Toxocara spp. y otros helmintos en muestras de suelo de plazas y parques de Puerto Ordaz, municipio Caroní, estado Bolívar, Venezuela / Toxocara spp. and others helminthes in soil samples from squares and parks in Puerto Ordaz, Caroní municipality, Bolívar state, Venezuela

Las plazas y parques son áreas de recreación, en especial para los niños; pero la presencia de huevos de Toxocara spp. y otros helmintos en dichos lugares puede representar un riesgo para contraer la toxocariasis y otras helmintiasis de origen zoonótico. Se realizó un estudio para determinar la presencia de huevos de Toxocara spp. y otros helmintos en plazas y parques de Puerto Ordaz, municipio Caroní, estado Bolívar, Venezuela. Cada plaza y parque seleccionado fue dividido en 4 cuadrantes y de cada uno se colectó una muestra de suelo la cual fue procesada mediante las técnicas de flotación de Willis-Malloy, Lutz y Araraki. En 8 (80%) plazas/parques se identificaron huevos o larvas de helmintos; hubo plazas/parques positivos en las tres parroquias de la ciudad. Del total de 40 muestras de tierra procesadas, 15 (37,5%) resultaron positivas para la presencia de larvas o huevos de helmintos, siendo la frecuencia de Toxocara spp. de 32,5% (13/40). Además de Toxocara spp., resaltó el hallazgo de Strongyloides spp. (5,0%), Ascaris spp. (2,5%) y Ancylostomideos (2,5%). En conclusión, se determinó una frecuencia de 80% de contaminación con huevos y larvas de helmintos en las plazas/parques evaluadas, destacando Toxocara spp. en el 32,5% de las muestras estudiadas

The squares and parks are recreation areas, especially for children; but the presence of eggs of Toxocara spp. and other helminths in these places can represent a risk of contracting toxocariasis and other helminthiasis of zoonotic origin. A study was carried out to determine the presence of Toxocara spp. eggs and other helminths in squares and parks from Puerto Ordaz, Caroní municipality, Bolívar state, Venezuela. Each square was divided into 4 quadrants and from each one a soil sample was collected which was processed using the techniques of Willis- Malloy, Lutz and Araraki. Of the 10 squares studied, 8 (80%) identified helminth eggs or larvae; there were positive places in the three parishes. Of the total of 40 processed soil samples, 15 (37.5%) were positive for the presence of larvae or helminth eggs, being the frequency of Toxocara spp., of 32.5% (13/40). In addition to the presence of Toxocara spp. (32.5%), highlighted the finding of Strongyloides spp. (5.0%), Ascaris spp. (2.5%) and Ancylostomideos (2.5%). In conclusion, an 80% frequency of contamination with eggs and larvae helminth was determined in the squares/parks evaluated, highlighting Toxocara spp. in 32.5% of the samples studied

Principales medidas de profilaxis en endoscopia bariátrica. Guía Española de Recomendación de Expertos / No disponible

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Main prophylactic measures in bariatric endoscopy. Spanish Expert Recommendations Guideline.

Bariatric endoscopy (BE) encompasses a number of techniques -some consolidated, some under development- aiming to contribute to the management of obese patients and their associated metabolic diseases as a complement to dietary and lifestyle changes. To date different intragastric balloon models, suture systems, aspiration methods, substance injections and both gastric and duodenal malabsorptive devices have been developed, as well as endoscopic procedures for the revision of bariatric surgery. Their ongoing evolution conditions a gradual increase in the quantity and quality of scientific evidence about their effectiveness and safety. Despite this, scientific evidence remains inadequate to establish strong grades of recommendation allowing a unified perspective on prophylaxis in BE. This dearth of data conditions leads, in daily practice, to frequently extrapolate the measures that are used in bariatric surgery (BS) and/or in general therapeutic endoscopy. In this respect, this special article is intended to reach a consensus on the most common prophylactic measures we should apply in BE. The methodological design of this document was developed while attempting to comply with the following 5 phases: Phase 1: delimitation and scope of objectives, according to the GRADE Clinical Guidelines. Phase 2: setup of the Clinical Guide-developing Group: national experts, members of the Grupo Español de Endoscopia Bariátrica (GETTEMO, SEED), SEPD, and SECO, selecting 2 authors for each section. Phase 3: clinical question form (PICO): patients, intervention, comparison, outcomes. Phase 4: literature assessment and synthesis. Search for evidence and elaboration of recommendations. Based on the Oxford Centre for Evidence-Based Medicine classification, most evidence in this article will correspond to level 5 (expert opinions without explicit critical appraisal) and grade of recommendation C (favorable yet inconclusive recommendation) or D (inconclusive or inconsistent studies). Phase 5: External review by experts. We hope that these basic preventive measures will be of interest for daily practice, and may help prevent medical and/or legal conflicts for the benefit of patients, physicians, and BE in general.

Factores predictivos de supervivencia a largo plazo del cáncer colorrectal tras la ablación de metástasis hepáticas con control ultrasonográfico / Predictive factors of long-term colorectal cancer survival after ultrasound-controlled ablation of hepatic metastases

Antecedentes y objetivo: Se evaluaron los factores de riesgo asociados a supervivencia a largo plazo en pacientes con metástasis hepáticas de carcinoma colorrectal sometidos a tratamientos ablativos. Pacientes y métodos: Estudio de cohorte unicéntrico, retrospectivo, analizando los pacientes consecutiva y prospectivamente, presentando metástasis hepáticas no resecables de carcinoma colorrectal, siendo tratados con procedimientos ablativos entre 1996 y 2013. Los factores asociados a supervivencia fueron identificados utilizando el modelo de Cox de riesgo proporcional con covariables dependientes del tiempo. También se realizó una selección de variables con el criterio de información de Akaike. Se calcularon el riesgo relativo y los intervalos de confianza al 95% para cada factor. La significación estadística se estableció en p<0,05. Resultados: Setenta y cinco pacientes con metástasis hepáticas de cáncer colorrectal, con una edad media de 65,6 (10,3) años, fueron sometidos a 106 tratamientos. Las variables seleccionadas fueron: extensión tumoral (RR 3,070, IC 95% 1,776-5,308) y buena calidad de vida (RR 0,308, IC 95% 0,150-0,632). La mediana de supervivencia global fue de 18,5 meses (IC 95% 17,4-24,4) y la mediana de pronóstico de supervivencia, de 13,5 frente a 23,4 meses para pacientes con y sin extensión del tumor, y de 23 frente a 12,8 meses para pacientes con buena y regular o mala calidad de vida, respectivamente. Conclusiones: La extensión tumoral y la buena calidad de vida fueron los únicos factores predictivos estadísticamente significativos de supervivencia a largo plazo en pacientes con carcinoma colorrectal con metástasis hepáticas sometidos a tratamiento ablativo con control ultrasonográfico (AU)

Background and objective: The risk factors associated to long-term survival were assessed in patients with liver metastases of colorectal carcinoma undergoing ablative therapies. Patients and methods: Single-centre cohort study, retrospectively analysed and prospectively collected consecutive patients with unresectable metastatic liver disease of colorectal carcinoma treated with ablative therapies between 1996 and 2013. Factors associated with survival time were identified using Cox's proportional hazard model with time-dependent covariates. A forward variable selection based on Akaike information criterion was performed. Relative risk and 95% confidence intervals for each factor were calculated. Statistical significance was set as P<.05. Results: Seventy-five patients with liver metastases of colorectal cancer, with a mean age of 65.6 (10.3) underwent 106 treatments. Variables selected were good quality of life (RR 0.308, 95% CI 0.150-0.632) and tumour extension (RR 3.070, 95% CI 1.776-5.308). The median overall survival was 18.5 months (95% CI 17.4-24.4). The survival prognosis in median was 13.5 vs. 23.4 months for patients with and without tumour extension, and 23.0 vs. 12.8 months for patients with good and fair or poor quality of life, respectively. Conclusions: Good quality of life and tumour extension were the only statistically significant predictors of long-term survival in patients of colorectal carcinoma with liver metastatic disease undergoing ablative treatment with ultrasound (AU)

Predictive factors of long-term colorectal cancer survival after ultrasound-controlled ablation of hepatic metastases. / Factores predictivos de supervivencia a largo plazo del cáncer colorrectal tras la ablación de metástasis hepáticas con control ultrasonográfico.

BACKGROUND AND OBJECTIVE: The risk factors associated to long-term survival were assessed in patients with liver metastases of colorectal carcinoma undergoing ablative therapies. PATIENTS AND METHODS: Single-centre cohort study, retrospectively analysed and prospectively collected consecutive patients with unresectable metastatic liver disease of colorectal carcinoma treated with ablative therapies between 1996 and 2013. Factors associated with survival time were identified using Cox's proportional hazard model with time-dependent covariates. A forward variable selection based on Akaike information criterion was performed. Relative risk and 95% confidence intervals for each factor were calculated. Statistical significance was set as P<.05. RESULTS: Seventy-five patients with liver metastases of colorectal cancer, with a mean age of 65.6 (10.3) underwent 106 treatments. Variables selected were good quality of life (RR 0.308, 95% CI 0.150-0.632) and tumour extension (RR 3.070, 95% CI 1.776-5.308). The median overall survival was 18.5 months (95% CI 17.4-24.4). The survival prognosis in median was 13.5 vs. 23.4 months for patients with and without tumour extension, and 23.0 vs. 12.8 months for patients with good and fair or poor quality of life, respectively. CONCLUSIONS: Good quality of life and tumour extension were the only statistically significant predictors of long-term survival in patients of colorectal carcinoma with liver metastatic disease undergoing ablative treatment with ultrasound.

Gastroduodenectomía total con preservación pancreática para el tratamiento del síndrome de Gardner con poliposis gastroduodenal y degeneración maligna / Total gastroduodenectomy with pancreatic preservation for the treatment of Gardner's syndrome with gastroduodenal polyposis and malignant transformation

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Morbidity- and mortality-related prognostic factors of nontraumatic splenectomies.

BACKGROUND: Splenectomy is a common surgical procedure, but few reports focus on nontraumatic splenectomies. The aim of this study was to determine the predictors of morbidity and mortality of patients submitted to elective nontraumatic splenectomy. METHODS: A descriptive cross-sectional study of 152 consecutive, nonselected, nontraumatic patients operated on by splenectomy between 1996 and 2010 was carried out. Clinical, laboratory, and surgical data, histological findings, perioperative mortality, and postoperative complications according to Clavien-Dindo classification, were recorded. Factors related to morbidity and mortality were analyzed. RESULTS: Of the 152 patients (89 male and 63 female; mean age 49.8 ± 17.8 years), 74 (48.7%) were operated on for malignant hematologic disorders, 44 for benign hematologic process, and 34 for other nonhematologic disorders. The spleen was enlarged in 95 patients (62.5%) and 78 patients (51.3%) had hypersplenism. The overall complications rate was 40.1%: Grades I and II in 27 cases (17.7%), and Grades III and IV in 23 patients (15.1%). Perioperative mortality was 7.2% (11 patients). In univariate analysis, significant negative predictors for morbidity were age (p = 0.004), anemia (p = 0.03), leukocytosis (p = 0.016), and blood transfusions (p < 0.001). In the multivariate analysis, only the need for blood transfusion remained as an independent prognostic factor (p = 0.001). Related to mortality, negative prognostic factors were age (p = 0.003), leukocytosis (p = 0.048), American Society of Anesthesiologists (ASA) score (p < 0.001), blood transfusion (p < 0.001), pleural effusion (p = 0.031), and pneumonia (p = 0.001). Pneumonia remained an independent prognostic factor of mortality (p = 0.024). CONCLUSION: Blood loss is the most important prognostic factor for postoperative complications after nontraumatic splenectomies. Pneumonia is the main prognosis factor for perioperative mortality.