Vacuum assisted closure: utilidad en el abdomen abierto y cierre diferido. Experiencia en 23 pacientes / Vacuum assisted closure in open abdomen and deferred closure: experience in 23 patients

Introducción: Analizamos nuestra experiencia y los resultados obtenidos con el uso del vacuum assisted closure (VAC®, KCI Clinic Spain SL) en el manejo del abdomen abierto. Material y métodos Revisamos de forma retrospectiva las laparostomías realizadas entre junio de 2006 y marzo de 2011 usando la terapia VAC® en el Hospital Xeral-Cíes de Vigo. Resultados Incluimos a 23 pacientes consecutivos (18 varones y 5 mujeres) en los que se usó el VAC® en un abdomen abierto por distintas indicaciones (traumatismo abdominal, peritonitis, pancreatitis, patología isquémica o síndrome compartimental abdominal). El VAC® precisó recambio una media de 3,1 veces por paciente (1-7), con una duración total media de la terapia de 14,8 días (2-43) hasta el cierre, lográndose el cierre primario en 18 de 21 pacientes (86%). La estancia media hospitalaria fue de 110,1 días (8-163) y 6 pacientes (26%) fallecieron durante el ingreso por problemas relacionados con su proceso de base. Siete casos (30%) presentaron complicaciones durante la terapia VAC®: 3 abscesos intraabdominales (13%), 4 fístulas o dehiscencias de suturas (17%) y 1 evisceración (4%).Conclusiones La terapia VAC® es de manejo sencillo con una aceptable tasa de complicaciones, particularmente la de fístulas intestinales, y una mortalidad reducida. De los diversos sistemas disponibles para el cierre diferido de un abdomen, el VAC® supone un progreso considerable en estos últimos años gracias a su material adaptable y sus numerosas ventajas. Posiblemente su uso aumentará en el futuro (AU)

Introduction: We analyse our experience and the results obtained with the use of vacuumassisted closure (VAC1, KCI Clinic Spain SL) in the management of open abdomen.Material and methods: We retrospectively reviewed the la parostomies performed between June 2006 and March 2011 using VAC1treatment in the Hospital Xeral-Cíes, Vigo. Results: We included 23 consecutive patients (18 males and 5 females) on whom the VAC1was used in the open abdomen due to different indications (abdominal trauma, peritonitis, pancreatitis, ischemic disease or abdominal compartmental syndrome). The VAC1neededchanging a mean of 3.1 times per patient (range 1-7), with total mean treatment duration of14.8 days (2-43) until closure, primary closure being achieved in 18 out of 21 patients (86%).The mean hospital stay was 110.1 days (8-163) and 6 patients (26%) died during their hospital stay due to problems related to their underlying disease. Seven cases (30%) had complications during the VAC1 therapy: 3 intra-abdominal abscesses (13%), 4 fistulas or suture dehiscence (17%), and 1 evisceration (4%).Conclusions: VAC1therapy is simple to manage, with an acceptable rate of complication, particularly of intestinal fistulas, and a reduced mortality. Of the various systems available for the deferred closure of the abdomen, the VAC1has made considerable progress in the past few years, mainly due to its adaptable material, and its numerous advantages. Its use will possibly increase in the future (AU)

[Vacuum assisted closure in open abdomen and deferred closure: experience in 23 patients]. / Vacuum assisted closure: utilidad en el abdomen abierto y cierre diferido. Experiencia en 23 pacientes.

INTRODUCTION: We analyse our experience and the results obtained with the use of vacuum assisted closure (VAC(®), KCI Clinic Spain SL) in the management of open abdomen. MATERIAL AND METHODS: We retrospectively reviewed the laparostomies performed between June 2006 and March 2011 using VAC(®) treatment in the Hospital Xeral-Cíes, Vigo. RESULTS: We included 23 consecutive patients (18 males and 5 females) on whom the VAC(®) was used in the open abdomen due to different indications (abdominal trauma, peritonitis, pancreatitis, ischaemic disease or abdominal compartmental syndrome). The VAC(®) needed changing a mean of 3.1 times per patient (range 1-7), with total mean treatment duration of 14.8 days (2-43) until closure, primary closure being achieved in 18 out of 21 patients (86%). The mean hospital stay was 110.1 days (8-163) and 6 patients (26%) died during their hospital stay due to problems related to their underlying disease. Seven cases (30%) had complications during the VAC® therapy: 3 intra-abdominal abscesses (13%), 4 fistulas or suture dehiscence (17%), and 1 evisceration (4%). CONCLUSIONS: VAC(®) therapy is simple to manage, with an acceptable rate of complication, particularly of intestinal fistulas, and a reduced mortality. Of the various systems available for the deferred closure of the abdomen, the VAC(®) has made considerable progress in the past few years, mainly due to its adaptable material, and its numerous advantages. Its use will possibly increase in the future.

Differential expression of serum clusterin isoforms in colorectal cancer.

Clusterin is an enigmatic protein altered in tumors of colorectal cancer patients. Because there is no information available about serum clusterin regarding this pathology, we applied proteomic techniques to analyze its isoforms in donors and patients. First we separated serum proteins through concanavalin A, obtaining a fraction with non- and O-glycosylated proteins (FI) and a second fraction enriched in N-glycoproteins (FII) wherein clusterin was supposed to elute on the basis of its glycosylation. Surprisingly analysis of the FI fraction revealed the existence of an unexpected and aberrantly N-glycosylated clusterin that was overexpressed in patients and comprised at least five isoforms with different isoelectric points. On the other hand, two-dimensional electrophoretic analysis of the clusterin eluted in FII detected one isoform that was increased and 15 isoforms that were decreased or absent in serum of patients. Finally immunoquantification by slot blot showed that in total serum and in FI the clusterin levels were significantly increased in patients, whereas in FII there was no significant variation. Therefore, serum clusterin and some of its isoforms could have a potential value as colorectal tumor markers and are interesting subjects for biomarker studies.