Reduction of the closure time of postoperative enterocutaneous fistulas with fibrin sealant.

AIM: To assess whether the use of fibrin sealant shortens the closure time of postoperative enterocutaneous fistulas (ECFs). METHODS: The prospective case-control study included 70 patients with postoperative ECFs with an output of < 500 mL/d, a fistulous tract of > 2 cm and without any local complication. They were divided into study (n = 23) and control groups (n = 47). Esophageal, gastric and colocutaneous fistulas were monitored under endoscopic visualization, which also allowed fibrin glue application directly through the external hole. Outcome variables included closure time, time to resume oral feeding and morbidity related to nutritional support. RESULTS: There were no differences in mean age, fistula output, and follow-up. Closure-time for all patients of the study group was 12.5 +/- 14.2 d and 32.5 +/- 17.9 d for the control group (P < 0.001), and morbidity related to nutritional support was 8.6% and 42.5%, respectively (P < 0.01). In patients with colonic fistulas, complete closure occurred 23.5 +/- 19.5 d after the first application of fibrin glue, and spontaneous closure was observed after 36.2 +/- 22.8 d in the control group (P = 0.36). Recurrences were observed in 2 patients because of residual disease. One patient of each group died during follow-up as a consequence of septic complications related to parenteral nutrition. CONCLUSION: Closure time was significantly reduced with the use of fibrin sealant, and oral feeding was resumed faster. We suggest the use of fibrin sealant for the management of stable enterocutaneous fistulas.

[Clinical predictors of staging in colorectal cancer]. / Predictores clínicos de etapificación en cáncer colorrectal.

OBJECTIVE: We undertook this study to determine the relationship between clinical symptoms as predictors for staging colorectal cancer (CRC). METHODS: We performed a cross-sectional study from January 2000 to January 2005 at the "Hospital Civil Fray Antonio Alcalde." All patients with histological diagnosis of CRC were included. Variables analyzed were gender, age, clinical manifestations and location of the tumor, as well as degree of differentiation and time of evolution. RESULTS: We studied 108 patients with CRC. There were 52 female patients (48.1%) and 56 male patients (51.9%). Twenty five patients were <40 years old (23.15%). Most tumors were well to mildly differentiated adenocarcinomas (88.9%). We observed 37% of proximal tumors with a median evolution time of 11.45 months. Distal tumors were observed in 68 patients with a median evolution time of 9.19 months (p = 0.20). Hemoglobin levels were lower in proximal carcinomas (p = 0.02). Advanced tumors (stages III and IV) corresponded to 82.4% of the cases. The three most common symptoms were rectal bleeding, change in bowel habits and nonspecific abdominal pain. All showed low sensitivity but moderately high specificity (rectal bleeding 89%, change in bowel habits 68%). Combinations of these last two symptoms to predict advanced stage were 55 and 68%. CONCLUSIONS: The majority of the patients were diagnosed with advanced stages of well-to-mildly differentiated adenocarcinomas. Symptom evaluation as predictors for staging showed a low sensitivity and a moderately high specificity due to a late diagnosis of advanced tumors. We attributed our results to a referral bias, the absence of screening programs and lack of clinical judgment to diagnose CRC at earlier stages.

Predictores clínicos de etapificación en cáncer colorrectal / Clinical predictors of staging in colorectal cancer

OBJECTIVE: We undertook this study to determine the relationship between clinical symptoms as predictors for staging colorectal cancer (CRC). METHODS: We performed a cross-sectional study from January 2000 to January 2005 at the [quot ]Hospital Civil Fray Antonio Alcalde.[quot ] All patients with histological diagnosis of CRC were included. Variables analyzed were gender, age, clinical manifestations and location of the tumor, as well as degree of differentiation and time of evolution. RESULTS: We studied 108 patients with CRC. There were 52 female patients (48.1%) and 56 male patients (51.9%). Twenty five patients were <40 years old (23.15%). Most tumors were well to mildly differentiated adenocarcinomas (88.9%). We observed 37% of proximal tumors with a median evolution time of 11.45 months. Distal tumors were observed in 68 patients with a median evolution time of 9.19 months (p = 0.20). Hemoglobin levels were lower in proximal carcinomas (p = 0.02). Advanced tumors (stages III and IV) corresponded to 82.4% of the cases. The three most common symptoms were rectal bleeding, change in bowel habits and nonspecific abdominal pain. All showed low sensitivity but moderately high specificity (rectal bleeding 89%, change in bowel habits 68%). Combinations of these last two symptoms to predict advanced stage were 55 and 68%. CONCLUSIONS: The majority of the patients were diagnosed with advanced stages of well-to-mildly differentiated adenocarcinomas. Symptom evaluation as predictors for staging showed a low sensitivity and a moderately high specificity due to a late diagnosis of advanced tumors. We attributed our results to a referral bias, the absence of screening programs and lack of clinical judgment to diagnose CRC at earlier stages.

[Frequency of heart tumors and their histopathological correlation]. / Frecuencia de tumores cardiacos y su correlación histopatológica.

BACKGROUND: The presentation of heart tumors is very uncommon. Eighty percent of primary heart neoplasias are benign, and myxomas represent the first cause in frequency among adult populations. Due to the frequency of presentation of these tumors, it is common to make the clinical/surgical diagnosis without obtaining histopathologic confirmation. Our objective was to determine the frequency of presentation of heart tumors and its correlation between the surgical/clinical and histopathologic diagnosis in our Institute. METHODS: This is a case series with 16 patients with cardiac tumors treated surgically at the Department of Cardiothoracic Surgery during a 4-year period. We used descriptive statistics, and quantitative variables are expressed as mean, range and standard deviation whereas qualitative variables were described as proportions. RESULTS: We included 3 men (19%) and 13 women (81%) with a mean age of 41.4 +/- 16.2 years. Clinical presentation was predominantly of congestive heart failure. Clinical diagnosis was determined in 15 patients (94%) and just one case of intracardiac thrombus (6%), whereas the histopathologic diagnosis reported myxoma in only 11 cases (68.8%), three patients with intra-cardiac thrombus (18.7%) and two patients with sarcomas (12.5%), leiomiosarcoma and angiosarcoma, respectively. We found a positive correlation between the clinical diagnosis and the histopathology results. There was no mortality. CONCLUSIONS: Even though myxomas represent the most frequent proportion of presentation in heart tumors, histopathological confirmation is necessary for diagnosis. Clinical and histopathologic correlation represents the basis for the choice of adequate management strategies and prognosis for the patient.

[Reduction of lymphatic drainage posterior to modified radical mastectomy with the application of fibrin glue]. / Reducción del drenaje linfático posterior a mastectomía radical modificada con la aplicación de gel de fibrina.

OBJECTIVE: Our objective was to investigate the effectiveness of fibrin glue to reduce hemato-lymphatic fluid production after modified radical mastectomy (MRM) in women with breast cancer. MATERIAL AND METHODS: A total of 43 women treated surgically were randomly assigned to receive 10 ml of fibrin glue at the end of the breast resection plus closed suction drains (n = 22), or drain system only as a control group (n = 23). Outcome variables were fluid collected in the drainage system measured each 24 h. Drains were removed when a 50 ml output per day was obtained. Seroma formation and flap complications were also investigated. RESULTS: The average age was 48.36 +/- 8.9 years for the study group and 52.87 +/- 9.74 years for the control group (p = 0.11). Body mass index (BMI) ranged between 22 and 35 kg/m2: 28.1 +/- 2.7 vs. 29.92 +/- 4.0 kg/m2 (p = 0.27). A reduction of the fluid drained was observed from the first postoperative day in the study group in contrast with the control (174.55 +/- 64.69 vs. 281.22 +/- 116.91, p = 0.001). A correlation between the BMI and the exposed surgical area was also statistically significant (p < 0.002), as well as the day the drains were extracted (p < 0.05). The incidence of seroma formation was 9% in the study group and 34.78% in the control, a statistically significant finding (p < 0.05). CONCLUSIONS: Fibrin glue locally applied to the surgical wound under the flap and axilla significantly reduced the amount and duration of lymphatic fluid produced after MRM with axillary dissection. Also, a significant reduction in the incidence of seromas was observed.

[Sensitivity, specificity, and predictive values of the level of hemoglobin, hematocrit and platelet count as an activity index in ulcerative colitis]. / Sensibilidad, espedificidad y valores predictivos del nivel de hemoglobina, hematócrito y cuenta plaquetaria como índices de actividad en colitis ulcerativa.

INTRODUCTION: Ulcerative colitis (UC) is a disease characterized by relapsing and remitting non-infectious inflammation of the colorectal mucosa. Its heterogeneity makes assessment of the disease's activity a prerequisite for a rational choice of therapy. We aimed to determine sensitivity, specificity, positive and negative predictive values of hemoglobin, hematocrit, and platelets to develop a simplified activity index of UC. MATERIAL AND METHODS: Sixty patients with UC were included and submitted to measurements of hemoglobin, hematocrit, and platelets, as well as sigmoidoscopy and biopsy. Sensitivity and specificity, positive and negative predictive values were correlated with the reported degree of activity in the biopsy. Kruskal-Wallis test was used to determine differences between groups, and Pearson and Spearman rank tests were used to correlate each parameter with the degree of activity. A p value < 0.05 was considered statistically significant. RESULTS: The patients had moderate (n = 15), severe (n = 15), and normal histology as a control group (n = 15). Thirty-four (57%) were female and 26 (43%) were male. Average age was 26 +/- 12.8 years. Sensitivity and specificity for hemoglobin level was 51% and 100% for hematocrit, respectively, 51% and 100% for hematocrit, and 84% and 100% for platelet counts. Spearman's correlation for hemoglobin was r = -0.866 (p < 0.001), for hematocrit r = -0.864 (p < 0.001) and for platelets r = 0.928 (p < 0.001). CONCLUSIONS: Hemoglobin and hematocrit are useful to catalog the degree of activity of UC when it is severe. Platelet count may be a marker of severity at any time, due to its high sensitivity and specificity as a diagnostic test.

[Splenic abscess secondary to massive bee bite in immunocompetent host. A case report]. / Absceso esplénico possiblemente secundario a picadura masiva de abejas en huésped immunocompetente. Reporte de un caso.

INTRODUCTION: Spleen abscesses are considered as an infrequent infectious disease. An increase in its presentation has been seen due to certain pathologies or clinical conditions associated with immune suppression, endocarditis being one of the most frequent causes. Gram-positive aerobes are the main causal agents with non-specific clinical manifestations. CT scan and ultrasound are the elective choices for diagnosis and imaging support for punction and drainage. OBJECTIVE: To describe the case of a patients with splenic abscess and its possible association with massive bee bite. CASE REPORT: A 51-year-old man, with no important medical history, suffered a massive bee bite and developed anaphylactic shock. He was managed at the emergency room where 116 bee stings were removed from the patient. He was discharged after 3 days. Eight days later he complained of abdominal pain localized in the left upper quadrant, persisting for 3 weeks. Abdominal pain increased and was accompanied by malaise, vomiting, fever, signs of peritonitis and leucocytosis. CT scan showed left pleural effusion, a single hypodense lesion in the inferior pole of the spleen, and thickness of the parenchyma. The patient was diagnosed with spleen abscess drained to cavity and was submitted to surgery. Surgical findings included localized peritonitis, friable spleen, and 200 ml of pus. Splenectomy was performed and IV antibiotic therapy was started. Blood culture, viral profile, Widal reactions, and serological test for HIV were negative. Secretion (pus) culture was positive for Enterococcus faecium. CONCLUSIONS: Spleen abscess is a rare entity and unusual diagnosis, representing a high mortality in non-treated patients. According to our search, there is no literature-based evidence of a similar case with this association. This report represents the first case of the association between spleen abscess and massive bee bite.