La importancia de la geriatría transversal en la cirugía abdominal oncológica / The importance of cross-speciality geriatrics in abdominal oncologic surgery

Introducción. El paciente de edad avanzada es el usuario más frecuente en los centros sanitarios. La Geriatría transversal comparteel proceso asistencial con el cirujano atendiendo la esfera cognitiva, funcional y social del paciente, con el objetivo de optimizar loscuidados (tales como mantenimiento de la independencia funcional, nutrición, detección del deterioro cognitivo…) ofreciendo unacobertura integral y reduciendo complicaciones, costes y estancia hospitalaria de manera sobreañadida. El objetivo del trabajo esdar visibilidad a la contribución que el geriatra puede llevar acabo en los servicios de Cirugía General. Material y métodos. Seriede casos mediante estudio descriptivo retrospectivo en el que se analizaron los pacientes mayores de 75 años intervenidos de cáncerde colón durante el año 2021 en el Hospital Central de la Cruz Roja mediante cirugía programada y su evolución clínica posteriora los 6 meses. Resultados: 10 pacientes (80% mujeres), edad media 76,4 años (±3,2), Escala Cruz Roja Funcional media de 1/5(±0,9), con índice de Barthel modificado 80/100 (±15,2), Escala Cruz Roja Mental de 0/5 (±0,6). Índice de Charlson medio de 4,3puntos (±2,2) con 60% enfermedades cardiovasculares, 20% insuficiencia renal crónica y 20% neumopatías. Destacó la elevadapolifarmacia (100%) y desnutrición (60%) previo a la cirugía. El 50% presentó delirium y el 40% padeció insuficiencia cardiacadescompensada. Conclusiones. La Geriatría transversal ayuda a detectar necesidades silentes y debe participar en la atenciónmulticomponente tanto previa a la cirugía (prehabilitación) como en la hospitalización y seguimiento posterior, colaborando con el cirujano en la atención al paciente crónico complejo geriátrico. (AU)

Introduction. The older patient is the most frequent user in healthcare centers. Cross-speciality geriatrics shares the care processwith the surgeon attending the cognitive, functional and social sphere of the patient, with the aim of optimizing care (such asmaintenance of functional independence, nutrition, detection of cognitive deterioration...) offering a comprehensive coverage andreducing complications, costs and hospital stay in a superadded way. The aim of this study is to give visibility to the contributionthat geriatricians can make in general surgery services. Material and methods. Case series by retrospective descriptive study inwhich patients over 75 years of age operated on for colon cancer during the year 2021 in the Central Hospital of the Red Cross byscheduled surgery and their clinical evolution after 6 months were analyzed. Results: 10 patients (80% women), mean age 76.4years (±3.2), mean Functional Red Cross Scale of 1/5 (±0.9), with modified Barthel index 80/100 (±15.2), Mental Red Cross Scaleof 0/5 (±0.6). Mean Charlson index of 4.3 points (±2.2) with 60% cardiovascular disease, 20% chronic renal failure and 20% pneumopathies. The high polypharmacy (100%) and malnutrition (60%) prior to surgery stood out. Fifty percent presented deliriumand 40% suffered from decompensated heart failure. Conclusions. Cross-speciality geriatrics helps to detect silent needs and shouldparticipate in multicomponent care both prior to surgery, during hospitalization and subsequent follow-up, collaborating with thesurgeon in the care of the geriatric complex chronic patient. (AU)

Fibrinolytic activity in laparoscopic cholecystectomy.

The aim of this study was to examine the fibrinolytic activity in laparoscopic cholecystectomy (LC) to determine whether changes occur that might indicate a greater risk of thrombosis. The study was carried out in 20 patients who had undergone laparoscopic surgery for cholelithiasis without complications. The average age was 59.4 years (34-77 years). Seventy-five percent were women. The mean operating time was 70 minutes (35-120 minutes). Pneumoperitoneum at 14 mm Hg was maintained in all patients, and they were in 30 degrees reverse Trendelenburg position. Postoperative mobilization was obtained before 24 hours, and patients were discharged 48 hours after surgery. The control group was composed of 12 patients, evenly distributed by age, sex, and length of surgery, who had undergone Bassini herniorrhaphy without complications or relapses. The following hemostatic parameters were studied: plasma fibrinolytic activity (PFA), euglobulin fibrinolytic activity (EFA), tissue-type plasminogen activator (t-PA), fast-acting plasminogen activator inhibitor-1 (PAI-1), and D-dimer (D-D). Samples were obtained at the following times: (1) under basal conditions the day before surgery, (2) preoperatively, (3) at the end of surgery, (4) 24 hours after surgery, and (5) on the seventh day following surgery. No patient had clinical manifestations of thromboembolic disease immediately after surgery or during an average follow-up period of 16 months (range 15-18 months). Analysis of the results of global fibrinolysis showed that fibrinolytic activity was enhanced only in the postoperative period (third sample) of the LC patients. The fraction of euglobulins enhances fibrinolytic activity in both groups in the third sample with regard to the other determinations; the LC patients showed a higher degree of significance (p<0.005). A significant increase of postoperative t-PA in both groups was found, being more significant in the LC group (p<0.005). In the PAI-1 values, no significant differences existed between either determinations or groups. A significant increase in D-dimer (p<0.05) occurred in the immediate postoperative period (third sample) and 24 hours later (fourth sample), returning to normal basal values on the seventh day. No significant differences were found between the two groups. These results seem to indicate that LC produces an increase in the fibrinolytic activity in plasma as a result of the liberation of tissue plasminogen activator from the venous endothelium, which could indicate hypocoagulability during the immediate postoperative period and, therefore, signify less thrombotic risk for patients undergoing this procedure.

[Anatomopathologic changes in the distal esophagus following proximal gastric vagotomy. Experimental study]. / Cambios anatomo-patológicos en el esófago distal tras la vagotomía gástrica proximal. Estudio experimental.

In order to determine the causes of postvagotomy dysphagia, we examined microscopic changes in the lower esophagus after a proximal gastric vagotomy. Forty dogs were divided into 4 groups (n = 10). Group I was used as control. In group II, the effect of denervation was studied by means of transthoracic vagotomy. In group III, the effect of mechanical traction of the lower esophagus was studied, without denervation or surgical manoeuvres. In group IV, the effect of denervation, esophageal traction and the surgical manoeuvres, of proximal gastric vagotomy was examined. No periesophageal hematomas or fibrosis was found. Degenerative nerve phenomena were found with no significant differences in the three groups. In groups III and IV, lesions of the esophageal muscular layer were observed, without significant differences. Chronic inflammatory changes and fibrosis were also encountered being more intense and significantly more frequent in group IV. We conclude that the surgical manoeuvers necessary to obtain denervation of the cardioesophageal function during proximal gastric vagotomy, could be responsible for the appearance of post-vagotomy dysphagia.

[Normal values for basal serum gastrin with and without stimulation]. / Estudio de los valores normales de la gastrina sérica basal y tras estimulación.

In the present work we report a study of the basal gastrin serum levels and stimulated serum gastrin levels after an hyperproteic meal, in a group of 20 healthy volunteers, with neither actual nor previous digestive symptoms. 60% were males, with a mean age of 35, 7 years, the highest percentage (40%) belonging to the fourth decade of life. The procedure used to determine serum gastrin levels is described. The mean value of the 3 samples obtained in basal conditions was of 51.01 pg/ml. The mean value of the 6 samples obtained after the stimulation meal was of 73.4 pg/ml. The results obtained in this study are discussed and compared with the ones of the reviewed literature.

[Risk factors of peptic ulcer hemorrhage]. / Estudio de factores de riesgo de la hemorragia por úlcera péptica.

A retrospective analysis is made of the risk factors in 229 patients admitted to hospital with hemorrhage from peptic ulcer. The factors that have been studied are: 1) age. 2) type of ulcer lesion. 3) associated disease. 4) antiinflammatory intake. 5) prior ulcer symptoms. 6) intensity and outcome of the bleeding episode. 7) endoscopic findings. 8) treatment modality. 9) mortality. The analysis of these factors tries to establish, by means of the square chi test with Yates correction, the possible relations between the factors, to determine which ones will have a pronostic value. From the results obtained we conclude that the factors with the highest pronostic importance are: 1) With respect to the severity of the bleeding episode, antiinflammatory intake and duodenal location of the ulcer lesion. 2) With respect to the need for urgent surgical treatment, antiinflammatory intake and prior ulcer symptoms. 3) With respect to mortality, severity, persistence and recurrence of bleeding, and the need for urgent surgical treatment. Finally, it is important to mention the absence of pronostic value, with respect to mortality, of advanced age and the endoscopic findings of active and/or recent bleeding.

[Blood gastrin changes in the late postoperative period after proximal gastric vagotomy]. / Alteraciones de la gastrinemia en el postoperatorio tardío tras vagotomía gástrica proximal.

Changes in serum gastrin levels in the late postoperative period have been studied in 24 patients with non-stenotic duodenal ulcer who underwent proximal gastric vagotomy. Twenty healthy volunteers were used as a control group. Serum gastrin levels were determined under basal conditions and after a high protein meal stimulation. Both measurements were done in the preoperative, early postoperative (12th day) and late postoperative periods (X = 5.5 yrs.). Regarding basal serum gastrin levels, the results show mean values of 46.2 pg/ml in the preoperative, 61.6 pg/ml in the early postoperative, 73.9 pg/ml in the late postoperative and 51 pg/ml in the control group. Early and late postoperative period values show statistical significant differences when compared with preoperative values (p < 0.05), but not with the control group ones. Stimulated gastrin levels show mean values of 75.7 pg/ml in the preoperative, 99.1 pg/ml in the early postoperative, 134.1 pg/ml in the late postoperative and 73.4 pg/ml in the control group. Late postoperative values show statistical significant differences when compared with preoperative and early postoperative values (p < 0.05), and also when compared with the control group (p < 0.05). Possible causes and the physiopathological effects of these variations are discussed.

Fetal rat pancreas transplantation in BB rats: immunohistochemical and functional evaluation.

Spontaneously diabetic BB/Wor rats received either a syngeneic fetal pancreas transplant or adult islets. In the former, 4-8 fetal pancreases were transplanted, and in the latter, 3-5000 islets. Transplantation was performed by transferring a blood clot containing the pancreases or islets to the renal subcapsular space. Insulin therapy was undertaken postoperatively, except in one experiment with adult islets. Of the fetal pancreas transplanted BB rats, 52% became normoglycaemic, and 21% remained so throughout an observation period of 10 months. Nephrectomy caused a prompt return of diabetes. The histological appearance of the grafts transplanted to the diabetic animals closely resembled that of grafts transplanted to normal rats in a parallel series. For comparison a group of BB rats received a syngeneic transplant of isolated adult islets from WF rats or BBW rats. Following adult islet transplantation, 5 out of 6 animals became hyperglycaemic after a median of 20.5 days when no insulin was given post-transplantation. Four out of 5 animals became hyperglycaemic after a median of 23 days when supportive insulin therapy was administered after the transplantation. The results indicate that recurrent diabetes is not inevitable following syngeneic fetal pancreas transplantation to spontaneously diabetic BB rats. Recurrent diabetes was only occasionally associated with mononuclear cell infiltration. Transplanted tissue was well-preserved and vascularized; mega-islets were a constant finding.

[Determination of basal and stimulated blood gastrin in duodenal ulcer]. / Valoración de la gastrinemia basal y estimulada en la úlcera duodenal.

Serum gastrin levels were measured under basal conditions and after hyperproteic meal stimulation in 24 patients with non-stenotic duodenal ulcer, 78% of them were males with a mean age of 36.4 years. Results were compared with those obtained in 20 volunteers. Basal gastrin levels in patients with duodenal ulcer 46.2 +/- 17.5 pg/ml did not show any significant statistical differences when compared with those in the control group (51.01 +/- 28.1 pg/ml). After meal stimulation gastrin levels at different time intervals, were similar in patients with duodenal ulcer and in the control group. We conclude that serum gastrin does not seem to play a relevant pathogenic role in the development of duodenal ulcer; its measurement is of no value as a biological marker of duodenal ulcer disease.