Cytoreductive surgery and perioperative intraperitoneal chemotherapy in patients with peritoneal carcinomatosis of colonic origin: outcomes after 7 years' experience of a new centre for peritoneal surface malignancies.

INTRODUCTION: Peritoneal carcinomatosis is a relatively frequent situation in the natural history of colorectal cancer and is associated with a dismal prognosis. Promising results have been shown after radical cytoreduction followed by intraperitoneal chemohyperthermic perfusion. The aim our study was to assess the outcomes after treating patients with peritoneal carcinomatosis of colonic origin by means of cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) followed by early postoperative intraperitoneal chemotherapy (EPIC). METHODS: Tumour resection was performed in accordance with the guidelines for oncologic surgery. Selective peritonectomies and remnant nodule electroevaporation were performed with the aim of achieving a complete cytoreduction. Peritoneal perfusion was carried out according to the Coliseum technique at 0.5-1 L/min, and chemotherapy was administered at 42oC for 40-90 min. Mitomycin C 10-12.5 mg/m(2) or oxaliplatin 360 mg/m(2) was used. Postoperative intraperitoneally administered 5-fluorouracil (5-FU) (650 mg/m(2) per day) was given for 5 consecutive days. RESULTS: Twenty patients were treated from 2001 to 2008. The mean peritoneal cancer index was 11 (range 2-39). Fifteen patients had undergone complete cytoreductive surgery. The morbidity was 40%. There was one case of death due to bone marrow aplasia. Ten patients had recurrence; five of them underwent salvage surgery. Two patients were treated with a second HIPEC. Actuarial overall survival and progression-free survival were 36% and 30% at 5 years, respectively, with a median follow-up of 18 (range 8-28) months. CONCLUSIONS: Cytoreductive surgery combined with HIPEC is a feasible technique that might increase patient survival. It represents a potential cure for selected patients who have no other alternatives.

Estudio Preliminar de Infección Nosocomial en el Hospital de Caldas (Manizales) / Preliminary Study of Nosocomial Infection in the Hospital de Caldas

La infección Nosocomial (IN) es aquella que no se hace presente ni está incubando en el momento de la hospitalización y tiene un período de incubación mínimo de dos días para que se haga clínicamente manifiesta. En este estudio se analizaron 60 casos de IN ocurridos en ocho servicios hospitalarios durante el mes de abril de 1995. La identificación bacteriana se realizó de manera convencional, la prueba de susceptibilidad de antibióticos fue determinada por el método MIC EM Sens BP Sensident de Merck. El tipo de IN más frecuente fue la infección de la herida quirúrgica. El servicio más afectado fue la Unidad de Cuidados Intensivos. Pseudomonas aeruginosa fue el microorganismo aislado con mayor frecuencia y el antibiótico más efectivo fue el imipenem. Se aisló una colonia de Staphylococcus aureus meticilino resistente. Este trabajo resume los aspectos más importantes de la IN en el Hospital de Caldas, incluida la etiología, la sensibilidad a los antibióticos y los sobrecostos generados