Sponge Sampling with Fluorescent In Situ Hybridization as a Screening Tool for the Early Detection of Esophageal Cancer.

INTRODUCTION: Sponge cytology is a novel screening tool for esophageal cancer but has been unable to be validated for widespread use. Our aim was to apply fluorescent in situ hybridization to sponge cytology samples in order to evaluate the safety and efficacy of this modality in screening for esophageal cancer. MATERIALS AND METHODS: At a single, multidisciplinary, NCI-designated cancer center, patients completed sponge cytology sampling prior to upper endoscopy. Samples were analyzed by p53 fluorescent in situ hybridization, and results were compared to the endoscopic diagnosis. RESULTS: Fifty patients were enrolled (96 % Caucasian, 68 % male, median age of 67). All patients successfully swallowed the capsule. No complications (string breakage, bleeding, mucosal injury) occurred. Endoscopy revealed that 38 % had normal esophageal mucosa and 62 % had an esophageal mucosal abnormality. In total, six samples demonstrated p53 loss (94 % specificity for any abnormality). The sensitivity of the p53 fluorescent in situ hybridization probe was13.3 % for any abnormality, 10 % for intestinal metaplasia, and 0 % for dysplasia or esophageal cancer. DISCUSSION: Esophageal sponge cytology is a promising, safe, and tolerable method for collecting esophageal cell samples. However, our data suggest that p53 fluorescent in situ hybridization does not improve the sensitivity for detecting cancer in these samples.

Hospitalization costs of open vs. laparoscopic appendectomy: 5-year experience.

BACKGROUND: There is an ongoing debate over certain aspects of laparoscopic appendectomy (LA) over open appendectomy (OA) in regard to hospitalization costs and associated complications. METHODS: A database was used to obtain the charts for either LA or OA performed during a 5-year period. Variables analyzed were age, gender, hospitalization cost, length of stay and complications. RESULTS: Of 1792 appendectomies performed, 633 (35.3%) were OA and 1159 (64.6%) were LA. Both groups were statistically similar with regard to gender (p = 0.075) but differed with respect to age, demonstrating an older patient population in the LA group (p <0.0001). Length of stay was significantly higher in the OA group (3.33 vs. 2.52) days, p <0.0001). The overall hospitalization cost of LA was 25% higher than the OA cost (p = 0.0005). The cost of an uncomplicated LA case was 1.7 times higher than in the OA group (p ≤ 0.0001). We found no statistically significant differences between the hospitalization cost of an OA and LA group when both procedures were associated with a complication (p = 0.5319). A higher complication rate was observed in the OA group, 60 cases (9.47%) as compared to the LA group, 46 cases (3.96%), p <0.0001. The increased rate of complications observed was related to cardiovascular, wound and infectious problems. CONCLUSIONS: Noncomplicated LA was associated with a higher hospitalization cost. There was no difference with regard to complicated cases. The incidence of complications increased in the OA group.

Hematoma intestinal por warfarina / Warfarin induced intestinal haematoma

No disponible

No disponible

Neuroblastoma in the adult. Case report.

BACKGROUND: Neuroblastoma is a common malignancy in infancy but extremely rare in adults. These tumors, commonly found in the abdomen, originate in the sympathetic nervous system. Staging and management are standardized in children and adults, although their prognosis is very different, being more aggressive and with a poorer outcome in the adult. CLINICAL CASE: We present the case of a 31-year-old male with non-specific abdominal pain and constipation. After several studies, a stage III giant retroperitoneal neuroblastoma was diagnosed. We discuss here the evaluation, management and follow-up of the patient. A literature review is presented as well. CONCLUSIONS: Adult neuroblastoma is an unusual disease with an insidious presentation and is usually diagnosed in advanced stages. Unlike its behavior in young patients, in the adult it is more aggressive and with a poor prognosis.

La asistencia manual es una alternativa a la conversión a laparotomía durante la sigmoidectomía laparoscópica / Hand assistance is an alternative to conversion to laparotomy during laparoscopic sigmoidectomy

Introducción En el tratamiento de la enfermedad diverticular la cirugía laparoscópica tiene diversos beneficios en comparación con la cirugía abierta. Existen 2 tipos de abordajes, el asistido por laparoscopia (LA) y el laparoscópico asistido con la mano (MA). El objetivo de este estudio es demostrar que la cirugía MA puede ser un recurso previo a la conversión a una laparotomía en caso de encontrar dificultades con el abordaje LA. Material y métodos Se realizó un estudio de cohorte retrospectivo en un hospital privado de tercer nivel en la ciudad de México. Se seleccionó a todo paciente con diagnóstico de enfermedad diverticular en el que se practicó una cirugía LA, incluidos aquellos pacientes en los que hubo dificultad técnica durante el procedimiento y se decidió continuar de manera MA. Resultados Se realizaron 47 sigmoidectomías LA, 33 de éstas se completaron de esta manera, 4 requirieron laparotomía y 10 se completaron de manera MA (de éstas ninguna requirió laparotomía). No hubo diferencia estadísticamente significativa entre los grupos laparoscópicos cuando se comparó el retorno de la función intestinal (p=0,879) y los días de estancia intrahospitalaria (p=0,679).Conclusiones La cirugía laparoscópica MA es una alternativa factible si durante una sigmoidectomía LA hay dificultad con la exposición o con la disección y evita la conversión a cirugía abierta (AU)

Introduction Laparoscopic surgery in the treatment of diverticular disease offers multiple benefits compared with its open surgery counterpart. There are two distinct techniques, the laparoscopically assisted and the laparoscopic hand assisted approach. The purpose of this study is to demonstrate that the hand assisted approach can be used if, during a laparoscopically assisted approach, there is difficulty in dissection and/or exposure, and before performing a laparotomy. Material and methods This study is a retrospective cohort series that was performed in a private tertiary hospital in Mexico City. Patients with the diagnosis of diverticular disease who underwent a laparoscopically assisted sigmoidectomy were selected. These included patients who, during their procedure required conversion to a hand assisted approach. Results A total of 47 sigmoid colectomies began with assisted laparoscopy, of which 33 were completed, 4 required laparotomy, and 10 where completed using hand assistance (none required laparotomy). There were no statistically significant differences in return of bowel function (P=0.879) and postoperative hospital stay (P=0.679) between the group that was completed by assisted laparoscopy vs. hand assisted.Conclusions If there is difficulty in exposure or dissection during a laparoscopically assisted sigmoid colectomy, the hand assisted approach is an alternative before the laparotomy (AU)

[Hand assistance is an alternative to conversion to laparotomy during laparoscopic sigmoidectomy]. / La asistencia manual es una alternativa a la conversión a laparotomía durante la sigmoidectomía laparoscópica.

INTRODUCTION: Laparoscopic surgery in the treatment of diverticular disease offers multiple benefits compared with its open surgery counterpart. There are two distinct techniques, the laparoscopically assisted and the laparoscopic hand assisted approach. The purpose of this study is to demonstrate that the hand assisted approach can be used if, during a laparoscopically assisted approach, there is difficulty in dissection and/or exposure, and before performing a laparotomy. MATERIAL AND METHODS: This study is a retrospective cohort series that was performed in a private tertiary hospital in Mexico City. Patients with the diagnosis of diverticular disease who underwent a laparoscopically assisted sigmoidectomy were selected. These included patients who, during their procedure required conversion to a hand assisted approach. RESULTS: A total of 47 sigmoid colectomies began with assisted laparoscopy, of which 33 were completed, 4 required laparotomy, and 10 where completed using hand assistance (none required laparotomy). There were no statistically significant differences in return of bowel function (P=0.879) and postoperative hospital stay (P=0.679) between the group that was completed by assisted laparoscopy vs. hand assisted. CONCLUSIONS: If there is difficulty in exposure or dissection during a laparoscopically assisted sigmoid colectomy, the hand assisted approach is an alternative before the laparotomy.

Neuroblastoma en el adulto: informe de un caso / Neuroblastoma in the adult: case report

Introducción: El neuroblastoma es una neoplasia común en la infancia, pero extremadamente rara en el adulto. Se origina del sistema nervioso simpático y su localización más común es abdominal. Su estadificación y tratamiento se han estandarizado en niños y adultos, aunque el pronóstico es muy distinto debido a un comportamiento más agresivo y menor sobrevida en los segundos. Caso clínico: Hombre de 31 años de edad evaluado por dolor abdominal inespecífico y constipación, a quien se le diagnosticó gran neuroblastoma retroperitoneal estadio III. Al no tolerar quimioterapia se realizó cirugía. Se presenta la evaluación, manejo y seguimiento, así como una revisión de la literatura. Conclusiones: El neuroblastoma en el adulto es una enfermedad poco común que cursa con una evolución inicial insidiosa y la presentación suele ser en estadios avanzados. A diferencia del comportamiento en la infancia, en el adulto es más agresivo y con menor sobrevida a pesar de realizar el mismo tratamiento.

BACKGROUND: Neuroblastoma is a common malignancy in infancy but extremely rare in adults. These tumors, commonly found in the abdomen, originate in the sympathetic nervous system. Staging and management are standardized in children and adults, although their prognosis is very different, being more aggressive and with a poorer outcome in the adult. CLINICAL CASE: We present the case of a 31-year-old male with non-specific abdominal pain and constipation. After several studies, a stage III giant retroperitoneal neuroblastoma was diagnosed. We discuss here the evaluation, management and follow-up of the patient. A literature review is presented as well. CONCLUSIONS: Adult neuroblastoma is an unusual disease with an insidious presentation and is usually diagnosed in advanced stages. Unlike its behavior in young patients, in the adult it is more aggressive and with a poor prognosis.