Raquel Bravo

Laparoscopic-assisted approach in rectal cancer patients: lessons learned from >200 patients

BackgroundThe applicability of laparoscopic surgery in the treatment of colorectal diseases is still controversial. Early reports on laparoscopic-assisted colectomy in patients with colon cancer suggested that it minimizes surgical trauma, decreases perioperative complications, and leads to a more rapid recovery. To our knowledge, no previous studies have compared the laparoscopic vs the open approach in rectal cancer. The aim of this paper was to assess the results of laparoscopic techniques in patients with rectal cancer.MethodsFrom March 1998 to February 2003, all patients admitted to our unit with adenocarcinoma of the rectum were evaluated for surgery by the laparoscopic approach.ResultsA total of 220 patients with a mean age of 67.3 years were included in the study. One hundred thirty patients (59%) were treated with neoadjuvant chemoradiotherapy. In >75% of the patients, a surgical procedure with sphincter preservation was perfomed. The rate of conversion to the open approach was 20%. Ten patients had intraoperative complications. Fifty-eight patients (26.3%) developed postoperative complications. The length of hospital stay was 6.8 days. The distribution of tumor stages was as follows: stage I, 16.81%; stage II, 33.6%; stage III, 26.36%; stage IV, 19.09%. The mean number of lymph nodes was 13.8. The incidence of local relapse was 5.3%, with a follow-up of 18 months.ConclusionLaparoscopic surgery can be safely performed in patients with adenocarcinoma of the rectum with good short-term results. Randomized controlled trials are needed to confirm these results.

Recurrent volvular herniation of the ileal pouch: a case report and literature review

Total proctocolectomy (TP) with ileal pouch-anal anastomosis (IPAA) is currently the surgical treatment of choice for medically refractory ulcerative colitis (UC), familial adenomatous polyposis (FAP), indeterminate colitis, and selected cases of Crohn’s disease (CD) [1]. In contrast to the low mortality rate after IPAA (less than 1 %), the morbidity rate occurs in 19 to 54 % of the cases [2]. Complications after this procedure can be classified as early (anastomotic leaks, pelvic sepsis, pouch bleeding) and late complications (pouchitis, pouch fistulae, small bowel obstruction, malignant transformation, and pouch failure) [2]. The most overall common complicationispouchitis. Inthisletter, wedescribea caseof a recurrent volvulus of the ileal pouch, an extremely rare complication described only once before in the literature [3].

WEIGHT LOSS MIGHT BE A NON-COGNITIVE SIGN OF PRECLINICAL ALZHEIMER'S DISEASE

Background: Patients who had a cerebrovascular event are at higher risk of developing vascular dementia, especially in older age. However, some patients appear resilient to cognitive impairment even at advanced age. One possible explanation is that they have resistance to small vessel disease, particularly white matter hyperintensities (WMH) detectable on MRI. We studied the relevance of WMH to cognition in relation to age in patients who had a TIA/non-disabling stroke, particularly the older-old (>80). Methods: 570 consecutive patients with recent TIA/nondisabling stroke from the Oxford Vascular Study underwent multimodal MRI and cognitive assessment with the Montreal Cognitive Assessment scale (MoCA). They were divided into two age groups (<80, N1⁄4461; 80, N1⁄4109) and three cognitive groups according to their MoCA score: no vascular cognitive impairment (NoCI, MoCA>24, N1⁄4384), mild vascular cognitive impairment (MildVCI, MoCA1⁄420-24, N1⁄4143) or severe vascular cognitive impairment (SevereVCI, MoCA<20, N1⁄443). WMHwere automatically segmented on FLAIR images using BIANCA (Griffanti et al., Neuroimage 2016) and the relative WMH volumes calculated. A two-way between groups factorial ANOVA was performed on the WMH volumes to test the interaction between age and cognition. Voxel-wise correlational analyses were then performed on the binarised, normalized, smoothed maps of WMH using non-parametric permutation test in FSL to explore if lower MoCA score would be associated with higher probability of WMH in different localization in the younger relative to the older-old patients. Results:A 2x3 between-group factorial ANOVA on WMH volumes showed significant main effects of age (F1⁄429.04, p<0.001) and cognitive group (F1⁄45.71, p1⁄40.004), and a significant age/cognition interaction (F1⁄44.67,p1⁄40.010), in that differences across cognitive groups were significant in the younger but not in the olderold group. Accordingly, the voxel-wise analysis showed a significant negative correlation (voxel-corrected p<0.05) between WMH probability and MoCA score in the younger group only, mainly in periventricular frontal areas (figure). Conclusions: WMH in patients aged 80 years with TIA/minor stroke is unrelated to cognition suggesting that the presence of WMH (i) does not undermine resilience to dementia in the older-old and (ii) should not prompt consideration of a diagnosis of vascular cognitive impairment in the older old.

Efectos del bypass gástrico sobre el riesgo cardiovascular estimado

INTRODUCTION The major goal of surgical treatment in morbid obesity is to decrease morbidity and mortality associated with excess weight. In this sense, the main factors of death are cardiovascular disease and metabolic syndrome. The objective of this study is to evaluate the effects of gastric bypass on cardiovascular risk estimation in patients after bariatric surgery. MATERIAL AND METHODS We retrospectively evaluated pre and postoperative cardiovascular risk estimation of 402 morbidly obese patients who underwent laparoscopic gastric bypass. The major variable studied is the cardiovascular risk estimation that is calculated preoperatively and after 12 months. Cardiovascular risk estimation analysis has been performed with the REGICOR Equation. REGICOR formulation allows calculating a 10 year risk of cardiovascular events adapted to the Spanish population and is expressed in percentages. RESULTS We reported an overall 4.1±3.0 mean basal REGICOR score. One year after the operation, cardiovascular risk estimation significantly decreased to 2,2±1,6 (P<.001). In patients with metabolic syndrome according to ATP-III criteria, basal REGICOR score was 4.8±3.1 whereas in no metabolic syndrome patients 2.2±1.8. Evaluation 12 months after surgery, determined a significant reduction in both groups (metabolic syndrome and non metabolic syndrome) with a mean REGICOR score of 2.3±1.6 and 1.6±1.0 respectively. CONCLUSION The results of our study demonstrate favorable effects of gastric bypass on the cardiovascular risk factors included in the REGICOR equation.