David Padilla

Prognostic implications of serum microRNA-21 in colorectal cancer.

MicroRNAs (miRNAs) are small, noncoding RNAs that are involved in carcinogenesis through postranscriptional gene regulatory activity. Few studies have focused on the detection of miR‐21 in serum rather than in tissue. The current study aimed to measure serum miR‐21 expression levels and to evaluate their association with the outcome of colorectal cancer (CRC).

Diagnostic and prognostic significance of serum microRNAs in colorectal cancer.

MicroRNAs are short non‐coding RNA molecules involved in the regulation of gene expression. There are few studies related to the determination of serum microRNAs in colorectal cancer. The identification of microRNAs in peripheral blood as noninvasive markers of tumor disease may lead to potential applications, although further clinical studies focusing on serum microRNAs are required to determine their clinical significance for the diagnosis and prognosis outcome of colorectal cancer. J. Surg. Oncol. 2013;107:217–220.

Puesta en marcha de una unidad de gestión de riesgos clínicos hospitalaria

Clinical risk management improves quality in health care by increasing patient safety and by trying to eliminate avoidable errors. Implementing risk management programs requires the creation of risk management units in hospitals that will be responsible of all the activities related to patient safety. This article describes the development one of the first clinical risk management units in Europe directed by medical and nursing staff who continue to work at the same time in their departments.

Response to steroid therapy of sclerosing cholangitis after duodenopancreatectomy due to autoimmune pancreatitis

Autoimmune pancreatitis is a chronic inflammation of the pancreas due to aetiopathogenic mechanisms of autoimmunity. There are no established definitive diagnostic criteria although histological, analytical, and radiological characteristics enable us to identify this entity in the differential diagnosis with chronic alcoholic pancreatitis and cancer of the pancreas.1–3 Nevertheless, this is not always possible, and the patient undergoes surgery with suspected cancer of the pancreas. Lymphoplasmacytic infiltration and the autoimmune response do not only affect the pancreas but can occasionally involve the retropancreatic and extrapancreatic biliary system. The relationship between the appearance of sclerosing cholangitis in patients with pancreatic pseudotumour due to autoimmune pancreatitis has even been considered the result of a systemic fibroinflammatory response.1,4 We present the exceptional case of a patient who, after a cephalic duodenopancreatectomy due to pancreatic pseudotumour, in lymphoplasmacytic pancreatitis, presented with a clinical-radiological picture of post-surgical sclerosing cholangitis, which resolved after therapy with steroids. In common with Kamisawa and colleagues,4 we consider autoimmune pancreatitis a lesion more as part of a condition with multifocal fibrosclerosis and we believe that this sclerosing cholangitis is an additional manifestation of an autoimmune systemic condition, possibly stimulated by surgery. A 78 year old male patient was admitted to our service for obstructive jaundice …

Cirugía y transfusión urgente en el paciente testigo de Jehová: revisión de las implicaciones médico-legales

Resumen Frecuentemente, en nuestra actividad medica, aparece una situacion de conflicto entre dos valores juridicos fundamentales, como son la vida y la libertad. Existen decisiones y autos contradictorios a lo largo de la jurisprudencia a la hora de anteponer por un lado la vida del enfermo (y, por lo tanto, la lex artis del profesional medico) a la libertad del paciente testigo de Jehova para rechazar las transfusiones de hemoderivados. Si bien, en principio, el derecho a la vida se antepone a la autonomia del enfermo porque el facultative asume, en funcion de su etica profesional, el deber de intentar la curacion. De esta forma se infringe la libertad del paciente, y puede dar lugar a actuaciones que pueden ser susceptibles de reclamaciones y responsabilidades juridicas. Por ello, realizamos un planteamiento general de todas y cada una de las posibles situaciones capaces de generar dudas, ademas de un analisis de la jurisprudencia y la possible responsabilidad derivada de nuestras decisiones.

Implications of the histological determination of microRNAs in the screening, diagnosis and prognosis of colorectal cancer.

MicroRNAs are short non‐coding RNA molecules that participate in the regulation of gene expression. Several studies have demonstrated the involvement of microRNAs in oncogenesis and a variety of physiological functions. We conducted a literature review of studies that evaluated histological microRNAs in colorectal cancer. Although additional clinical studies are required to substantiate the relationship between microRNAs and colorectal cancer, there is preliminary evidence that microRNAs are related to the diagnosis and prognosis of colorectal cancer. J. Surg. Oncol. 2013;108:70–73.

Valores séricos de factor de crecimiento del endotelio vascular en pacientes con cáncer colorrectal y su significación pronóstica

Fundamento y objetivo: Un tercio de los enfermos con cancer colorrectal intervenidos quirurgicamente con intencion curativa fallece a consecuencia de una recidiva de la enfermedad. La estadificacion anatomopatologica constituye el indicador pronostico mas fiable, aunque resulta insuficiente. Intentamos conocer el valor pronostico de la determinacion serica pre y postoperatoria del factor de crecimiento del endotelio vascular (VEGF) en enfermos con cancer colorrectal. Pacientes y metodo: Se realizo un estudio de cohorte de 52 enfermos con cancer colorrectal intervenidos quirurgicamente en nuestro Servicio (Complejo Hospitalario de Ciudad Real) con caracter electivo entre 1998 y 2000. Se determinaron las concentraciones sericas de VEGF y antigeno carcinoembrionario (CEA), el dia previo a la intervencion quirurgica y 30 dias despues. Resultados: Los valores preoperatorios de VEGF en enfermos con cancer colorrectal (media de 430,8 [38,5] pg/ml) son mas elevados que en los controles (p = 0,008). A los 30 dias de la intervencion quirurgica hubo un descenso significativo de los valores de VEGF (343 [31,2] pg/ml; p < 0,0001). Las neoplasias con mala diferenciacion presentaron valores pre y postoperatorios mas elevados (p = 0,009 y p = 0,008, respectivamente) que aquellas con buena diferenciacion. Los valores pre y postoperatorios de VEGF y CEA se relacionaron significativamente con la recidiva de la enfermedad (p = 0,037, p = 0,017, p = 0,048 y p = 0,001, respectivamente). En el estudio multivariante solo los valores postoperatorios de VEGF se relacionaron con recidiva de la enfermedad (p = 0,003; razon de riesgo = 1,007; intervalo de confianza del 95%, 1,002-1,012). Los valores pre y postoperatorios de CEA (p < 0,001 y p = 0,001, respectivamente) y postoperatorios de VEGF (p = 0,001) se relacionaron con una menor supervivencia de los enfermos. En el analisis multivariante, solo la estadificacion anatomopatologica (p = 0,01) y los valores de VEGF (p = 0,02) se relacionaron con la mortalidad. La determinacion serica de VEGF en el postoperatorio, junto a las determinaciones pre y postoperatoria de CEA, incremento la especificidad y el poder predictivo positivo al 100% respecto a la mortalidad del enfermo. Conclusiones: La determinacion serica pre y postoperatoria de VEGF puede considerarse un marcador pronostico relevante, independiente de la estadificacion neoplasica en el cancer colorrectal. Valores postoperatorios superiores a 343 pg/ml, en modelos uni y multivariantes, se relacionan significativamente con la recidiva y mortalidad del enfermo, por lo que deberiamos valorar su utilizacion como marcador de seguimiento junto al CEA, habitualmente utilizado

Primary Neuroendocrine Breast Carcinoma

Introduction In 2003, the World Health Organization (WHO) defined the neuroendocrine breast carcinoma (NEBC) as a subtype of invasive mammary carcinoma in which 50% of the tumor cells express neuroendocrine markers; immunohistochemical staining include chromogranin, synaptophysin, and neurospecific enolase (NSE). The reported incidence is 2%-5%, accounting for 0.1% of all breast cancers and 1% of all neuroendocrine tumors. We report 4 cases of primary NEBC, describing the histopathological features of NEBC, and giving some future challenges of this entity.

Determinación inmunohistoquímica y utilidad pronóstica del receptor del factor de crecimiento epidérmico en los tumores estromales gastrointestinales

INTRODUCTION The epidermal growth factor receptor, EGFR (HER-1), is a tyrosine kinase receptor. EGFR activation plays an important role in increased cell proliferation, angiogenesis, and decreased apoptosis. Our objective was to study EGFR immuno-expression in GIST, as well as its prognostic value. PATIENTS AND METHOD A retrospective study that included all patients operated on with a histologic diagnosis of GIST at Department of Surgery, Hospital General, Ciudad Real, between 1995 and 2007. CLINICAL FEATURES age, sex, manifestations, mortality, recurrence. Pathological features: origin, size, tumoral necrosis, mitotic index, cell type. Immunohistochemical features: vimentin, (V9, Dako A/s); smooth muscle actin (HHF-35, Biogenex); CD34 (QBEND/10); S100 (Policlonal Dako A/S), CD117, (c-kit Rabbit, antihuman polyclonal antibody, 1:600); PDGFR-alfa (Rabbit polyclonal antibody, 1:50, Sta. Cruz Biotechnology). Prognostic molecular features: P-53, PAb240 (DakoCytomation) 1:75; Ki-67, clona MIBI (Dako, Denmark). Malignancy criteria: Fletchers criteria. RESULTS From 1995 to 2007, 35 GISTs were resected in our Department. Mean age: 61.11 +/- 11.02, with a female predominance of 62.9%. Initial clinical manifestation included digestive hemorrhage in 40%. Median follow-up was 28 months (3-133). Mortality was 54.3%, and recurrence rate was 40%. The most frequent origin was the stomach, 51.4%, (18). There was tumor necrosis in 57.1% (20). There were spindle-like cells in 57.1%, and epithelioid cells in 14.3%. Mean size was 9.58 +/- 6.29. Mitotic index per 50 high-power fields was 13.44 +/- 16.08; 51.45% (18) were high-risk tumors. Immunohistochemical expression: CD117+, 85.7%. PDGFRA+, 85.7%. CD34+, 77.1%. EGFR+, 62.9%. S100+, 34.3%. Actin+, 20%. Vimentin+, 100%. p53+, 40%. ki67+, 10.71 +/- 10.82. There was no correlation between EGFR expression and recurrence and/ or mortality, p = 0.156 and p = 0.332, respectively. Mitosis index related to mortality, p = 0.02, and recurrence, p = 0.013. CONCLUSION In our study there was no relation between EGFR immunohistochemical expression and the prognosis of GIST.

Krukenberg tumor after gastric bypass for morbid obesity. Bariatric surgery and gastric cancer

Gastric bypass is one of the most frequently performed surgical procedures in bariatric surgery. A neoplasm within the gastric pouch is a somewhat infrequent complication but with important survival consequences. We present the case of a 51-year-old woman who developed an adenocarcinoma in the bypassed stomach three years after bariatric surgery; the tumour was incidentally discovered after gynaecological surgery for uterine myomas. Various diagnostic modalities for the excluded stomach were analysed.