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Resumen La pileflebitis o trombosis séptica portal es una complicación rara pero con gran morbilidad y mortalidad de los procesos infecciosos abdominales que drenan al sistema venoso portal. Con mayor frecuencia se relaciona con la apendicitis y diverticulitis. La incidencia ha aumentado en los últimos años con la disponibilidad de pruebas de imagen, como ecografía y tomografía axial computada abdominal. Esta facilidad en el diagnóstico y sobre todo la prescripción de antibióticos han mejorado el pronóstico, aunque no hay claro consenso en cuanto al tratamiento de esta infección y la anticoagulación es un tema controvertido.

Abstract Pylephlebitis or suppurative thrombophlebitis of the portal mesenteric venous system is a rare but deadly complication of abdominal infections drained by the portal venous system. Usually, it is seen in the setting of appendicitis and diverticulitis. The incidence have been increased in the last years because of the use of modern diagnosis imaging such as ultrasonography and computed tomography scans. The more sensitive imaging techniques and the availability of antibiotics have improve the prognosis, although there is not consensus about the empiric antibiotic regimens and the anticoagulation therapy is a controversial topic.

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INTRODUCTION: This study aims to identify the causes for the incomplete donation process at a tertiary care hospital. MATERIALS AND METHODS: A descriptive, retrospective study was performed; all potential donors reported to the Transplant Service within the period of 2005 to 2014 were included. Descriptive statistics were used across frequencies and proportions for categorical variables, central tendency, and dispersion for continuous variables. RESULTS: The total number of deaths reported at the University Hospital (HU) was 8472, of which 815 (n = 815) were reported to COETRA ("Consejo Estatal de Trasplantes"). Among organ or tissue donors, the main known cause of death was head trauma (HT) in 26% (72). Cardiac arrest (CA) as cause of death provided the largest number of donations (141, 57%); of these, 102 (41%) were male and 39 (16%) were female. In comparison, brain death (BD) provided 104 (43%); of these, 65 (27%) were male, and 39 (16%) were female. The age interval was with a higher donation rate was 45 to 49 y (BD 18, CA 22). Donation request was not performed in 359 patients because of medical contraindication 60% (215), rapid deterioration 18% (64), and incomplete donation process 8% (27). Of 452 organ requests, 207 were not accomplished, because of body integrity 28% (57), family disagreement 20% (42), and no acceptance of BE 13% (26). CONCLUSIONS: Opportunity areas: (1) Ensure the notification of all deaths to Transplant Department for identification of potential donors; (2) Reduce rapid deterioration and raise number of completed donation protocols; (3) Increase the donation rate.

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Colorectal cancer (CRC) is one of the most frequent cancer in first world. Two hereditary CCR syndrome have been described: familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer. A recently described biallelic mutation of MYH, is responsible for adenomatous polyposis with an increased risk of CRC and is responsible for 30-40 % of adenomatous polyposis cases in which an APC mutation cannot be found. However, there is no clear consensus in the literature as whether a monoallelic mutation increases the risk for colorectal cancer. In addition, some authors have indicated that the spectrum of extracolonic lesions in MYH associated polyposis (MAP) might be far different from that observed in FAP and could be more similar to Lynch syndrome spectrum. In this review we are going to describe some general and specific aspects of MAP, including genetic topics, clinical features, different phenotypes and strategies to reduce CCR risk.

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Colorectal cancer (CRC) is the most common malignant tumor in Western countries. Despite efforts made to implement screening programmes for early detection and treatment, still half of the patients present or will eventually develop distant metastasis. Management of advanced CRC should be discussed within an experienced multidisciplinary team, to adequately select the most appropriate systemic therapeutic option, as well as the optimal way to integrate it with surgical procedures when indicated. Disease localization and extent, resectability of primary and metastatic disease, tumor biology and dynamics, clinical symptoms, personal preferences and patient's ability to tolerate intensive chemotherapy or extensive surgical procedures are the key factors to properly design a customized treatment plan. The aim of the current manuscript is to provide synthetic practical guidelines regarding therapeutic options for advanced CRC.

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BACKGROUND: With the introduction of high resolution manometry (HRM) and esophageal topography a novel classification (Chicago Classification) has been proposed for the diagnosis of esophageal motor disorders (EMD). Clinical differences with the traditional classification are currently under evaluation. AIM: To investigate differences between the Chicago (CC) and traditional (TC) classifications in the diagnosis of EMD. METHODS: Consecutive patients with indication for esophageal manometry were studied. HRM was performed with a 36 sensors solid-state catheter and Manoview software (V2.0).Conventional manometric tracings were analyzed by an investigator blinded to the results of HRM. Diagnosis by CC and CT were compared. RESULTS: Two hundred patients were studied, 106 (53%) of them women (53%) with a mean patient age of 43.4 (range 16 - 84) years. Preoperative evaluation for GERD 152 (76%) was the most frequent indication. Achalasia (8), scleroderma (2) and peristaltic dysfunction (60 vs. 59) were similarly diagnosed by CC and CT. Spastic disorders were more frequently identified by CC: nutcracker esophagus (NC) in 3, spastic NC in3 and segmental NC in 11 patients versus TC: NC 5. Three patients had spasm with CC and 1 with TC. Non specific motor disorder was diagnosed by TC and 2 patients had functional obstruction with CC. Hypotensive lower esophageal sphincter was identified in 63 patients with CC vs.57 with TC. CONCLUSIONS: Spastic disorders and functional obstruction were the EMD better identified by HRM and CC.

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Avaliou-se o efeito da adição de soro de leite líquido à dieta sobre os parâmetros sanguíneos e sobre a digestibilidade aparente da matéria seca (DAMS), da proteína bruta (DAPB), da fibra em detergente neutro (DAFDN) e da fibra em detergente ácido (DAFDA) em 12 vacas Girolando, secas, que receberam feno de coastcross (Cynodon dactylon), suplementado com sal proteinado, e zero (controle), 15, 30 ou 45 litros de soro de leite/dia. A adição de soro na dieta afetou a DAMS e a DAPB (P<0,01) e não houve efeito sobre a DAFDN e a DAFDA. Quanto maior a quantidade de soro, maior o valor da DAMS e da DAPB. Os valores médios de glicose no plasma sanguíneo - 59,3; 64,0; 66,6 e 69.2mg/dL - variaram (P<0,01) entre os tratamentos, ajustando-se a regressões lineares positivas. A inclusão de soro afetou (P<0,01) a quantidade de ureia no sangue de maneira decrescente - 22,83; 20,17; 17,5 e 15,67. O soro de leite melhorou a eficiência de utilização de compostos nitrogenados no rúmen e pode ser utilizado para complementar suplementos proteicos com elevados teores de ureia.

The effect of liquid whey addition in the diet on blood parameters and on the apparent digestibility of dry matter (ADDM), crude protein (ADCP), neutral detergent fiber (ADNDF), and acid detergent fiber (ADADF) was evaluated in 12 dry Gir cows, receiving coastcross (Cynodon dactylon) hay supplemented with protein salt and zero (control), 15, 30, or 45 liters of whey per day. The inclusion of the whey in the diet affected the ADDM and ADCP (P<0.01) and had no effect on ADNDF and ADADF. As high the volume of whey inclusion, higher the ADDM and ADCP values. The average values of glucose in blood plasma - 59.3, 64.0, 66.6, and 69.2mg/dL - varied (P<0.01) among treatments, adjusting themselves to positive linear dL regressions. The whey inclusion diminished (P<0.01) blood urea values - 22.83, 20.17, 17.5, and 15.67. The whey improved the efficiency of utilization of nitrogen compounds in the rumen and can be used to complement protein supplements with high levels of urea.

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Avaliou-se o efeito da adição de soro de leite líquido à dieta sobre os parâmetros sanguíneos e sobre a digestibilidade aparente da matéria seca (DAMS), da proteína bruta (DAPB), da fibra em detergente neutro (DAFDN) e da fibra em detergente ácido (DAFDA) em 12 vacas Girolando, secas, que receberam feno de coastcross (Cynodon dactylon), suplementado com sal proteinado, e zero (controle), 15, 30 ou 45 litros de soro de leite/dia. A adição de soro na dieta afetou a DAMS e a DAPB (P<0,01) e não houve efeito sobre a DAFDN e a DAFDA. Quanto maior a quantidade de soro, maior o valor da DAMS e da DAPB. Os valores médios de glicose no plasma sanguíneo - 59,3; 64,0; 66,6 e 69.2mg/dL - variaram (P<0,01) entre os tratamentos, ajustando-se a regressões lineares positivas. A inclusão de soro afetou (P<0,01) a quantidade de ureia no sangue de maneira decrescente - 22,83; 20,17; 17,5 e 15,67. O soro de leite melhorou a eficiência de utilização de compostos nitrogenados no rúmen e pode ser utilizado para complementar suplementos proteicos com elevados teores de ureia.(AU)

The effect of liquid whey addition in the diet on blood parameters and on the apparent digestibility of dry matter (ADDM), crude protein (ADCP), neutral detergent fiber (ADNDF), and acid detergent fiber (ADADF) was evaluated in 12 dry Gir cows, receiving coastcross (Cynodon dactylon) hay supplemented with protein salt and zero (control), 15, 30, or 45 liters of whey per day. The inclusion of the whey in the diet affected the ADDM and ADCP (P<0.01) and had no effect on ADNDF and ADADF. As high the volume of whey inclusion, higher the ADDM and ADCP values. The average values of glucose in blood plasma - 59.3, 64.0, 66.6, and 69.2mg/dL - varied (P<0.01) among treatments, adjusting themselves to positive linear dL regressions. The whey inclusion diminished (P<0.01) blood urea values - 22.83, 20.17, 17.5, and 15.67. The whey improved the efficiency of utilization of nitrogen compounds in the rumen and can be used to complement protein supplements with high levels of urea.(AU)

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BACKGROUND: Colon transverse volvulus is an uncommon pathology which is associate with alterations of the colonic motility, mental disorders and congenital anomalies of the fixation of the colon sistem. Up to 1994, 72 cases has been reported in world-wide literature. AIM: To report a case of colon transverse volvulus and the treatment. CASE REPORT: A female 46 years old who show intense abdominal pain 2 days of evolution. The physical exploration show important abdominal distension and pain in left inferior quadrant. The Rx of abdomen with gas absence in rectal descendent colon and ampula with level and important distension of proximal colon. Colonoscopic study with impossibility to advance endoscopy throw colon transverse by zone of stenosis, wasn't made a contrast study, underwent laparotomy of urgency, it was done right hemicolectomy and ileocoloanastomosis with good evolution and given of discharge fourth postsurgical day. CONCLUSIONS: This possibility is due to have in mind diagnoses, the treatment is surgical secondary to a high index of recidivate, nevertheless recommends the colonoscopy study accomplishment in order to discard obstructive injuries mainly cancer.

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OBJECTIVE: To present two cases of anorectal malignant melanoma as due to its non specific presentation and rarity they are often misdiagnosed like hemorrhoids. BACKGROUND: Anal melanomas are rare tumors that constitute less than 1% of the malignant colorectal tumors and represent both a diagnostic and therapeutic challenge to physicians. They are generally pigmented but could be amelanotic in 29% of the cases and they are associated with poor prognosis, regardless of the surgical procedure used. Melanomas are often misdiagnosed by a lot of anorectal conditions and diagnosis must be suspected in patients with an anal mass. CASE REPORT: We present two anorectal cases of malignant melanoma treated by wide local excision, the principal complain in both patients was the presence of an anal mass and bleeding. Both patients were treated by local excision since survival rates are comparable to those of patients treated by abdomino perineal resections (with a high morbility and mortality rates) and a better quality of life is achieved with control of the symptoms. CONCLUSIONS: Anal melanoma is a rare entity with a poor prognosis. The overall treatment goal should be to optimize the quality of life.

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OBJECTIVE: To report a case of rectal duplication in the adult and make a literature review. BACKGROUND: The intestinal duplications are injuries of congenital origin that can exist from the base of the tongue to the anal verge, being the most frequent site at level of terminal ileum (22%) and at the rectal level in 5% To date approximately exist 80 reports in world-wide Literature generally in the pediatric population being little frequent in the adult age. Its presentation could be tubular or cystic. The recommended treatment is the surgical resection generally in block with coloanal anastomosis. METHOD: A case review of rectal duplication in the adult and the conducted treatment. RESULT: The case of a patient appears with diagnose of rectal duplication with tubular type,whose main symptom was constipation and fecal impactation. In the exploration was detect double rectal lumen (anterior and posterior) that it above initiates by of the anorectal ring with fibrous ulcer of fibrinoid aspect of 3 approx cm of length x 1 cm wide, at level of the septum that separates both rectal lumina. CONCLUSIONS: The rectal duplication is a rare pathology in the adult nevertheless is due to suspect before the existence of alterations in the mechanics of the defecation, rectal prolapse and rectal bleeding,the election treatment is a protectomy with colonic pouch in "J" and coloanal anastomosis.

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Signalling pathways that emerge from EGFR activation are critical in colon cancer (CC) biology. Its targeting with specific drugs has opened a new window in the treatment of this disease. In this regard, monoclonal antibodies (mAb) have evidenced a high degree of efficiency opposed to the uselessness of tyrosine-kinase inhibitors. Cetuximab is the mAb that has evidenced most activity in CC. After its initial approval as an irinotecan-resistance reversal agent, cetuximab has demonstrated its efficiency from the first line to heavily pretreated patients. In the first line, its addition may increase response rate to chemotherapy, improving liver metastases resection rate. Another promising approach has been suggested from combination schedules with bevacizumab. Panitumumab has been recently approved for CC. Although there is limited clinical experience, the latest data have confirmed its activity in heavily pretreated patients resulting in a clinical benefit vs. best support care. In spite of the clinical benefits, adverse events and the high sanitary cost derived from these drugs force the selection of patients with the highest probability of benefit. At the moment, when EGFR expression evidenced by immunohistochemistry has no value, skin toxicity and, fundamentally, K-Ras mutations may hint at critical information for confirmatory prospective studies.

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Lung cancer is a frequent cause of cancer-related deaths in the world. There is no valid screening process and this limits its detection to the late stages, with consequently high mortality rates. Volatile organic compounds (VOC) are chemical compounds (mainly the products of cell catabolism) found as gases in the human breath. Different methods have been developed to analyse VOCs and to compare them in healthy subjects and lung cancer patients. In this review, we summarise the different techniques used to analyse VOC. Many reports have been published with promising results similar to those achieved with accepted screening methods such as mammography. These methods show good perspectives on lung cancer screening.

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Late perforation after ventriculoperitoneal (VP) shunting is extremely rare. Colonic perforation is uncommon and represents 0.1%-0.7% of abdominal complications. Colonic perforation can challenge diagnostic and therapeutic decisions, and there are no clear guidelines on the management of this problem. We present a 34-year-old woman who was admitted for a 1-week history of sensation of a foreign body through the anus at the time of bowel movements. She had previously undergone a VP derivation for hydrocephalus secondary to neurocysticercosis. Plain abdominal radiographs demonstrated the shunt within the colonic lumen and through the descendening and sigmoid colon. The shunt was exteriorized in the cervical area and a laparotomy was performed with a primary two-layer colonic close. The patient received antibiotic therapy for 2 weeks with good outcome. Percutaneous and endoscopic approaches have been reported in patients with no abdominal signs. Prompt recognition of this complication is critical to avoid high mortality rates.

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We present a case of the rare occurrence of a mucus-secreting adenocarcinoma originating in an anal gland. A 37-year-old diabetic man had an anal fistulotomy 16 years before. He had four ischiorectal abscesses in a 6-month period. A seton was inserted in a complex fistula tract in the left anterior lateral aspect. Due to delayed healing, a new surgical exploration was carried out; pathological analysis of the curetted mucinous tissue revealed a mucoid adenocarcinoma. Surgical resection is the first choice of curative treatment, and additional treatments include chemotherapy, radiotherapy and brachytherapy.

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OBJECTIVES: Fecal incontinence is a common, incapacitating and largely unrecognized medical problem and can be caused by various factors. Obstetric trauma is the most common cause of fecal incontinence secondary to trauma. We aimed to analyze the role of endoanal ultrasound in assessment of this type of fecal incontinence, and report the functional results of surgical treatment. METHODS: We reviewed the records of all 22 patients with fecal incontinence secondary to obstetric trauma who were evaluated by endoanal ultrasound and underwent surgical management in our department from April to 1997 to April 2002. Pre- and postoperative evaluation of the degree of incontinence was done using the incontinence score of Jorge and Wexner. RESULTS: The patients had a median age of 43 (range, 29-68) years. All had vaginal deliveries, five of which (22.7%) were instrumental. Most of the patients had total fecal incontinence (solids) with preoperative incontinence score values of 15-20 (median, 18). Endoanal ultrasound confirmed structural defects in the anterior external anal sphincter alone in 16 (72.7%) patients, and both anterior external and internal sphincter defects in six (27.3%) patients. A thinned perineal body was present in all patients. All patients received surgical treatment with overlapping sphincteroplasty and there was improvement of continence in 19 (86.4%) patients with postoperative incontinence score values between 4 and 0 (median, 2). CONCLUSIONS: Endoanal sonography is an accurate method for assessing sphincter anatomy, delineating both internal and external anal sphincters. Surgical treatment of sphincter defects is associated with good outcome.

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