Association of γδ T cells with disease severity and mortality in septic patients.

Gamma-delta T cells are the most abundant of all epithelial-resident lymphocytes and are considered a first line of defense against pathogens in the mucosa. Our objective was to confirm the reduction in γδ T cell subsets and its relationship with mortality in patients with sepsis. We studied 135 patients with sepsis attended in the emergency department and intensive care unit of two hospitals and compared them with a similar control group of healthy subjects. The αß and γδ T cell subsets were determined via flow cytometry according to the stage of the sepsis and its relationship with mortality. All the lymphocyte subsets were reduced with respect to the corresponding subsets in the control group. All the γδ T cell populations decreased significantly as the septic picture worsened. Furthermore, γδ T cells showed decreases at days 2, 3, and 4 from the start of sepsis. Twenty-six patients with sepsis died (19.3%). The γδ T cells, specifically, the CD3(+) CD56(+) γδ T cells, were significantly reduced in those septic patients who died. Our results indicate that, during sepsis, γδ T cells show the largest decrease and this reduction becomes more intense when the septic process becomes more severe. Mortality was associated with a significant decrease in γδ T cells.

Un método para individualizar el riesgo de una errónea clasificación ganglionar negativa en el cáncer de colon / A method for individualising the risk of a negative lymph node classification error in cancer of the colon

Introducción y objetivos: En el cáncer de colon, el número de ganglios linfáticos que se deberían analizar antes de clasificar a un paciente como libre de afectación ganglionar ha sido ampliamente discutido. Se propone un modelo matemático basado en el teorema de Bayes para calcular la probabilidad de error (PE) similar al utilizado habitualmente para la evaluación de una prueba diagnóstica pero adaptado a una variable cuantitativa como es un recuento ganglionar. Métodos: Se revisaron las historias clínicas de 480 pacientes intervenidos de forma programada de cáncer de colon con intención curativa, excluyendo los casos que presentaban metástasis de cualquier tipo. Con el fin de calcular las PE, para la serie completa y para diversos subgrupos de pacientes (tumores T2, T3, y T4) se aplicó la fórmula que proponemos basada en dicho teorema de Bayes. Resultados: Para las probabilidades de error al clasificar un paciente como N negativo que oscilaran entre un 5% hasta un 1‰ (próximo o prácticamente 0), la mínima cifra de ganglios negativos necesarios para analizar fluctuó entre 7 y 17 respectivamente para la serie completa. Esta cifra mínima también fue cambiante para los diversos subgrupos (tumores T2, T3, y T4) considerados. Fundamentalmente, tales cifras dependen de las características de la casuística de un grupo de trabajo concreto en cuanto a prevalencia de casos N+ que manejen, y de su capacidad históricamente demostrada para recolectar e identificar ganglios positivos en los pacientes que los presentaran. Conclusión: Desde el punto de vista matemático, el número mínimo de ganglios que se deberían analizar en el cáncer de colon para clasificar a un paciente como N negativo no es una constante. Este depende del error que se esté dispuesto a asumir para tal diagnóstico, puede estar en función de ciertos rasgos del tumor, y además, se debería adaptar a la casuística de cada grupo de trabajo (AU)

Introduction: In cancer of the colon, the number of lymph nodes that should be analysed before a patient is classified as free of lymph node involvement has been widely discussed. A mathematical model is proposed which is based on the Bayes Theorem for calculating the probality of error (PE) similar to that normally used to evaluate a diagnostic test, but adapted to a quantitative variable, the lymph node count. Methods: The clinical histories of 480 patients routinely operated on in attempt to cure cancer of the colon were reviewed. Cases with any kind of mesttasis were excluded. The proposed formula based on the Bayes Theorem was applied with the aim of calculating the PEs for the complete series and for different patient sub-groups (T2, T3, and T4 tumours). Results: For the probabilities of error of classifying a patient as N negative, which varied between 5% and 1% (near or practically 0), the minimum number of negative lymph nodes required for analysis fluctuated between 7 and 17, respectively, for the complete series. This minimum figure was also variable for the different sub-groups (T2, T3, and T4 tumours) studied. These numbers mainly depended on the case characteristics of a specific study group as regards the prevalence of the N+ cases that they dealt with, and of its historically demonstrated ability to collect and identify positive lymph nodes in those patients that had them. Conclusion: From a mathematical point of view, the minimum number of lymph nodes that have to be analysed in cancer of the colon in order to classify a patient as N negative is not a constant. This depends on the error that is prepared to be assumed for that diagnosis, possibly depending on certain tumour traits, and also may be adapted to the cases of each study group (AU)

[A method for individualising the risk of a negative lymph node classification error in cancer of the colon]. / Un método para individualizar el riesgo de una errónea clasificación ganglionar negativa en el cáncer de colon.

INTRODUCTION: In cancer of the colon, the number of lymph nodes that should be analysed before a patient is classified as free of lymph node involvement has been widely discussed. A mathematical model is proposed which is based on the Bayes Theorem for calculating the probability of error (PE) similar to that normally used to evaluate a diagnostic test, but adapted to a quantitative variable, the lymph node count. METHODS: The clinical histories of 480 patients routinely operated on in attempt to cure cancer of the colon were reviewed. Cases with any kind of metastasis were excluded. The proposed formula based on the Bayes Theorem was applied with the aim of calculating the PEs for the complete series and for different patient sub-groups (T2, T3, and T4 tumours). RESULTS: For the probabilities of error of classifying a patient as N negative, which varied between 5% and 1% (near or practically 0), the minimum number of negative lymph nodes required for analysis fluctuated between 7 and 17, respectively, for the complete series. This minimum figure was also variable for the different sub-groups (T2, T3, and T4 tumours) studied. These numbers mainly depended on the case characteristics of a specific study group as regards the prevalence of the N+ cases that they dealt with, and of its historically demonstrated ability to collect and identify positive lymph nodes in those patients that had them. CONCLUSION: From a mathematical point of view, the minimum number of lymph nodes that have to be analysed in cancer of the colon in order to classify a patient as N negative is not a constant. This depends on the error that is prepared to be assumed for that diagnosis, possibly depending on certain tumour traits, and also may be adapted to the cases of each study group.

[Impact of endorectal advancement flaps in fecal incontinence]. / Impacto de los colgajos transanales de avance en la continencia fecal.

OBJECTIVE: The aim of this study was the prospective evaluation of the functional results of a series endorectal advancement flaps in the treatment of complex anal fistulas. MATERIAL AND METHODS: A total of 90 patients were operated on for a complex anal fistula by means of fistulectomy and endorectal advancement flap. The functional results were evaluated using the Wexner continence scale and an anorectal manometry study before and after surgery. RESULTS: There were seven patients with fistula recurrence (7.7%) and the same surgical procedure was performed on five of them, resulting in healing in all cases. Significant reductions in maximum resting pressure (83.85+/-30.96 vs 46.51+/-18.67; p<0.001) and maximum squeeze pressure (220.97+/-100.21 vs 183.06+/-75.36; p<0.001) were seen 3 months after surgery. On the continence scale, 80% of patients had a normal continence with a value of 0 on the postoperative Wexner scale, while 20% recorded changes in continence values, most of them lower than 3 points. CONCLUSIONS: Endorectal advancement flap is an effective surgical procedure in complex anal fistulas treatment, with a low recurrence rate. Only 20% of the patients showed changes in the continence value.

[Phlebectomies or foam sclerosis for treatment of the distal venous segment in the 3-S saphenectomy technique]. / Flebectomías o esclerosis con espuma para el tratamiento del segmento venoso distal en la técnica 3-S safenectomía.

INTRODUCTION: The aim of this study was to compare the recurrent rates of varicose veins after treatment with two surgical techniques: 3-S saphenectomy and 3-S saphenectomy with distal sclerosis. PATIENTS AND METHOD: 105 patients with trunk varicose veins were randomly assigned. The control group consisted of 51 patients who underwent the 3-S saphenectomy technique (the sapheno-femoral junction sclerosis with foam, saphenectomy and distal phlebectomies); test group: 3-S saphenectomy with distal sclerosis technique (the sapheno-femoral junction sclerosis with foam, saphenectomy and distal segment sclerosis). RESULTS: Overall recurrence: group I 35.3%, group II 57.4% (p < 0.001). Trunk recurrence: group I 17.7%, group II 38.9% (p = 0.028). Collateral recurrence: group I 9.8%, group II 11.1% (p = 1). Perforator vein recurrence: group I 5.9%, group II 5.6% (p = 1). Reticulated recurrence: group I 2%, group II 1.9% (p = 1). CONCLUSIONS: The substitution of Müller phlebectomy instead of foam sclerosis, is not a better treatment of the distal venous segment, and has a greater recurrence rate. The 3-S saphenectomy technique is the most suitable for the treatment for trunk varicose veins.

Flebectomías o esclerosis con espuma para el tratamiento del segmento venoso distal en la técnica 3-S safenectomía / Phlebectomies or foam sclerosis for treatment of the distal venous segment in the 3-S saphenectomy technique

Introducción. El objetivo de este estudio es comparar la tasa de recidiva de las varices operadas mediante dos técnicas quirúrgicas diferentes: la 3-S safenectomía y la 3-S safenectomía más esclerosis distal. Pacientes y método. Se distribuyó aleatoriamente a 105 pacientes con varices tronculares: grupo I o control (n = 51), técnica 3-S safenectomía (esclerosis del cayado con espuma, safenectomía y flebectomías del segmento distal); grupo II o estudio (n = 54), técnica 3-S safenectomía más esclerosis distal (esclerosis del cayado con espuma, safenectomía y esclerosis del segmento distal). Resultados. Recidivas en total: grupo I, 35,3%; grupo II, 57,4% (p < 0,001). La recidiva troncular fue en el grupo I del 17,7% y en el grupo II, del 38,9% (p = 0,028). La recidiva colateral fue en el grupo I del 9,8% y en el grupo II, del 11,1% (p = 1). La recidiva tipo vena perforante fue en el grupo I del 5,9% y en el grupo II, del 5,6% (p = 1). La recidiva reticular fue en el grupo I del 2% y en el grupo II, del 1,9% (p = 1). Conclusiones. La sustitución de la flebectomía de Müller por la esclerosis con microespuma no permite un mejor tratamiento del lecho venoso distal, y se objetiva un mayor número de recidivas a este nivel, por lo que la técnica 3-S safenectomía es la más adecuada para el tratamiento de las varices tronculares (AU)

Introduction. The aim of this study was to compare the recurrent rates of varicose veins after treatment with two surgical techniques: 3-S saphenectomy and 3-S saphenectomy with distal sclerosis. Patients and method. 105 patients with trunk varicose veins were randomly assigned. The control group consisted of 51 patients who underwent the 3-S saphenectomy technique (the sapheno-femoral junction sclerosis with foam, saphenectomy and distal phlebectomies); test group: 3-S saphenectomy with distal sclerosis technique (the sapheno-femoral junction sclerosis with foam, saphenectomy and distal segment sclerosis). Results. Overall recurrence: group I 35.3%, group II 57.4% (p < 0.001). Trunk recurrence: group I 17.7%, group II 38.9% (p = 0.028). Collateral recurrence: group I 9.8%, group II 11.1% (p = 1). Perforator vein recurrence: group I 5.9%, group II 5.6% (p = 1). Reticulated recurrence: group I 2%, group II 1.9% (p = 1). Conclusions. The substitution of Müller phlebectomy instead of foam sclerosis, is not a better treatment of the distal venous segment, and has a greater recurrence rate. The 3-S saphenectomy technique is the most suitable for the treatment for trunk varicose veins (AU)

[Results of a medication reconciliation project in routine medical treatment after surgical discharge]. / Resultados de un proyecto de control y adecuación del tratamiento médico habitual tras el alta quirúrgica.

OBJECTIVE: To reduce the number of medication-related problems by ensuring reconciliation between ambulatory treatment and surgical prescription and to increase patients' understanding of drug therapy and treatment adherence. MATERIAL AND METHOD: Information on ambulatory medication was obtained through a personal interview and a review of the patient's personal and pharmacotherapeutic history. A dossier was created that included detailed information on each medication and a chronopictogram with all doses. On the day of discharge, a second interview with the patient was performed in which information was obtained orally and in writing about all treatment. The process was evaluated through a satisfaction questionnaire. Two weeks after discharge a telephone interview was carried out to detect post-discharge medication-related problems. RESULTS: During the study period (April-December 2006) 544 patients were included. There were 658 pharmaceutical interventions: 87% educational, 8% safety, 5% efficiency. A total of 346 satisfaction questionnaires were properly completed (63% of those distributed). Responses to questionnaires were evaluated from 0 (completely dissatisfied) to 5 (highly satisfied). Interest in the information received was scored 4.75, understanding of the information 4.67, and satisfaction with the intervention 4.59. CONCLUSIONS: Including the pharmacist in the surgical team ensures reconciliation between ambulatory treatment and surgical prescription and reduces medication errors. Providing information to patients about their medication at discharge increases their understanding of drug treatment and adherence.

Resultados de un proyecto de control y adecuación del tratamiento médico habitual tras el alta quirúrgica / Results of a medication reconciliation project in routine medical treatment after surgical discharge

Objetivos. Reducir el número de problemas relacionados con la medicación asegurando la conciliación del tratamiento. Aumentar la comprensión y el cumplimiento del tratamiento del paciente. Material y método. Se obtiene la medicación ambulatoria del paciente mediante una entrevista personal y la revisión de su historia clínica y farmacoterapéutica. Se elabora un dossier que incluye información detallada de cada medicamento y un cronopictograma con las pautas posológicas. El día del alta se realiza una segunda entrevista con el paciente, donde se le informa oralmente y por escrito sobre todo su tratamiento. El proceso se valora mediante un cuestionario de satisfacción. A las 2 semanas del alta se realiza una encuesta telefónica para detectar problemas relacionados con la medicación posteriores al alta hospitalaria. Resultados. Durante el período de estudio (abril-diciembre de 2006) se incluyó a 544 pacientes. Se realizaron 658 intervenciones farmacéuticas; el 87%, educativas; el 5%, de eficacia, y el 8%, de seguridad. Se recuperaron 346 cuestionarios de satisfacción debidamente cumplimentados (el 63% de los repartidos). Las respuestas del cuestionario se puntúan de 0 (nada satisfecho) a 5 (muy satisfecho). Interés por la información recibida, 4,75; grado de comprensión de la información, 4,67; satisfacción con la intervención, 4,59. Conclusiones. La inclusión del farmacéutico en el equipo quirúrgico asegura la conciliación entre el tratamiento ambulatorio del paciente y el prescrito por el cirujano y disminuye los errores de medicación. Proporcionar información al paciente sobre su medicación en el momento del alta aumenta su comprensión del tratamiento farmacológico y su cumplimiento (AU)

Objective. To reduce the number of medication-related problems by ensuring reconciliation between ambulatory treatment and surgical prescription and to increase patients' understanding of drug therapy and treatment adherence. Material and method. Information on ambulatory medication was obtained through a personal interview and a review of the patient's personal and pharmacotherapeutic history. A dossier was created that included detailed information on each medication and a chronopictogram with all doses. On the day of discharge, a second interview with the patient was performed in which information was obtained orally and in writing about all treatment. The process was evaluated through a satisfaction questionnaire. Two weeks after discharge a telephone interview was carried out to detect post-discharge medication-related problems. Results. During the study period (April-December 2006) 544 patients were included. There were 658 pharmaceutical interventions: 87% educational, 8% safety, 5% efficiency. A total of 346 satisfaction questionnaires were properly completed (63% of those distributed). Responses to questionnaires were evaluated from 0 (completely dissatisfied) to 5 (highly satisfied). Interest in the information received was scored 4.75, understanding of the information 4.67, and satisfaction with the intervention 4.59. Conclusions. Including the pharmacist in the surgical team ensures reconciliation between ambulatory treatment and surgical prescription and reduces medication errors. Providing information to patients about their medication at discharge increases their understanding of drug treatment and adherence (AU)

[Classical surgery versus 3-S saphenectomy in the treatment of lower extremity varices]. / Cirugía clásica frente a 3-S safenectomía para el tratamiento de las varices del miembro inferior.

INTRODUCTION: The rate of recurrence requiring redo surgery after primary surgical treatment of varicose veins is between 20 and 30%. Several techniques to reduce the high rate of recurrence after stripping have been designed over the years, especially reticulated recurrences at the sapheno-femoral junction. The aim of this study was to compare the recurrence rates of varices after treatment with two surgical techniques: stripping and 3-S saphenectomy. PATIENTS AND METHOD: One hundred patients with leg varicose veins were randomly assigned to two groups. Group I consisted of 50 patients who underwent classical surgery (ligature and section at the sapheno-femoral junction and collateral veins, with saphenectomy). Group II consisted of 50 patients who underwent the 3-S saphenectomy technique (sclerosis injection at the sapheno-femoral junction with microfoam through a catheter, with saphenectomy and distal phlebectomies). The rate and type of recurrences were evaluated through echo-Doppler 12 months after the procedure. RESULTS: Overall recurrence: group I: 78%, group II: 44% (P< .05). Trunk recurrence: group I 12%, group II 16% (P=NS). Collateral recurrence: group I 16%, group II 6% (P=NS). Perforator vein recurrence: group I 18%, group II 18% (P=NS). Reticulated recurrence: group I 32%, group II 4% (P=.002). CONCLUSIONS: The 3-S saphenectomy technique decreases the overall rate of recurrence, particularly reticulated type recurrences. We recommend avoidance of surgery of the branches at the sapheno-femoral junction.

Cirugía clásica frente a 3-S safenectomía para el tratamiento de las varices del miembro inferior / Classical surgery versus 3-S saphenectomy in the treatment of lower extremity varices

Introducción. Se estima que aproximadamente entre un 20 y un 30% de las varices operadas necesitarán ser reintervenidas. A lo largo de estos años, se han diseñado diferentes técnicas con la pretensión de reducir la elevada tasa de recidivas que se produce tras el clásico stripping, y de modo especial la recidiva del tipo reticular que se genera en la unión safenofemoral. El objetivo de este estudio es comparar la tasa de recidiva de las varices operadas con dos opciones técnicas: la safenectomía clásica y la 3-S safenectomía. Pacientes y método. Se distribuyó a 100 pacientes con varices de la extremidad inferior de forma aleatoria en 2 grupos: grupo I: 50 pacientes sometidos a cirugía clásica (ligadura y sección en la unión safenofemoral y venas colaterales, más safenectomía); grupo II: 50 pacientes sometidos a la técnica 3-S safenectomía (esclerosis del cayado con esclerosante en forma de espuma a través de un catéter, safenectomía más flebectomías del segmento distal). A los 12 meses de la intervención, se evaluó a los pacientes mediante eco-Doppler para determinar la tasa y el tipo de recidiva en cada técnica. Resultados. La recidiva global fue: grupo I: 78% y grupo II: 44% (p < 0,05). La recidiva troncular fue en el grupo I del 12% y en el grupo II del 16% (p = NS). La recidiva colateral fue en el grupo I del 16% y en el grupo II del 6% (p = NS). La recidiva de la vena perforante fue en el grupo I del 18% y en el grupo II del 18% (p = NS). La recidiva tipo variz reticular fue en el grupo I del 32% y en el grupo II del 4% (p = 0,002). Conclusiones. La técnica 3-S safenectomía disminuye la tasa global de recidivas, y especialmente las de tipo reticular. Se aconseja evitar el abordaje quirúrgico de las ramas colaterales del cayado de la vena safena (AU)

Introduction. The rate of recurrence requiring redo surgery after primary surgical treatment of varicose veins is between 20 and 30%. Several techniques to reduce the high rate of recurrence after stripping have been designed over the years, especially reticulated recurrences at the sapheno-femoral junction. The aim of this study was to compare the recurrence rates of varices after treatment with two surgical techniques: stripping and 3-S saphenectomy. Patients and method. One hundred patients with leg varicose veins were randomly assigned to two groups. Group I consisted of 50 patients who underwent classical surgery (ligature and section at the sapheno-femoral junction and collateral veins, with saphenectomy). Group II consisted of 50 patients who underwent the 3-S saphenectomy technique (sclerosis injection at the sapheno-femoral junction with microfoam through a catheter, with saphenectomy and distal phlebectomies). The rate and type of recurrences were evaluated through echo-Doppler 12 months after the procedure. Results. Overall recurrence: group I: 78%, group II: 44% (P<.05). Trunk recurrence: group I 12%, group II 16% (P=NS). Collateral recurrence: group I 16%, group II 6% (P=NS). Perforator vein recurrence: group I 18%, group II 18% (P=NS). Reticulated recurrence: group I 32%, group II 4% (P=.002). Conclusions. The 3-S saphenectomy technique decreases the overall rate of recurrence, particularly reticulated type recurrences. We recommend avoidance of surgery of the branches at the sapheno-femoral junction (AU)

Neumoperitoneo debido a neumatosis quística intestinal / Pneumoperitoneum due to pneumatosis cystoides intestinalis

La neumatosis quística intestinal es una enfermedad rara caracterizada por la presencia de quistes llenos de gas en la submucosa o subserosa del tracto intestinal. Generalmente va acompañada de enfermedades sistémicas o se encuentra relacionada con la toma de fármacos o traumatismos. Se presentan 2 casos de neumatosis quística intestinal asociada a neumoperitoneo y se discuten los aspectos generales y el manejo de esta enfermedad (AU)

Hernioplastia inguinal con doble prótesis bajo anestesia local. Análisis de la técnica a los 5 años sobre 465 pacientes / Plug-and-mesh hernioplasty under local anesthesia. Analysis of results at 5 years in 465 patients

Introducción. La reparación de la hernia inguinal es la intervención que se practica con más frecuencia en un servicio de cirugía general. Tiene una prevalencia del 5 por ciento en los países occidentales. El objetivo es analizar la técnica, en cuanto a la morbilidad y la tasa de recidiva de la hernioplastia con doble prótesis tras 5 años de seguimiento medio (mínimo 4, máximo 6 años).Material y método. Fueron intervenidos 465 pacientes de forma ambulatoria por hernia inguinal primaria. La técnica quirúrgica empleada fue la de hernioplastia con doble prótesis, mediante la introducción de un tapón de polipropileno en el orificio inguinal interno más la colocación de una prótesis microperforada de politetrafluoroetileno expandido sobre la pared posterior fijada con ágrafes. La técnica anestésica fue local con sedación intravenosa. Resultados. Los ingresos no previstos fueron 4. La morbilidades postoperatorias más frecuentes fueron: dolor (2,6 por ciento) y equimosis-edema de testículos (1,1 por ciento).La tasa de recidiva fue del 0 por ciento hasta el momento. La media de incorporación a la vida laboral de los trabajadores manuales fue de 5 semanas (rango, 2-8).Conclusiones. La hernioplastia con doble prótesis con anestesia local ha reducido la tasa de recidiva y las complicaciones con respecto a las técnicas clásicas. Se produce una pronta incorporación del paciente a la actividad sociolaboral, es una técnica rápida y sencilla, y es posible realizarla de forma ambulatoria (AU)