[CA 19.9 and HDL-cholesterol behaviour in a sporadic colorectal carcinoma sample]. / Compartimiento del CA 19.9 y de fracción HDL-colesterol en una muestra de pacientes con carcinoma colorrectal esporádico.

BACKGROUND AND OBJECTIVE: We have carried out a comparative prediction analysis in sporadic colorectal carcinoma of plasmatic lipids and currently tumor markers used in this neoplasia (carcinoembrionary antigen - CEA, CA 19.9 and sialic acid -SA). PATIENTS AND METHODS: Transversal hospital-based case-control study. Sample was composed by 53 sporadic colorectal neoplasia patients just before surgery and 40 non matched controls. A 90 per cent of cases were at Dukes A and B stages. A multivariable model was fitted with non-conditional logistic regression. Confidence intervals were calculated at 95 per cent of confidence. Model sensibility and specificity were performed at 50 per cent cutting point. We also explored possible interactions. RESULTS: All three tumor markers (CEA, CA 19.9 and SA) were elevated in cases (p<0.01). Multivariable model included: Total cholesterol (TC) (OR= 0.69; CI: 0.50-0.96) high density lipoprotein fraction (HDL) (OR = 0.30; CI: 0.11-0.83) very low density lipoprotein fraction (VLDL) (OR = 2.21; CI = 1.07-4.55) years of age (OR = 1.11; CI = 0.98-1.26) CA 19.9 (OR = 1.20; CI = 1.02-1.42) and alkaline phosphatase (OR = 1.09; CI = 1.01 - 1.19). No interactions were found out. Model sensibility reached 96.23% and a specificity of 92.50%. CONCLUSIONS: HDL showed a similar diagnostic strength than CA 19.9 in this sporadic colorectal carcinoma sample but with an inverse OR. This multivariable model is going to be validated.

Comportamiento del CA 19.9 y de la fracción HDL-colesterol en una muestra de pacientes con carcinoma colorrectal esporádico / CA 19.9 and HDL-cholesterol behaviour in a sporadic colorectal carcinoma sample

Fundamento y objetivo: Hemos realizado un estudio comparativo del valor de predicción diagnóstica en el carcinoma colorrectal esporádico (CCRE) de los diferentes lípidos plasmáticos y de los marcadores tumorales utilizados comúnmente para esta neoplasia (antígeno cárcinoembrionario, CA 19.9 y ácido siálico). Pacientes y métodos: Estudio transversal hospitalario de casos y controles no pareados. Se recogieron un total de 53 casos incidentes de CCRE (90 por ciento de ellos en estadío A y B de Dukes) y 40 controles con patología no neoplásica en el mismo servicio. Realizamos un análisis con regresión logística no condicionada (RL) multivariante. Los intervalos de confianza (IC) estimados fueron del 95 por ciento. La sensibilidad (S) y la especificidad (E) del modelo final se calcularon con un punto de corte del 50 por ciento. Realizamos también un estudio de posibles interacciones. Resultados: Los tres marcadores tumorales utilizados estuvieron elevados en los casos con respecto a los controles (p<0,01). El modelo multivariante ajustado mediante RL incluía las siguientes variables: colesterol total (CT) (OR = 0,69; IC: 0,50 - 0,96), fracción de lipoproteína de alta densidad (HDL) (OR = 0,30; IC: 0,11 - 0,83 ) fracción de lipoproteína de muy baja densidad (VLDL) (OR = 2,21; IC: 1,07 - 4,55) edad en años (OR = 1,11; IC: 0,98 - 1,26 ) CA 19.9 (OR = 1,20; IC: 1,02 - 1,42) y fosfatasa alcalina (FA) (OR = 1,09; IC = 1,01 - 1,19). No se detectaron interacciones. La sensibilidad de este modelo fuel 96,23 por ciento y la especificidad del 92,50 por ciento. Conclusiones: La HDL se expresó en esta muestra con una fuerza de predicción diagnóstica semejante a la del marcador tumoral CA 19.9 pero con una OR inversa. El modelo multivariante sobre el que se basa esta afirmación está pendiente de ser validado (AU)

Experimental study of sutureless colorectal anastomosis.

BACKGROUND/AIMS: The present research project has been made mainly with the idea of comparing the tensile strength values and histological answers of three types of colon anastomosis: sutured with silk 5/0; polyglycolic acid 5/0; and sutureless anastomosis with human fibrin gum. METHODOLOGY: One hundred and five (105) Wistar breath rats allocated into 3 groups of 35 animals were used to implement this experimental research project: silk, polyglycolic acid and human fibrin gum. Furthermore, each group was subdivided in 5 series respectively to carry out an experimental study on the tensile strength parameter and anatomic-pathological determinations on the 10th, 20th, 30th, 40th and 50th day after the surgical intervention. The following surgical interventions were practiced on them: A cross section of the colon, followed by: group 1: an end-to-end discontinuous suture anastomosis with Silk; group 2: an end-to-end discontinuous suture anastomosis with polyglycolic acid; group 3: sutureless anastomosis with human fibrin gum. On the 10th, 20th, 30th, 40th and 50th days we proceeded to measure the anastomosis' tensile strength value for each series. We used a tensile strength apparatus and waited until the break down of the suture sample took place and wrote down the value, in g/cm, given by the voltmeter at that moment. RESULTS: The results obtained indicate that anastomosis made in group 1 (silk) lasted longer to the tensile strength apparatus; followed by those practiced in group 2 (polyglycolic acid); and finally anastomosis carried out in group 3 (human fibrin gum). However in the anastomotic process carried out with the human fibrin gum the healing started from the 10th day. In the same period of time we carried out the following anatomic-pathological determinations: a) sharp inflammation; b) edema; c) non-specific chronic inflammatory infiltrate; d) granulomatous inflammatory infiltrate to foreign bodies; e) fibrosis. CONCLUSIONS: The results show a better answer for anastomosis made with human fibrin gum than those carried out with the two other suture materials. This conclusion is based on the facts that the human fibrin gum used to carry out sutureless anastomosis during this research project generated a lower sharp inflammation and speediness in its absorption; absence of granular reaction to a foreign body; a minor or non-existent edema at all; as well as a good fibrous healing speediness process. Therefore, all these experimental results lead us to conclude that the human fibrin gum used to carry out sutureless anastomosis may be an alternative to the handmade conventional anastomosis. Moreover they are easy to be implemented.

Hemorragia digestiva por hemangiomatosis difusa de intestino delgado en el anciano / Gastrointestinal hemorrhage caused by a difuse hemangiomatosis of the small bowel in an elderly patient

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[Duodenal adenocarcinoma in celiac disease with late diagnosis and treatment]. / Adenocarcinoma duodenal en enfermedad celíaca de diagnóstico y tratamiento tardíos.

It seems to be a link between small intestine cancer and celiac disease. We describe here a patient who developed a duodenal carcinoma fifteen years after the celiac disease diagnosis. Tumor endoscopic study and biopsy sampling are the more useful diagnostic approach. This is usually difficult because the lesion is very small or there are rests of food biding the lesion. Poor clinical layout and a later diagnosis favour the development of metastasis. A wide segmental resection including lymph nodes is the best therapy for tumors of the second and third duodenal segments.

[Effect of somatostatin-14 in simple mechanical obstruction of the small intestine]. / Action de la somastostatine-14 dans l'occlusion mécanique simple de l'intestin grêle.

In order to investigate the properties of somatostatin-14 we studied an experimental model of simple mechanical and closed loop occlusion. Forty-eight New Zealand rabbits were assigned randomly to three groups of 16: group C (controls) was operated and treated with saline solution (4 cc/Kg/h); group A was operated and initially treated with saline solution and an equal dose of somatostatin-14 (3.5 micrograms/Kg/h; and group B was operated and treated in the same manner as group A, but later, 8 hours after the laparotomy. The animals were sacrificed 24 hours later; intestinal secretion was quantified, blood and intestinal fluid chemistries were performed and specimens of the intestine were prepared for histological examination. Descriptive statistical analysis of the results was performed with the ANOVA, a semi-quantitative test and the covariance test. Somatostatin-14 produced an improvement in the volume of intestinal secretion in the treated groups compared with the control group. The results were statistically significant in group B treated after an 8-hour delay: closed loop (ml): 6.40 +/- 1.12, 2.50 +/- 0.94, 1.85 +/- 0.83 and simple mechanical occlusion (ml): 175 +/- 33.05, 89.50 +/- 9.27, 57.18 +/- 21.23, p < 0.01 for groups C, A and B C, A and B respectively. Net secretion of Cl and Na ions was also improved, p < 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)

[Postoperative gastritis due to alkaline reflux. Our results]. / Gastritis postquirúrgica por reflujo alcalino. Nuestros resultados.

We present the results of a retrospective study carried out on 23 patients with alkaline gastric reflux (AGR) verified through endoscopy, biopsies and Tc99m HIDA, which were operated on in our department with Y of Roux, Braun, Henley as the correction techniques of this pathology. The criteria of surgical indications were evaluated in these patients as also the results obtained in reference to residual symptoms and changes in the histologic and gammagraphic patterns.

Liver, spleen and kidney cultures in different conditions of splenic preservation.

The appearance of the postsplenectomy syndrome has made investigators focus all attention on the immunitary aspects that could change following a splenic extirpation. Besides this, bacterial clearance has been considered fundamental in this pathology. We present an experimental study comparing liver, spleen and kidney cultures in different conditions of splenic preservation, including autotransplantation, and with sepsis induced by the inoculation of capsulated Escherichia coli. The majority of tissue cultures were positive, showing, in must cases, a statistical correlation between the number of microorganisms in each organ for every animal. This confirms that all three organs act alike, as bacterial filters.

[Ileocecal and lymph node tuberculosis: a rare association in our area]. / Tuberculosis ileocecal y ganglionar: asociación rara en nuestro medio.

A case of ileocecal tuberculosis associated to lymphatic nodes TB, is presented. This association is not frequently observed in all series and isolated cases registered in medical literature. In this particular case, we comment on the pathogenic problems of primary intestinal TB and the importance of the systemic clinical suspicion to diagnose this, nowadays, rare problem in our area. Finally, we discuss the value of certain diagnosis criteria related to the actual therapy, in which the conservative character is dominant, this therapy also being applied to post-surgical fistula in some individual cases such as the one presented here.

[Angiodysplasia of the colon. Apropos of 2 cases]. / Angiodisplasia de colon. A propósito de dos observaciones.

Angiodysplasia of the colon is a vascular lesion which involves the arterioles, venules and small venous vessels; usually it is a lesion of the aged and presents with rectorrhagia, melena or chronic anemia due to chronic blood loss. We present two cases of angiodysplasia of the colon in two female patients in the eighth decade of their lives, treated in the Servicio de Cirugía del Hospital Universitario Virgen Macarena de Sevilla. We emphasize the value of the angiographic study for the diagnosis of this lesion, and also the usefulness of isotopic study with labeled erythrocytes for the localization. The treatment of choice is surgical resection of the affected area. It was performed in both patients. One of them died.