Dysregulated acetylcholine-mediated dopamine neurotransmission in the eIF4E Tg mouse model of autism spectrum disorders.

Autism Spectrum Disorders (ASD) consist of diverse neurodevelopmental conditions where core behavioral symptoms are critical for diagnosis. Altered dopamine neurotransmission in the striatum has been suggested to contribute to the behavioral features of ASD. Here, we examine dopamine neurotransmission in a mouse model of ASD characterized by elevated expression of the eukaryotic initiation factor 4E (eIF4E), a key regulator of cap-dependent translation, using a comprehensive approach that encompasses genetics, behavior, synaptic physiology, and imaging. The results indicate that increased eIF4E expression leads to behavioral inflexibility and impaired striatal dopamine release. The loss of normal dopamine neurotransmission is due to a defective nicotinic receptor signaling that regulates calcium dynamics in dopaminergic axons. These findings reveal an intricate interplay between eIF4E, DA neurotransmission, and behavioral flexibility, provide a mechanistic understanding of ASD symptoms and offer a foundation for targeted therapeutic interventions.

Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis.

BACKGROUND: The influence of vascular imaging acquisition on workflows at local stroke centers (LSCs) not capable of performing thrombectomy in patients with a suspected large vessel occlusion (LVO) stroke remains uncertain. We analyzed the impact of performing vascular imaging (VI+) or not (VI- at LSC arrival on variables related to workflows using data from the RACECAT Trial. OBJECTIVE: To compare workflows at the LSC among patients enrolled in the RACECAT Trial with or without VI acquisition. METHODS: We included patients with a diagnosis of ischemic stroke who were enrolled in the RACECAT Trial, a cluster-randomized trial that compared drip-n-ship versus mothership triage paradigms in patients with suspected acute LVO stroke allocated at the LSC. Outcome measures included time metrics related to workflows and the rate of interhospital transfers and thrombectomy among transferred patients. RESULTS: Among 467 patients allocated to a LSC, vascular imaging was acquired in 277 patients (59%), of whom 198 (71%) had a LVO. As compared with patients without vascular imaging, patients in the VI+ group were transferred less frequently as thrombectomy candidates to a thrombectomy-capable center (58% vs 74%, P=0.004), without significant differences in door-indoor-out time at the LSC (median minutes, VI+ 78 (IQR 69-96) vs VI- 76 (IQR 59-98), P=0.6). Among transferred patients, the VI+ group had higher rate of thrombectomy (69% vs 55%, P=0.016) and shorter door to puncture time (median minutes, VI+ 41 (IQR 26-53) vs VI- 54 (IQR 40-70), P<0.001). CONCLUSION: Among patients with a suspected LVO stroke initially evaluated at a LSC, vascular imaging acquisition might improve workflow times at thrombectomy-capable centers and reduce the rate of futile interhospital transfers. These results deserve further evaluation and should be replicated in other settings and geographies.

Predictors of Functional Outcome After Thrombectomy in Patients With Prestroke Disability in Clinical Practice.

BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) in ischemic stroke patients with poor prestroke conditions remains controversial. We aimed to analyze the frequency of previously disabled patients treated with MT in clinical practice, the safety and clinical response to MT of patients with preexisting disability, and the disabled patient characteristics associated with a better response to MT. METHODS: We studied all consecutive patients with anterior circulation occlusion treated with MT from January 2017 to December 2019 included in the Codi Ictus Catalunya registry-a government-mandated, prospective, hospital-based data set. Prestroke disability was defined as modified Rankin Scale score 2 or 3. Functional outcome at 90 days was centrally assessed by a blinded evaluator of the Catalan Stroke Program. Favorable outcome (to return at least to prestroke modified Rankin Scale at 90 days) and safety and secondary outcomes were compared with patients without previous disability. Logistic regression analysis was used to assess the association between prestroke disability and outcomes and to identify a disabled patient profile with favorable outcome after MT. RESULTS: Of 2487 patients included in the study, 409 (17.1%) had prestroke disability (313 modified Rankin Scale score 2 and 96 modified Rankin Scale score 3). After adjustment for covariates, prestroke disability was not associated with a lower chance of achieving favorable outcome at 90 days (24% versus 30%; odds ratio, 0.79 [0.57-1.08]), whereas it was independently associated with a higher risk of symptomatic intracranial hemorrhage (5% versus 3%; odds ratio, 2.04 [1.11-3.72]) and long-term mortality (31% versus 18%; odds ratio, 1.74 [1.27-2.39]) compared with patients without disability. Prestroke disabled patients without diabetes, Alberta Stroke Program Early CT Score >8 and National Institutes of Health Stroke Scale score <17 showed similar safety and outcome results after MT as patients without prestroke disability. CONCLUSIONS: Despite a higher mortality and risk of symptomatic intracranial hemorrhage, prestroke-disabled patients return as often as independent patients to their prestroke level of function, especially those nondiabetic patients with favorable early ischemic signs profile. These data support a potential benefit of MT in patients with previous mild or moderate disability after large anterior vessel occlusion stroke.

Proyectos de estandarización del tratamiento del cáncer de la unión esofagogástrica: centralización, registros y formación / Standardizing the treatment of oesophagogastric junction tumours: Centralization, registries and surgical training

El tratamiento quirúrgico de los adenocarcinomas de la unión esofagogástrica se basa en gastrectomías totales o esofaguectomías oncológicas, procedimientos de alta complejidad y considerable morbimortalidad. Los datos obtenidos del análisis de registros quirúrgicos poblacionales muestran una elevada variabilidad en el enfoque terapéutico y los resultados entre diferentes centros hospitalarios y zonas geográficas. Una de las principales medidas destinadas a reducir esta variabilidad, mejorando los resultados globales, es la centralización de la enfermedad en centros de referencia, proceso que debe basarse en el cumplimiento de unos estándares de calidad e ir acompañada de la armonización de protocolos terapéuticos. La cirugía mínimamente invasiva puede disminuir la morbilidad postoperatoria sin comprometer la supervivencia, pero es técnicamente más demandante que la cirugía abierta. Los programas de formación quirúrgica tutelada permiten incorporar la cirugía mínimamente invasiva a la práctica de los equipos quirúrgicos sin que la curva de aprendizaje condicione la morbimortalidad ni la radicalidad oncológica

Surgical treatment of oesophagogastric junction adenocarcinomas is based on total gastrectomies or oesophagectomies, which are complex procedures with potentially high morbidity and mortality. Population-based registers show a considerable variability of protocols and outcomes among different hospitals and regions. One of the main strategies to improve global results is centralization at high-volume hospitals, a process that should take into account the benchmarking of processes and outcomes at referral hospitals. Minimally invasive surgery can improve postoperative morbidity while maintaining oncological guaranties, but is technically more demanding than open surgery. This fact underlines the need for structured training and mentorship programs that minimize the impact of surgical teams’ training curves without affecting morbidity, mortality or oncologic radicality

Standardizing the treatment of oesophagogastric junction tumours: Centralization, registries and surgical training. / Proyectos de estandarización del tratamiento del cáncer de la unión esofagogástrica: centralización, registros y formación.

Surgical treatment of oesophagogastric junction adenocarcinomas is based on total gastrectomies or oesophagectomies, which are complex procedures with potentially high morbidity and mortality. Population-based registers show a considerable variability of protocols and outcomes among different hospitals and regions. One of the main strategies to improve global results is centralization at high-volume hospitals, a process that should take into account the benchmarking of processes and outcomes at referral hospitals. Minimally invasive surgery can improve postoperative morbidity while maintaining oncological guaranties, but is technically more demanding than open surgery. This fact underlines the need for structured training and mentorship programs that minimize the impact of surgical teams' training curves without affecting morbidity, mortality or oncologic radicality.

Techniques and short-term outcomes for total minimally invasive Ivor Lewis esophageal resection in distal esophageal and gastroesophageal junction cancers: pooled data from six European centers.

INTRODUCTION: Esophagectomy for cancer can be performed in a two-stage procedure with an intrathoracic anastomosis: the Ivor Lewis esophagectomy. A growing incidence of distal and gastroesophageal junction adenocarcinomas and increasing use of minimally invasive techniques have prompted interest in this procedure. The aim of this study was to assess short-term results of minimally invasive Ivor Lewis esophagectomy (MIE-IL). METHODS: A retrospective cohort study was performed from June 2007 until September 2014, including patients that underwent MIE-IL for distal esophageal and gastroesophageal junction cancer in six different hospitals in the Netherlands and Spain. Data were collected with regard to operative techniques, pathology and postoperative complications. RESULTS: In total, 282 patients underwent MIE-IL, of which 90.2 % received neoadjuvant therapy. Anastomotic leakage was observed in 43 patients (15.2 %), of whom 13 patients (4.6 %) had empyema, necessitating thoracotomy for decortication. With an aggressive treatment of complications, the 30-day and in-hospital mortality rate was 2.1 %. An R0-resection was obtained in 92.5 % of the patients. After neoadjuvant therapy, 20.1 % of patients had a complete response. CONCLUSIONS: Minimally invasive Ivor Lewis esophagectomy for distal esophageal and gastroesophageal junction adenocarcinomas is an upcoming approach for reducing morbidity caused by laparotomy and thoracotomy. Anastomotic leakage rate is still high possibly due to technical diversity of anastomotic techniques, and a high percentage of patients treated by neoadjuvant chemoradiotherapy. An aggressive approach to complications leads to a low mortality of 2.1 %. Further improvement and standardization in the anastomotic technique are needed in order to perform a safe intrathoracic anastomosis.

Evolución demográfica del Camp de Tarragona (Cataluña, España) 1570-1880: las grandes crisis de mortalidad

El Camp de Tarragona (España) participó con fuerza en la revolución comercial de la época moderna y la evolución de su población fue constante y creciente.OBJETIVO: analizar si fueron las graves crisis de mortalidad y la falta de salud lo que incentivó la evolución de la población en la zona, y el papel que estas tuvieron.MÉTODOS: con registros parroquiales y censos se construye durante casi tres siglos y medio la evolución demográfica. Se presentan aspectos significativos de la mortalidad por crisis a través del método Dupâquier y Flinn.RESULTADOS: la sequía es el indicador indirecto del stress económico y la salud. Las mayores defunciones ocurrían en años de malas cosechas, guerra o infección. Durante uno o varios años la mortalidad se elevó por encima de su nivel normal (nivel 4-5 determina graves crisis con el método Dupâquier). El Camp lo alcanzó cuatro veces: la primera vez, a principios del siglo XVII debido al factor determinante de la sequía, luego por enfermedad y las otras por guerra. Posteriormente, se dieron crisis urbanas y rurales.CONCLUSIONES: la influencia de estas graves crisis sobre el crecimiento demográfico y económico era importante cuando la capacidad del hombre era limitada. El Camp supo mantener una hegemonía demográfica y económica importante en esta época. Graves crisis de mortalidad afectaron con dureza menguando la población. Como conclusión, el papel de la mortalidad por graves crisis no es determinante, aunque estas tuvieron un papel importante en la recuperación de los habitantes del Camp.

Camp de Tarragona (Spain) participated strongly in the commercial revolution of the modern era and its population grew steadily.OBJECTIVE: to analyze whether the serious mortality crisis and lack of health stimulated the evolution of the population in the area and what role these crisis played in them.Methods: demographic change is reconstructed with parish registers and census from nearly three centuries. Significant aspects of mortality by crisis are presented through the Dupâquier and Flinn method.RESULTS: Drought is the indirect indicator of economic stress and health. Deaths increased in years of bad harvests, war or infection. For one or more years mortality rose above its normal level (level 4-5 determines serious crisis with the Dupâquier method). Camp reached this level on four times: in the early seventeenth century with drought as a determining factor, another time by disease and the other by war. It was succeeded by urban and rural crisis.CONCLUSIONS:The influence of these serious crisis on the population and economic growth was important when man's capacity was limited. The Camp was able to maintain an important demographic and economic hegemony at this time. Severe mortality crisis severely dwindled the population. As a conclusion, it is found that the role of mortality does not appear decisive for serious crisis but played an important role in the recovery momentum of the residents of Camp.

Discovery and validation of an INflammatory PROtein-driven GAstric cancer Signature (INPROGAS) using antibody microarray-based oncoproteomics.

This study aimed to improve gastric cancer (GC) diagnosis by identifying and validating an INflammatory PROtein-driven GAstric cancer Signature (hereafter INPROGAS) using low-cost affinity proteomics. The detection of 120 cytokines, 43 angiogenic factors, 41 growth factors, 40 inflammatory factors and 10 metalloproteinases was performed using commercially available human antibody microarray-based arrays. We identified 21 inflammation-related proteins (INPROGAS) with significant differences in expression between GC tissues and normal gastric mucosa in a discovery cohort of matched pairs (n=10) of tumor/normal gastric tissues. Ingenuity pathway analysis confirmed the "inflammatory response", "cellular movement" and "immune cell trafficking" as the most overrepresented biofunctions within INPROGAS. Using an expanded independent validation cohort (n = 22), INPROGAS classified gastric samples as "GC" or "non-GC" with a sensitivity of 82% (95% CI 59-94) and a specificity of 73% (95% CI 49-89). The positive predictive value and negative predictive value in this validation cohort were 75% (95% CI 53-90) and 80% (95% CI 56-94), respectively. The positive predictive value and negative predictive value in this validation cohort were 75% (95% CI 53-90) and 80% (95% CI 56-94), respectively. Antibody microarray analyses of the GC-associated inflammatory proteome identified a 21-protein INPROGAS that accurately discriminated GC from noncancerous gastric mucosa.

[Neuroendocrine tumor in a horseshoe kidney: relative risk of association of two related entities]. / Tumor neuroendocrino en el riñón en herradura: riesgo relativo de asociacion de dos entidades relacionadas.

OBJECTIVE: Primary renal neuroendocrine tumor (NET) is a very rare neoplasia with a higher frequency of appearance in horseshoe kidney (HK). From 1966, when Resnick published the first case, approximately 2 of each 10 new cases appear in kidneys with this malformation. From the diagnosis of a case of primary NET in a HK, we calculated the relative risk of their presentation as associated entities. METHODS: 63-year-old male with the incidental diagnosis of an 8 cm solid renal mass in the isthmus of a HK. At the time of diagnosis there were no signs of local-regional extension of the primary neoplasia neither metastasis. The patient underwent nephrectomy and pathologic study confirmed the diagnosis of NET. After a systematic review using multiple search platforms (Blackwell, Ovid, Proquest, PubMed, Science Direct, and Wiley) our case is No. 11 of NET in HK from a total of 57 renal NET. RESULTS: Despite its very low frequency 19.3% of NET present in HK. Using 1/400 as the incidence of HK in general population, the calculated relative risk in HK is 77 times greater than that of a normal kidney CONCLUSIONS: The relative risk of presentation of NET in HK is enormously superior than that of general population. This diagnosis must be suspected in patients with HK, mainly if the tumor is located in the renal isthmus. Due to its potentially aggressive clinical course and poor response to other therapies, measures for improvement of surgical treatment must be considered priority.

Tumor neuroendocrino en el riñón en herradura: riesgo relativo de asociación de dos entidades relacionadas / Neuroendocrine tumor in a horseshoe kidney: relative risk of association of two related entities

Objetivo: El tumor neuroendocrino (TNE) renal primario es una neoplasia muy rara aunque con una mayor frecuencia de aparición en el riñón en herradura (RH). Desde que en 1966 Resnik publicó el primer caso, aproximadamente 2 de cada 10 nuevos diagnósticos aparecen en riñones con esta malformación. A partir del diagnóstico de un caso de TNE primario en RH, calculamos su riesgo relativo de presentación como entidades asociadas Métodos: Varón de 63 años al que descubrimos incidentalmente una masa sólida de 8 cm. ubicada en el istmo de un RH. En el momento del diagnóstico no se evidenciaron signos de extensión locoregional, sospecha de otra neoplasia primaria extrarrenal. El paciente fue sometido a heminefrectomía y el estudio histológico confirmó el diagnóstico de TNE. Tras una revisión sistemática de la literatura utilizando múltiples plataformas (Blackwell, Ovid, Proquest, PubMed, Science Direct y Wiley), el nuestro, representa el caso decimoprimero de TNE en RH de un total de 57 TNE originados en riñón. Resultados: Pese a su escasa frecuencia, un 19.3% de los TNE se presentan en un RH. Utilizando una incidencia de RH en la población general de 1/400, el riesgo relativo calculado de TNE en RH respecto al de un riñón normal es 77 veces mayor. Conclusiones: El riesgo relativo de presentación de un TNE en el RH es enormemente superior al de la población general. Este diagnóstico debe sospechase en pacientes con RH, sobre todo si el tumor asienta en el istmo renal. Dado su potencial curso clínico agresivo y pobre respuesta a otras terapias, las medidas encaminadas a mejorar el tratamiento quirúrgico deben ser consideradas prioritarias (AU)

Objective: Primary renal neuroendocrine tumor (NET) is a very rare neoplasia with a higher frequency of appearance in horseshoe kidney (HK). From 1966, when Resnick published the first case, approximately 2 of each 10 new cases appear in kidneys with this malformation. From the diagnosis of a case of primary NET in a HK, we calculated the relative risk of their presentation as associated entities. Methods: 63-year-old male with the incidental diagnosis of an 8 cm solid renal mass in the isthmus of a HK. At the time of diagnosis there were no signs of local-regional extension of the primary neoplasia neither metastasis. The patient underwent nephrectomy and pathologic study confirmed the diagnosis of NET. After a systematic review using multiple search platforms (Blackwell, Ovid, Proquest, PubMed, Science Direct, and Wiley) our case is No. 11 of NET in HK from a total of 57 renal NET. Results: Despite its very low frequency, 19.3% of NET present in HK. Using I/400 as the incidence of HK in general population, the calculated relative risk in HK is 77 times greater than that of a normal kidney. Conclusions: The relative risk of presentation of NET in HK is enormously superior than that of general population. This diagnosis must be suspected in patients with HK, mainly if the tumor is located in the renal isthmus. Due to its potentially aggressive clinical course and poor response to other therapies, measures for improvement of surgical treatment must be considered priority (AU)

Gastric perforations from abdominal trauma.

BACKGROUND: Gastric rupture due to abdominal trauma is rare (0.02-1.7%); it is usually caused by traffic accidents. Delayed diagnosis, abdominal contamination and associated lesions cause morbidity and mortality. PATIENTS AND METHODS: Retrospective review of 2,083 patients with abdominal traumatism treated at our center over 20 years. We reviewed recent ingestion of a meal, etiology, time to surgery, site, Stomach Injury Scale, abdominal contamination, treatment, associated injuries, complications and mortality. RESULTS: Gastric perforation occurred in 25 patients (1.2%), median age 35 years. Stomachs were distended from recent meals in 16 (64%). The commonest causes were traffic accidents (n = 13) and blunt weapon injury (n = 7). The median time to surgery was 1 h. Gastric lesions occurred predominantly in the anterior wall (n = 12) followed by the greater curvature (n = 7). Type II lesions repaired with simple suturing were the most usual. Abdominal contamination occurred in all cases. Associated lesions were present in 22 patients; the most commonly affected intra-abdominal organ was the liver, and the lungs were the most affected extra-abdominal organ. The morbidity rate was 60% (n = 15) and the mortality rate 4% (n = 1). CONCLUSION: Early diagnosis and surgical treatment are important for reducing the morbidity and mortality in these patients.

Targeting the CYP2B 1/cyclophosphamide suicide system to fibroblast growth factor receptors results in a potent antitumoral response in pancreatic cancer models.

The CYP2B1/cyclophosphamide (CPA) suicide gene therapy approach has been shown to be highly promising in clinical trials for the treatment of pancreatic cancer. However, delivering the therapeutic gene to a sufficient number of tumor cells able to trigger a complete response remains a challenge. Target-specific delivery of adenovirus to fibroblast growth factor receptors (FGFRs) has been obtained in a variety of tumor models and has been shown to highly increase transduction efficiency. In the present paper we have tested the therapeutic outcome of retargeting the adenoviral vector, Ad-CYP2B1, to FGFRs, using an FGF2-Fab' conjugate, in pancreatic cancer models. First, we show a heterogeneous subcellular distribution of overexpressed FGFR-1 in pancreatic cancer cells. Higher transduction efficiency was observed in five of the six cell lines studied after FGF2-AdGFPLuc infection. Interestingly, an association between FGFR-1 membrane cell expression and viral entry was found. Moreover, tumors injected with FGF2-AdGFPLuc showed enhanced and persistent transgene expression. Importantly, we demonstrate the relevant enhanced cytotoxic effect of the FGF2-Ad-CYP2B]/CPA system in four of the six cell lines studied. Moreover, retargeting Ad-CYP2B1/CPA to FGFRs resulted in a potent antitumoral effect and in an increased survival rate, in two human pancreatic xenograft models. Thus, our results indicate that redirecting adenoviruses to FGFRs highly increases the potency of the suicide system CYP2B1/CPA. Consequently, it may constitute a promising approach to the treatment of patients with pancreatic tumors, in which a high proportion of FGF receptors precisely localize to the plasma membrane.

Video-assisted surgery in gastric cancer.

INTRODUCTION: The present study presents the initial results of the use of video-assisted surgery in the curative intent treatment of gastric cancer in a specialised unit of esophago-gastric pathology. METHODS: Since December 2002 we have substituted laparotomy for video-assisted surgery for the surgical treatment of gastric cancer. We report our initial experience in 28 patients. In 20 we performed a total gastrectomy with Roux Y esophago-jejunum reconstruction. In another 8 cases we performed subtotal gastrectomy with Roux Y reconstruction. The anastomoses in total gastrectomy were performed with laparoscopy with the EEA head descending via the endo-esophageal route. The resected piece is extracted via minimum laparotomy. The associated complete lympadenectomy D2 was performed in the tumours of the gastric antrum and D1 plus the lymph node groups 7, 8, 9 and proximal 11 at the second level in the gastric body and fundus. RESULTS: The mean duration of intervention was 222 minutes and the mean blood loss was 185 ml. Mortality was 3.7% and morbidity was 19%. There was a reduction in post-operative analgesia requirements and the mean hospital stay was 11 days. CONCLUSIONS: Gastric resection and related lympadenectomy can be performed using video-assisted surgery in a manner that is as safe as conventional surgery and, further, has considerable advantages. The greater complexity requires that the surgical team is better trained in the use of the laparoscopy technique. In the few studies on the theme, there appears to be no oncological inconveniences associated with the technique.

Video-assisted surgery in gastric cancer

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Introduction. The present study presents the initialresults of the use of video-assisted surgery in thecurative intent treatment of gastric cancer in a specialisedunit of esophago-gastric pathology.Methods. Since December 2002 we have substitutedlaparotomy for video-assisted surgery for the surgicaltreatment of gastric cancer. We report our initialexperience in 28 patients. In 20 we performed a totalgastrectomy with Roux Y esophago-jejunum reconstruction.In another 8 cases we performed subtotalgastrectomy with Roux Y reconstruction. Theanastomoses in total gastrectomy were performedwith laparoscopy with the EEA head descendingvia the endo-esophageal route. The resected piece isextracted via minimum laparotomy. The associatedcomplete lympadenectomy D2 was performed inthe tumours of the gastric antrum and D1 plus thelymph node groups 7, 8, 9 and proximal 11 at thesecond level in the gastric body and fundus.Results. The mean duration of intervention was 222minutes and the mean blood loss was 185 ml. Mortalitywas 3.7% and morbidity was 19%. There was areduction in post-operative analgesia requirementsand the mean hospital stay was 11 days.Conclusions. Gastric resection and related lympadenectomycan be performed using video-assistedsurgery in a manner that is as safe as conventionalsurgery and, further, has considerable advantages.The greater complexity requires that the surgicalteam is better trained in the use of the laparoscopytechnique. In the few studies on the theme, thereappears to be no oncological inconveniences associatedwith the technique

Obstrucción intestinal por vólvulo de ciego / Intestinal occusion due to cecal volvulus

El vólvulo de ciego es infrecuente en Occidente y representa únicamente el 1% de los casos de oclusión intestinal en el adulto. Se describen 3 casos de obstrucción intestinal a consecuencia de un vólvulo de ciego, en 2 mujeres de 74 y 61 años y un varón de 81, con múltiples antecedentes patológicos. Presentaban dolor, distensión abdominal y ausencia de emisión de heces. Fueron tratados quirúrgicamente con hemicolectomía derecha y anastomosis ileocólica mecánica. El curso postoperatorio fue favorable en las 2 mujeres, pero el varón falleció. Las pacientes realizan una actividad sociolaboral correcta, acorde con su edad y su enfermedad de base (AU)

Cecal volvulus is uncommon in the West and represents only 1% of cases of intestinal occlusion in adults. We describe three cases of intestinal occlusion due to cecal volvulus in two women aged 74 and 61 years old and a man aged 81 years old with multiple pathological antecedents. The patients had pain, abdominal distension and absent feces. They were treated surgically with right hemicolectomy and mechanical ileocolonic anastomosis. The postoperative course was favorable in the two women but the man died. The two female patients are currently able to perform appropriate social and occupational activities for their age and underlying diseases (AU)

Factores de riesgo de dehiscencia aguda de la pared abdominal tras laparotomía en adultos / Risk factors for acute abdominal wall dehiscence after laparotomy in adults

Introducción. La evisceración total es la salida de vísceras abdominales por una dehiscencia de todos los planos de la pared, tras una laparotomía. Cuanto mayores son los factores de riesgo más elevada es la probabilidad de sufrir evisceración. Pacientes y método. Estudio retrospectivo de los pacientes con evisceración tratados en los últimos 9 años. Resultados. En 12.622 pacientes laparotomizados se detectaron 57 evisceraciones (45 varones y 12 mujeres; edad media 70 años). El diagnóstico fue de peritonitis en 26 casos y de oclusión intestinal en 19. La cirugía fue urgente en 48 pacientes. Fue preciso reintervenir en 12 pacientes. En todos se detectaron complicaciones postoperatorias, entre las que destacaba la infección de la herida y el íleo paralítico. En la clínica predominó el manchado del apósito. La analítica mostró leucocitosis, hipoproteinemia y anemia. Se repararon mediante cierre simple y/o puntos totales y en 6 casos se asociaron mallas. La morbilidad posterior fue del 77%. En 26 pacientes fue preciso aplicar cuidados intensivos. La estancia media fue de 28,5 días. Hubo 41 curaciones (72%) y 16 muertes (28%). Tras revisar 18 parámetros implicados en la evisceración, 45 pacientes (80%) presentaban 9 o más factores de riesgo. Conclusiones. La evisceración es una enfermedad muy grave, con una elevada morbimortalidad. Los factores de riesgo más frecuentes, en nuestra serie, fueron: edad > 65 años, inestabilidad hemodinámica, aumento de la presión intraabdominal, cirugía urgente, infección de la herida o de la pared, hipoproteine- mia y anemia. Dado que estos factores de riesgo son predecibles, ante la suma de varias de estas causas deberíamos añadir medidas de refuerzo al cierre de la pared abdominal (AU)

Introduction. Total evisceration consists of protrusion of the abdominal viscera due to dehiscence of all the planes of the abdominal wall after laparotomy. The greater the number of risk factors, the greater the probability of evisceration. Patients and method. We performed a retrospective study of patients with evisceration treated in the previous 9 years. Results. Among 12,622 patients who underwent laparotomy, 57 eviscerations were detected (45 men, 12 women; mean age 70 years). The diagnosis was peritonitis in 26 patients and intestinal occlusion in 19. Emergency surgery was performed in 48 patients. Reintervention was performed in 12 patients. Postoperative complications were found in all patients, especially wound infection and paralytic ileus. The main clinical finding was staining of the dressing. Laboratory investigations revealed leukocytosis, hypoproteinemia, and anemia. Surgical repair consisted of simple closure and/or retention sutures; mesh was associated in 6 patients. Subsequent morbidity was 77%. Twenty-six patients required admission to the intensive care unit. The mean length of hospital stay was 28.5 days. The were 41 recoveries (72%) and 16 deaths (28%). Review of 18 parameters involved in evisceration showed that 80% (45 patients) presented 9 or more risk factors. Conclusions. Evisceration is a serious occurrence that produces high morbidity and mortality. The most frequent risk factors in our series were age greater than 65 years, hemodynamic instability, increased in-tra-abdominal pressure, emergency surgery, infection of the wound or abdominal wall, hypoproteinemia and anemia. Because these risk factors can be predicted, when several are grouped together, reinforcement should be used when closing the abdominal wall (AU)

[Localization of prostate cancer within the central gland by endorectal MR spectroscopic imaging]. / Localización del cáncer de próstata en la glándula central mediante espectroscopia de resonancia magnética endorectal.

OBJECTIVES: The endorectal MR spectroscopic imaging is a new imaging test which allows more accurate and reliable localization and staging of prostate cancer than simple endorectal MRI. The combination of spectroscopic MR and MRI has recently achieved technical improvements that increased reliability in the detection of prostate cancer. Our group is now working in the detection of prostate cancer with the spectroscopic MR, in co-operation with the Agency for the Evaluation of Technology for Medical Research (Agencia de Evaluación de Tecnología para la Investigación Médica-AATRM); although we are waiting for definitive results, we can advance that this technique may be used as a good alternative for localization of prostate cancer in patients with previous negative biopsies in whom the suspicion of prostate cancer persists. METHODS: We present a series of 5 patients under control for permanent elevation of PSA with previous negative biopsies. We were performing ultrasound guided sextant biopsies every 6 months, after blood test for PSA. Endorectal MRI and spectroscopic MRI were performed to try to localize the prostate cancer so diminishing the number of biopsies. RESULTS: All patients in the series had a low intensity lesion within the normal low intensity of the central gland, with an obvious spectroscopic metabolic abnormality suggesting the existence of prostate cancer, as it was then demonstrated by biopsy. CONCLUSIONS: The endorectal MR spectroscopic imaging is a non invasive method which offers the ability to detect prostate cancer within the central gland with a higher reliability in selected patients. The central gland is an area in which prostate cancer is less commonly localized, but it often shows the same signal intensity than hyperplastic tissue, so that it is difficult to be detected by purely morphological methods. Endorectal MR spectroscopic imaging allows evaluating the metabolic disturbances in the whole gland, increasing the reliability of detection of prostate cancer both in the central and peripherical glands.

Localización del cáncer de próstata en la glándula central mediante espectroscopia de resonancia magnética endorectal / Localization of prostate cancer within the central gland by endorectal MR spectroscopic imaging

OBJETIVO: La espectroscopia de resonanciamagnética endorectal (E-RME) es una nueva técnicade imagen que permite una evaluación más acuraday fiable de la localización y estadiaje del cáncerde próstata (CaP) que la resonancia magnética endorectalsola. La combinación de la RME y la E-RME haconseguido recientemente mejorías técnicas que hanpermitido aumentar la fiabilidad en la detección delCaP. Nuestro grupo está actualmente trabajando con laE-RME en la detección del CaP, en colaboración con laAgencia de Evaluación de Tecnología para laInvestigación Médica (AATRM), y en espera de resultadosdefinitivos podemos avanzar que ésta técnicapuede ser utilizada como una buena alternativa en lalocalización de CaP en pacientes con biopsias previasnegativas pero en quienes persiste la sospecha de CaP.MÉTODOS: Presentamos aquí una serie de 5 casos clínicosde pacientes controlados por elevación persistentedel PSA y biopsias previas negativas. Realizamosbiopsias por sextantes mediante ecografía transrectal aintervalos de 6 meses, después de determinar los valoresde PSA. La RME y E-RME se realizó para intentarlocalizar el CaP y de este modo intentar minimizar elnúmero de biopsias.RESULTADOS: Todos los pacientes en esta serie presentaronuna lesión de baja intensidad localizada en lahipointensidad normal de la glándula central, pero conuna clara alteración metabólica en la espectroscopiaque sugería la existencia de un CaP, tal como sedemostró posteriormente por biopsia.CONCLUSIONES: La E-RME es un método poco invasivoque ofrece la capacidad de detectar el CaP en laglándula central con mayor fiabilidad en pacientesseleccionados. La glándula central es una zona en laque el CaP se localiza con menor frecuencia, pero amenudo adopta la misma intensidad de señal que eltejido hiperplásico, y por tanto, resulta difícil de detectarpor métodos puramente morfológicos. La E-RME permiteevaluar las alteraciones metabólicas en toda laglándula y aumentar así la fiabilidad en la deteccióndel CaP, tanto en la glándula central como en la periférica

OBJECTIVES: The endorectal MRspectroscopic imaging is a new imaging test whichallows more accurate and reliable localization andstaging of prostate cancer than simple endorectal MRI.The combination of spectroscopic MR and MRI hasrecently achieved technical improvements that increasedreliability in the detection of prostate cancer. Our groupis now working in the detection of prostate cancer withthe spectroscopic MR, in co-operation with the Agencyfor the Evaluation of Technology for Medical Research(Agencia de Evaluación de Tecnología para laInvestigación Médica-AATRM); although we are waitingfor definitive results, we can advance that this techniquemay be used as a good alternative for localization ofprostate cancer in patients with previous negative biopsiesin whom the suspicion of prostate cancer persists.METHODS: We present a series of 5 patients undercontrol for permanent elevation of PSA with previousnegative biopsies. We were performing ultrasound guidedsextant biopsies every 6 months, after blood test forPSA. Endorectal MRI and spectroscopic MRI wereperformed to try to localize the prostate cancer sodiminishing the number of biopsies.RESULTS: All patients in the series had a low intensitylesion within the normal low intensity of the centralgland, with an obvious spectroscopic metabolicabnormality suggesting the existence of prostate cancer,as it was then demonstrated by biopsy.CONCLUSIONS: The endorectal MR spectroscopicimaging is a non invasive method which offers theability to detect prostate cancer within the central glandwith a higher reliability in selected patients. The centralgland is an area in which prostate cancer is lesscommonly localized, but it often shows the same signalintensity than hyperplastic tissue, so that it is difficult tobe detected by purely morphological methods.Endorectal MR spectroscopic imaging allows evaluatingthe metabolic disturbances in the whole gland, increasingthe reliability of detection of prostate cancer both in thecentral and peripherical glands

[Intestinal occlusion due to cecal volvulus]. / Obstrucción intestinal por vólvulo de ciego.

Cecal volvulus is uncommon in the West and represents only 1% of cases of intestinal occlusion in adults. We describe three cases of intestinal occlusion due to cecal volvulus in two women aged 74 and 61 years old and a man aged 81 years old with multiple pathological antecedents. The patients had pain, abdominal distension and absent feces. They were treated surgically with right hemicolectomy and mechanical ileocolonic anastomosis. The postoperative course was favorable in the two women but the man died. The two female patients are currently able to perform appropriate social and occupational activities for their age and underlying diseases.