RESUMO
Introduction: The anastomotic leak (AL) is one of the most feared complications of colorectal surgery, since it is associated with a high rate of morbidity, mortality, length of hospital stay and cost of care. Our aim was to determine the risk factors associated with anastomosis leak in colorectal cancer patients who underwent surgical resection with anastomosis. Methods: A multicentre observational, analytical, retrospective and case-control study was carried out. For each case, two controls were included from three national hospitals from Lima, Peru during the period 2021-2022. To determine the degree of association, multivariate logistic regression model was carried out. Results: A total of 360 patients were included, 120 from each hospital. The mean age of the population was 68.03 ± 14.21 years old. The majority were 65 years old or older (66.1%), 52.8% were female, and 63.3% had clinical stage III. The 40% of the patients had albumin levels lower than 3.5 g/dL. Regarding the surgery, 96.4% were elective, 68.9% underwent open approach, and 80.8% had an operative time of more than 180 minutes. Most of them had right colon cancer (50.8%). In the multivariate analysis, a significant association was found with the age variable (OR = 2.48; 95%CI:1.24-4.97), clinical tumour level (OR = 2.71; 95%CI:1.34-5.48), American Society of Anesthesiologists (ASA) Score (OR = 3.23; 95%CI:1.10-9.50), preoperative serum albumin (OR = 22.2; 95%CI:11.5-42.9). Conclusion: The most important independent risk factors associated with AL among patients with colorectal cancer were pre-operative such as lower preoperative serum albumin levels, followed by a higher ASA Score, clinical-stage III-IV, and an age ≥65 years old.
RESUMO
BACKGROUND: Evidence regarding differences in survival associated with the site of metastasis in triple-negative breast cancer (TNBC) remains limited. Our aim was to analyze the overall survival (OS), distant relapse free survival (DRFS), and survival since the diagnosis of the relapse (MS), according to the side of metastasis. METHODS: This was a retrospective study of TNBC patients with distant metastases at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru) from 2000 to 2014. Prognostic factors were determined by multivariate Cox regression analysis. RESULTS: In total, 309 patients were included. Regarding the type of metastasis, visceral metastasis accounted for 41% and the lung was the most frequent first site of metastasis (33.3%). With a median follow-up of 10.2 years, the 5-year DRFS and OS were 10% and 26%, respectively. N staging (N2-N3 vs. N0, HR = 1.49, 95%CI: 1.04-2.14), metastasis in visceral sites (vs. bone; HR = 1.55, 95%CI: 0.94-2.56), the central nervous system (vs. bone; HR = 1.88, 95% CI: 1.10-3.22), and multiple sites (vs. bone; HR = 2.55, 95%CI:1.53-4.25) were prognostic factors of OS whereas multiple metastasis (HR = 2.30, 95% CI: 1.42-3.72) was a predictor of MS. In terms of DRFS, there were no differences according to metastasis type or solid organ. CONCLUSION: TNBC patients with multiple metastasis and CNS metastasis have an increased risk of death compared to those with bone metastasis in terms of OS and MS.
Assuntos
Neoplasias da Mama , Neoplasias de Mama Triplo Negativas , Humanos , Feminino , Neoplasias de Mama Triplo Negativas/patologia , Peru/epidemiologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias da Mama/patologia , Recidiva Local de Neoplasia/patologia , PrognósticoRESUMO
This study aims at understanding the vascularization of the human liver to determine the correct way to divide it into "divisions" (sectors) and segments, for which we dissected 250 livers using the acrylic resin injection method. The results showed the role of the "Porta hepatis" in the hepatic vascular distribution, the existence of seven vascular pedicles for seven portal segments, and the role of portal fissures in the parenchymal division of the liver. Our research provides the definition of a portal segment and demonstrates the role of the hepatic portal vein in originating any liver parenchymal division.
Quisimos estudiar la vascularización del hígado humano para determinar la forma correcta de dividirlo en "divisiones" y segmentos, para lo cual disecamos 250 hígados usando técnicas de inyección acrílica. Los resultados mostraron la función de la Porta hepatis en la distribución vascular del hígado, la existencia de siete pedículos vasculares para siete segmentos portales, y el rol de las fisuras portales en la división parenquimal del hígado. Ofrecemos la definición de lo que es un segmento portal y demostramos el rol de la vena porta hepática en originar cualquier división parenquimal del hígado.
Assuntos
Humanos , Veia Porta/anatomia & histologia , Fígado/irrigação sanguínea , DissecaçãoRESUMO
Presentamos definiciones y propuestas en relación a la anatomía del hígado basados en los resultados de estudiar 286 hígados humanos de ambos sexos, diferentes razas y edades que van desde fetos hasta octogenarios, mediante disección, inyección acrílica, radiología y reconstrucciones tomográficas tridimensionales. Definimos: 1) Segmento portal, 2) Pedículo portal, pedículo segmentario, 3) Fisuras portales, 4) Porta hepática o hilio hepático inferior, 5) Grupos de las venas hepáticas de retorno, 6) Trayecto de la vena hepática izquierda y 7) Conductos biliares aberrantes. Proponemos: 1) Segmento V único formante de la división medial derecha, 2) Siete ramas portales segmentarias terminales para siete segmentos, 3) Irrigación arterial segmentaria, 4) Formación de los conductos biliares, 5) Cambiar la denominación de fisura portal principal por fisura portal intermedia, 6) Incluir dentro del concepto "Fisura umbilical" a la fisura del ligamento redondo y la fisura del ligamento venoso, 7) Fisuras portales horizontales, 8) Venas que drenan en la Cava inferior, 9) No denominar Porción posterior del hígado (A05.8.01.043) al lóbulo caudado.
We present definitions and proposals in relation to the anatomy of the liver based on our investigation using dissection, acrylic injection, tomographic and radiological studies of 286 human livers of sexes, different races and ages ranging from fetuses to octogenarians. We define: 1) Portal segment, 2) Portal pedicle, segmental pedicle, 3) Portal fissures, 4) Porta Hepatis or Lower hepatic hilum, 5) Groups of hepatic return veins, 6) Left hepatic vein pathway and 7) Aberrant bile duct. We propose: 1) Segment V only formant of the right medial division, 2) Seven terminal segmental portal branches, 3) Segmental arterial irrigation, 4) Formation of bile ducts, 5) Change the denomination of main portal fissure by intermediate portal fissure , 6) Include within the concept "umbilical fissure" the fissure of the round ligament and fissure of the venous ligament, 7) Horizontal portal fissures, 8) Veins that drain in the inferior vena Cava, 9) Do not call the posterior portion of the liver (A05.8.01.043) to the caudate lobe.
Assuntos
Humanos , Fígado/anatomia & histologia , Terminologia como AssuntoRESUMO
Antecedentes: Sigue siendo una cuestión de debate si el cierre por tercera intención de incisiones abdominales contaminadas reduce las infecciones del sitio quirúrgico en comparación con un cierre primario. Objetivo: Determinar el tipo de cierre que predispone a Infección de Sitio Operatorio en heridas contaminadas de Cirugía Digestiva del Hospital Nacional Dos de Mayo (HNDM) 2013. Material y Método: Se desarrolló un estudio descriptivo, prospectivo y transversal en población hospitalaria intervenida por cirugía abdominal en el HNDM durante el periodo de abril 2013 - noviembre 2013. Resultados: La infección de sitio operatorio (ISO) entre heridas contaminadas observada en nuestra serie fue de 41.7 por ciento, fue más frecuente en el cierre por tercera intención respecto al cierre por primera intención (57.7 por ciento vs. 29.4 por ciento respectivamente). Los factores asociados a ISO en nuestra serie fueron: sexo masculino (64 por ciento), IMC >26 (60 por ciento), laparotomía exploratoria (70 por ciento), agente infeccioso Bacteroides y E. Coli (40 por ciento y 24 por ciento respectivamente) y colección líquida libre (24 por ciento). Esta asociación podría deberse a otros factores no evaluados. Conclusiones: En nuestra serie, la ISO se asocia al cierre por tercera intención, además de otros factores que deben ser estudiados en investigaciones que se desprendan de la actual.
Background: it is still a discussion of debate if the delayed primary closure of abdominal incisions that are contaminated reduces the surgical site infections in comparison with the primary closure. Objectives: Determine the type of closure that predisposes the infection of the surgical site of infected wounds from the department of Surgical Digestive Department of the National Hospital Dos de Mayo (NHDM). Material and methods: We develop a descriptive, prospective, transversal study in the population of the hospital that was intervened by the abdominal surgical team in the HNDM during the period of April 2013-November 2013. Results: The infection of the surgical site (ISS) among contaminated wounds was 41.7 per cent; it was more frequent in the delayed primary closure than the primary closure (57.7 per cent vs. 29.4 per cent respectively). The factors that were associated in ISS where: being a male gender (64 per cent), IMC >26 (60 per cent), infectious agent Bacteroides and E. coli (40 per cent y 24 per cent respectively) and free fluid collection (24 per cent). This association may be by other factor not evaluated. Conclusion: In our study, ISS associates to the closure of second intention, also the other factors must be studied in investigations that are not related to the actual one.
Assuntos
Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fatores de Risco , Infecção da Ferida Cirúrgica , Procedimentos Cirúrgicos do Sistema Digestório , Técnicas de Fechamento de Ferimentos , Estudos Prospectivos , Estudos TransversaisRESUMO
El objetivo del estudio, realizado en el Centro de Medicina Nuclear IPEN-INEN, fue identificar, como hallazgos incidentales, focos hipercaptadores de aspecto inflamatorio en la cavidad oral, en las gammagrafías óseas que se realizan a los pacientes con patología neoplásica. Se realizó un estudio descriptivo y retrospectivo estudiando las gammagrafías óseas realizadas en los pacientes con diagnóstico de cáncer que acudieron al Centro de Medicina Nuclear en el año 2003 y revisando las historias clínicas de los pacientes con focos hipercaptadores en la cavidad oral. Se concluye que en los pacientes con cáncer, los hallazgos gammagráficos de tipo inflamatorio en la cavidad oral son subestimados. Se necesitan trabajos prospectivos para determinar la frecuencia de la patología oral inflamatoria detectada en la gammagrafía ósea.
The main aim of the present work, done in the Nuclear Medicine Center IPEN-INEN, was to identify as incidental findings, increased inflammatory uptake in oral cavity, in routine bone scintigraphies for neoplasic diseases control. A descriptive and retrospective study was performed studying bone scants from patients with cancer, that came to the Nuclear Medicine Center in 2003 and revising records of those who had inflammatory uptake in the oral cavity. It is concluded that, in cancer patients these findings are underestimated. Prospective research should be needed in order to determine the frequency of inflammatory oral cavity pathology detected in bone scintigraphies.
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Boca , Neoplasias , Epidemiologia Descritiva , Estudos RetrospectivosRESUMO
Estudio de evaluación de fungicidas para el control de enfermedades foliares en sandía, llevado a cabo en terrenos del Centro de Enseñanza e Investigaciones Agropecuarias de Chiriquí (CELACHI) en la Facultad de Agronomía, Universidad de Panamá. El ensayo constó de 8 tratamientos de 3 repeticiones cada uno, distribuidos en un diseño experimental de bloques completamente al azar. En la evaluación del efecto de los fungicidas, se encontró que no hubo diferencias significativas entre ellos, debido a que quizá las condiciones climáticas no favorecieron el desarrollo del hongo para que manifestara severamente la enfermedad. Los rendimientos del ensayo fueron afectados por los hurtos de las frutas y por la incidencia de la enfermedad abiótica conocida como pudrición apical debido a la falta de humedad durante el período de rápido crecimiento de los frutos