Alejandro Zárate

Prevalencia de la incontinencia fecal en centros de salud y casas de reposo

BACKGROUND Fecal and urinary incontinence (FI and UI) are psychologically and socially debilitating and embarrassing conditions. AIM To determine the prevalence of FI and associated factors in patients assessed in health centers (HC) and nursing home (NH) residents. MATERIAL AND METHODS Prospective, multicentric survey carried out in 3 HC and 16 NH of Santiago. Patients and residents of NH were interrogated about FI between March and July 2004. RESULTS The questionnaire was answered by 618 patients attending health centers aged 18 to 87 years (75% females) and 128 nursing home residents aged 40 to 103 years (80% females). The prevalence of liquid or solid FI in HC and NH was 2.7 and 45%, respectively. Among the latter, the incontinence for liquids and solids was 19% and 42%, respectively. The prevalence of UI was 30.1 and 62.7% in HC patients and NH residents, respectively. Among patients attending HC, multivariable analysis showed a relation between older age and urinary incontinence with liquid or solid FI. Among NH residents, multivariate analysis showed a relation between urinary incontinence and motor disabilities with liquid or solid FI. CONCLUSIONS The prevalence of liquid or solid FI among patients assessed in health center is 2.7%. This figure increases in older people, those with UI and in NH residents.

Síndrome de Lynch: selección de pacientes para el estudio genético mediante análisis de inestabilidad microsatelital e inmunohistoquímica

BACKGROUND Selection of patients with Lynch Syndrome (LS) for a genetic study involves the application of clinical criteria. To increase the rate of identification of mutations, the use of molecular studies as Microsatellite Instability (MSI) and Immunohistochemistry (IHC) in the tumor has been proposed. AIM To demonstrate the usefulness of MSI and IHC in the detection of mutations in patients with LS. MATERIAL AND METHODS From our Familial Colorectal Cancer Registry, families suspected of LS were selected according to Amsterdam or Bethesda clinical criteria. Screening of germline mutations of MLH1, MSH2 and MSH6 genes was performed. In addition, analysis of MSI and IHC were performed in colorectal tumors. RESULTS A total of 35 families were studied (19 met Amsterdam and 16 met Bethesda criteria). Twenty one families harbored a germline alteration in MLH1, MSH2 or MSH6 (18 Amsterdam and 3 Bethesda). In these families, eighteen different alterations were found, 15 of which were mutations and 3 corresponded to variants of uncertain pathogenicity. On the other hand, 80% of the tumors showed positive microsatellite instability (27 MSI-high and 1 MSI-low), and immunohistochemical testing showed that 77% of tumors had the loss of a protein. Correlation between results of tumor molecular studies and the finding of germline nucleotide change showed that IHC and MSI predicted mutations in 81 and 100% of patients, respectively. CONCLUSIONS MSI and IHC can efficiently select patients with a high probability of carrying a mutation in DNA repair genes.

Are topical oestrogens useful in faecal incontinence? Double‐blind randomized trial

Background  Histopathological studies have shown the presence of oestrogenic receptors in the anal sphincter, which presumes a role in muscular trophism for circulating oestrogens. This could explain the increase in faecal incontinence (FI) in postmenopausal women.

Programa de detección de neoplasias colorrectales en población mayor de 50 años

BACKGROUND Mortality from colorectal cancer (CCR) in Chile has nearly doubled over the past 15 years. International studies have shown that CCR screening programs based on fecal occult blood test (FOBT) reduce CCR mortality. AIM To analyze the results from a CCR screening model in people over 50 years. MATERIAL AND METHODS Between 2007 and 2009, a prospective multicenter study was performed in seven major Chilean cities. FOBT using an immunological method, was measured in asymptomatic subjects aged 50 years or more, without risk factors. In patients with a positive FOBT, with symptoms or with family risk factors, a colonoscopy was indicated. RESULTS A total of 6348 subjects were assessed, FOBT was performed in 4938 of them, with a compliance of 77%. The result was positive in 9.6%. A total of 2359 colonoscopies were ordered, with an overall compliance of 50.1%. Of the 1184 colonoscopies performed, adenomas and high risk adenomas were found in 304 (26%) and 75 (6%) patients, respectively. Thirteen patients were diagnosed with stage I and IICCR. Three of these lesions were excised endoscopically and 10 surgically. The detection rate of polyps, high risk adenomas and cancer was 75, 12 and 2 per 1000 screened individuals, respectively. CONCLUSIONS This program allowed the early detection of an important number of high risk colon lesions, and all patients with CCR were diagnosed at early stages.

New treatment for faecal incontinence using zinc–aluminium ointment: a double‐blind randomized trial

Aim  In a randomized double‐blind study the therapeutic effect of a novel zinc–aluminium ointment was compared with placebo in patients with faecal incontinence.

International collaboration between Japan and Chile to improve detection rates in colorectal cancer screening

In Chile, mortality from colorectal cancer (CRC) has increased rapidly. To help address this issue, the Prevention Project for Neoplasia of the Colon and Rectum (PRENEC) program was initiated in 2012 with intensive support from Tokyo Medical and Dental University (TMDU) in Tokyo, Japan, as part of an international collaboration.

Resultados preliminares de la cirugía laparoscópica del cáncer colorrectal

Resumen es: Han pasado 15 anos desde la primera publicacion de una cirugia laparoscopica por cancer colorrectal (CLCC) y finalmente parece ser que la evidencia la ap...

Mesenchymal stem cells and platelet-rich plasma in the treatment of patients with perineal Crohn's disease.

Dear Editor: Crohn’s disease (CD) is characterized by mucosal inflammation of the digestive tract, anywhere between the mouth and anus. Perineal Crohn’s disease (PCD) is observed in 13–40 % of CD patients and represents a level of severity that significantly compromises the quality of life of these patients. Initial treatment of PCD includes adequate surgical drainage of the infectious process, installation of non-cutting setons in order to maintain fistula drainage over time and associated anti-TNF treatment, with or without posterior surgical fistula repair. This combined approach shows success in ∼65 % of patients, but high rates of recurrence (up to 40 %) have been reported. Regenerative cellular therapy based on mesenchymal stem cells (MSCs) may offer a therapeutic alternative in patients with PCD. In adult patients, MSCs can be obtained from the adipose tissue, bone marrow, dental pulp and other tissues. MSCs are able to divide indefinitely in cell cultures and have the capacity to develop into nearly every mature tissue type. Furthermore, anti-inflammatory characteristics of MSCs have been described by humoral and cellular mechanisms. There are some reports that show adipose tissue-derived mesenchymal stem cells (ASCs) to be effective in the treatment of perianal fistula. On the other hand, wound healing includes a series of complex mechanisms, with platelets playing an important role. A doserelated association between platelet concentration and MSC proliferation, fibroblast proliferation and collagen synthesis, has been shown, and platelet-rich plasma (PRP) has been used to improve the results of a surgical repair of cryptoglandular fistulae. In consequence, the purpose of this protocol is to offer patients with PCD a combined treatment with ASC, PRP, and surgical repair and assess the mid-term outcomes. This prospective, observational study was performed between March 2013 and December 2014, following the current treatment protocols for PCD at the IBD program and the Laboratory for Tissue Engineering at our institution. The treatment protocol was previously approved by our institution’s IRB. The following inclusion criteria were applied as follows: adult patients (>18 years of age) diagnosed with CD at least 6 months prior to study enrollment, with the presence of complex anal fistula refractory to previous surgical and/or biological treatment. Clinical remission or at most mild disease activity (CDAI<220) was a requirement. Fertile female patients were only included with a negative pregnancy test. Patients who had never received CD treatment and patients with moderate to severe proctitis, anal stenosis, and/or comorbidities (such as impairment of kidney or liver function) were excluded. The surgical treatment was performed in two stages. Stage 1: Exam under anesthesia, fistula mapping, drainage, and seton placement or change. During the same anesthesia, a lipoaspiration of approximately 200 cc of subcutaneous adipose tissue was performed, which was transferred to the Laboratory for Tissue Engineering, where ASCs were separated, cultured, and expanded. Stage 2: At 4–6 weeks following the first surgery, setons were removed and the fistula tract was debrided. The fistula’s internal opening was closed by * Claudio Wainstein cwainstein@clc.cl

Stem cell therapy in refractory perineal Crohn's disease: long-term follow-up

To describe the long‐term outcomes of adipose‐mesenchymal stem cells, platelet‐rich plasma and endorectal advancement flaps in patients with perineal Crohns disease.

Resultados de la cirugía laparoscópica en el tratamiento electivo de la enfermedad diverticular de colon

BACKGROUND The laparoscopic approach is an alternative for the elective treatment of diverticular colon disease (DCD). AIM To analyze the results of patients electively operated for DCD using a laparoscopic technique. MATERIAL AND METHODS Data of patients with DCD operated using laparoscopy at the Catholic University of Chile Clinical Hospital were prospectively recorded from January 1999 to August 2006. Indications for surgery were repetitive crises of acute diverticulitis, the persistence of the symptoms or anatomic deformity after the first crisis and complicated diverticulitis (Hinchey 1-2) that responded to the medical treatment. The laparoscopic technique used five ports and the surgical specimen was extracted through a suprapubic approach. RESULTS One hundred and six patients aged 32 to 82 years (49% females) were operated in the study period. Fifty five percent had a previous abdominal surgery. The mean operative time was 213 minutes (range: 135-360). Four patients were converted to open surgery (3.7%). One or more early post-operative complications were observed in five patients (4.7%). The mean time for passing gases and reinitiate liquid diet was 1.7 and 2.4 days respectively. The median post operative stay after surgery was 4 days. There was no operative mortality. Mean follow-up time was 27 months and only one patient (0.9%) had a new episode of acute diverticular disease, with a satisfactory response to medical treatment. No patient has developed bowel obstruction. CONCLUSIONS The laparoscopic approach is a safe alternative in the elective surgical treatment of DCD.