Risk factors and outcomes of conversion in minimally invasive distal pancreatectomy: a systematic review.

PURPOSE: The reported conversion rates for minimally invasive distal pancreatectomy (MIDP) range widely from 2 to 38%. The identification of risk factors for conversion may help surgeons during preoperative planning and patient counseling. Moreover, the impact of conversion on outcomes of MIDP is unknown. METHODS: A systematic review was conducted as part of the 2019 Miami International Evidence-Based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR). The PubMed, Cochrane, and Embase databases were searched for studies concerning conversion to open surgery in MIDP. RESULTS: Of the 828 studies screened, eight met the eligibility criteria, resulting in a combined dataset including 2592 patients after MIDP. The overall conversion rate was 17.1% (range 13.0-32.7%) with heterogeneity between studies associated with the definition of conversion adopted. Only one study divided conversion into elective and emergency conversion. The main indications for conversion were vascular involvement (23.7%), concern for oncological radicality (21.9%), and bleeding (18.9%). The reported risk factors for conversion included a malignancy as an indication for surgery, the proximity of the tumor to vascular structures in preoperative imaging, higher BMI or visceral fat, and multi-organ resection or extended resection. Contrasting results were seen in terms of blood loss and length of stay in comparing converted MIDP and completed MIDP patients. CONCLUSION: The identified risk factors for conversion from this study can be used for patient selection and counseling. Surgeon experience should be considered when contemplating MIDP for a complex patient. Future studies should divide conversion into elective and emergency conversion.

The role of older age and obesity in minimally invasive and open pancreatic surgery: A systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: The aim of this study was to assess the impact of older age (≥70 years) and obesity (BMI ≥30) on surgical outcomes of minimally invasive pancreatic resections (MIPR). Subsequently, open pancreatic resections or MIPR were compared for elderly and/or obese patients. METHODS: A systematic review was conducted as part of the 2019 Miami International Evidence-Based Guidelines on MIPR (IG-MIPR). Study quality assessment was according to The Scottish Intercollegiate Guidelines Network (SIGN). A meta-analysis was performed to assess the impact of MIPR or open pancreatic resections in elderly patients. RESULTS: After screening 682 studies, 13 observational studies with 4629 patients were included. Elderly patients undergoing laparoscopic distal pancreatectomy (LDP) had less blood loss (117 mL, p < 0.001) and a shorter hospital stay (3.5 days p < 0.001) than elderly patients undergoing open distal pancreatectomy (ODP). Postoperative pancreatic fistula (POPF) B/C, major complication and reoperation rate were not significantly different in elderly patients undergoing either laparoscopic or open pancreatoduodenectomy (OPD). One study compared robot PD with OPD in obese patients, indicating that patients with robotic surgery had less blood loss (mean 250 ml vs 500 ml, p = 0.001), shorter operative time (mean 381 min vs 428 min, p = 0.003), and lower rate of POPF B/C (13% vs 28%, p = 0.039). CONCLUSION: The current available limited evidence does not suggest that MIPR is contraindicated in elderly or obese patients. Additionally, outcomes in MIPR are equal or more beneficial compared to the open approach when applied in these patient groups.

Antifungal activity of sakurasosaponin from the root extract of Jacquinia flammea.

The methanolic crude extract from the roots of Jacquinia flammea showed moderate antifungal activity against dermatophytes and very strong antifungal activity against Colletotrichum gloeosporioides. The bioassay-guided purification of the extract, using a combination of vacuum-liquid chromatography and high performance liquid chromatography, allowed the identification of sakurasosaponin as the main metabolite responsible for the antifungal activity.

Leishmanicidal evaluation of extracts from native plants of the Yucatan peninsula.

Methanol extracts were prepared from different parts of 18 plants collected in the Yucatan peninsula and evaluated in an in vitro bioassay for leishmanicidal activity against Leishmania mexicana promastigotes. The ten most potent plant extracts (IC(50)<50 microg/ml) were Aphelandra scabra leaves, Byrsonima bucidaefolia bark, Byrsonima crassifolia bark, Clusia flava leaves, Cupania dentata bark, Diphysa carthagenensis leaves, Dorstenia contrajerva whole plant, Milleria quinqueflora roots, Tridax procumbens whole plant, and Vitex gaumeri bark.

Quiste hidatídico hepático y quiste de colédoco reporte de un caso / Liver hydatidic cyst and choledochal cysts report of a case

Se reporta el caso de una paciente mujer de 26 años, natural de Huamanga. Ingresa al Servicio Nº3 de Cirugía General del Hospital Guillermo Almenara Irigoyen referida de un policlínico periférico de EsSALUD por presentar dolor abdominal y una masa palpable que ecográficamente corresponde a una tumoración quística hepática. Se le realizaron exámenes auxiliares todos ellos dentro de límites normales salvo un examen Western Blot positivo para Hidatidosis. Tomográficamente se evidencian dos tumoraciones quísticas, una en los segmentos 4 y 5 u otra en el segmento 7 compatibles con Hidatidosis Hepática. La paciente recibe albendazol 400 mg b.i.d. por 28 días (preoperatorio). Al ser intervenida quirúrgicamente se evidenció como hallazgo la presencia de un quiste de colédoco fusiforme Todani I y un quiste hepático calcificado en el segmento 7. Se realizó una colecistectomía, resección del quiste de colédoco, mucosectomía del remamente coledociano, y anastomosis hepatoyeyunal en Y de Roux. La paciente evolucionó favorablemente y fue dada de alta al 6º día. Se revisa la bibliografía existente acerca de etiología, presentación, complicaciones, diagnóstico y tratamiento del Quiste de Colédoco. Conclusión: No existe una relación entre la Hidatidosis Hepática y el Quiste de Colédoco, sin embargo debe tomarse en cuenta ya que la presencia de dos patologías quísticas hepatobiliares puede dificultar el diagnóstico. La cirugía realizada es la más recomendada en el tratamiento de este tipo de quistes, y debe realizarse un control y seguimiento de los pacientes ante la posibilidad de desarrollar complicaciones o enfermedades malignas asociadas.

The efficacy of ECT in mixed affective states.

ECT is efficacious in the treatment of both the depressed and manic phases of bipolar disorder. While ECT is believed to be equally efficacious in the treatment of mixed affective states, to our knowledge there are no empirical studies on this issue. A chart review study was conducted to compare treatment response and clinical course in three groups of patients who received ECT in a general hospital service: bipolar depressed (n = 38), bipolar manic (n = 5), and bipolar mixed (n = 10), diagnosed by DSM-IV criteria. All three groups showed robust response rates, but the number of days of hospitalization was significantly longer in the mixed group (mean 30, SD 19.0 days) compared with the depressed group (mean 19.0, SD 10.9 days, t = 2.4, p < 0.03). There was a trend for the number of ECT treatments to be greater in the mixed compared with the depressed group. These findings indicate that patients with mixed affective states do respond well to a course of ECT, but the longer hospital stays and greater number of ECT treatments suggest that they may be more difficult to treat with ECT than patients with pure bipolar depression or bipolar mania.