Diverticulitis cecal solitaria con enterolitiasis en su interior en paciente intervenido por sospecha de apendicitis aguda / No disponible

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Colecistitis aguda alitiásica tras apendicectomía por apendicitis aguda en edad pediátrica / No disponible

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Enzymatic and morphological evaluation of the hepatic cytoprotective effect of somatostatin and octreotide during extended experimental liver preservation.

Cytoprotective effects on the liver of somatostatin (ST) and octreotide (OT) have been previously described in normothermic ischemia-reperfusion models. The purpose of this study was an enzymatic and morphological assessment of hepatic cytoprotective effects during extended cold storage. Rat livers were washed in situ via the portal vein with University of Wisconsin solution (UW) UW+ST, or UW+OT. After 24 or 48 hours of cold ischemia time (CIT), livers were reperfused for 2 hours via the portal vein with oxygenated KHB at 37 degrees C using a nonrecirculating ex situ isolated perfusion system. Levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and creatinine kinase (CK) were assessed in the perfusate during ex situ isolated reperfusion. After a 24-hour cold ischemia time (CIT) ALT, LDH, and CK levels were significantly lower (P < .05) in the UW+ST and the UW+OT livers than the UW livers. After 48-hour CIT, AST, ALT, LDH, and CK levels were significantly lower (P < .05) in the UW+ST and the UW+OT livers than the UW livers. Histopathological examination revealed mild differences after 24-hour CIT but an evidently less ischemically damage organ after 48-hour CIT. With the limitations of an in vitro model, ST and OT showed enzymatic and morphological effects during extended liver preservation.

Electrical impedance of the liver during experimental long-term liver preservation.

Measurements of electrical impedance were performed to assess ischemic damage in the rabbit liver during long-term preservation with University of Wisconsin (UW) or histidine-tryptophan-ketoglutarate (HTK) solution. The impedance was measured at a frequency of 200 Hz after in situ perfusion and after cold storage for 24 and 48 hours in UW or HTK solution (six livers per group). Z(200 Hz) was significantly higher (P < .01) after 48 compared with 24 hours of cold storage with both protection solutions without significant differences between the livers preserved with both solutions. Electrical impedance was observed to be a sensitive indicator of liver damage during long-term protection, showing similar preservation quality for both preservation solutions.

Renal paratransplant hernia: an unusual complication of renal transplantation?

Renal paratransplant hernia constitutes an unusual variant of internal hernia caused by entrapment of bowel through a defect in the peritoneum covering the transplanted kidney. Only three cases have been previously reported. We present three new cases of renal paratransplant hernia. Abdominal pain and vomiting were the main symptoms. Clinical diagnosis of bowel obstruction and paratransplant hernia was reached using abdominal CT scan. All patients underwent an emergency surgical procedure, and one patient needed resection of necrotic bowel. The three patients survived owing to early surgical intervention, and they were discharged asymptomatic. Paratransplant hernia represented 1.1% of our series of transplant patients. Early diagnosis and surgical treatment are esential in transplant patients with bowel obstruction to avoid high morbidity and mortality rates.

Neumomediastino y enfisema cervical tras consumo de “éxtasis” (3, 4 metilendioximetanfetamina) / Pneumomediastinum and cervical emphysema after “ecstasy” (3, 4 methylenedioxymetamphetamine) consumption

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Estudio prospectivo de la frecuencia de infección nosocomial y factores de riesgo en un servicio de cirugía general / Prospective study of the frequency of nosocomial infection and its risk factors in a general surgery department

Objetivo. Cuantificar la frecuencia de infección nosocomial (IN) en un servicio de cirugía general e identificar los factores de riesgo asociados. Pacientes y método. Se realizó un estudio prospectivo, longitudinal, descriptivo y analítico, entre enero de 1995 y diciembre de 1998, de una cohorte de 2.794 pacientes que fueron intervenidos quirúrgicamente, con una estancia postoperatoria superior a las 48 h. Resultados. La IN más frecuente fue la infección quirúrgica (IQ), con una tasa de incidencia acumulada (IA) global del 7,7 por ciento, oscilando entre el 3,4 por ciento para la cirugía limpia y el 23,7 por ciento para la cirugía sucia. Le siguen, en orden de frecuencia, la infección del tracto urinario (ITU) y la bacteriemia (B), con el 1,5 por ciento, y la neumonía nosocomial (NN) con el 0,5 por ciento. Una puntuación de la American Society of Anesthesiology (ASA) superior a 2 multiplica por 1,76 el riesgo de IQ, por 2,13 el riesgo de ITU, por 5,93 el riesgo de NN y por 4,72 el riesgo de B. La probabilidad de detectar una IQ según la estancia posquirúrgica oscila entre el 0,4 en los pacientes con una estancia de 3-4 días hasta el 0,93 en los pacientes con una estancia de 10-12 días. Conclusiones. La IN más frecuente fue la IQ. Una puntuación ASA superior a 2, la estancia prequirúrgica, el número de días con sonda urinaria, con catéter venoso central, con ventilación mecánica, así como el mejor uso de profilaxis antibiótica son factores que influyeron en la frecuencia de infección nosocomial. La frecuencia de IN ha disminuido a lo largo de los años del estudio; sin embargo, el acortamiento de la estancia posquirúrgica enmascara el verdadero valor de este descenso (AU)

Nosocomial infection and related risk factors in a general surgery service: a prospective study.

OBJECTIVES: The aim of this study was to quantify the frequency of nosocomial infection in the general surgery service of a tertiary-care hospital and to identify associated risk factors. METHODS: A prospective, longitudinal, descriptive and analytical study was made from January 1995 to December 1998 of a clinical cohort of 2794 patients who underwent a surgical procedure with a post-surgery stay of more than 48 h. The criteria for infection were those defined by the Center for Disease Control and Prevention (CDC) of the USA. RESULTS: The most frequent nosocomial infection was surgical infection (SI), with a global cumulative incidence (CI) of 7.7%, ranging from 3.4% for clean surgery to 23.7% for dirty surgery. The next most frequent were urinary tract infection (UTI) and bacteremia (1.5%) and nosocomial pneumonia (NP) (0.5%). The global CI of SI decreased from 11.7% in 1995 to 4% in 1998. An ASA classification higher than 2 multiplied the risk of SI by 1.76; with respect to UTI multiplied the risk by 2.13; the risk of NP by 5.93 and multiplied the risk of B by 4.72. CONCLUSIONS: The most frequent nosocomial infection was surgical infection. An ASA higher than 2, the stay prior to surgery; the number of days with a urinary catheter, with a central venous catheter and with mechanical ventilation; as well as the improvement in the use of antimicrobial prophylaxis, were all factors that influenced the frequency of nosocomial infection.

Is pancreas and/or spleen resection required in total gastrectomy for advanced gastric cancer?

OBJECTIVE: Total gastrectomy for advanced gastric cancer is frequently combined with extended lymphadenectomy. This technique is easier when resection of distal pancreas and/or spleen is performed. We have tried to evaluate whether the resection of both structures and total gastrectomy in patients with advanced gastric cancer actually improve survival rates. PATIENTS: From 1991 to 1999, 140 patients with advanced gastric cancer underwent total gastrectomy at the General Hospital of Albacete: 43 with simple total gastrectomy, 57 with total gastrectomy plus splenectomy and 40 with total gastrectomy plus distal pancreaticosplenectomy. Univariate and multivariate analysis were conducted in order to evaluate different prognostic factors and survival curves among the groups. RESULTS: Survival rates of the three groups were compared for each factor, being only significant variables the degree of tumor infiltration in the gastric wall, the size of the tumor, the staging and the type of lymphatic infiltration. Neither splenectomy nor distal pancreaticosplenectomy improved the survival compared to simple total gastrectomy. Morbimortality rates increased with more aggressive surgical procedures, but differences were not significant. CONCLUSIONS: Resection of distal pancreas and/or spleen plus total gastrectomy for advanced gastric cancer is associated to a greater number of isolated lymph nodes, but do not improve the survival of patients.

¿Es necesaria la resección pancreática y/o esplénica en la gastrectomía total por cáncer gástrico avanzado? / Is pancreas and/or spleen resections required in total gastrectomy for advanced gastric cancer?

Objetivo: la gastrectomía total en el cáncer gástrico avanzado, es asociada a una linfadenectomía extendida en gran parte de los casos. Esta técnica se ve facilitada si se practica una resección del páncreas distal y/o del bazo. Intentamos analizar si la resección de una o ambas estructuras junto a la gastrectomía total en el cáncer gástrico avanzado, mejoraba realmente el pronóstico de los pacientes. Pacientes: desde 1991 a 1999 se han realizado 140 gastrectomías totales por cáncer gástrico avanzado en el Hospital General de Albacete: 43 mediante gastrectomía total simple, 57 mediante gastrectomía total con esplenectomía y 40 mediante gastrectomía total con pancreatectomía distal y esplenectomía. Un análisis univariante y multivariante permitió analizar los diferentes factores pronósticos y las curvas de supervivencia entre los grupos. Resultados: se comparó la supervivencia de cada grupo para cada factor analizado resultando sólo variables significativas el grado de infiltración tumoral en la pared gástrica, el tamaño del tumor, el estadiaje y el tipo de infiltración linfática. Ni la esplenectomía ni la pancreaticoesplenectomía distal mejoró la supervivencia con respecto a la gastrectomía total simple. La morbi-mortalidad fue mayor en los pacientes con cirugía más agresiva pero sin valor significativo. Conclusiones: la resección de bazo y/o páncreas distal en la gastrectomía total por cáncer gástrico avanzado conlleva un mayor número de ganglios aislados pero no influye en la supervivencia de los enfermos (AU)

Septic arthritis due to Scedosporium apiospermum: case report and review.

Septic arthritis is a relatively common disease, but reports of septic arthritis caused by fungi are still rare and it is often associated with predisposing factors that reduce cellular immunity (alcoholism, cancer, endogenous or exogenous hypercortisolism, intravenous drug abuse). Articular conditions caused by Scedosporium apiospermum are uncommon. Here we report the case of a 32-year-old immunocompetent male with septic arthritis caused by S. apiospermum and review 12 other cases.