Perioperative and oncologic outcomes of interval colectomy performed by acute care surgeons after stenting as a bridge to surgery for left-sided malignant colonic obstruction are non-inferior to the outcomes of colorectal surgeons in the elective setting: single center experience.

PURPOSE: To analyze if perioperative and oncologic outcomes with stenting as a bridge to surgery (SEMS-BS) and interval colectomy performed by acute care surgeons for left-sided occlusive colonic neoplasms (LSCON) are non-inferior to those obtained by colorectal surgeons for non-occlusive tumors of the same location in the full-elective context. METHODS: From January 2011 to January 2021, patients with LSCON at University Regional Hospital in Málaga (Spain) were directed to a SEMS-BS strategy with an interval colectomy performed by acute care surgeons and included in the study group (SEMS-BS). The control group was formed with patients from the Colorectal Division elective surgical activity dataset, matching by ASA, stage, location and year of surgery on a ratio 1:2. Stages IV or palliative stenting were excluded. Software SPSS 23.0 was used to analyze perioperative and oncologic (defined by overall -OS- and disease free -DFS-survival) outcomes. RESULTS: SEMS-BS and control group included 56 and 98 patients, respectively. In SEMS-BS group, rates of technical/clinical failure and perforation were 5.35% (3/56), 3.57% (2/56) and 3.57% (2/56). Surgery was performed with a median interval time of 11 days (9-16). No differences between groups were observed in perioperative outcomes (laparoscopic approach, primary anastomosis rate, morbidity or mortality). As well, no statistically significant differences were observed in OS and DFS between groups, both compared globally (OS:p < 0.94; DFS:p < 0.67, respectively) or by stages I-II (OS:p < 0.78; DFS:p < 0.17) and III (OS:p < 0.86; DFS:p < 0.70). CONCLUSION: Perioperative and oncologic outcomes of a strategy with SEMS-BS for LSCON are non-inferior to those obtained in the elective setting for non-occlusive neoplasms in the same location. Technical and oncologic safety of interval colectomy performed on a semi-scheduled situation by acute care surgeons is absolutely warranted.

[Characteristics of motor behaviour in premature infants during the first months of postnatal life. A literature review]. / Rasgos característicos del comportamiento motor del niño con prematurez durante los primeros meses de vida posnatal: una revisión de la literatura.

OBJECTIVE: To describe the characteristics of motor behaviour in premature infants during the first months of postnatal life, according to the available evidence. MATERIALS AND METHODS: A systematic literature review was carried out; this method forms part of secondary studies under investigation and describes a phenomenon in detail based on primary sources of information. RESULTS: The literature search in the databases consulted yielded 7,228 articles; of these, 15 more were identified through "snowball" search strategies. At the start of the screening process, 63 eligible records were chosen based on their title and summary, and 14 were excluded because they were duplicates. A total of 49 articles were selected for a full text revision and, of these, 37 were excluded because they did not meet all the inclusion criteria. Finally, 12 articles were selected to prepare the qualitative synthesis of the present research work. CONCLUSIONS: In comparison with neonates born at term, premature infants demonstrate a particular motor repertoire, due to the immaturity of their systems; their motor behaviour follows a line of development mainly characterised by deficits in muscle tone, postural control, muscle balance, and antigravity muscle activation.

Dermatitis urticante. Un patrón de reacción cutánea / Urticarial Dermatitis. A Cutaneous Reaction Pattern

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Cases of swine flu in kidney transplant recipients in our hospital.

In late March 2009, an outbreak of influenza A virus infection was detected in Mexico with subsequent cases observed in many other countries. The pandemic was caused by an H1N1 virus that represents a quadruple reassortment of 2 swine strains, 1 human strain, and 1 avian strain of influenza. Until February 1, 2010, a total of 47 cases of influenza A (Inf A) were recorded by the Spanish Society of Nephrology in kidney transplant recipients. Herein we have reported our 3 cases (6.4%) in this registry. A 17-year-old girl with hepatorenal polycystosis received a liver and kidney transplant at 37 months previously. She displayed high fever and mild respiratory symptoms that resolved without treatment. A 38-year-old woman with chronic renal failure (CRF) of undetermined etiology received a kidney transplant 9 months previously. She was admitted with a 5-day history of febrile syndrome and respiratory symptoms, with extensive bilateral pneumonia and acute severe respiratory failure that required admission to the intensive care unit. Her evolution was satisfactory. A 38-year-old woman with CRF of undetermined etiology received a kidney transplant 2.5 months previously. She was admitted in November 2009 with a 2-week history of fever, myalgia, general malaise, cough, and expectoration. Her course was satisfactory. In these cases we determined H1N1 Inf A pandemic variant by detection of Inf A Matrix Protein 2 gene M2 and the specific H1 gene for influenza pandemic H1N1 2009 with reverse transcriptase polymerase chain reaction Inf A/H1N1 (Roche). The 3 cases of Inf A in kidney transplant recipients recorded in the province of Almeria occurred in young women shortly after kidney transplantation, and with no other risk factors apart from those associated with the transplantation itself. From the consideration of respiratory and renal situations, their courses were satisfactory.

Carcinoma intraductal de mama con microinvasión (T1mic): revisión a propósito de 53 nuevos casos / No disponible

Introducción: El desarrollo de las campañas de diagnósticoprecoz del cáncer de mama está determinando un incrementoen el hallazgo de carcinomas intraductales, en ocasiones confocos de microinfiltración (T1mic). En la bibliografía ha existidodisparidad en los criterios para su definición, y en consecuenciaen la valoración de su incidencia, índice de afectaciónaxilar y actitud terapéutica.Material y métodos: De un total de 225 carcinomas intraductalesse han seleccionado 53 por cumplir los criterios paraser definidos como T1mic en la Clasificación TNM (1997). Seanalizan algunas características clínicas, morfológicas y biológicas,así como su tratamiento y seguimiento.Resultados: El 77,4% de los casos fueron hallazgo de unchequeo mamográfico. El subtipo comedo fue la variante másfrecuente (52%) sobre la que asentó la microinfiltración. En el49,1% de los casos se encontró dos o más focos de microinfiltración,hallazgo más frecuente sobre el subtipo comedo(60,7%). Se practicó cirugía conservadora en 24 casos y mastectomíaen 29 (15 de ellos con reconstrucción inmediata). Enninguna caso se encontró afectación axilar y tras un seguimientomedio de 70 meses todas están vivas (una con metástasisa distancia).Conclusiones: Es necesario unificar los criterios que defineneste estadio tumoral y seguir los propuestos por la clasificaciónTNM en su versión AJCC-1997. Aceptando estos criterios,el tratamiento será el mismo al indicado para elcarcinoma intraductal, y dado el bajo índice de afectación axilarse recomienda recurrir al estudio del ganglio centinela sóloen los casos en que el comedo sea el subtipo dominante o elcarcinoma intraductal muy extenso(AU)

Introduction: The development of screening campaignsfor breast cancer is producing an increment in the incidence ofintraductal carcinomas (DCIS) with foci of microinvasion(T1mic). However, there is a degree of inconsistency in the literaturewith respect to defining these carcinomas and as aconsequence, there is no consensus regarding the incidence ofaxillar involvement and the appropriate treatment for these tumours.Material and Methods: Of 225 patients with intraductalcarcinomas, 53 cases were selected that complied with the requisitesfor defining microinvasive carcinomas, according tothe TNM cancer staging criteria laid down in 1997 (T1mic < 1mm). The morphological and biological characteristics of thecarcinomas were analysed, as were the results of the treatmentfollowed.Results: Referral to our department was provoked by the resultsof a screening study in 78% of the cases. The comedosubtype was the most frequent DCIS variant found and it waspresent in 52,8% of the cases studied. In 26 cases (49,1%), 2 ormore foci of microinvasion were observed, this occurring morefrequently among the comedo variants (60,7%). Conservativesurgery was performed in 24 cases and mastectomy was carriedout in 29 cases (in 15 of which immediate breast reconstructionwas performed). Involvement of the axillary lymph nodes wasnot observed and after a mean period of 70 months, all the patientswere alive (one with a distant metastasis).Conclusions: In order to be able to reach definitive conclusionsregarding this type of carcinoma, it is necessary to unifythe criteria of definition according to those proposal by theAJCC in 1997. In accepting these criteria, the therapeutic recommendationsare the same as those followed for intraductalcarcinoma...(AU)

Carcinoma tubular de mama: revisión de una serie de 38 casos / No disponible

Introducción: El carcinoma tubular de mama (CTM) representaun subtipo de carcinoma infiltrante, bien diferenciado,poco frecuente, de diagnóstico diferencial en ocasiones difícil.Material y métodos: Estudio retrospectivo de 38 casos queanaliza algunas de sus características clínicas y biológicas, asícomo del tratamiento utilizado.Resultados: Edad media de 51,5 años, el motivo diagnósticomás común fue la presencia de una tumoración palpable(50%), y otro 50% resultado de un chequeo mamario. En trescasos se presentó un carcinoma bilateral (uno de ellos sincrónico).Tamaño tumoral medio de 1,4 cm; el 81,8% fueron pT1.Afectación ganglionar axilar en el 13,1% de los casos (todosCTM mixtos). Se observó alto índice de tumores RE positivos,bajo índice proliferativo (Ki67) y muy baja expresión de p53 yc-erbB2. En el 79% de los casos se practicó cirugía conservadoracon vaciamiento axilar. La supervivencia a 10 años fuedel 97,4%.Conclusiones: Carcinoma poco frecuente, cuyo hallazgoes cada vez más resultado de estudios de screening. Se presentacomo una imagen estelar que obliga al diagnóstico diferencialcon algunas lesiones benignas.Su habitual pequeño tamaño y buena diferenciación histológica,permiten el tratamiento conservador en la mayoría delos casos, siendo excepcional la afectación ganglionar axilar.Dado su buen pronóstico, se discute la utilidad/necesidadde tratamiento adyuvante e incluso la cirugía axilar en los detamaño < 1 cm, especialmente en las formas puras(AU)

Introduction: Tubular carcinoma (TC) is a rare and well-differentiatedhistological variant of all breast cancer. The diagnosisof TC is some occasions difficult.Material and methods: We conducted a retrospectivestudy that analyzes 38 cases of TC (it supposes 1,6% of BreastCancer treated in our Breast Unit).The clinical and biological features and the treatment areanalyzed.Results: The medium average age was of 51,5 years. Themore frequent consultation was the presence of a palpablebreast mass followed by the screening. In three patients weobserved a bilateral cancer (1 out of 3 were synchronous tumour).The size half size tumour was of 1,4 cm and 81,8% theywere tumours pT1. Metastatic axillary disease was observed in13,1% of cases. We found a high rate of tumours was with positivehormonal receivers, low KI-67) and very low expressionof p53 and c-erb-2. The 79% of patient were treated with breastconservation therapy. With a median follow-up of 10 yearsthe survival was 97,4%.Discusion: TC is a rare breast cancer that can be discoveredin screening. TC can appear in mammography as a spiculatedabnormality and therefore it can be difficult to distinguishfrom radial scar or sclerosing adenosis. TC usually presents asa small tumour that can be treated with conservative surgery.Maxillary nodal metastases are uncommon. Because it is goodprognosis, adjuvant postoperative treatment and even any axillarysurgical procedure are controversial in TC(AU)

Enfermedad de Paget de la mama: análisis de una serie de 27 casos / Paget's disease of the breast: analysis of a series of 27 patients

Objetivo: Analizar las características de una serie, con especial referencia a su histogénesis y las posibilidades de la cirugía conservadora. Material y métodos: Se revisó a 27 pacientes portadoras con cáncer de mama (CM) y afectación del pezón con características de enfermedad de Paget (EP). Resultados: Las pacientes tenían una media de 56,5 años, los motivos de consulta fueron: eccema de pezón (48,1%), presencia de tumor mamario (26%) y secreción por el pezón (18,5%). El examen físico advirtió la lesión eccematosa en 26/27 casos. En 11 casos la imagen mamográfica se localizó a nivel retroareolar, en 13 casos distal al pezón y en 3 casos la mamografía fue normal. En 15 casos correspondió a un carcinoma intraductal, y en los 12 restantes a carcinoma ductal infiltrante. En uno la EP fue hallazgo del estudio seriado de la pieza de mastectomía. Se practicó una cirugía conservadora en 5 casos y mastectomía en 22 (6 con reconstrucción inmediata). Tras 6,5 años de seguimiento medio, 2 pacientes presentaron diseminación a distancia y una de las pacientes sometida a cirugía conservadora presentó recidiva local. Conclusiones: La EP representa el 1,4 % de los CM en nuestra serie y el signo diagnóstico característico es el eccema de pezón-aréola. La mamografía muestra una baja sensibilidad diagnóstica; se puede recurrir a la resonancia magnética en los casos de EP sin patología mamográfica y se debe realizar biopsia de la lesión ante la menor duda diagnóstica. El tratamiento más utilizado fue la mastectomía, y se recurrió a la cirugía conservadora en casos seleccionados de EP limitada al pezón, o con lesión subareolar circunscrita, conociendo los riesgos de un tumor subyacente inadvertido

Objective: To analyze the characteristics of a series, with special reference to histogenesis and the possibilities of conservative surgery. Material and methods: We reviewed 27 patients with breast cancer, nipple involvement and characteristics of Paget's disease. Results: The mean age of the patients was 56.5 years. Reasons for consulting were eczema of the nipple (48.1%), breast tumor (26%), and nipple secretion (18.5%). Physical examination revealed an eczematous lesion in 26/27 patients. The mammographic image was localized in the retroareolar area in 11 patients, distal to the nipple in 13 patients and was normal in three patients. Intraductal carcinoma was found in 15 patients and invasive ductal carcinoma in the remaining 12 patients. In one patient, Paget's disease was detected on examination of serial sections of the mastectomy specimen. Conservative surgery was performed in five patients and mastectomy in 22 (six with immediate reconstruction). After a mean follow-up of 6.5 years, distant dissemination occurred in two patients and local recurrence occurred in one patient who underwent conservative surgery. Conclusions: Paget's disease represented 1.4% of breast carcinoma in our series and the characteristic diagnostic sign was eczema of the nipple-aureola. Mammography showed low diagnostic sensitivity. Magnetic resonance imaging should be used in patients with Paget's disease without breast abnormalities. Biopsy of the lesion should be performed when there is diagnostic doubt. The most common treatment was mastectomy. Conservative surgery can be used in selected patients with Paget's disease limited to the nipple or with a circumscribed subareolar lesion, although the risk of an underlying tumor must be taken into account

Lipomas submucosos de colon / Submucous large-bowel lipomas

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Influencia del estudio intraoperatorio de los márgenes de resección sobre la recidiva local en la cirugía conservadora del cáncer de mama / No disponible

Introducción: la cirugía conservadora del cáncer de mamaes en la actualidad la técnica estándar en los tumores de pequeñotamaño; no obstante precisa generalmente de radioterapiacomplementaria y tiene el riesgo de presentar recidivastumorales en la misma mama. Se analizan las posibles ventajasdel estudio intraoperatorio de los bordes de resección parala reducción de las posibles reintervenciones y de las recidivaslocales tras cirugía conservadora.Material y métodos: analizamos retrospectivamente 1.010casos de cáncer de mama tratados mediante cirugía conservadora(resección segmentaria y linfadenectomía axilar), complementadacon radioterapia. En todos los casos se efectuó estudiointraoperatorio de los bordes de resección mediante cortespor congelación. Con un seguimiento medio de 6 años se valorande las recidivas locales y su significado.Resultados: con una media de edad de 52,2 años, el71,4% fueron tumores pT1, observándose afectación axilaren el 29,5%. El estudio intraoperatorio evidenció afectaciónde bordes en 251 casos (24,8%) obligando a su ampliación enel mismo acto operatorio; en 21 casos fue necesaria mas deuna ampliación. De esta forma en el estudio definitivo en parafinase confirmó un 97% de casos con bordes de resecciónlibres de tumor.Tras 6 años de seguimiento medio se han observado 24 recidivaslocales (2,4%), 12 de ellas en el área de tumorectomíaprevia y otras 12 en otro cuadrante.Conclusiones: en la cirugía conservadora, la obtención deunos márgenes quirúrgicos libres de tumor, y suficientementeamplios, constituye un factor importante para la reducción delas recidivas locales. El estudio intraoperatorio de los márgenes,es una técnica que permite lograr este objetivo a la vezque reduce la necesidad de reintervenciones diferidas(AU)

Introduction: breast-conserving therapy (BCT) is the standardtechnique for early-stage breast cancer; nevertheless BCTusually requires postoperative radiotherapy and has the risk oflocal recurrence in the same breast. We analyzed in this studythe need for intraoperative frozen section study of resectionmargins in order to reduce the reoperations and local recurrenceafter BCT.Material and methods: we conducted a retrospective studywith 1010 cases of Breast cancer treated with BCT (segmentalresection and axillary lymphadenectomy), followed by radiotherapy.In all cases intraoperative frozen section study of resectionmargin was made We analyzed the local recurrencerate with a mediam follow-up of 6 years.Results: the average age was 52.2 year-old age. 71.4%were pT1 tumors, and axillary nodes metastasis was found in29.5%. The intraoperative frozen section showed affectedmargins in 251 cases (24.8%) prompting re-resection. Provisionof additional tissue in two o more occasions was neededin 21 cases. Following this protocol, we found 97% of caseswith free resection margins on permanent paraffin embeddedsamples.With a median follow-up of 6 years, 24 local recurrenceswere observed (2.4%): 12 localized at the site of originalbreast tumor (true local recurrence), and 12 localized in a differentsite (most likely a second primary).Conclusions: during BCT, is very import to achieve freeresection margins in order to reduce the local recurrencerate. Intraoperative frozen section study contributes to reducelocal recurrence and provides information for reoperations(AU)

Lesiones proliferativas intraductales: aspectos inmunohistoquímicos / No disponible

Introducción: la difusión de la mamografía de cribado ha incrementado el diagnóstico de lesiones proliferativas. Dado que algunas lesiones proliferativas aumentan el riesgo de desarrollar un cáncer de mama, se ha incrementado el interés en las mismas. El cáncer de mama es probablemente el resultado de sucesivos cambios genéticos (cada uno con su correlación histológica) en la secuencia hiperplasia ductal atípica (HDA) a carcinoma. El objetivo de este estudio es analizar la correlación entre las determinaciones inmunohistoquímicas (IHQ) de diferentes marcadores biológicos (receptores hormonales, Ki 67, p53, y c-erbB-2)y el diagnóstico de diferentes lesiones proliferativas ductales. Material y métodos: se estudian mediante técnicas de IHQ la expresión en tejido mamario de receptores de estrógeno(RE), proliferación celular (Ki67), p53 y c-erbB-2 en 228 pacientes portadoras de: hiperplasia ductal atípica (HDA) en 28casos, carcinoma intraductal CDIS en 60 casos, carcinoma intraductal con microinfiltración (T1mic) en 40 casos, carcinoma ductal infiltrante con CDIS extenso en 40 casos y CDI puro en60 casos. Las lesiones benignas fueron clasificadas de acuerdo a los criterios de Page. El carcinoma intraductal se clasificó segúnsu grado histológico (GH) y su patrón nuclear. Resultados: la expresión de RE fue del 100% en las HDAy decrece hasta el 70% en CDIS y CDI. No se observa expresión de p53 y c-erbB2 en la HDA, pero aumenta con el desarrollo del cáncer de mama, especialmente con la presencia de infiltración. Un alto GH se asoció a tumores con RE-, alto índice de proliferación y sobrexpresión de p53 y c-erbB-2. Conclusiones: en las etapas iniciales de la secuencia de lesiones proliferativas ductales no se observa expresión de p53ni c-erbB2. Ambos marcadores se incrementan en el cáncer de mama en relación con el GH...(AU)

Background: breast screening has greatly increased the number of women diagnosed with proliferative breast disease. Recent studies have shown an association between benign breast diseases and subsequent breast cancer, hence have focussed on benign proliferative lesions. Breast cancer is probably the result of a series of genetic events (each with its own histologic correlation and sequence) from atypical ductal hyperplasia(ADH) to carcinoma. The goal of this study was to determine the diagnostic value of immunohistochemical determinations of biological markers(hormonal receptors, Ki67, p53 and c-erbB-2 expresion) in this sequence. Methods: expression of estrogen receptors (ER), cellular proliferation (Ki67), p53 and c-erbB-2 were examined by immunohistochemistry in samples of breast tissue from 228 patients with varying mammary lesions: ADH (28 cases), ductal carcinoma in situ (60 cases), ductal carcinoma in situ with microinfiltration(40 cases), invasive ductal carcinoma with extensive CDIS (40 cases) and pure invasive ductal carcinoma (60cases). A paraffin block was selected for immuno histochemical studies. DCIS was classified according to the Page’s criteria and histologic grading of invasive carcinoma following criteria given by Scarff-Bloom-Richardson modified by Elston and Ellis. Results: the ER expresion was 100% in ADH but decreases down to 70% in DCIS and DCI. Expression for p53 andcerbB-2 was not observed in ADH; but appears with the development of breast cancer: was observed in 21.7% in DCIS, 42.5% in DCIS-mic and 41.5% in pure DCI. High histological grade has been associated with estrogen receptor negativity, cellular proliferation, p53 and c-erbB-2 over expression. Conclusions: a p53 and c-erb-2 over expression were not observed in the early stages of the sequence atypical hyperplasia-carcinoma...(AU)

Liver transplant results for hepatocellular carcinoma applying strict preoperative selection criteria.

INTRODUCTION: Liver transplantation is currently the best therapeutic option for small hepatocellular carcinoma (HC) in selected cirrhotic patients. The main aim of this study was to analyze the results of a recent series of liver transplant cirrhotic patients with small HC applying strict preoperative selection criteria. PATIENTS AND METHODS: During a period of 6 years we performed 53 liver transplants with a final diagnosis of HC on cirrhosis. The selection criteria for liver transplantation (LT) by modern imaging techniques were the Milan criteria (TNM I and II of the modified classification). RESULTS: Of the 53 patients, 44 (83%) were transplanted with preoperatively known HC, and 9 (17%) with incidental HC. The mean time on the waiting list was 74 +/- 62 days. Despite using strict selection criteria, 23 patients (43%) exceeded the Milan criteria in the specimen and 17 (32%) even exceeded the extended criteria of the UCSF. With a mean follow-up of 2 years, only two patients have developed recurrences. The overall survival at 1, 3, and 5 years was 80%, 70%, and 70%, respectively. The survival of patients that exceeded the Milan or USF criteria at 1, 3, and 5 years was 72% and 76%; 67% and 69%; 67% and 69%, respectively. CONCLUSIONS: The results of liver transplantation for HC are excellent when applying strict preoperative selection criteria. The current imaging methods lead to a considerable infrastaging percentage (30% to 40%), extending the indications for liver transplant due to HC beyond the scope that clinical reports would justify.

Preoperative factors and models predicting mortality in liver transplantation.

We analyzed preoperative factors related to postoperative mortality after liver transplantation among a cohort of 268 consecutive liver transplant patients over 6 years. We studied the impact of 10 recipient variables, 14 donor features, and three operative aspects. We also studied the correlation with death and survival using various predictive scores (Child, Cordoba Score, MELD, and UCLA). Univariate analysis showed that the factors with a significant association with postoperative mortality were the use of noradrenaline in the donor, total ischemia time (>12 hours), and transplant indication (hepatitis C virus versus the rest). Multivariate analysis of mortality showed the impact of female donor sex, recipients over >60 years, recipient albumin less than 2.8, and total graft ischemia time more than 12 hours. Univariate analysis of 1-year survival showed a statistically significant relation with D/R gender similarity, as well as donor GOT (>170) and GPT (>140) values. Multivariate analysis of 1-year survival showed donor GOT (>170) and donor/recipient gender similarity to be significant. Concerning the prediction models, Child-Pugh (AB versus C) best determined postoperative mortality (P < .006), MELD was predictive of 1-year survival (P < .03). The most important variables related to postoperative mortality were total ischemia time over 12 hours, recipient albumin less than 2.8, and age above 60 years. The variable with most impact on 1-year survival was the degree of graft hepatocyte lesion as determined by GOT. The Child-Pugh system is still the best indicator of postoperative mortality, although MELD may also be a good predictor of survival.

Adenoma velloso hipersecretor de recto. Diagnóstico y tratamiento / Secreting villous adenoma. Diagnosis and treatment

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