Novel surgical concept in antireflux surgery: long-term outcomes comparing 3 different laparoscopic approaches.

BACKGROUND: The Nissen fundoplication procedure is the most widely used type of antireflux surgery. The results are not always as good as expected, and several modifications to the original technique have been proposed. Long-term effectiveness studies comparing different techniques of antireflux surgery are limited. Our group developed a new concept in antireflux surgery (complete fixed "nondeformable" fundoplication) in order to improve its outcome; we present the long-term comparative results of this novel concept/technique. METHODS: Overall, 512 patients were included in the study and assigned into 1 of 3 fundoplications groups: partial (131), Nissen (133), and fixed "nondeformable" (121). We compared the groups with each other and with a group who chose to receive medical treatment (MT) (127). All patients underwent clinical evaluation, upper gastrointestinal endoscopy, esophageal manometry, 24-hour esophageal pH monitoring, and the SF-36 health status survey prior to operation and at 1, 5, 10, and 15 years of follow-up. RESULTS: At the 15-year follow-up, we were able to complete the protocol in 319 patients: 103 patients from the partial group, 102 patients from the Nissen group, 97 patients from the fixed "nondeformable" group, and 17 patients from the medical treatment group. A lower prevalence of erosive gastroesophageal reflux disease (GERD) was observed in the fixed "nondeformable" group (7.20%) versus 21.56% for Nissen, 39.80% for partial, and 47.05% for MT (P < .01). Lower esophageal sphincter (LES) pressure and LES length were more constant in the fixed "nondeformable" group (14.7 mm Hg/2.2 cm) compared with the Nissen (9 mm Hg/0.7 cm), partial (7 mm Hg/2 cm), and MT (5.64 mm Hg/1.3 cm) groups (P < .01). Reflux recurrence was observed in 168 patients (13 in fixed "nondeformable," 41 in Nissen, and 98 in partial (P < .01). CONCLUSION: The complete fixed "nondeformable" fundoplication showed best results in studied parameters and had a lower long-term recurrence compared with Nissen and partial techniques.

Paciente anciano con síndrome de QT largo adquirido secundario a levetiracetam / Elderly patient with acquired long QT syndrome secondary to Levetiracetam

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Amiloidosis intestinal en paciente con infección por VIH / Intestinal amyloidosis in a patient with HIV infection

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[Gas-containing hepatic abscess from an unusual etiology]. / Absceso hepático gaseoso de etiología inusual.

Pyogenic hepatic abscesses used to be caused by an abdominal infection. Cholangitis due to stones is the commonest cause, followed by diverticulitis or appendicitis. Most patients presenting with pyogenic liver abscesses have a polymicrobial infection usually with Gram negative aerobic and anaerobic organisms. Escherichia coli or Klebsiella pneumoniae are frequently implicated but they do not usually produce gas into the abscesses. We comment a case of a gas-containing liver abscess after an acute pancreatitis without any risk factor associated.

Absceso hepático gaseodo de etiología inusual / Gas-containing hepatic abscess from an unusual etiology

Los abscesos hepáticos piógenos suelen tener su origen en una infección abdominal. Las colangitis por cálculos son la causa más frecuente seguida de las diverticulitis o apendicitis. Sus causantes suelen ser aerobios gram negativos o anaerobios de origen abdominal. Los gérmenes del tipo Escherichia coli o Klebsiella pneumoniae se ven frecuentemente implicados; lo que no es tan habitual es que este tipo de microorganismos produzcan gas dentro de las colecciones. Comentamos un caso en el que esto sucede tras un episodio de pancreatitis aguda en una paciente sin factores de riesgo

Pyogenic hepatic abscesses used to be caused by an abdominal infection. Cholangitis due to stones is the commonest cause, followed by diverticulitis or apendicitis. Most patients presenting with pyogenic liver abscesses have a polymicrobial infection usually with Gram negative aerobic and anaerobic organisms. Escherichia coli or Klebsiella pneumoniae are frequently implicated but they do not usually produce gas into the abscesses. We comment a case of a gas-containing liver abscess after an acute pancreatitis without any risk factor associated

Dolor abdominal autolimitado: diagnóstico por imagen / Self-limited abdominal pain: diagnostic imaging

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Angiomiolipomatosis renal y esclerosis tuberosa / Renal angiomyolipoma and tuberous sclerosis complex

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Diseño de un modelo multiparamétrico de riesgo de eventos microvasculares en el paciente diabético tipo 2 mediante regresión logística múltiple / Design of a multiparametric risk model of microvascular events in the diabetic type 2 patient by means of multiple logistical regression

Propósito del estudio. Diseño de un modelo multiparamétrico de riesgo de eventos microvasculares en el paciente diabético tipo 2 mediante análisis de regresión logística múltiple que permita discriminar las variables asociadas a un mayor riesgo y los individuos más susceptibles de presentar este tipo de complicaciones. Métodos usados. Estudio observacional analítico de 60 diabéticos tipo 2. Muestreo aleatorio sistematizado aplicando un análisis de regresión logística múltiple (programa JMP del SAS Institute).Resultados. Perfil poblacional: edad media: 61,15 ñ 10,69 años; sexo: 36 por ciento hombres/64 por ciento mujeres; índice de masa corporal (IMC): 30,5 ñ 5,03; índice cintura-cadera: 0,97 ñ 0,05; hipertensión arterial: 65 por ciento; sistólica: 143,61ñ16mmHg; diastólica: 83,65 ñ 10,67 mmHg; dislipidemias: 70 por ciento; eventos microvasculares: 35 por ciento; glucemia basal: 174,63 ñ 54,53 mg/dl; HbA1c: 6,56ñ1,61 por ciento; colesterol: 222,61ñ51,37 mg/dl; triglicéridos: 184,93 ñ 15,77 mg/dl; c-HDL: 49,03 ñ 1 mg/dl; microalbuminuria: 16,6 por ciento. Diseño de un modelo de regresión logistica múltiple de eventos microvasculares, análisis de verosimilitud p < 0,0025. Están relacionadas en este modelo las siguientes variables ordenadas según su peso específico en la ecuación de riesgo: microalbuminuria, índice cintura-cadera, hipertensión arterial y glucemia basal. Conclusiones. Se diseña un modelo multiparamétrico de riesgo de eventos microvasculares en el paciente diabético tipo 2 que considera como variables discriminativas asociadas a un mayor riesgo: indice cintura-cadera, hipertensión arterial, microalbuminuria y glucemia basal (AU)

[Chronic metabolic syndrome: a predictive model of risk of macrovascular events?]. / El síndrome metabólico crónico: un modelo predictivo de riesgo de episodios macrovasculares?

OBJECTIVES: To establish a predictive model of the risk of macrovascular complications in patients with Chronic Metabolic Syndrome by means of multiple logistic regression analysis. To identify Chronic Metabolic Syndrome as an independent health problem, given its frequency and importance in the genesis of macrovascular complications. DESIGN: A descriptive observational study. SETTING: An urban Health District in Malaga. PATIENTS: 47 patients with Chronic Metabolic Syndrome were chosen by systematic randomised sampling. MEASUREMENTS AND MAIN RESULTS: The best predictive model of macrovascular events was established as the one which included high values of the Waist-Hip index, blood pressure, Fibrinogenaemia and basal Glucaemia, and low values of HDL cholesterol. CONCLUSIONS: 1. A model to predict macrovascular events in patients with Chronic Metabolic Syndrome included high values of the Waist-Hip index, blood pressure, Fibrinogenaemia and basal Glucaemia, and low values of HDL cholesterol. 2. We believe that this association should be considered an independent health problem on the list of problems, with the name Syndrome X or Chronic Metabolic Syndrome.