Alberto Marcacuzco

Implicaciones clínicas de la enfermedad diverticular del apéndice. Experiencia en los últimos 10 años

BACKGROUND Diverticular disease of the appendix is an uncommon condition, with an incidence from 0.004 to 2.1%. It usually occurs between the fourth or fifth decades of life, does not present gastrointestinal symptoms but only insidious abdominal pain. Patients usually delay consultation, leading to increased morbidity and mortality. The aim of this study was to determine the clinical features of diverticular disease of the appendix. METHODS A retrospective study of all patients undergoing appendectomy in a tertiary hospital between September 2003 and September 2013 was performed. RESULTS During this period, 7,044 appendectomies were performed, and 42 cases of diverticular disease of the appendix were found, which represents an incidence of 0.59%. A total of 27 patients were male. The mean age was 46.6±21 years. The average hospital stay was 4.5 days. A perforated appendix was identified in 46% of patients. In 80% of the cases, a complementary imaging test was performed. The incidence of neoplastic disease with diverticulum of the appendix was 7.1%. CONCLUSIONS Diverticular disease of the appendix is an incidental finding. In its acute phase, it presents as an acute appendicitis. The treatment of choice is appendectomy. It presents a higher risk of developing neoplastic disease of the appendix.

Long-term Outcomes Using Uncontrolled Donors after Circulatory Death (uDCD) for Liver Transplantation. A 10-Year Single Center Experience

Introduction The good results obtained along the years with liver transplantation (LT) have led to an increasing number of candidates on the waiting list, while the number of liver grafts is not enough to attend all patients who need an OLT. That is because many LT teams have proposed to expand the number of available grafts using livers from donors after circulatory death (DCD). The aim of this study is to analyse the use of liver grafts from type 2 uDCD donors for LT, comparing post-OLT complications and recipient outcome at 10-year follow-up with a group of patients who received liver grafts from donors after brain death (DBD). To our knowledge this series represents the largest experience using this kind of donors. Materials and Methods Between January 2006 and December 2016 we performed 783 LT in adult recipients. Seventy-five LT were performed using grafts from uDCD (Maastricht type 2), and 265 LT using livers from DBD donors. We compared the results using uDCD donors vs. DBD donors in adult recipients. Results The mean age of recipients of uDCD donors was 58.8±8 years vs. 54.7±10 (p=0.000) in DBD donors. Comparing both groups of recipients, there were no statistically significant differences in relation with gender, body mass index, Child-Pugh, MELD score, LT indication, and pre-LT laboratory tests. Mean age of uDCD donors was 41.7±10 years vs. 47.8±15 of DBD donors (p=0.001), with a higher frequency use of vasopressors in uDCD group (100%) vs. 48.3% in DBD (p=0.001), and higher significantly levels of AST prior to donation. No differences were found with respect to the presence of esteatosis, preservation injury, and cold ischemia time. Mean warm ischemia time was significantly lower in recipients of uDCD donors: 62±14 min in uDCD vs 70 ±36 in DBD (p=0.010). The units of transfused hemoderivates (packed red blood cells, fresh frozen plasma, platelets and fibrinogen) was significantly higher in recipients of uDCD than in recipients of DBD donors. Primary non-function of liver graft was significantly higher in uDCD group: 8.1% vs 2.1% in DBD group (p=0.031). Retransplant rate was also higher in recipients of uDCD donors: 12% vs. 4.6% in DBD (0.028). Moreover, ischemic cholangiopathy was significantly more frequent in uDCD: 31.1% vs. 5.6% in recipients of DBD liver donors (p=0.000). Patient survival at 1, 3 and 5-year was in recipients of uDCD donors was 81.3%, 70.2% and 68.6%, respectively, while in recipients of DBD donors was 89%, 83.7% and 78.8% (p=0.070). Graft survival at 1, 3 and 5-year in uDCD group was 72%, 62.2% and 60.7%, vs 87.1%, 81.9% and 76.5%, in DBD (p=0.003). Conclusion Even with the associated higher risk of primary non-function of liver graft and higher risk of ischemic cholangiopathy, liver grafts from uDCD donors type 2 constitute a safe source of grafts for LT.

A retrospective analysis of patients with gallbladder cancer: surgical treatment and survival according to tumor stage

INTRODUCTION gallbladder cancer is the most common biliary neoplasm and the sixth most common tumor of the digestive system. The disease has an ominous prognosis, with a 5-year survival rate of approximately 5%. It is usually diagnosed late and surgical resection is the only potential cure. METHODS a retrospective study was carried out in 92 patients with a pathological diagnosis of gallbladder cancer from January 2000 to January 2016. RESULTS the mean age of cases was 72 ± 11 years; 64 subjects were females and 28 were males. Symptoms at admission included abdominal pain (78%), anorexia (77%), nausea (76%) and jaundice (45%). Surgery was indicated in 92 (100%) patients and 59 (64%) underwent a curative/intent resection. The initial surgical procedures included simple cholecystectomy in 69 (75%) cases and extended cholecystectomy in eleven (11%) subjects. Rescue surgery was performed in 15 patients with tumor tissue in the cholecystectomy specimen; ten individuals underwent an R0 curative resection. Adjuvant therapy was administered in 30 (33%) patients. The median survival in our series was 12.5 months, with survival rates of 57%, 30% and 20% at one, three and five years, respectively. CONCLUSION to conclude, surgical treatment with a complete tumor resection should be considered for all patients, provided that their clinical status allows it.

Outcome of patients with hemodialysis or peritoneal dialysis undergoing simultaneous pancreas-kidney transplantation. Comparative study

Controversy remains with regard to the higher risk of intra‐abdominal infections and lower patient and graft survival when peritoneal dialysis (PD) rather than hemodialysis (HD) is used in simultaneous pancreas‐kidney transplantation (SPKT).