Lourdes Sanz

Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess.

BACKGROUND Pyogenic liver abscess is a threatening condition. The purpose of this study was to audit the clinical behavior and to analyze the risk factors. METHODS One hundred and thirty-three patients treated in five hospitals during the years 1985 to 1997 were studied. By univariate and multivariate analysis we tried to identify any risk factor associated with complicated clinical course and complicated-related clinical course, and with hospital mortality. RESULTS Sixty-three patients (47%) were subjected to a percutaneous drainage, 45 (34%) were treated by open surgical drainage, and the remaining 25 cases (19%) received antibiotic therapy alone. Prognostic variables for a complicated clinical course were the presence of shock, low hemoglobin level, elevated prothrombin time, and polymicrobial infection. Shock, distress, low hemoglobin level, increased creatinine, and positive blood culture were significant predictors of a complicated-related clinical course. Concerning mortality, a biliary origin, shock, multiple abscesses, low hemoglobin level, and high concentration of blood urea nitrogen were independent predictors. CONCLUSIONS Treatment of pyogenic liver abscesses should be tailored to each patient, however, the majority of them can be successfully treated with antibiotics and percutaneous methods. Those with signs of organ failure or septicemia should preferably be managed in the intensive care unit.

Single and Multiple Pyogenic Liver Abscesses: Etiology, Clinical Course, and Outcome

Background: Pyogenic liver abscesses are uncommon but they still carry a high mortality rate when encountered. This study was undertaken to evaluate the differences in the clinical behaviour of patients with single and multiple abscesses. Methods: From January 1985 to December 1997, 133 patients with this disease were treated in the surgical departments of five hospitals, 97 had a single abscess and 36 had multiple abscesses. Clinical features, methods of treatment, and outcome were assessed and compared in both types of abscesses. Results: A biliary origin from ascending cholangitis was most frequently found in multiple abscesses (p = 0.007). Mean age and duration of symptoms were higher in multiple lesions (p = 0.03 and p = 0.001). High levels of alkaline phosphatase were more frequently seen in multiple abscesses than in solitary ones (p = 0.02). They were both most frequently located on the right side. Antibiotic therapy alone was most frequently used in multiple abscesses (p = 0.01). Mortality rate was also higher in this type of patients (p = 0.01). The abscess-related morbidity rate was higher in multiple lesions as well but the statistical difference was not significant. Conclusions: These results suggest that multiple liver abscesses comprise a disease of biliary origin, higher age, longer symptomatic periods, and also higher mortality rate than in single abscess.

Pyogenic liver abscesses: a comparison of older and younger patients.

BACKGROUND Pyogenic liver abscess is a life-threatening disease. Few studies have specifically explored the way in which the clinical features and management of elderly patients with pyogenic liver abscess differ from those of younger individuals. METHODS A retrospective study was undertaken to evaluate whether older patients with pyogenic liver abscess have distinctive presenting features or whether their management and outcome differ from that of younger patients. A total of 133 patients with liver abscess treated in five hospitals during 13 years comprised two groups: 78 patients aged 60 years or above (older group) and 55 patients below age 60 years (younger group). Clinical features, laboratory data, imaging and microbiological findings, management and outcome were determined in each group. RESULTS The older group contained more patients with associated diseases (p=0.03), nausea and vomiting at presentation (p=0.02), higher APACHE II (Acute Physiological and Chronic Health Evaluation II scale) score (p<0.001) and blood urea nitrogen (p<0.001) and serum creatinine levels (p=0.002). Multiple abscess (p=0.05) and bilobar (p=0.03) abscess were also commoner in this group. By contrast, in the younger group men predominated (p=0.01), and there was a higher overall complication rate (p=0.05).Time to diagnosis, hospital mortality rate and other variables analysed were similar in both groups. DISCUSSION Elderly patients with pyogenic liver abscess have some subtle differences in clinical and laboratory presentation, but these do not appear to delay diagnosis. Active management is tolerated well, with a lower morbidity rate than in younger patients and no difference in the mortality rate.

Abscesos hepáticos piógenos. Importancia de la existencia de gas

Resumen Introduccion Nuestro objetivo fue analizar el comportamiento clinico de los pacientes con abscesos hepaticos piogenos formadores de gas y, ademas, determinar si existia alguna diferencia en relacion con los enfermos con abscesos sin produccion de gas Pacientes y metodos Mediante un estudio multicentrico se han revisado, retrospectivamente, las historias clinicas de 126 pacientes diagnosticados de abscesos hepaticos piogenos, durante un periodo de 13 anos. Los enfermos fueron divididos en dos grupos: 25 con visualizacion radiologica de gas en el absceso (grupo 1) y 101 sin formacion de gas (grupo 2). Los aspectos estudiados y comparados entre ambos grupos fueron: caracteristicas clinicas, biologicas y bacteriologicas, morfologia y topografia lesional, tratamiento y evolucion clinica Resultados La presentacion clinica de los pacientes del grupo 1 se caracterizo por la mayor frecuencia de perdida de peso (60 frente al 37,6%; p = 0,03), shock (16 frente al 4%; p = 0,04) y derrame pleural (48 frente al 26%; p = 0,03).Tambien en dicho grupo hubo mayor tasa de complicaciones relacionadas con el absceso (36 frente al 18%; p = 0,04). En el resto de datos clinicos, microbiologicos y terapeuticos no hubo diferencias siginificativas entre los dos grupos Conclusiones La aparicion de gas en los abscesos genera escasas peculiaridades en la presentacion clinica, pero su presencia implica peor evolucion clinica, sobre todo en lo concerniente a la morbilidad relacionada con el absceso

Estudio ergonómico del cirujano durante la colecistectomía por vía abierta y laparoscópica

Resumen Introduccion La ingenieria del factor humano (la ergonomia) ha investigado muy poco el trabajo quirurgico. Nuestro objetivo es determinar la carga postural de la colecistectomia laparoscopica y compararla con la abierta, para establecer el nivel de riesgo de lesion musculosqueletica y buscar soluciones ergonomicas que mejoren la comodidad del cirujano y la eficacia del acto quirurgico. Material y metodo Se recogieron datos sobre 16 intervenciones quirurgicas (11 laparoscopicas y 5 abiertas) aplicando el metodo OWAS (Ovako Working Posture Analysis System) y se compararon ambas tecnicas quirurgicas respecto a la carga estatica. Resultados Encontramos diferencias importantes entre la colecistectomia laparoscopica y la abierta respecto a la posicion de los brazos (p Conclusiones Ambas tecnicas de colecistectomia comportan un nivel de riesgo de lesion musculosqueletica mas que moderado. La aplicacion de criterios ergonomicos derivados del mundo industrial en el diseno del instrumental quirurgico y del quirofano pueden mejorar la comodidad del cirujano y, por tanto, la eficacia de su trabajo.

Mismatch repair protein MSH2 expression and prognosis of colorectal cancer patients

INTRODUCTION AND AIMS The role of genetic factors in the etiology and prognosis of patients with sporadic colo-rectal cancer is controversial. We have therefore investigated the biological and clinicopathological influence of immunohistochemical MSH2 expression in colorectal cancer. PATIENTS AND METHODS A total of 49 consecutive patients with unselected colorectal cancer operated on in our unit were included in the study. All tumors were resected and tumor specimens were evaluated for MSH2 expression. Clinicopathological data and patient survival were correlated with MSH2 staining. Uni- and multivariate analyses were performed. The minimum follow-up period was five years. RESULTS Curative resection was performed in 34 patients (64.9%), 14 of whom subsequently relapsed. At the end of the overall follow-up 25 (51%) patients had died, 21 of cancer-related causes. Twenty-eight patients (57.1%) were negative for MSH2 staining. Only vascular invasion was significantly correlated with MSH2 expression (lower median values; p=0.04). The overall median survival was 47.9 months (95% CI=27-86.6%). Multivariate analysis of variables in relation to survival showed that T stage (p=0.001), N stage (p<0.001) and MSH2 expression (p=0.01) were independent factors for survival. CONCLUSIONS Reduced MSH2 expression is frequent in unselected colorectal cancer patients. Only vascular invasion was correlated with MSH2 expression in this study. Survival was related to TN stage and MSH2 staining. (Int J Biol Markers 2004; 19: 190-5).

Altered intragenic DNA methylation of HOOK2 gene in adipose tissue from individuals with obesity and type 2 diabetes.

Aims/Hypothesis Failure in glucose response to insulin is a common pathology associated with obesity. In this study, we analyzed the genome wide DNA methylation profile of visceral adipose tissue (VAT) samples in a population of individuals with obesity and assessed whether differential methylation profiles are associated with the presence of type 2 diabetes (T2D). Methods More than 485,000 CpG genome sites from VAT samples from women with obesity undergoing gastric bypass (n = 18), and classified as suffering from type 2 diabetes (T2D) or not (no type 2 diabetes, NT2D), were analyzed using DNA methylation arrays. Results We found significant differential methylation between T2D and NT2D samples in 24 CpGs that map with sixteen genes, one of which, HOOK2, demonstrated a significant correlation between differentially hypermethylated regions on the gene body and the presence of type 2 diabetes. This was validated by pyrosequencing in a population of 91 samples from both males and females with obesity. Furthermore, when these results were analyzed by gender, female T2D samples were found hypermethylated at the cg04657146-region and the cg 11738485-region of HOOK2 gene, whilst, interestingly, male samples were found hypomethylated in this latter region. Conclusion The differential methylation profile of the HOOK2 gene in individuals with T2D and obesity might be related to the attendant T2D, but further studies are required to identify the potential role of HOOK2 gene in T2D disease. The finding of gender differences in T2D methylation of HOOK2 also warrants further investigation.

Inmunoexpresión de la oncoproteína p53 en el carcinoma epidermoide de esófago resecado

Resumen Introduccion Aunque la supervivencia de los pacientes sometidos a reseccion por cancer de esofago ha mejorado discretamente en el mundo occidental, los resultados distan mucho de ser satisfactorios. El estudio de la ploidia o la expresion de ciertos genes como el p53 abren, al menos en teoria, grandes posibilidades terapeuticas y pronosticas. El objetivo de este trabajo es evaluar la expresion de la proteina p53 y su influencia sobre la evolucion de los pacientes con carcinoma epidermoide tras exeresis. Pacientes y metodo Estudio retrospectivo (sobre una base de datos prospectiva) de 65 pacientes con cancer epidermoide de esofago sometidos a reseccion y validos para un seguimiento minimo de 30 meses en los que se determino por inmunohistoquimica las alteraciones de la expresion de la proteina p53. Los resultados fueron comparados con variables clinicopatologicas habituales y con la supervivencia de los pacientes. Resultados Veinticuatro enfermos (36,9%) han sido negativos y los 41 restantes han presentado inmunotincion positiva. han predominado las resecciones con intencion curativa, 36 (55,4%); las lesiones t3, 24 (36,9%), y t4, 26 (40%), los ganglios positivos n1, 35 (53,8%), y las metastasis (m1, 11) de origen sobre todo ganglionar. en consecuencia, los estadios iii (30 enfermos) y iv (11) suponen el 63,1% de la muestra. la inmunotincion no se ha relacionado con ninguna de las variables clinicopatologicas estudiadas. la supervivencia mediana global de la serie ha sido de 16,5 meses (intervalo de confianza [ic] del 95%, 13,7- 19,3) y la supervivencia a los 12, los 36 y los 60 meses, del 67,9, el 20,8 y el 12,3%, respectivamente. la expresion de la oncoproteina p53 no ha condicionado la supervivencia, el intervalo libre de enfermedad ni la probabilidad de recurrencia. Conclusiones Nuestro grupo de pacientes con cancer de esofago resecado, que consultan con enfermedad muy evolucionada, expresan oncoproteina p53 en 2/3 de los casos. La supervivencia, limitada, y el intervalo libre de enfermedad no se ven influidos por los resultados inmunohistoquimicos.

Relación de nm23-H1 con las metástasis en el cáncer de recto

Resumen Introduccion y objetivos El gen nm23-H1 es un supresor de metastasis estudiado en distintos tipos de tumores humanos. El objeto de este estudio es determinar su prevalencia en el cancer de recto y su relacion con los parametros clinicopatologicos clasicos y con la supervivencia. Pacientes y metodos Estudio retrospectivo inmunohistoquimico y clinico con un anticuerpo monoclonal de raton sobre 54 pacientes con tumores de recto resecados consecutivamente con una mediana de seguimiento de 37 meses. Resultados La positividad fue de 42 casos (77,8%) en el tumor primario frente a 6 casos (26,1%) en los ganglios metastatizados (p = 0,03). La expresion de nm23-H1 se correlaciona de forma inversa con la existencia de diseminacion ganglionar (p = 0,05) y de metastasis (p = 0,03). No hubo influencia sobre la supervivencia. Conclusiones Existe una perdida de la expresion de nm23-H1 en las metastasis ganglionares de los tumores rectales. La determinacion inmunohistoquimica de nm23-H1 en el tejido tumoral primario puede predecir la existencia de diseminacion ganglionar o metastasis a distancia en el cancer de recto.

Morbimortalidad y supervivencia tras la paliación de la obstrucción maligna de la vía biliar

Introduccion El desarrollo de nuevos procedimientos paliativos para el alivio de la obstruccion tumoral biliar exige el conocimiento de las distintas posibilidades de cada uno, la morbimortalidad asociada y la calidad de vida. El estudio de la supervivencia es la consecuencia logica. Pacientes y metodos Estudio retrospectivo de 114 pacientes con compromiso tumoral del drenaje biliar extrahepatico, no subsidiarios de reseccion, la mayoria, 99 (86,8%) con ictericia en el momento del diagnostico. Predominaron los tumores del area periampular (62 [54,4%]) y, en consecuencia, las obstrucciones distales (63 [55,3%]). La paliacion se llevo a cabo por medios quirurgicos en 65 casos (57%) y radiologicos en 46 (40,4%). Se realizo un analisis univariante para discriminar variables con influencia sobre la morbimortalidad, y el calculo de la supervivencia de los pacientes validos para seguimiento. Resultados La estancia hospitalaria postratamiento fue similar en ambos grupos; 47 pacientes (41,2%) tuvieron complicaciones y 35 (30,7%) fallecieron, la mayoria por problemas relacionados con ictericia y sepsis. La morbilidad, variada, se agrupa en tres grandes apartados: hemorragia, sepsis y obstruccion de la protesis/cateter. De las variables estudiadas solo los valores de bilirrubina condicionaron la muerte de los pacientes. La mediana de la supervivencia fue de 7 meses y solo el 7% vivian a los 2 anos. Conclusiones La morbimortalidad es elevada, independiente del metodo de paliacion empleado. Los valores de bilirrubina influyen en la posibilidad de muerte.