Modified Chevrel technique for abdominal closure in critically ill patients with abdominal hypertension and limited options for closure.

Abdominal compartment syndrome is a potentially life-threatening condition seen in critically ill patients, and most often caused by acute pancreatitis, postoperative abdominal vascular thrombosis or mesenteric ischemia. A decompressive laparotomy is sometimes required, often resulting in hernias, and subsequent definitive wall closure is challenging. AIM: This study aims to describe short term results after a modified Chevrel technique for midline laparotomies in patients witch abdominal hypertension. MATERIALS AND METHODS: We performed a modified Chevrel as an abdominal closure technique in 9 patients between January 2016 and January 2022. All patients presented varying degrees of abdominal hypertension. RESULTS: Nine patients were treated with new technique (6 male and 3 female), all of whom had conditions that precluded unfolding the contralateral side as a means for closure. The reasons for this were diverse, including presence of ileostomies, intraabdominal drainages, Kher tubes or an inverted T scar from previous transplant. The use of mesh was initially dismissed in 8 of the patients (88,9%) because they required subsequent abdominal surgeries or active infection. None of the patients developed a hernia, although two died 6 months after the procedure. Only one patient developed bulging. A decrease in intrabdominal pressure was achieved in all patients. CONCLUSION: The modified Chevrel technique can be used as a closure option for midline laparotomies in cases where the entire abdominal wall cannot be used.

Atrapamiento mesentérico como manifestación inicial de metástasis de carcinoma sarcomatoide pleomórfico de pulmón / Mesenteric involvement as the initial manifestation of pleomorphic sarcomatoid lung carcinoma metastasis

Mujer de 69 años no fumadora, que acude a urgencias por dolor abdominal, intolerancia oral y síndrome constitucional. Se solicita TAC identificando adenopatías axilares, mediastínicas y mesentéricas, derrame pleural bilateral, obstrucción ureteral derecha y lesión ósea blástica en D12 compatible con metástasis, sin objetivar tumor primario. La evolución clínica fue desfavorable, precisando nuevo TAC, observándose cambio de calibre en íleon terminal sin visualizar causa obstructiva. Se decide intervención quirúrgica, objetivándose dilatación intestinal, engrosamiento mesentérico, con obstrucción ileal adyacente a válvula íleocecal, secundaria a tumoración mesentérica retroperitoneal, realizándose hemicolectomía derecha. El diagnóstico anatomopatológico fue de metástasis de carcinoma pulmonar tipo sarcomatoide en su variante pleomórfica, hallazgo excepcional por lo infrecuente de la diseminación mesentérica de estos tumores. Había afectación de 15 ganglios mesentéricos, positividad en la citología del derrame pleural y de ganglios axilares. La paciente presentaba una diseminación peritoneal. Dado el mal pronóstico, se decidió quimioterapia paliativa (Carboplatino-Paclitaxel) (AU)

A 69 year-old women, non-smoker, who came to the emergency for abdominal pain, oral intolerance and constitutional syndrome. A CT scan identified axillary, mediastinal and mesenteric lymphadenopathy, bilateral pleural effusion, right ureteral obstruction and blast bone metastasis lesion in D12, without observing a primary tumor. The clinical course was unfavorable, requiring new CT scan, where a change in caliber in terminal ileum was observed without an obstructive cause. Surgical intervention was proposed, intestinal dilation and mesenteric thickening were found, with ileal obstruction adjacent to the ileocecal valve, secondary to a retroperitoneal mesenteric tumor, a right hemicolectomy was performed. The pathological diagnosis was pleomorphic sarcomatoid lung carcinoma metastasis. This finding is exceptional due to the infrequency of the mesenteric dissemination of these tumors. There were involvement of 15 mesenteric lymph nodes, positive cytology of the pleural effusion and axillary lymph nodes. Due to the bad prognosis, palliative chemotherapy (Carboplatin-Paclitaxel) was proposed (AU)

Use of Nonvascularized Fascia in Liver Transplantation.

Abdominal wall transplant is developed in the context of intestinal and multivisceral transplant, in which it is often impossible to perform a primary wall closure. Despite the fact that abdominal wall closure is not as consequential in liver transplant, there are circumstances in which it might determine the success of the liver graft, especially in situations that compromise the abdominal cavity and facilitate an abdominal compartment syndrome. CASE 1: A 14-year-old girl suffering from cryptogenic cirrhosis with severe portal hypertension that causes ascites and severe malnutrition. Uneventful liver transplant, with a graft procured from a 14-year-old donor. At the time of wall closure it was decided to implant a nonvascularized fascia graft to supplement the right side of the transverse incision, with a 17 x 7 cm defect. This required reintervention after 4 months for biliary stricture. At that point, the wall graft was almost completely integrated into the native tissue. CASE 2: A 63-year-old man, transplanted for hepatitis C virus+ hepatocellular carcinoma+ nonocclusive portal thrombosis. Thirty-six hours after transplant the patient developed portal thrombosis. Thrombectomy and closure with biological mesh were performed. After 24 hours he was reoperated on for abdominal compartment syndrome and temporary closure with a Bogotá bag. Six days later he underwent omentectomy, intestinal decompression, and left components separation, identifying a 25 x 20 cm defect. For definitive closure, a nonvascularized fascia graft procured from a different donor was used, accomplishing a reduction in intra-abdominal pressure. Nonvascularized fascia transplantation is an interesting alternative in liver transplant recipients with abdominal wall closure difficulties.

Morbidly Obese Patients Awaiting Liver Transplantation-Sleeve Gastrectomy: Safety and Efficacy From a Liver Transplant Unit Experience.

BACKGROUND: The prevalence of obesity has increased dramatically, even in the population awaiting a liver transplantation. Despite their associated complications, we cannot consider morbid obesity any longer as an absolute contraindication to liver transplantation. Dietary approaches alone are usually completely ineffective. Bariatric surgery is the gold-standard treatment for morbid obesity and can be performed before, during, or after transplantation. MATERIALS AND METHODS: At our Liver Transplantation Unit, a single surgeon performed a sleeve gastrectomy in 8 patients with liver cirrhosis due to nonalcoholic steatohepatitis, alcohol, or HCV. The Child score was A in 6 patients and B in the remaining 2 patients. Two of our patients had portal hypertension with mild esophageal varices. The procedure was performed laparoscopically in 7 cases (87.5%); in the other case, it was performed by open approach due to portal hypertension and according to patient preferences. RESULTS: Patients showed no postoperative morbidity or mortality. The mean postoperative body mass index of our patients was 37.4, 33.3, and 30.3 kg/m2 at 3, 6, and 12 months after surgery, respectively. The mean percentage excess weight loss of our patients was 42.9%, 62.2%, and 76.3% at 3, 6, and 12 months. Two of the patients have already undergone a successful liver transplant. CONCLUSION: Bariatric surgery in selected patients with compensated cirrhosis and without significative portal hypertension is reasonable. There are not clear guidelines on the use of bariatric surgery in patients with cirrhosis. In our experience, the sleeve gastrectomy is safe and effective in the treatment of patients with compensated cirrhosis; in a short time, the sleeve gastrectomy can improve candidacy in morbidly obese patients awaiting transplantation.

[Functional endoscopic evaluation of swallowing in infants with deglutition disorders]. / Evaluación funcional endoscópica de la deglución en lactantes con alteración en la mecánica de la deglución.

BACKGROUND: Functional endoscopic evaluation of swallowing (FEES) is a recognized method for Deglutition Disorders (DD) in adults, with anecdotal experience in children, obtaining not conclusive results. OBJECTIVE: To compare the accuracy of test FEES in infants with high suspicion of altered DD seen in a third level hospital with the gold standard Videofluoroscopic (VF). PATIENTS, MATERIAL AND METHODS: The results and findings by FEES and VF of 66 children with clinical diagnosis of DD were compared. STATISTICAL ANALYSIS: An estimate of the sensitivity and specificity of FEES was performed. As well as calculating positive predictive value (PPV), negative predictive value (NPV) and likelihood ratios. RESULTS: 60 patients enrolled, 4 and FEES showed high sensitivity to identify the presence of aspiration and penetration (9 98%) and high specificity for the arrest of spillage and waste (94% and 95%). Gastroesophageal reflux to make the diagnosis of DD with FEES had a sensitivity of 80% and specificity of 84%. Spill and penetration had the highest agreement with respect to the gold standard of 0.81. CONCLUSIONS: FEES in infants diagnosed with DD had a sensitivity of 80.8% and specificity 85.3%. 0696 concordance regarding to the VFD in the diagnosis of DD, and to identify suction stroke had a kappa of 0815.

ANTECEDENTES: La Evaluación Funcional Endoscópica de la deglución (EFED) es un método reconocido para evaluar alteración en la mecánica de la deglución (AMD), con experiencia anecdótica en niños, y con resultados no concluyentes. OBJETIVO: Comparar la exactitud de la EFED en lactantes con alta sospecha de alteración en la mecánica de la deglución atendidos en un hospital de tercer nivel, con el estándar de oro, la Vídeo Fluoroscopia de Deglución (VFD). Tipo de estudio: transversal, analítico, observacional, ambilectivo. Diseño: Prueba diagnóstica. PACIENTES, MATERIAL Y METODOS: Se compararon los resultados y hallazgos por EFED y VFD de 66 niños con diagnóstico clínico de AMD. ANALISIS ESTADISTICO: Se realizó la estimación de sensibilidad y especificidad de la EFED, así como cálculo de valor predictivo positivo (VPP), valor predictivo negativo (VPN) y razones de verosimilitud. RESULTADOS: De los 60 pacientes incluidos, el EFED presentó una alta sensibilidad para la presencia de aspiración y penetración (94 y 98%), y una alta especificidad para la detención de derrame y residuo (94% y 95%). El reflujo gastroesofágico para hacer el diagnóstico de AMD con el EFED tuvo una sensibilidad del 80% y especificidad del 84%. Derrame y penetración tuvieron la más alta concordancia con respecto al estándar de oro de 0.81. CONCLUSIONES: La EFED tuvo una sensibilidad del 80,8% y especificidad 85,3% en lactantes con diagnóstico de AMD. Una concordancia del 0,696 con respecto a la VFD en el diagnóstico de la AMD, y para identificar derrame y aspiración tuvo una kappa de 0,815.

Evaluación funcional endoscópica de la deglución en lactantes con alteración en la mecánica de la deglución / Functional endoscopic evaluation of swallowing in infants with deglutition disorders

Antecedentes. La Evaluación Funcional Endoscópica de la deglución (EFED) es un método reconocido para evaluar alteración en la mecánica de la deglución (AMD), con experiencia anecdótica en niños, y con resultados no concluyentes. Objetivo. Comparar la exactitud de la EFED en lactantes con alta sospecha de alteración en la mecánica de la deglución atendidos en un hospital de tercer nivel, con el estándar de oro, la Vídeo Fluoroscopia de Deglución (VFD). Tipo de estudio: transversal, analítico, observacional, ambilectivo. Diseño: Prueba diagnóstica. Pacientes, material y métodos. Se compararon los resultados y hallazgos por EFED y VFD de 66 niños con diagnóstico clínico de AMD. Análisis estadístico. Se realizó la estimación de sensibilidad y especificidad de la EFED, así como cálculo de valor predictivo positivo (VPP), valor predictivo negativo (VPN) y razones de verosimilitud. Resultados. De los 60 pacientes incluidos, el EFED presentó una alta sensibilidad para la presencia de aspiración y penetración (94 y 98%), y una alta especificidad para la detención de derrame y residuo (94% y 95%). El reflujo gastroesofágico para hacer el diagnóstico de AMD con el EFED tuvo una sensibilidad del 80% y especificidad del 84%. Derrame y penetración tuvieron la más alta concordancia con respecto al estándar de oro de 0.81. Conclusiones. La EFED tuvo una sensibilidad del 80,8% y especificidad 85,3% en lactantes con diagnóstico de AMD. Una concordancia del 0,696 con respecto a la VFD en el diagnóstico de la AMD, y para identificar derrame y aspiración tuvo una κ de 0,815 (AU)

Background. Functional endoscopic evaluation of swallowing (FEES) is a recognized method for Deglutition Disorders (DD) in adults, with anecdotal experience in children, obtaining not conclusive results. Objective. To compare the accuracy of test FEES in infants with high suspicion of altered DD seen in a third level hospital with the gold standard Videofluoroscopic (VF). Patients, material and methods. The results and findings by FEES and VF of 66 children with clinical diagnosis of DD were compared. Statistical analysis. An estimate of the sensitivity and specificity of FEES was performed. As well as calculating positive predictive value (PPV), negative predictive value (NPV) and likelihood ratios. Results. 60 patients enrolled, 4 and FEES showed high sensitivity to identify the presence of aspiration and penetration (9 98%) and high specificity for the arrest of spillage and waste (94% and 95%). Gastroesophageal reflux to make the diagnosis of DD with FEES had a sensitivity of 80% and specificity of 84%. Spill and penetration had the highest agreement with respect to the gold standard of 0.81. Conclusions. FEES in infants diagnosed with DD had a sensitivity of 80.8% and specificity 85.3%. 0696 concordance regarding to the VFD in the diagnosis of DD, and to identify suction stroke had a κ of 0815 (AU)

Post-transplant monitoring of NK cell counts as a simple approach to predict the occurrence of opportunistic infection in liver transplant recipients.

BACKGROUND: Monitoring of peripheral blood lymphocyte subpopulation (PBLS) counts might be useful for estimating the risk of infection after liver transplantation (LT). METHODS: We prospectively measured total lymphocyte and PBLS counts at baseline and post-transplant months 1 and 6 in 92 LT recipients. PBLS were enumerated by single-platform 6-color flow cytometry technology. Areas under receiver operating characteristic (ROC) curves were used to evaluate the accuracy of different PBLS for predicting cytomegalovirus (CMV) disease and overall opportunistic infection (OI). Adjusted hazard ratios (aHRs) for both outcomes were estimated by Cox regression. RESULTS: After a median follow-up of 730.0 days, 29 patients (31.5%) developed 38 episodes of OI (including 22 episodes of CMV disease). The counts of CD3(+) , CD4(+) , and CD8(+) T cells, and CD56(+) CD16(+) natural killer (NK) cells at month 1 were significantly lower in patients subsequently developing OI. The NK cell count was the best predictive parameter (area under ROC curve for predicting CMV disease: 0.78; P-value = 0.001). Patients with an NK cell count <0.050 × 10(3) cells/µL had higher cumulative incidences of CMV disease (P-value = 0.001) and overall OI (P-value <0.001). In the multivariate models, an NK cell count <0.050 × 10(3) cells/µL at month 1 post transplantation remained as an independent risk factor for CMV disease (aHR: 5.54; P-value = 0.003) and overall OI (aHR: 7.56; P-value <0.001). CONCLUSION: Post-transplant kinetics of NK cell counts may be used as a simple and affordable proxy to the cell-mediated immunity status in LT recipients and to their associated risk of OI.

Innate Lymphoid Cells Groups 1 and 3 in the Epithelial Compartment of Functional Human Intestinal Allografts.

We examined intraepithelial lymphocytes (IELs) in 213 ileal biopsies from 16 bowel grafts and compared them with 32 biopsies from native intestines. During the first year posttransplantation, grafts exhibited low levels of IELs (percentage of CD103(+) cells) principally due to reduced CD3(+) CD8(+) cells, while CD103(+) CD3(-) cell numbers became significantly higher. Changes in IEL subsets did not correlate with histology results, isolated intestine, or multivisceral transplants, but CD3(-) IELs were significantly higher in patients receiving corticosteroids. Compared with controls, more CD3(-) IELs of the grafts expressed CD56, NKp44, interleukin (IL)-23 receptor, retinoid-related orphan receptor gamma t (RORγt), and CCR6. No difference was observed in granzyme B, and CD3(-) CD127(+) cells were more abundant in native intestines. Ex vivo, and after in vitro activation, CD3(-) IELs in grafts produced significantly more interferon (IFN)-γ and IL-22, and a double IFNγ(+) IL-22(+) population was observed. Epithelial cell-depleted grafts IELs were cytotoxic, whereas this was not observed in controls. In conclusion, different from native intestines, a CD3(-) IEL subset predominates in grafts, showing features of natural killer cells and intraepithelial ILC1 (CD56(+) , NKp44(+) , CCR6(+) , CD127(-) , cytotoxicity, and IFNγ secretion), ILC3 (CD56(+) , NKp44(+) , IL-23R(+) , CCR6(+) , RORγt(+) , and IL-22 secretion), and intermediate ILC1-ILC3 phenotypes (IFNγ(+) IL-22(+) ). Viability of intestinal grafts may depend on the balance among proinflammatory and homeostatic roles of ILC subsets.

Pregnancy and orthotopic liver transplantation.

BACKGROUND: Sexual and reproductive abnormalities affect up to 50% patients with terminal liver failure. However, these functions recover quickly after orthotopic liver transplantation (OLT). Thus, 80%-90% of OLT women of childbearing age recover menstruation within a few months after transplantation. The aim of our study was to analyze the impact of pregnancy among liver transplant recipients at our center, as well as to analyze the effects of immunosuppression on the fetus. METHODS: From April 1986 to April 2011, we performed 1500 OLT in 1341 recipients. Among these recipients, 18 patients (1.2%) become pregnant during the follow-up. RESULTS: The most frequent causes of terminal liver failure were as follows: chronic parenchymal disease (n = 9; 50%), cholestatic disease (n = 3; 16.6%), acute liver failure (n = 5; 27.7%), and metabolic disease (n = 1; 5.5%) The average recipient age at the beginning of pregnancy was 21.2 (±7.3) years. Sixteen patients (88%) became pregnant beyond a year after OLT. The 30 pregnancies in our study resulted in the following: newborns alive (NBA; n = 20; 66.6%) abortions (n = 8; 26.6%) or fetal deaths (n = 2; 6%). The most common immunosuppressant used during pregnancy was tacrolimus (75%) followed by cyclosporine (25%). There were no maternal deaths during pregnancy or the postpartum period. DISCUSSION: We did not observe significant differences between immunosuppression type and maternal complications, pregnancy duration, and childbirth type. Although pregnancy is potential risk, the literature and our results suggest that at a year or more after OLT it usually is safe and successful.

Everolimus monotherapy or combined therapy in liver transplantation: indications and results.

INTRODUCTION: Everolimus is a potent immunosuppressant with several advantages over calcineurin inhibitors, such as good tolerance, preventive effects on cardiovascular morbidity, and mortality and cancer prevention as it inhibits cell proliferation. PATIENTS AND METHODS: Between April 1986 and December 2010, we performed 1500 liver transplants (OLT) in 1341 recipients, including 57 patients who were prescribed everolimus 24 (42.1%) as monotherapy and 33 (57.9%) as treatments combined with other immunosuppressants. We performed a retrospective analysis of our experience with conversion to everolimus in OLT recipients. RESULTS: The 43 men and 14 women had a mean overall age at transplantation of 59.1 ± 10 years. The most frequent indication for OLT was hepatocellular carcinoma (HCC; 53.8%). Everolimus was introduced to prevent HCC recurrence (53%), development of de novo tumors (33%), address renal dysfunction (7%), or overcome side effects of other immunosuppressants (7%). We observed a significant improvement in renal function using the estimated glomerular filtration rate (Crockcroft-Gault formula) from 68.5 mL/min before to 74.5 mL/min after switching to everolimus. The 72% of recipients who developed ≥1 adverse event, most frequently showed hyperlipidemia (34.4%). CONCLUSION: Both monotherapy and combined everolimus regimens were well-tolerated immunosuppressive regimens in liver transplant recipients with recurrent or de novo malignancies. Everolimus improved renal function. The most common side effects were hyperlipidemia, edema, and mouth ulcerations, which were well controlled with anti-lipidemic agents or decreased everolimus dosages.

Community-acquired pneumonia in immunocompromised older patients: incidence, causative organisms and outcome.

The number of elderly patients in the community with immunosuppressive conditions has increased progressively over recent decades. We sought to determine the incidence, causative organisms and outcome of community-acquired pneumonia (CAP) occurring in immunocompromised older patients. We prospectively compared cases of CAP in immunocompromised and non-immunocompromised patients admitted to five public hospitals in three Spanish regions. Of 320 cases studied, 115 (36%) occurred in immunocompromised patients, including: solid or hematological malignancy (97), corticosteroids or other immunosuppressive drugs (44), solid organ or stem cell transplant (five), and other conditions (eight). The etiology was established in 44% of immunocompromised patients vs. 32% of non-immunocompromised patients (p 0.03). Streptococcus pneumoniae was the most common causative organism in both groups (29% vs. 21%; p 0.08), followed by Legionella pneumophila (3% vs. 6%; p 0.01). Gram-negative bacilli were more frequent among immunocompromised patients (5% vs. 0.5%; p <0.01), particularly Pseudomonas aeruginosa (3% vs. 0%; p 0.04). Nocardiosis was only observed in immunocompromised patients (two cases). Bacteremia occurred similarly in the two groups. No significant differences were found with respect to ICU admission (8%, in both groups) or the length of stay (12.5 vs. 10.4 days). The early (<48 h) (3.5 vs. 0.5%; p 0.04) and overall case-fatality rates (12% vs. 3%; p <0.01) were higher in immunocompromised patients. In conclusion, a substantial number of older patients hospitalized for CAP are immunocompromised. Although relatively uncommon, CAP due to gram-negative bacilli, including P. aeruginosa, is more frequent among these patients. CAP occurring in immunocompromised patients causes significant morbidity and mortality.

Liberación de óxido nítrico en arterias tumorales de pacientes con cáncer colorrectal / Nitric oxide release on tumour arteires form patients with colorectal cancer

INTRODUCCIÓN. El óxido nítrico es un factor liberado por el endotelio vascular que participa en los procesos de formación de tumores porque es capaz de estimular la proliferación celular, fomentar la angiogénesis y regular el flujo sanguíneo tumoral. Además, la dilatación de los vasos sanguíneos tumorales provocada por el NO puede aumentar la eficacia de los tratamientos oncológicos ya que facilita el acceso al tumor de los fármacos antineoplásicos e incrementa la oxigenación de la masa tumoral potenciando los efectos beneficiosos de la radioterapia. MATERIAL Y MÉTODO. Para estudiar si la liberación de NO está alterada en las arterias tumorales, se obtuvieron de 19 pacientes intervenidos quirúrgicamente por cáncer de colon y recto, arterias mesentéricas irrigando el tumor y arterias mesentéricas de una región alejada del tumor, y asimismo se obtuvieron arterias mesentéricas de pacientes intervenidos de diverticulitis (n=4) o enfermedad inflamatoria intestinal (n=3). Los segmentos vasculares se montaron en un sistema de registro de la tensión isométrica y se realizaron curvas de concentraciónrespuesta a la bradikinina, con las arterias previamente contraídas con U46619 en presencia de placebo, del inhibidor de óxido nítrico cintaza L-NAME y del inhibidor de la ciclooxigenasa meclofenamato. RESULTADOS. La relajación a la bradikinina fue similar en los tres grupos de arterias y esta vasodilatación era disminuida en presencia de L-NAME y no se modificaba con meclofenamato. CONCLUSIÓN. La liberación de NO está preservada en las arterias humanas que irrigan los tumores de colon y recto (AU)

INTRODUCTION. Nitric oxide is an endothelium-derived relaxing factor involved in tumour growth because it could regulate celular proliferation, tumour angiogenesis and tumor blood flow. So this relaxation of tumour arteries could enhance medical effects of oncological therapy because facilitates the delivery of anticancer drugs to tumor cells and stimulates oxygenation of tumor tissue increasing the response to radiotherapy. MATERIAL AND METHOD. To study whether release of nitric oxide is altered in tumooir arteries, mesenteric arteries suppying blood flow to colorectal tumor, mesenteric arteries far from said tumor were obtained from 19 patients undergoing colectomy and mesenteric arteries were also obtained from surgical patients with diveticulitis (n=4) or inflammatory bowel disease (n=3). Arteries were prepared for isometric tension recording in an organ bath and were precontrated with U46619. The relaxation produced by bradykinin was recorded in each of these arteries with and without the nitric oxide sinthase inhibitor L-NAME and cyclooxygenase inhibitor meclofenamate. RESULTS. Bradykinin produced a dose-dependent relaxation that was similar in all the three types of artery. This relaxation was reduced with L-NAME and was not modified with meclofenamate. CONCLUSION. Nitric oxide release is preservered in human arteries supplying blood flow to colorectal tumors (AU)

Surgical management of hereditary colorectal cancer: surgery based on molecular analysis and family history.

The importance of colorectal cancer (CRC) is increasing. A proportion show a hereditary component, as in Lynch syndrome and Familial Adenomatous Polyposis, and a recently defined entity as well, namely, Familial Colorectal Cancer type X. The high probability to develop CRC in these groups may, at the time of recognition, change surgical management, including its timing or even the surgical technique. In some cases prophylactic surgery can play an important role. The possibility of using tools that allow recognition of the aforementioned syndromes, including microsatellite instability, immunohistochemistry for DNA mismatch repair system proteins, and especially their mutations, is on the basis of therapeutic strategies that differ from those employed in sporadic CRC cases.

Surgical management of hereditary colorectal cancer: surgery based on molecular analysis and family history

The importance of colorectal cancer (CRC) is increasing. Aproportion show a hereditary component, as in Lynch syndromeand Familial Adenomatous Polyposis, and a recently defined entityas well, namely, Familial Colorectal Cancer type X. The highprobability to develop CRC in these groups may, at the time ofrecognition, change surgical management, including its timing oreven the surgical technique. In some cases prophylactic surgerycan play an important role. The possibility of using tools that allowrecognition of the aforementioned syndromes, including microsatelliteinstability, immunohistochemistry for DNA mismatchrepair system proteins, and especially their mutations, is on thebasis of therapeutic strategies that differ from those employed insporadic CRC cases(AU)

Effect of angiotensin converting enzyme inhibitors on 1.25-(OH)2 D levels of hypertensive patients. Relationship with ACE polymorphisms.

BACKGROUND: The effect of angiotensin converting enzyme inhibitors (ACEIs) on 1.25-dihydroxyvitamin D [1.25-(OH)2D] levels has not been studied. The purpose of this study is to assess the relationship between 1.25-dihydroxyvitamin D levels and I/D angiotensin-converting enzyme polymorphism (ACE) in hypertensive patients. MATERIALS AND METHODS: The study included 60 individuals (31 females and 29 males) with systolic and/or diastolic hypertension. The 25-hydroxyvitamin D levels were measured by HPLC and the 1.25-(OH)2 D was determined by RIA. ACE polymorphism was analyzed by Polymerase Chain Reaction (PCR) using a modification of the original method described by Rigat. RESULTS: Treatment with ACEIs produced an increase in total calcium (p=0.003) and a decrease in the 1.25-(OH)2 D (p=0.0001). No relationship between final calcium and 1.25-(OH)2 D (r=-0.171, p=0.198) was observed. When the effects of enalapril and quinapril were analyzed separately, the results were similar. When the patients were divided according to genotype, the decrease in 1.25-(OH)2 D was observed only in patients with D allele, genotype Ins/Del (69+/-23 vs. 48+/-19, p=0.021 ) and in those of genotype Del/Del (64+/-19 vs. 17, p=0.004). CONCLUSION: The ACE inhibitors in combination with the presence of the DD genotype decrease the level of 1.25-(OH)2 D. There was no difference between enalapril and quinapril treated groups.

Bone mass and bone modelling markers in hypertensive postmenopausal women.

Numerous phosphocalcium alterations associated with bone mineral density in hypertension have been described, but very few studies assess them. This study assesses bone mass in hypertensive postmenopausal women and the hypertension influence determining both calcium homeostasis and bone turnover markers. Blood and urine samples were analysed for calcium metabolism-related parameters. Densitometry studies were conducted in the lumbar spine (L2-L4). Hypertensive osteoporotic women--selected from 82 women, with 22% osteoporosis prevalence, similar to the rate for the same age in the Spanish population--had significantly higher levels of body mass index (29+/-4 vs 26+/-4, P=0.019), calciuria (293+/-146 vs 210+/-116 mg/24 h, P=0.023) and calcium/creatinine ratio (0.33+/-0.2 vs 0.22+/-0.1 P=0.003) vs hypertensive nonosteoporotic women. No relation was found between systolic and diastolic blood pressure with bone mass. However, there was a negative osteocalcin correlation (r=-0.386, P=0.0001, and r=-0.242, P=0.033). Calciuria is associated with bone mass decrease in hypertensive women, and there is no relation between bone mass and blood pressure.