Risk factors for anastomotic leakage following total or subtotal colectomy

Introduction: A higher rate of anastomotic leakage (AL) is reported after ileosigmoid anastomosis (ISA) or ileorectal anastomosis (IRA) in total or subtotal colectomy (TSC) compared with colonic or colorectal anastomosis. Themain aimof the present studywas to assess potential risk factors for AL after ISA or IRA and to investigate determinants of morbidity. Methods: We identified 180 consecutive patients in a prospective referral, single center database, in which 83 of the patients underwent TSC with ISA or IRA. Data regarding the clinical characteristics, surgical treatment, and outcome were assessed to determine their association with the cumulative incidence of AL and surgical morbidity. Results: Ileosigmoid anastomosis was performed in 51 of the patients (61.5%) and IRA in 32 patients (38.6%). The cumulative incidence of ALwas 15.6% (13 of 83 patients). A higher AL rate was found in patients under 50 years-old (p=0.038), in the electivelaparoscopic approach subgroup (p=0.049), and patients in the inflammatory bowel disease (IBD) subgroup (p=0.009). Furthermore, 14 patients (16.9%) had morbidity classified as Clavien-Dindo ≥ IIIA. Discussion: A relatively high incidence of AL after TSC was observed in a relatively safe surgical procedure. Our findings suggest that the risk of AL may be higher in IBD patients. According to our results, identifying risk factors prior to surgerymay improve short-term outcomes. (AU)

Cirugía endoscópica para cierre de fístula de líquido cefalorraquídeo en la base de cráneo: experiencia de dos hospitales en Bogotá, 2012-2018 / Endoscopic surgery for closure of cerebrospinal fluid fistula at the base of the skull: experience of two hospitals in Bogotá, 2012-2018

Objetivo: describir la experiencia en el manejo quirúrgico de cierre de fístula de líquido cefalorraquídeo en base de cráneo, mediante la técnica endoscópica transnasal en dos hospitales de Bogotá. Diseño: estudio observacional descriptivo. Metodología: se realizó un estudio descriptivo con recolección retrospectiva, se evaluaron pacientes con diagnóstico de fístula de líquido cefalorraquídeo manejados con endoscópica transnasal, para determinar complicaciones, manifestaciones clínicas, hallazgos imagenológicos, morbilidad y recidiva. Resultados: se incluyeron 19 casos de fístula de LCR manejados con técnica endoscópica transnasal. El 63% de los pacientes fueron de sexo femenino, con una mediana de edad de 40 años (RIQ: 31 - 52), los síntomas más frecuentes fueron rinoliquia (73%), cefalea (42%) y me- ningitis (21%). La etiología idiopática se presentó en la mayoría de los casos (47%) seguida de origen tumoral (31%). El cierre fue exitoso en el 94% de los pacientes. El 94% de los pacientes no presentó complicaciones, solo en un caso se reportó meningitis. Conclusión: El abordaje endoscópico para el cierre de fístulas de líquido cefalorraquídeo ha demostrado ser una opción de tratamiento adecuado con buen desempeño clínico y baja recidiva de las lesiones.

Objectives: to describe the experience in the surgical management of cerebrospinal fluid fistula by the transnasal endoscopic technique in the Otorhinolaryngology Service in two tertiary hospitals in Bogotá. Desing: Descriptive study. Methods: a descriptive study with retrospective collection was carried out, patients with a diagnosis of cerebrospinal fluid fistula managed with transnasal endoscopy were evaluated to determine complications, clinical manifestations, imaging findings, morbidity and recurrence. Results: We included 19 cases of CSF fistula managed with transnasal endoscopic technique during between the years 2012 to 2018. 63% were female, median age of 40 years (RIQ: 31 - 52), the most frequent symptoms were rhinoliquia (73%), headache (42%) and meningitis (21%). The idiopathic etiology was the majority (47%). The closure was successful in 94% of patients, 94% of the patients did not present complications, one case reported meningitis. Conclusions: The endoscopic approach for the closure of cerebrospinal fluid fistulas has proven to be an adequate option with good clinical outcomes and low recurrence.

Beetle (Ulomoides dermestoides) fat improves diabetes: effect on liver and pancreatic architecture and on PPARgamma expression

Ulomoides dermestoides is a beetle traditionally consumed to treat diabetes. In this study, we performed a composition analysis of U. dermestoides to obtain the principal fractions, which were used to assess the effect on glycemia, liver and pancreatic architecture, and PPARγ and GLUT4 expression. Normal mice and alloxan-induced diabetic mice were administered fractions of chitin, protein or fat, and the acute hypoglycemic effect was evaluated. A subacute study involving daily administration of these fractions to diabetic mice was also performed over 30 days, after which the liver and pancreas were processed by conventional histological techniques and stained with hematoxylin and eosin to evaluate morphological changes. The most active fraction, the fat fraction, was analyzed by gas chromatography-mass spectrometry (GC-MS), and PPARγ and GLUT4 mRNA expressions were determined in 3T3-L1 adipocytes. The protein and fat fractions exhibited hypoglycemic effects in the acute as well as in the 30-day study. Only the fat fraction led to elevated insulin levels and reduced glycemia, as well as lower intake of water and food. In the liver, we observed recovery of close hepatic cords in the central lobule vein following treatment with the fat fraction, while in the pancreas there was an increased density and percentage of islets and number of cells per islet, suggesting cellular regeneration. The GC-MS analysis of fat revealed three fatty acids as the major components. Finally, increased expression of PPARγ and GLUT4 was observed in 3T3-L1 adipocytes, indicating an antidiabetic effect.