Cirugía sin sangre en las prótesis totales de rodilla / Bloodless surgery in total knee arthroplasty

Introducción. El objetivo del trabajo es intentar disminuir el índice transfusional en cirugía de prótesis de rodilla aplicando métodos de ahorro de sangre. Consideramos un objetivo realista conseguir un índice transfusional por debajo del10%.Material y método. Estudio de cohortes: una cohorte actual, con 105 pacientes (107 prótesis totales de rodilla), y otra histórica de control con 193 (197 prótesis totales de rodilla). El período de estudio comprende desde mayo de 2004 hasta agosto de 2005.Resultados. El índice transfusional en la cohorte histórica fue del 57,3% (113 pacientes), y en la cohorte actual del 7,5% (8 pacientes). La eritropoyetina ha conseguido una mejoría en el aumento de los niveles de hemoglobina preoperatorios: valor promedio de 2,3 g/dl más alto que el nivel inicial. En la cohorte histórica, 3 pacientes entraron en un programa de predonación; en el grupo actual, 34/55 pacientes (61,8%). El promedio del nivel de hemoglobina preoperatoria fue de 13,9 g/dl (rango: 13-14,9 g/dl) y pasó a 12 (rango: 10,6-13,6 g/dl) tras la extracción de las dos unidadesde sangre. De las 67 bolsas de sangre extraídas, sólohan sido utilizadas 45 (67,1%) y 22 se han desechado(32,9%).Conclusiones. El empleo de eritropoyetina y el programade autotransfusión han demostrado su utilidad en el ahorro de sangre a transfundir en la cirugía de prótesis total de rodilla

Introduction. The purpose of this study is to try to decrease the amounts of blood transfused in knee prosthetic surgery by using blood-saving methods. We consider that a realistic target would be reducing the transfusion rate to less than 10%.Materials and methods. Cohort study made up of a currentcohort of 105 patients (107 total knee arthroplasties) and a historical control cohort of 193 patients (197 total knee arthroplasties). The study period extended from May 2004 to August 2005.Results. Transfusion rate: historical cohort: 57.3% (113 patients); current cohort: 7.5% (8 patients). Erythropoietin has led to an increase in preoperative hemoglobin levels (mean value: 2.3 g/dl higher than the initial level). In the historicalcohort, 3 patients entered a predonation program. In the current group, 34/55 patients (61.8%) entered such a program. The mean preoperative hemoglobin level was 13.9 g/dl (range: 13-14.9 g/dl) and decreased to 12 (range: 10.6-13.6 g/dl) after extraction of the two blood units. Of the 67 blood bags extracted, only 45 (67.1%) were used and 22 were discarded (32.9%).Conclusions. Erythropoietin and the autotransfusion program have shown their usefulness in reducing the amount of blood transfused in prosthetic knee surgery

Íleo biliar / Ciliary ileus

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Torsión de vesícula biliar / Gallbladder torsion

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Carcinoide biliar intrahepático / Intrahepatic biliary carcinoid

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Hiperplasia linfoide nodular hepática. Pseudolinfoma hepático / Nodular lymphoid hyperplasia of the liver. Hepatic pseudolymphoma

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Laparoscopic gastrectomy for gastric adenocarcinoma. Long-term results.

BACKGROUND: The objective of our paper is to report on the long-term results of patients with gastric cancer treated by mini-invasive surgery with "intention-to-treat" laparoscopy. PATIENTS AND METHODS: Between June 1993 and January 2006, 130 patients comprising 94 men and 36 women with gastric adenocarcinoma were prospectively selected by two surgical teams in three hospitals based on a prior agreement (CHU Charleroi, Belgium, Centre Hospitalier de Luxembourg and Zumárraga Hospital, Spain). Patients with adenocarcinoma of the cardia were excluded. Mean age of patients was 68 years (range, 37-85 years). RESULTS: Post-operative mortality within 60 days of operation was 6 patients; 109 patients were therefore properly followed up for an average of 49 months (range, 2-153 months).Average survival time for 10 non-resected patients was 4.5 months. Average survival rate for all 14 palliatively resected patients was 6.9 months. Actuarial 5-year survival rate for R0-type surgery was 35%. Global actuarial 5-year survival rate after resective surgery was 31%. CONCLUSIONS: Laparoscopic gastrectomy with any kind of lymphadenectomy is a major but safe operation with acceptable mortality and morbility rates in patients with advanced gastric cancer, usually in poor general condition. Laparoscopic gastrectomy for locally advanced cancers is equivalent to laparotomy as far as long-term oncological results are concerned.

MRI and endoscopic ultrasonography in the staging of gastric cancer.

OBJECTIVE: to determine the diagnostic precision of endoscopic ultrasounds (EUS) and magnetic resonance imaging (MRI) in the preoperative staging of gastric cancer. METHODS: a prospective, blind study was carried out in 17 patients diagnosed with gastric cancer (GC) using endoscopic biopsy from November 2002 to June 2003. Patients underwent preoperative MRI and EUS. The reference test used was pathology, and laparotomy for non-resectable cases. RESULTS: MRI (53%) was better than EUS in the assessment of gastric wall infiltration (35%). MRI (50%) was also superior to EUS (42%) for N staging. After pooling stages T1-T2 and T3-T4 together, results improved for both MRI (67 and 87.5%, respectively) and EUS (67 and 62.5%, respectively) (p < 0.05). N staging--lymph node invasion--results were correct in 50% for MRI as compared to EUS (42%). In classifying positive and negative lymph nodes EUS was superior to MRI (73 versus 54%). CONCLUSIONS: MRI was the best method in the assessment of gastric wall infiltration. EUS was superior to MRI for T1 staging, and in the assessment of lymph node infiltration.

Resonancia magnética y ecoendoscopia para el estadiaje del cáncer gástrico / MRI and endoscopic ultrasonography in the staging of gastric cancer

Objetivo: determinar cuál de las dos técnicas: ultrasonografíaendoscópica (USE) o resonancia magnética (RM) permite una mejorestadificación preoperatoria del cáncer gástrico (CG).Material y métodos: se diseñó un estudio prospectivo de lospacientes con CG diagnosticados de noviembre del 2002 a juniodel 2003. A los pacientes se les realizó una RM y una USE previaa la cirugía. El diagnóstico final de los pacientes se estableció medianteel estudio anatomopatológico de la pieza quirúrgica y/o laparotomía.Resultados: se incluyeron 17 pacientes. El grado de infiltracióntumoral de la pared gástrica (T) obtenida por RM se confirmóen el 53% de los casos y por USE en el 35%. Cuando se agrupabanlos estadios T1 y T2 el diagnóstico era correcto en el 67% delos casos tanto por la RM como para la EUS. Cuando se agrupabanel estadio T3 con el T4 el diagnóstico fue correcto en el87,5% de los casos por RM y en el 62,5% por EUS (p < 0,05). Elgrado de infiltración tumoral de los ganglios (N) por RM obtuvoconfirmación en el 50% de los casos y por USE en el 42%. Al clasificarlos ganglios en positivos (N1, N2 y N3) y negativos (N0) laUSE fue superior a la RM (73 vs. 54%).Conclusiones: la infiltración tumoral del CG en la pared gástricafue mejor valorada con la RM. La USE era mejor que la RMpara valorar el estadio T1 y la infiltración tumoral de adenopatías

Objective: to determine the diagnostic precision of endoscopicultrasounds (EUS) and magnetic resonance imaging (MRI) in thepreoperative staging of gastric cancer.Methods: a prospective, blind study was carried out in 17 patientsdiagnosed with gastric cancer (GC) using endoscopic biopsyfrom November 2002 to June 2003. Patients underwent preoperativeMRI and EUS. The reference test used was pathology, andlaparotomy for non-resectable cases.Results: MRI (53%) was better than EUS in the assessment ofgastric wall infiltration (35%). MRI (50%) was also superior to EUS(42%) for N staging. After pooling stages T1-T2 and T3-T4 together,results improved for both MRI (67 and 87.5%, respectively)and EUS (67 and 62.5%, respectively) (p < 0.05). N staging–lymph node invasion– results were correct in 50% for MRI ascompared to EUS (42%). In classifying positive and negativelymph nodes EUS was superior to MRI (73 versus 54%).Conclusions: MRI was the best method in the assessment ofgastric wall infiltration. EUS was superior to MRI for T1 staging,and in the assessment of lymph node infiltration

Expresión de proteínas relacionadas con resistencia a múltiples drogas (MDR-Proteínas) y resistencia a la quimioterapia en el cáncer de pulmón / Expression of proteins related to multiple drug resistance (MDR-proteins) in chemotherapy-resistant lung cancer

Propósito: El objetivo de este estudio es analizar la expresión de proteinas transportadoras de fármacosy la resistencia a la quimioterapia en el cáncer de pulmón.Material y métodos: Se recogieron 147 muestras tumorales procedentes de 143 pacientes (35broncoscópicas y 112 quirúrgicas). Resultaron válidas para el estudio 101 muestras correspondientes a99 pacientes. Las muestras tumorales criocongeladas fueron sometidas a análisis inmunohistoquímicopara la detección de las tres MDR-proteínas, Pgp, Mrp1 y Lrp.Resultados: No expresaron ninguna proteína, 16 casos. Expresaron una sola proteína, 32 casos: 3Pgp, 11 Mrp1 y 18 Lrp=0. Expresaban dos proteínas, 34 casos: 24 Pgp y Lrp, 5 Mrp1 y Pgp, 5 Mrp1 yLrp=0. Expresaban las tres proteínas, 17 casos. No hemos detectado relación significativa entre laedad y la expresión de Pgp (p=0.74), Mrp1 (p=0.95), o Lrp (p=0.26). No observamos diferencias significativasentre sexos, tanto al analizar por el número (p=0.72), como por el tipo (p=0.39) de proteínasexpresadas de forma simultánea.Tampoco detectamos diferencias significativas entre los diferentesestadios tumorales, tanto para el número (p=0.55), como para el tipo (p=0.21) de MDR-proteínasexpresada. Tampoco encontramos diferencias significativas entre los diferentes grados histológicos,tanto para el número (p=0.59), como para el tipo (p=0.51) de MDR-proteínas expresadas simultáneamenteesadas simultáneamente. La tendencia de Pgp y Lrp a expresase asociadas ha resultado muysignificativa (p<0.01), no ocurrió lo mismo para la sociación Pgp y Mrp1 (p=0.18) o Mrp1 y Lrp(p=0.26).Conclusiones: Pgp se expresa fundamentalmente asociada a Lrp. Solamente la expresión de Pgpy el número de proteinas expresabas simultáneamente parece guardar relación con la respuesta a laquimioterapia

Purpose: To evaluate the expression of MDR-proteins in the response to lung cancerchemotherapy.Methods: 147 tumor samples were collected from 143 patients, 35 of which were obtained bybronchoscopy and 112 from surgery; 101 samples belonging to 99 patients were considered valid forthe study. The samples were cryopreserved and immunochemistry with monoclonal murine antibodiesused to determine the MDR-proteins Pgp, Mrp1 and Lrp.Results: No MDR-proteins were expressed in 16 cases. One MDR-protein was present in 32cases: Pgp in 3, Mrp1 in 11 and Lrp in 18. Two MDR-proteins were expressed in 34 cases: Pgp andLrp in 24, Mrp1 and Pgp in 5, and Mrp and Lrp in 5. All the three MDR-proteins were present in 17cases. No differences were observed considering age (Pgp, p = 0.74; Mrp1, p = 0.95; Lrp, p = 0.26).Neither sex produced changes when considering either number of MDR-proteins (p = 0.55) or types ofthem (p = 0.21). Significant differences of MRD-proteins were also lacking for number (p = 0.59) andtype (p = 0.51) in relation to the tumor histologic grade. The tendency to the simultaneous expressionof Pgp and Lrp was very significant (p < 0.01), while the simultaneous expression of Mrp1 and Lrpshowed to be no significant (p = 0.26).Conclussions: Pgp and Lrp are frequently expressed simultaneously. Only the expression of Pgpand the number of MDR-proteins expressed simultaneously seem to be related to response tochemotherapy

Carcinoma epidermoide sobre sinus pilonidal / Epidermoid carcinoma upon pilonidal sinus

Introducción: La degeneración maligna es unacomplicación rara observada principalmente en casode enfermedad pilonidal crónica recurrente y se asociacon un muy mal pronóstico.Material y métodos: Se han revisado 367 pacientesafectos de quiste pilonidal, bien simple ocomplicado. Entre ellos hemos encontrado 3 casos(0,81%) de carcinoma epidermoide.Conclusión: El carcinoma epidermoide de sinuspilonidal es una enfermedad infrecuente asociado aun muy mal pronóstico

Introduction: Malignant degeneration ofpilonidal sinus is a rare complication observedmainly in recurrent chronic cases of the disease,associated to a very bad prognosis.Material and methods: We have reviewed 367patients with simple and complicated pilonidalcysts. We found 3 cases (0.81%) of epidermoidcarcinoma.Conclusions: Pilonidal sinus epidermoid carcinomais an infrequent disease predicting for very pooroutcome

Mucinous adenocarcinoma on chronic perianal fistula treated by neoadjuvant QT-RT neoadyuvante and laparoscopic abdominoperineal resection / Mucinous adenocarcinoma on chronic perianal fistula treated by neoadjuvant QT-RT neoadyuvante and laparoscopic abdomino-perineal resection

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Utilidad de la colonoscopia en pacientes derivados desde Atención Primaria por rectorragia / The value of colonoscopy to assess rectal bleeding in patients referred from Primary Care Units

Objetivos: la rectorragia es frecuente en la población general. En la mayoría de las ocasiones está producida por patología anorrectal benigna. Nuestro objetivo era determinar la necesidad de realizar pruebas endoscópicas en pacientes con rectorragia. Pacientes y métodos: se incluyeron de forma prospectiva durante tres meses todos los pacientes que eran derivados desde la Atención Primaria por rectorragia. En todos los pacientes se realizó historia clínica y exploración física que incluía tacto rectal, analítica básica y una colonoscopia.Resultados: se incluyeron 126 pacientes con una edad mediade 49,2 años (19-80). El tacto rectal fue anormal en 75 (59,5%). En 22 pacientes se encontró patología severa o positiva (lesiones neoplásicas, angiodisplasias y enfermedad inflamatoria intestinal); 10 pacientes pólipos, en 6 cáncer colorrectal y en 6 enfermedadinflamatoria intestinal. De los 63 pacientes menores de 50 años, 5 presentaron patología severa todos ellos con enfermedad inflamatoria intestinal. Conclusiones: la patología neoplásica en menores de 50 años con rectorragia es rara. Se debe realizar una rectoscopia eneste grupo de edad para descartar una enfermedad inflamatoria intestinal

Objectives: rectal bleeding is very common in the general population. It is produced mainly because of benign disease originating in the anus and the rectum. Our aim was to evaluate the need for colonoscopy in patients presenting with rectal bleeding. Patients and methods: patients referred from Primary Care Units and complaining of rectal bleeding were included prospectively in a three-month study. All patients underwent a careful medical history along with physical examination, laboratory tests, and colonoscopy. Results: 126 patients with a mean age of 49.2 years (range: 19-80) were studied. Rectal digital examination was abnormal in 75 cases (59.5%). Severe disease was encountered in 22 patients (neoplasm, angiodysplasia, and inflammatory bowel disease); 10 patients had polyps, 6 had colorectal cancer, and 6 had inflammatory bowel disease. Out of 63 patients younger than 50 years, 5 had severe disease, all of them in the form of inflammatory bowel disease. Conclusions: a neoplasm of the rectum and colon in patients younger than 50 years is a rare event. A colonoscopy must be performed in this group of patients to rule out inflammatory bowel disease

Expresión de proteínas relacionadas con resistencia a múltiples drogas (MDR-Proteínas) en el cáncer de pulmón / Expression of proteins related to multiple drug resistance (MDR-proteins) in lung cancer

• Introducción: La reducción en la acumulación intracelular de los fármacos, es uno de los mecanismosmás frecuentes de resistencia a los antineoplásicos. Las proteinas transportadoras de membrana juegan un papelesencial en este fenómeno.• Material y métodos: Se recogieron 147 muestras tumorales procedentes de 143 pacientes. De éstas,35 eran broncoscópicas y 112 quirúrgicas. Resultaron válidas para el estudio 101 muestras correspondientes a99 pacientes. Las muestras tumorales criocongeladas fueron sometidas a análisis inmunohistoquímico para ladetección de las tres MDR-proteínas, Pgp, Mrp1 y Lrp• Resultados: No expresaban ninguna proteína, 16 casos. Expresaban una sola proteína, 32 casos: 3 Pgp,11 Mrp1 y 18 Lrp=0. Expresaban dos proteínas, 34 casos: 24 Pgp y Lrp, 5 Mrp1 y Pgp, 5 Mrp1 y Lrp=0. Expresabanlas tres proteínas, 17 casos. No hemos detectado relación significativa entre la edad y la expresión dePgp (p=0.74), Mrp1 (p=0.95), o Lrp (p=0.26). No detectamos diferencias significativas entre sexos, tanto alanalizar por el número (p=0.72), como por el tipo (p=0.39) de proteínas expresadas de forma simultánea.Tampocodetectamos diferencias significativas entre los diferentes estadios tumorales, tanto para el número(p=0.55), como para el tipo (p=0.21) de MDR-proteínas expresada. Tampoco detectamos diferencias significativasentre los diferentes grados histológicos, tanto para el número (p=0.59), como para el tipo (p=0.51) deMDR-proteínas expresadas simultáneamente esadas simultáneamente.La tendencia de Pgp y Lrp a expresarse asociadas ha resultado muy significativa (p<0.01), no ocurrió lo mismopara la asociación Pgp y Mrp1 (p=0.18) o Mrp1 y Lrp (p=0.26).• Conclusiones: El cáncer de pulmón expresa con frecuencia MDR-proteínas.De las tres MDR-proteínasestudiadas, Pgp Mrp1 y Lrp, es Lrp la más frecuentemente expresada. Los adenocarcinomas expresan menosMrp1 que el resto de los tipos histológicos.Los carcinomas escamosos expresan menos Lrp que los adenocarcinomasy carcinomas indiferenciados de célula grande.Una proporción importante de pacientes expresan de formasimultánea más de una MDR-proteína. Los carcinomas escamosos, son los que con más frecuencia expresanPgp, Mrp1 y Lrp de forma simultánea. Pgp se expresa fundamentalmente asociada a Lrp

• Introduction: Lowering of intracellular drug deposition plays an important role in the resistance tochemotherapy of many neoplasms. MDR-proteins regulate the process.• Material and methods: 147 tumor samples were collected from 143 patients, 35 were obtained bymeans of bronchoscopy and 112 were surgical specimens; 101 samples from 99 patients were consideredcorrect for final analysis. Samples were cryopreserved and immuno-staining techniques used for MDRproteinscharacterization (Pgp, Mrp1, and Lrp). A monoclonal murine antibody to each was employed.• Results: 16 cases failed to express any of the three analysed MDR-proteins. One protein was expressedin 32 cases: 3 Pgp, 11 Mrp1, and 18 Lrp. The expression of two proteins was observed in 34 cases: 24 Pgp andLrp, 5 Mrp1 and Pgp, and 5 Mrp1 and Lrp. All the three proteins were expressed in 17 cases. No differenceswere found in the expression according to age: Pgp (p=0.74), Mrp (p=0.95) and Lrp (p=0.26). Sex showed nodifferences when considered either number (p=0.72) or type of proteins (p=0.39). No significative differenceswere found according to tumor stage analysing either number (p=0.55) or type (p=0.21) of expressed MRDproteins.Differences were also not observed in relation to histologic grade for number (p=0.59) or type(p=0.51) of expressed proteins.A tendency to the simultaneous expression of Pgp and Lrp was very significative (p<0.01). No similartendency was observed for the association of Mrp- Lrp (p=0.26) and Pgp-Mrp1 (p=0.18).• Conclussions: Lung cancer cells frequently express MDR-proteins. Lrp was the most frequently found inour series. Adenocarcinomas rarely express Mrp1 as compared with other histological classes. Squamous-cellcarcinomas express less Lrp than adenocarcinomas and large-cell undifferentiated carcinomas. The simultaneousexpression or more than two proteins was observed in a significant number of cases. Squamous-cell carcinomastend to express Pgp, Mrp1 and Lrp simultaneously. Pgp is ussually expressed associated to Lrp

Glucagonoma y eritema necrolítico migratorio / No disponible

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