Procalcitonin and C-reactive protein as early markers of postoperative intra-abdominal infection in patients operated on colorectal cancer.

PURPOSE: The aim of this study was to evaluate the accuracy of serum procalcitonin (PCT) and C-reactive protein (CRP) for early diagnosis of postoperative intra-abdominal infections (PIAI) after elective surgery for colorectal cancer. METHODS: Prospective observational study including patients operated on for colorectal cancer between January and December of 2015 was performed. Serum PCT and CRP levels were measured before surgery and daily until postoperative day 3. RESULTS: One hundred twenty patients were included. Seven patients (5.8%) had PIAI. PCT levels were significantly higher in patients with PIAI on postoperative days 1 and 3, whereas CRP levels only were significantly more elevated on postoperative day 3. The ratio between CRP levels on postoperative day 3 and CRP levels on postoperative days 2 (CRP D3/CRP D2) and 1 (CRP D3/CRP D1) was significantly higher in patients with PIAI. PCT on postoperative day 3, for a cutoff of 0.45 ng/mL, had the best sensitivity (100%) with a specificity of 73.8%. The ratio CRP D3/CRP D1 yielded the higher specificity and positive predictive value (90.9 and 27.3%, respectively, for a cutoff of 1.8). The higher negative predictive value was obtained for PCT on postoperative days 1 and 3 (100%, with cutoff of 0.76 and 0.45 ng/mL, respectively) and for CRP on postoperative day 3 (100% with cutoff of 10 mg/dL). CONCLUSION: PCT and CRP serum levels are associated with the appearance of PIAI after colorectal cancer surgery, although the positive predictive values were low for both PCT and CRP. However, the negative predictive values were high.

Carcinoma de células de Merkel

El carcinoma de células de Merkel es un tumor maligno cutáneo poco frecuente del que han sido descritos unos 500 casos en la literatura médica mundial. Por ser un tumor cutáneo es fácilmente accesible al diagnóstico precoz. Sin embargo, la apariencia que suelen adoptar y el desconocimiento de su existencia pueden inducir a confusión con procesos inflamatorios, retrasándose el diagnóstico y con ello su adecuado tratamiento.En el presente artículo se revisan sus aspectos clínicos e histológicos, así como las modalidades terapéuticas utilizadas y sus resultados (AU)

[Cushing syndrome caused by macronodular hyperplasia ACTH-independent]. / Síndrome de Cushing por hiperplasia macronodular ACTH independiente.

Case report of a 49-year old male patient who presented with signs and symptoms in agreement with Cushing's Syndrome, the etiology of which was shown to be an ACTH-independent macronodular hyperplasia. In such cases, the therapeutical choice is bilateral adrenalectomy which was adopted by us using a posterior approach. The relevance of the clinical diagnosis and therapeutical aspects of this condition are reviewed.

[PSA levels and its relationship with digital examination, age, and score of prostatic symptoms]. / Valor del PSA en relación con el tacto, edad y score de la sintomatología prostática.

Between November 1992 and March 1993 our Service conducted a campaign for early detection of prostate disease among the male population of Vigo. The study focused in the relationship of PSA with the age, rectal examination and prostate symptomatology score. In view of the results obtained it has been concluded that PSA levels increase gradually as a function of age, volume and prostate symptomatology score.

[Radical surgery of locally advanced prostatic cancer]. / Cirugía radical en el cáncer de próstata localmente avanzado.

Retrospective study in 51 patient with locally advanced prostate cancer (34 pT3 and 17 N+) selected from 88 radical prostatectomies performed between February 1985 and December 1993. An evaluation is made of the clinical/pathological stage correlation and the effectiveness of the different diagnostic methods (61% of understaging). The possibility to rescue locally spread tumours is analyzed, 7/51 (13.72%) patients receiving pre-operative neoadjuvant hormonal therapy. Estimated survival at 8 years was 82.6% of all patients treated with radical surgery and, at the end of the study, the situation of 30/46 (65.2%) patients assessed by digital rectal examination, quality of life index, PSA follow-up, abdominal ultrasound and/or CT, bone scan and chest X-ray, was an estimated 8-year disease-free evolution. It is observed that radical surgery and the post-surgical hormonal approach permit good survival in locally advanced prostate cancer and that the use of a neoadjuvant hormonal approach permit good survival in locally advanced prostate cancer and that the use of a neoadjuvant hormonal approach allows in many cases the rescue of patients for radical surgery.

[Conn's syndrome]. / Síndrome de Conn.

Adrenal hypertension is an uncommon phenomenon. When seen in association with hypokalemia the existence of primary aldosteronism, the most frequent cause of which is an adenoma of the adrenal gland cortex, should be suspected. This paper contributes one case of primary aldosteronism treated by unilateral resection of the adrenal adenoma, with no surgical complications and good medium-term results.

[Acquired cystic renal disease. Association with hypernephroma]. / Enfermedad renal quística adquirida. Asociación con hipernefroma.

Emergence of multiple bilateral renal cysts observed in patients undergoing periodic haemodialysis is 40%. The pathology, known as Acquired Cystic Renal Disease (A.C.R.D.) presents a high association to renal cancer. Two cases of A.C.R.D. and their association with hypernephroma, one resulting in secondary retroperitoneal haemorrhage and the other in intracystic haemorrhage, are presented. Forms and diagnosis are analyzed, insisting upon the need of monitoring the patients in haemodialysis from the point of view of tumour emergence.

[Adenocarcinoma in bladder. Apropos of a case]. / Adenocarcinoma en vejiga. A propósito de un caso.

Finding an adenocarcinoma at the vesicle suggests three possible diagnosis: Intestinal adenocarcinoma with vesical location. Adenocarcinoma of the urachus. Vesical primitive adenocarcinoma. Presentation of one case of intestinal adenocarcinoma, revealed by its mictional symptomatology, with the endoscopic appearance of being a single vesical tumour, later shown to be a vesical adenocarcinoma, on which extended surgery of the gut and partial surgery of the bladder was performed.

[Papillary-cystic carcinoma of the pancreas: an infrequent tumor with favorable prognosis]. / Carcinoma papilar-quístico del páncreas: un tumor infrecuente con un pronóstico favorable.

Two cases are presented of papillary-cystic carcinoma of the pancreas diagnosed and treated in the II General Surgery Service of the Gregorio Marañón General Hospital of Madrid (Spain) over the last six years. Both occurred in young women who presented with pain and abdominal mass. The tumors were large and were located on the tail of the pancreas. One was treated by local resection and the other by distal pancreatectomy. Both women are free of disease after a follow-up period of 6 years and 10 months, respectively. This is a very infrequent tumor, about 100 cases having been described up until the present, and it has a very favorable prognosis. Its clinical, diagnostic, pathologic, therapeutic and prognostic features are analyzed.