Sonia Puig

Regulation of glycosyltransferases and Lewis antigens expression by IL-1β and IL-6 in human gastric cancer cells.

Inflammation of stomach mucosa has been postulated as initiator of gastric carcinogenesis and the presence of pro-inflammatory cytokines can regulate specific genes involved in this process. The cellular expression pattern of glycosyltransferases and Lewis antigens detected in the normal mucosa changed during the neoplassic transformation. The aim of this work was to determine the regulation of specific fucosyltransferases and sialyltransferases by IL-1β and IL-6 pro-inflammatory cytokines in MKN45 gastric cancer cells. IL-1β induced significant increases in the mRNA levels of FUT1, FUT2 and FUT4, and decreases of FUT3 and FUT5. In IL-6 treatments, enhanced FUT1 and lower FUT3 and FUT5 mRNA expression were detected. No substantial changes were observed in the levels of ST3GalIII and ST3GalIV. The activation of FUT1, FUT2 and FUT4 by IL-1β is through the NF-κB pathway and the down-regulation of FUT3 and FUT5 by IL-6 is through the gp130/STAT-3 pathway, since they are inhibited specifically by panepoxydone and AG490, respectively. The levels of Lewis antigens after IL-1β or IL-6 stimulation decreased for sialyl-Lewis x, and no significant differences were found in the rest of the Lewis antigens analyzed, as it was also observed in subcutaneous mice tumors from MKN45 cells treated with IL-1β or IL-6. In addition, in 61 human intestinal-type gastric tumors, sialyl-Lewis x was highly detected in samples from patients that developed metastasis. These results indicate that the expression of the fucosyltransferases involved in the synthesis of Lewis antigens in gastric cancer cells can be specifically modulated by IL-1β and IL-6 inflammatory cytokines.

Benchmarking Complications Associated with Esophagectomy

Objective: Utilizing a standardized dataset with specific definitions to prospectively collect international data to provide a benchmark for complications and outcomes associated with esophagectomy. Summary of Background Data: Outcome reporting in oncologic surgery has suffered from the lack of a standardized system for reporting operative results particularly complications. This is particularly the case for esophagectomy affecting the accuracy and relevance of international outcome assessments, clinical trial results, and quality improvement projects. Methods: The Esophageal Complications Consensus Group (ECCG) involving 24 high-volume esophageal surgical centers in 14 countries developed a standardized platform for recording complications and quality measures associated with esophagectomy. Using a secure online database (ESODATA.org), ECCG centers prospectively recorded data on all resections according to the ECCG platform from these centers over a 2-year period. Results: Between January 2015 and December 2016, 2704 resections were entered into the database. All demographic and follow-up data fields were 100% complete. The majority of operations were for cancer (95.6%) and typically located in the distal esophagus (56.2%). Some 1192 patients received neoadjuvant chemoradiation (46.1%) and 763 neoadjuvant chemotherapy (29.5%). Surgical approach involved open procedures in 52.1% and minimally invasive operations in 47.9%. Chest anastomoses were done most commonly (60.7%) and R0 resections were accomplished in 93.4% of patients. The overall incidence of complications was 59% with the most common individual complications being pneumonia (14.6%) and atrial dysrhythmia (14.5%). Anastomotic leak, conduit necrosis, chyle leaks, recurrent nerve injury occurred in 11.4%, 1.3%, 4.7%, and 4.2% of cases, respectively. Clavien-Dindo complications ≥ IIIb occurred in 17.2% of patients. Readmissions occurred in 11.2% of cases and 30- and 90-day mortality was 2.4% and 4.5%, respectively. Conclusion: Standardized methods provide contemporary international benchmarks for reporting outcomes after esophagectomy.

Estudio ecográfico y manométrico del esfínter anal interno en individuos con fisura anal crónica

Resumen Introduccion El aumento de la presion en reposo es uno de los factores implicados en la patogenia de la fisura anal cronica. Se desconoce, sin embargo, si esta anormalidad en la funcion del esfinter anal interno (EAI) se corresponde con alteraciones en su morfologia. Los objetivos son determinar el grosor del EAI en pacientes con fisura anal cronica e investigar la correlacion entre el grosor del EAI y la presion en reposo. Pacientes y metodo Estudio observacional prospective (noviembre de 1999-diciembre de 2002). Se incluyo a pacientes con fisura anal cronica y se excluyo a los que tenian antecedentes de enfermedad inflamatoria, cirugia anal y tratamiento previo con nitroglicerina topica o toxina botulinica. Se practicaron una ecografia endoanal y una manometria. Se considero que el grosor del EAI estaba aumentado cuando era > 2,5 mm en pacientes 3 mm en pacientes ≥ 50 anos. Se considero que la presion en reposo estaba aumentada cuando superaba los 80 mmHg. Resultados Se analizo a 63 pacientes. El EAI estaba aumentado de grosor en 58 (92%) pacientes. El grosor medio del EAI fue de 3,7 ± 0,7 mm. La presion en reposo estaba aumentada en 47 (66%) pacientes. La presion en reposo media fue de 91 ± 28 mmHg. No encontramos ninguna correlacion positiva entre el grosor del EAI y la presion en reposo (r = 0,05; p Conclusiones La mayoria de los pacientes con fisura anal presenta una hipertrofia del EAI. El aumento del grosor del EAI no se correlaciona con un aumento de la presion en reposo.

Tratamiento quirúrgico de la úlcera péptica perforada: comparación entre los abordajes laparoscópico y abierto

OBJECTIVE To analyse the outcomes of laparoscopic versus open repair for perforated peptic ulcers (PPU). METHODS All patients undergoing PPU repair between January 2002 and March 2012 were included in the study. Demographic characteristics, operation time, complications, and length of hospital stay were evaluated. RESULTS Two hundred and twelve patients (median age, 49 years) were included, 60 in the laparoscopic group and 52 in the open group. Patients operated laparoscopically were significantly younger and had a higher consumption of tobacco, alcohol and cannabis. Median acute symptoms time was shorter in the laparoscopic group (6h) compared to the open group (12h; P=.025) Symptoms time was shorter in the laparoscopic group. Median operating time was significantly longer in the laparoscopic group (104.5min vs. 76min, P=.025). The percentage of conversion to open repair was 25%. There was no difference in morbidity between 2 groups, but there were 3 deaths in the open group. Median hospital stay was significantly shorter in patients treated laparoscopically when compared with the open group (6 days vs. 8 days; P=.041). CONCLUSION Laparoscopic and open repair are equally safe in the management of PPU. A shorter hospital stay can be achieved in the laparoscopic group.

A sporadic multiple gastrointestinal stromal tumor with unique clinical and molecular features

Most sporadic gastrointestinal stromal tumors occur as solitary lesions, whereas a multicentric appearance involving the stomach, the small intestine, or both sites is suspicious for lesions developed in the setting of hereditary or idiopathic tumor syndromes or metastatic disease. The rare occurrence of multiple sporadic gastrointestinal stromal tumors has been recently reported in the literature. Here, we report a case of multiple sporadic gastrointestinal stromal tumors affecting the small intestine in a 61-year-old man, unique with regard to the number of lesions (>30) and the molecular profile. Four different mutations of KIT involving exons 11, 13, and 17 were present among 4 of 10 excised tumors. In addition, BRAF p.V600E mutation was detected in 5 tumors and was mutually exclusive with KIT mutations. To our knowledge, this is the first time a case of a synchronic multisporadic gastrointestinal stromal tumor outstanding for the high number of lesions, which are of independent origin, is reported.

Impacto de la disponibilidad de un servicio externo de medicina nuclear en la aplicación de la biopsia del ganglio centinela en cirugía del cáncer de mama

Resumen Introduccion La realizacion de la tecnica de la biopsia selectiva del ganglio centinela (BSGC) en el tratamiento del cancer de mama requiere disponer de un servicio de medicina nuclear (SMN) y de la validacion de su tecnica. El objetivo del presente estudio es analizar la posibilidad de realizar esta tecnica con un SMN externo ya validado, y estudiar su impacto en la indicacion de la linfadenectomia axilar radical (LAR) y en la estancia postoperatoria. Pacientes y metodos Estudio prospectivo en una cohorte de pacientes con cancer de mama a partir de la implantacion en nuestro centro de la tecnica de la BSGC gracias a la colaboracion de un SMN externo que realizaba la linfogammagrafia y la deteccion del ganglio centinela (GC), en tanto que su identificacion intraoperatoria se llevaba a cabo mediante una sonda portatil. Se analiza la viabilidad del proyecto y su impacto clinico tomando como resultados finales la disminucion del numero de linfadenectomias y la estancia hospitalaria. Resultados Se ha tratado a 196 pacientes, con 201 carcinomas de mama. Las intervenciones mayoritarias fueron la tumorectomia (TC) con BSGC en 124 casos (62%), y la TC con BSGC y LAR en 62 casos (31%). La visualizacion del GC en la linfogammagrafia se obtuvo en 187 de 201 casos (93,1%) y se ha detectado el GC durante la intervencion en 182 de los 187 (97,4%) casos. La deteccion de GC en la cadena mamaria interna se ha producido en 23 de los 201 casos (11,4%). Se ha evitado la LAR en 131 de los 201 casos (65%). La diferencia de dias de ingreso postoperatorio con o sin LAR fue de una media de 1,8 dias (3,1 frente a 1,3; p Conclusiones La tecnica de BSGC ha sido factible con la colaboracion de un SMN externo; se evito el 65% de las LAR y disminuyo la estancia media en 1,8 dias.