder capacity and bladder capacity at first voiding desire were significantly lower in the radiotherapy group. Univariate analysis showed that the radiotherapy group evinced a risk to present a diminished compliance of 3.5 times more and 9.3 times more to find stress urinary incontinence, but we did not found increased risk for detrusor overactivity. In multivariate analysis the history of radical surgery acted as a confounding factor in the risk of stress urinary incontinence, but not to suffer diminished bladder compliance. CONCLUSIONS: The main long-term adverse effect of pelvic radiotherapy on male bladder function during filling is the increased risk of low bladder compliance

Papel de los micro-RNA en el cribado del cáncer colorrectal / Role of micro-RNA in colorectal cancer screening

Los micro-RNAs son responsables de la regulación de múltiples procesos biológicos de índole metabólica, de proliferación, de diferenciación, de apoptosis, del desarrollo y de la oncogénesis. En la carcinogénesis, los micro-RNA pueden ejercer su función a través de la alteración de los genes supresores de tumores o mediante la interacción con los oncogenes. Se ha determinado la presencia de diferentes micro-RNA en distintas enfermedades neoplásicas como cáncer de colon, próstata, mama, estómago, páncreas, pulmón, etc. Existen datos prometedores sobre la utilidad de cuantificar los micro-RNA en diferentes fluidos orgánicos y tejidos. Se ha realizado una revisión sobre las determinaciones de los micro-RNA en el diagnóstico del cáncer colorrectal

MicroRNAs are involved in carcinogenesis through postranscriptional gene regulatory activity. These molecules are involved in various physiological and pathological functions, such as apoptosis, cell proliferation and differentiation, which indicates their functionality in carcinogenesis as tumour suppressor genes or oncogenes. Several studies have determined the presence of microRNAs in different neoplastic diseases such as colon, prostate, breast, stomach, pancreas, and lung cancer. There are promising data on the usefulness of quantifying microRNAs in different organic fluids and tissues. We have conducted a review of the determinations of microRNAs in the diagnosis of colorectal cancer

Role of micro-RNA in colorectal cancer screening.

MicroRNAs are involved in carcinogenesis through postranscriptional gene regulatory activity. These molecules are involved in various physiological and pathological functions, such as apoptosis, cell proliferation and differentiation, which indicates their functionality in carcinogenesis as tumour suppressor genes or oncogenes. Several studies have determined the presence of microRNAs in different neoplastic diseases such as colon, prostate, breast, stomach, pancreas, and lung cancer. There are promising data on the usefulness of quantifying microRNAs in different organic fluids and tissues. We have conducted a review of the determinations of microRNAs in the diagnosis of colorectal cancer.

[Tumor markers in colorectal cancer]. / Marcadores tumorales en el cáncer colorrectal.

INTRODUCTION: In 2008, colorectal cancer represented the third most commonly diagnosed tumor in Spain, and the second tumor with more deaths. Despite the new potential biomarkers in colorectal cancer, there are many challenges that need to be overcome, resulting in a need for the standardization of its determinations. DISCUSSION: The continuous advance in tumor disease knowledge makes this review a summary of the current accepted, recommended and studied tumor markers for the diagnosis and monitoring of colorectal cancer, such as fecal markers, tissue markers and serological markers, and various prognostic markers on which there are different lines of treatment in colorectal cancer. CONCLUSIONS: Oncological guidelines recommend only a minority of tumor markers for routine use, such as the study of fecal occult blood, CEA determination in the postoperative followup, microsatellite instability to identify people susceptible to hereditary nonpolyposis colorectal cáncer, and mutation of APC in the diagnosis of familial adenomatous polyposis.

Métodos radiológico-quirúrgicos para la identificación de anomalías celiaco-mesentéricas de la arteria hepática ante una duodenopancreatectomía / Radiological-surgical methods to identify celiac-mesenteric anomalies of the hepatic artery before duodenopancreatectomy

Introducción: El sistema hepático arterial presenta variaciones anatómicas en hasta un 45%. La identificación pre o intraoperatoria de estas anomalías anatómicas evitará morbilidad adicional a la realización de una duodenopancreatectomía. Rutinariamente son identificadas en el preoperatorio mediante tomografía computarizada (TC). En determinadas ocasiones no son informadas y solo se descubren durante la intervención quirúrgica. El acceso inicial retroperitoneal de la arteria mesentérica superior (AMS) evitará una intervención poco útil si existe invasión de arteria mesentérica superior, e identificará las variantes anatómicas con origen en arteria mesentérica superior. Estas anomalías adquieren importancia dado que su lesión inadvertida ocasionaría severo compromiso vascular y/o hemorragias perioperatorias. Objetivos• Analizar anomalías celiaco-mesentéricas de la arteria hepática ante una duodenopancreatectomía, mediante información de tomografía computarizada multicorte (TCMD), en régimen no protocolizado, •protocolizado y con reconstrucción multidimensional, proyección de intensidad máxima (MIP), tras acceso quirúrgico inicial a AMS. Enfermos y método Estudio restrospectivo de variables clínicas, anatomopatológicas y quirúrgicas de enfermos con (..) (AU)

Introduction: Up to 45% anatomical variations are found in hepatic arterial system. Identifying these anatomical anomalies before or during surgery would prevent additional morbidity in performing a duodenopancreatectomy. They are routinely (..) (AU)

Serum VEGF and VEGF-C values before surgery and after postoperative treatment in gastric cancer.

INTRODUCTION: Angiogenesis and lymphangiogenesis are essential processes for the formation of blood and lymphatic vessels that allow tumour growth and spread. The binding of VEGF and VEGF-C factors with their receptors (VEGFR2, VEGFR3) in endothelial cells triggers signals that regulate these processes. We compared preoperative serum VEGF and VEGF-C levels with samples obtained after completion of surgery and adjuvant treatment in patients with gastric cancer. In addition, we determined the prognostic value and relationship to survival of serum VEGF and VEGF-C levels. METHODS: We used a prospective cohort study of 59 gastric cancer patients who underwent surgery. Serum VEGF and VEGF-C were measured by enzyme-linked immunosorbent assay (ELISA) the day before surgery and 6 months later, after completion of adjuvant treatment. RESULTS: Serum VEGF values decreased after treatment in patients with resectable tumours (mean ± SD) (405.42 ± 298.38 vs. 306.38 ± 212.47 pg/ml; p < 0.01), poorly differentiated and undifferentiated tumours (G3, G4) (438 ± 339.71 vs. 322.47 ± 210.71 pg/ml; p = 0.01), locally advanced gastric tumours (T4 stage) (424.27 ± 323.08 vs. 333.62 ± 221.72 pg/ml; p = 0.03) and tumours with a greater number of involved regional lymph nodes (N3) (442.38 ± 311.52 vs. 337.4 ± 203.64 pg/ml; p = 0.04). Serum preoperative VEGF values over 761 pg/ml were associated with shorter patient survival. The mean overall survival time for patients with serum VEGF levels higher than 761 pg/ml was 7 ± 2.99 months (95 % CI 1.14-12.86) while for patients with serum VEGF levels of less than 761 pg/ml was 21.18 ± 2.88 (95 % CI 15.54-26.83) The mean disease-specific survival time for patients with serum VEGF levels higher than 761 pg/ml was 6.25 ± 2.53 months (95 % CI 1.29-11.21) while for patients with serum VEGF levels of less than 761 pg/ml was 27.57 ± 3.45 (95 % CI 20.80-34.35). Multivariate analysis identified preoperative serum VEGF levels as an independent prognostic factor (HR = 0.144; p = 0.03). CONCLUSIONS: Serum VEGF levels decreased after the completion of treatment in patients with resected tumours, suggesting VEGF tracking may be useful in monitoring progression. Preoperative measurement of serum VEGF may help us identify patients with a poor prognosis.

[Radiological-surgical methods to identify celiac-mesenteric anomalies of the hepatic artery before duodenopancreatectomy]. / Métodos radiológico-quirúrgicos para la identificación de anomalías celiaco-mesentéricas de la arteria hepática ante una duodenopancreatectomía.

INTRODUCTION: Up to 45% anatomical variations are found in hepatic arterial system. Identifying these anatomical anomalies before or during surgery would prevent additional morbidity in performing a duodenopancreatectomy. They are routinely identified before surgery using CT imaging, but on certain occasions they are not reported and are only discovered during the surgical operation. The initial retroperitoneal access by the superior mesenteric artery (SMA) will avoid a fairly useless intervention if there is superior mesenteric artery invasion, and will identify the anatomical variations originating in the superior mesenteric artery. These anomalies acquire importance in that their unnoticed injury could lead to severe vascular compromise and/or perioperative bleeding. OBJECTIVES: To analyse celiac-mesenteric anomalies of the hepatic artery before duodenopancreatectomy using the information from multidetector computed tomography (MDCT) using a non-standardised method, a standardised method with multidimensional reconstruction, and maximum intensity projection (MIP), after initial surgical access to the SMA. PATIENTS AND METHODS: A retrospective study of the clinical, histopathological and surgical variables was conducted on patients with an indication for duodenopancreatectomy in our Department from 2008 until April 2010. A study was performed on the reports made after image acquisition by MDCT. A blind, three-dimensional, MIP reconstruction was performed on all the patients to identify arterial anomalies. A description is given of hepatic artery anomalies after initial access to the SMA. RESULTS: A total of 61 patients were included in the study. The mean age was 65 ± 11 years, with 33 (54%) males and 28 (46%) females. Vascular anomalies, right hepatic artery (RHA) (SMA) substitute (subst), 5 (8%); RHA (SMA) accessory (acc), 4 (7%); left hepatic artery (LHA) (left gastric artery) (LGA) acc 3 (5%); common hepatic artery (CHA) (SMA) subst 3 (5%); RHA (SMA) acc+LHA (LGA) acc2 (3%); CHA (aorta) subst, 1 (2%); RHA+RGA+2 LHA (celiac trunk), 1 (2%); and CHA (SMA)+LHA (LGA) acc. CONCLUSION: On being able to identify arterial anomalies with a mixture of preoperative radiological and methodological criteria, with three-dimensional reconstruction, MIP, and initially performing a dissection of the superior mesenteric artery could avoid duodenopancreatectomies that may not benefit the patient and compromise bleeding.

Idiopathic thrombosis of the superficial scrotal veins (Mondor's disease) during the postoperative period of an umbilical herniorraphy.

OBJECTIVE: Mondor's disease is a superficial thrombophlebitis and usually occurs in the anterior and lateral chest. The scrotal vein thrombosis is a fairly rare disease. METHODS: Thirty-four year old male who consulted for inguinal tumor and pain in the postoperative period of an umbilical hernia repair, which resulted in a subsequent scrotal vein thrombosis treated conservatively. RESULTS: It was resolved with conservative treatment, with recanalization of the scrotal veins. CONCLUSION: Mondor's disease is a rare entity, related to multiple etiological factors. The diagnosis is made easily with Doppler ultrasound and most resolve with conservative treatment.

Trombosis idiopática de las venas superficiales del escroto. "Enfermedad de mondor escrotal" en el postoperatorio de una herniorrafia umbilical / Idiopathic thrombosis of the superficial scrotal veins (Mondor's disease) during the postoperative period of an umbilical herniorraphy

OBJETIVO: La enfermedad de Mondor es una tromboflebitis superficial que suele darse en la cara anterior y lateral del tórax. La trombosis de las venas escrotales es una patología bastante infrecuente. MÉTODOS: Paciente varón de 34 años de edad que consultó por molestias y sensación de bulto en la ingle en el postoperatorio de una herniorrafia umbilical, que resultó en una trombosis de las venas escrotales posteriores tratado de forma conservadora. RESULTADOS: Se resolvió con tratamiento conservador, con recanalización de las venas escrotales. CONCLUSIÓN: La enfermedad de Mondor es una entidad muy poco frecuente, relacionada con múltiples factores etiológicos cuyo diagnóstico se realiza fácilmente con ecodoppler y que en su mayoría se resuelve con tratamiento conservador (AU)

OBJECTIVE: Mondor’s disease is a superficial thrombophlebitis and usually occurs in theanterior and lateral chest. The scrotal vein thrombosis is a fairly rare disease. METHODS: Thirty-four year old male who consulted for inguinal tumor andpain in the postoperative period of an umbilical hernia repair, which resulted in a subsequent scrotal vein thrombosis treated conservatively. RESULTS: It was resolved with conservative treatment, with recanalization of the scrotalveins. CONCLUSION: Mondor’s disease is a rare entity, related to multiple etiological factors. The diagnosis is made easily with Doppler ultrasound and most resolve withconservative treatment (AU)

Delayed intestinal obstruction due to posttraumatic diaphragmatic hernia.

BACKGROUND: Diaphragmatic rupture can be missed during trauma diagnosis. Different pressures between the thorax and the abdomen allow the abdominal viscera to herniate into the chest cavity. Cardiorespiratory and abdominal symptoms may appear later due to passive compression and incarceration, respectively. CLINICAL CASE: We report the case of a 52-year-old female with abdominal pain and vomiting. Chest x-ray demonstrated an elevation of the right hemidiaphragm, and computed tomography showed herniation of small bowel and colon into the chest cavity with dilated small bowel due to a diaphragmatic hernia. CONCLUSIONS: History of traumatic events should be considered with high suspicion in the diagnostic process to avoid delayed diagnosis of this condition. The nonspecific symptoms of this condition often lead the patient to consult different specialists. A multidisciplinary approach is required and aimed at preventing an unnecessary increase of morbidity and mortality.

Merkel cell carcinoma: case report and literature review.

BACKGROUND: Merkel cell carcinoma is an aggressive neuroendocrine cell carcinoma arising in the epidermis of patients aged >60 years. This lesion is found in sun-exposed areas and presents as a small violet raised nodule. It is usually painless and rapidly growing. Although its clinical presentation and characteristic histology are usually sufficient, immunohistochemical features are helpful in making an accurate diagnosis. CLINICAL CASE: We present the case of a 62-year-old male with epidermoid carcinoma of the lung who was treated with surgery and local radiation for 2 months. He presented a painless 8-cm subcutaneous mass of some weeks of evolution, without inflammatory signs. Computerized tomography demonstrated a mass of probable lymph node origin. Fine-needle aspiration biopsy (FNAB) reported malignant cells and excisional surgery of the mass was performed, revealing a subcutaneous Merkel cell carcinoma. CONCLUSIONS: Merkel cell carcinoma is a rare entity that develops in mature patients, often in sun-exposed areas, and presents cutaneous injury in intact skin. Definitive diagnosis is done using immunohistochemistry.