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Moya P, Parra P, Arroyo A, Peña E, Benavides J, Calpena R. Sacral nerve stimulation versus percutaneous posterior tibial nerve stimulation in the treatment of severe fecal incontinence in men. Tech Coloproctol 2016; 20:317-319. [PMID: 26925981 DOI: 10.1007/s10151-016-1443-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/14/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sacral nerve stimulation and percutaneous posterior tibial nerve stimulation have been described previously as effective treatments for fecal incontinence. Nevertheless, there does not exist any study that compares the efficiency of both. The aim of this study was to compare the use of SNS and PPTNS in males with FI. METHODS We conducted a prospective cohort study on men with FI treated with SNS or PTNS in the Coloproctology Unit of the University General Hospital of Elche and Reina Sofia of Murcia between January 2010 and December 2011. Preoperative assessment included physical examination, anorectal manometry, and anal endosonography. Anal continence was evaluated using the Wexner continence grading system. Quality of life was evaluated using the Fecal Incontinence Quality of life Scale. RESULTS Nineteen patients were included (ten patients SNS and nine PPTNS). SNS improved FI in nine of the ten patients. The mean Wexner score decreased significantly from a median of 14 (12-16) (preoperative) to 4 (1-8) (6-month revision) (p = 0.007). PTNS improved FI in seven of the nine patients. The mean Wexner score decreased significantly from a median of 12 (11-19) (preoperative) to 5 (4-7) (6-month revision) (p = 0.018). Both treatments produced symptomatic improvement without statistical differences between them. CONCLUSIONS Our study was nonrandomized with a relatively small number of patients. PPTNS had similar efficiency to the SNS in our men population. However, more studies are necessary to exclude selection bias and analyze long-term results.
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Affiliation(s)
- P Moya
- Coloproctology Unit, Department of Surgery, University General Hospital of Elche, Alicante, Spain.
| | - P Parra
- Coloproctology Unit, Department of Surgery, University General Hospital Reina Sofia, Murcia, Spain
| | - A Arroyo
- Coloproctology Unit, Department of Surgery, University General Hospital of Elche, Alicante, Spain
| | - E Peña
- Coloproctology Unit, Department of Surgery, University General Hospital Reina Sofia, Murcia, Spain
| | - J Benavides
- Coloproctology Unit, Department of Surgery, University General Hospital Reina Sofia, Murcia, Spain
| | - R Calpena
- Coloproctology Unit, Department of Surgery, University General Hospital of Elche, Alicante, Spain
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Rojas-Machado SA, Romero-Simó M, Arroyo A, Rojas-Machado A, López J, Calpena R. Prediction of anastomotic leak in colorectal cancer surgery based on a new prognostic index PROCOLE (prognostic colorectal leakage) developed from the meta-analysis of observational studies of risk factors. Int J Colorectal Dis 2016; 31:197-210. [PMID: 26507962 DOI: 10.1007/s00384-015-2422-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE To obtain a prognostic index, which has been named PROCOLE (prognostic colorectal leakage), it can predict the risk that a certain individual may suffer anastomotic leakage. METHODS The methodology consists of a systematic review to identify potential risk factors for anastomotic leakage and a meta-analysis of studies of each of these factors. In the meta-analysis, the prognostic index integrates factors that are statistically significant, which are weighted according to the estimated value of the effect size. The prognostic index was validated using retrospectively collected data from patients who underwent colorectal cancer surgery anastomosis at our institution. RESULTS The mean and standard deviation of the PROCOLE prognostic index in patients with anastomotic leakage is 1.9 ± 6.13, whereas in controls, it is 3.63 ± 2.1. The predictive ability of the PROCOLE, assessed by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC), results in an AUC of 0.82 with a 95% confidence interval (CI) (0.75, 0.89) of the AUC, and it can be considered a good prognostic indicator. CONCLUSIONS The PROCOLE prognostic index predicts the risk of a certain individual developing anastomotic leakage after colorectal cancer surgery. Specifically, the PROCOLE prognostic index establishes a discrimination value threshold of 4.83 for recommending the implementation of a protective stoma. We have developed free software with a simple interface that only requires the selection of risk factors to obtain the PROCOLE value.
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Affiliation(s)
- S A Rojas-Machado
- Coloproctology Unit, Department of Surgery, University Hospital of Alicante, Alicante, Spain.,Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - M Romero-Simó
- Coloproctology Unit, Department of Surgery, University Hospital of Alicante, Alicante, Spain.,Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - A Arroyo
- Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain. .,Coloproctology Unit, Department of Surgery, University Hospital of Elche, C/ Camí de l'Almazara no. 11, 03203, Elche, Spain.
| | - A Rojas-Machado
- Coloproctology Unit, Department of Surgery, University Hospital of Alicante, Alicante, Spain.,Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - J López
- Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - R Calpena
- Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.,Coloproctology Unit, Department of Surgery, University Hospital of Elche, C/ Camí de l'Almazara no. 11, 03203, Elche, Spain
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Moya P, Arroyo A, Del Mar Aguilar M, Galindo I, Giner L, Bellón M, Candela F, Calpena R. Percutaneous posterior tibial nerve stimulation in the treatment of refractory anal fissure. Tech Coloproctol 2016; 20:197-8. [PMID: 26768730 DOI: 10.1007/s10151-015-1417-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- P Moya
- Division of Colorectal Surgery, Department of General Surgery, University General Hospital of Elche, Camí de L'Almazara, 11, 03203, Elche, Spain.
| | - A Arroyo
- Division of Colorectal Surgery, Department of General Surgery, University General Hospital of Elche, Camí de L'Almazara, 11, 03203, Elche, Spain
| | - M Del Mar Aguilar
- Division of Colorectal Surgery, Department of General Surgery, University General Hospital of Elche, Camí de L'Almazara, 11, 03203, Elche, Spain
| | - I Galindo
- Division of Colorectal Surgery, Department of General Surgery, University General Hospital of Elche, Camí de L'Almazara, 11, 03203, Elche, Spain
| | - L Giner
- Division of Colorectal Surgery, Department of General Surgery, University General Hospital of Elche, Camí de L'Almazara, 11, 03203, Elche, Spain
| | - M Bellón
- Division of Colorectal Surgery, Department of General Surgery, University General Hospital of Elche, Camí de L'Almazara, 11, 03203, Elche, Spain
| | - F Candela
- Division of Colorectal Surgery, Department of General Surgery, University General Hospital of Elche, Camí de L'Almazara, 11, 03203, Elche, Spain
| | - R Calpena
- Division of Colorectal Surgery, Department of General Surgery, University General Hospital of Elche, Camí de L'Almazara, 11, 03203, Elche, Spain
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López-Delgado A, Arroyo A, Ruiz-Tovar J, Alcaide MJ, Diez M, Moya P, Santos J, Calpena R. Effect on anal pressure of percutaneous posterior tibial nerve stimulation for faecal incontinence. Colorectal Dis 2014; 16:533-7. [PMID: 24674305 DOI: 10.1111/codi.12628] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/28/2014] [Indexed: 02/08/2023]
Abstract
AIM Previous studies on percutaneous posterior tibial nerve stimulation (PTNS) for faecal incontinence do not report anal pressure changes. In the present study the effect of percutaneous PTNS on anal manometry was determined. METHOD This was a prospective observational study of patients with faecal incontinence. They underwent one 30-min session of PTNS weekly for 12 consecutive weeks. Patients who showed improvement were given six more sessions at 2-weekly intervals. Anal manometry was performed before and after treatment. Clinical data including the Wexner score, psychological testing, quality of life using the Fecal Incontinence Quality of Life Score and the contents of a continence diary were recorded before and after the procedure. RESULTS Twenty-four patients were included in the study of whom 17 (70.83%) demonstrated some degree of clinical or manometric improvement at 3 months. Before treatment 18 patients had urgency of <1 min. At 3 and 6 months this had risen to 5 min in 62.5% and 70.83% (P < 0.001). The anal resting pressure increased from 21.7 to 37.6 mmHg (P = 0.021), the maximum squeeze pressure from 58.2 to 72.2 mmHg (P = 0.045) and the Wexner score fell from 15 to 10 (P = 0.018) at 6 months. Predictive factors for a response included fewer than three incontinent episodes per week (P = 0.027). Negative predictive factors included episiotomy and an initial Wexner score of > 12 (P = 0.035). CONCLUSION Percutaneous PTNS was effective in over 70% of patients in the present study with improvements in urgency, anal pressures and Wexner score.
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Affiliation(s)
- A López-Delgado
- Coloproctology Unit, Department of Surgery, University Hospital of Elche, Elche, Alicante, Spain
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Martinez-Ramos D, Calero A, Escrig-Sos J, Mingol F, Daroca-Jose JM, Sauri M, Arroyo A, Salvador-Sanchis JL, de Juan M, Calpena R, Lacueva FJ. Prognosis for gastric carcinomas with an insufficient number of examined negative lymph nodes. Eur J Surg Oncol 2013; 40:358-65. [PMID: 24075824 DOI: 10.1016/j.ejso.2013.08.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/24/2013] [Accepted: 08/24/2013] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The optimal system for lymph node (LN) staging in gastric cancer is still a subject of debate. The aim of our study was to analyse the probability of error in negative LN (pN0) gastric carcinomas when a low number of LNs were harvested using a probabilistic model. METHODS Patients with gastric carcinoma who underwent R0 resection at three university hospitals between 2004 and 2009 were retrospectively included. A Bayesian model was used to analyse the probability of error for negative LNs (pN0) gastric carcinomas. Kaplan-Meier survival curves and the log-rank test were used to compare the overall and specific mortality of prognosis groups. RESULTS Of the 291 patients included, 123 were classified as pN0 (42%). A significant correlation was found between the extent of the LN dissection performed and the number of the LNs retrieved. According to the Bayesian model the carcinomas with 9 or fewer negative lymph nodes were considered to have a high risk (HR) of misclassification, whereas patients with 10-25 LNs analysed and those with more than 26 negative lymph nodes were considered to have a moderate risk (MR) and low risk (LR), respectively. The log-rank test showed a significant improvement in the disease-specific survival for the MR pN0 (p < 0.001) and LR pN0 (p < 0.04) but not for the HR pN0 patients compared to pN1 patients. CONCLUSIONS The proposed probabilistic model is clinically useful for differentiating the prognosis in pN0 gastric carcinomas when an insufficient number of negative lymph nodes are retrieved.
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Affiliation(s)
- D Martinez-Ramos
- Department of General and Digestive Surgery, Hospital General Universitario, Castellon, Spain.
| | - A Calero
- Department of General and Digestive Surgery, Hospital General Universitario, Elche, Spain
| | - J Escrig-Sos
- Department of General and Digestive Surgery, Hospital General Universitario, Castellon, Spain
| | - F Mingol
- Department of General and Digestive Surgery, Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - J M Daroca-Jose
- Department of General and Digestive Surgery, Hospital General Universitario, Castellon, Spain
| | - M Sauri
- Department of General and Digestive Surgery, Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - A Arroyo
- Department of General and Digestive Surgery, Hospital General Universitario, Elche, Spain
| | - J L Salvador-Sanchis
- Department of General and Digestive Surgery, Hospital General Universitario, Castellon, Spain
| | - M de Juan
- Department of General and Digestive Surgery, Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - R Calpena
- Department of General and Digestive Surgery, Hospital General Universitario, Elche, Spain
| | - F J Lacueva
- Department of General and Digestive Surgery, Hospital General Universitario, Elche, Spain
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Moya P, Arroyo A, Lacueva J, Candela F, Soriano-Irigaray L, López A, Gómez MA, Galindo I, Calpena R. Sacral nerve stimulation in the treatment of severe faecal incontinence: long-term clinical, manometric and quality of life results. Tech Coloproctol 2013; 18:179-85. [PMID: 23624794 DOI: 10.1007/s10151-013-1022-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 04/18/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Faecal incontinence (FI) is a complex and multifactorial health problem. Treatment has to be individualised, analysing the aetiology and gravity in every case. Sacral nerve stimulation (SNS) has been shown to effectively improve treatment of FI. METHODS Fifty patients with severe FI treated with SNS between March 2002 and December 2010 were analysed. Preoperative assessment included physical examination, anorectal manometry and anal endosonography. Anal continence was evaluated using the Wexner continence grading system. Quality of life was evaluated using the Fecal Incontinence Quality of life Scale (FIQLS). Follow-up appointments were scheduled at 1, 6 and 12 months and annually thereafter. Wexner score, FIQLS and the ability to defer defecation were assessed at each visit. RESULTS Fifty patients underwent a permanent implant. The overall mean follow-up period was 55.52 ± 31.84 months. After 6 months, SNS significantly improved FI and positively impacted quality of life, as evidence by significant improvements in all 4 scales of the FIQLS. Anorectal manometry showed a trend towards an increase in maximum resting pressure and maximum pressure. After the first assessment at 6 months, Wexner score and FIQLS remained stable. Ability to defer defecation was also maintained. During follow-up, 3 patients (6 %) experienced implant site pain and episodes of extremity pain and paresthesias that were refractory to medical management and required device explantation. The implant site infection rate was 2 %. CONCLUSIONS Analysis of our long-term results confirms the safety and effectiveness of SNS in the management of patients with FI.
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Affiliation(s)
- P Moya
- Department of Surgery, University General Hospital of Elche, Elche, Alicante, Spain,
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7
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Moya P, Navarro JM, Arroyo A, López A, Ruiz-Tovar J, Calpena R. Sacral nerve stimulation during pregnancy in patients with severe fecal incontinence. Tech Coloproctol 2012; 17:245-6. [DOI: 10.1007/s10151-012-0874-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 08/02/2012] [Indexed: 10/28/2022]
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López Delgado RT, López Delgado A, Moya P, Santos JE, Arroyo A, Rodríguez JM, Calpena R. Laparoscopic pancreatic necrosectomy: a minimally invasive alternative to laparotomic debridement of pancreatic necrosis. MINERVA CHIR 2012; 67:363-364. [PMID: 23022762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Moya P, Arroyo A, Pérez-Legaz J, Serrano P, Candela F, Soriano-Irigaray L, Calpena R. Applicability, safety and efficiency of outpatient treatment in uncomplicated diverticulitis. Tech Coloproctol 2012; 16:301-7. [PMID: 22706731 DOI: 10.1007/s10151-012-0847-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 05/16/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND In most cases of diverticulitis, inflammation is mild, and the only treatment required is a clear liquid diet and antibiotics. Until recently, patients were given this treatment as inpatients with the consequent expenditure of resources. The aim of this study was to assess the safety and efficacy of an outpatient treatment protocol with oral antibiotics in selected patients with uncomplicated acute diverticulitis in comparison with inpatient intravenous treatment. METHODS We conducted a prospective non-randomized study between January 2007 and December 2009. We included all patients diagnosed with uncomplicated acute diverticulitis, at the Emergency Department of the University General Hospital of Elche. We compared the efficacy, safety and costs of hospital treatment with intravenous antibiotics and outpatient treatment with oral antibiotics. Seventy-six patients were included in the study. Forty-four of them underwent intravenous treatment with Metronidazole 500 mg/8 h + Ciprofloxacin 400 mg/12 h (hospital treatment group) and 32 took oral antibiotics Metronidazole 500 mg/8 h and Ciprofloxacin 500 mg/12 h (outpatient group). RESULTS Outpatient treatment is viable in almost 95 % of those patients suffering from uncomplicated acute diverticulitis. Treatment was effective in resolving inflammation, and there were no complications in the majority of cases (94 %). Only 2 patients (6 %) required admission after outpatient treatment. The results further reflect complications and relapse rates similar to those of patients admitted to hospital and treated with intravenous antibiotics. There are no significant statistical differences (p = 0.86) between inpatients and outpatients. It is possible to save approximately 1,600 € per patient with outpatient treatment (p < 0.05). CONCLUSIONS Outpatient treatment has demonstrated a safety and efficiency similar to inpatient treatment, producing an important reduction in expenses and medical resources.
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Affiliation(s)
- P Moya
- Department of Surgery, University General Hospital of Elche, Alicante, Spain.
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Martínez Cantó A, Castillejo A, Castillejo M, Barberá V, Egoavil C, Ochoa E, Lázaro R, Lacueva F, Calpena R, Soto J. 77 Germline allele-specific expression of TGFBR1 as a susceptibility factor for sporadic colorectal cancer. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Arroyo A, González-Argenté FX, García-Domingo M, Espin-Basany E, De-la-Portilla F, Pérez-Vicente F, Calpena R. Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome. Br J Surg 2008; 95:1521-7. [PMID: 18942056 DOI: 10.1002/bjs.6328] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND This prospective multicentre study assessed the safety and effectiveness of stapled transanal rectal resection (STARR) for treatment of obstructive defaecation syndrome (ODS). METHODS Between February 2001 and June 2006, 104 patients diagnosed with ODS were treated with STARR. Follow-up was scheduled for 1, 3 and 6 months after surgery, and annually thereafter. Variables related to the patient, surgical technique and outcome were analysed. RESULTS Mean operating time was 46.7 min. Haemorrhage at the staple line occurred in 55 patients (52.9 per cent). Three patients required surgical revision in the first 48 h owing to persistent bleeding. The median postoperative pain score was 2.4 on a scale from 1 to 10. Mean hospital stay was 2.2 days. The mean constipation score improved from 13.5 before surgery to 5.1 at 1-year follow-up (P = 0.006). Twenty-three patients reported faecal incontinence at 4 weeks after surgery, but only nine still had minor residual incontinence by 1 year. At a median follow-up of 26 (range 12-72) months, ODS had recurred or persisted radiologically and/or clinically in 11 patients. CONCLUSION STARR is associated with low morbidity and a short hospital stay, and is an effective alternative treatment for ODS.
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Affiliation(s)
- A Arroyo
- Coloproctology Unit, Hospital General Universitario Elche, Elche, Spain.
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Fernández-Frías AM, Pérez-Vicente F, Arroyo A, Sánchez-Romero AM, Navarro JM, Serrano P, Oliver I, Costa D, Candela F, Calpena R. Is anal endosonography useful in the study of recurrent complex fistula-in-ano? Rev esp enferm dig 2006; 98:573-81. [PMID: 17048993 DOI: 10.4321/s1130-01082006000800002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION performing anal endosonography in complex fistula-in-ano allows us to design a personalized surgical strategy in each case, thereby improving results. However, there are doubts in the literature as to its utility in recurrent complex fistulas. The aim of this study was to compare the utility of anal ultrasonography in the study of primary versus recurrent complex fistula-in-ano. PATIENTS AND METHOD prospective study of patients diagnosed and treated for complex fistula-in-ano. Physical examination and anal ultrasonography provided data on primary track, internal opening, horseshoe extension and the presence of secondary tracks or cavities in a protocol designed specifically for the study. These assessments were subsequently contrasted with operative findings. RESULTS we included 35 patients, 19 (54.3%) with primary complex anal fistulas and 16 (45.7%) with recurrent fistulas. According to the operative findings, fistulas were classified as high transsphincteric in 28 patients (80%), suprasphincteric in 6 (17.1%) and extrasphincteric in one patient (2.9%), with no differences between groups. Physical examination correctly classified 28 of the 35 fistulous tracks, in contrast to the 32 (91.4%) correctly described on ultrasonography (80%). We did not find any statistically significant differences between the primary and the recurrent fistula groups with regard to sensibility, positive predictive value and accuracy of the anal ultrasonography for any of the parameters studied. CONCLUSION the accuracy of anal ultrasonography does not decrease in recurrent complex fistula-in-ano.
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Affiliation(s)
- A M Fernández-Frías
- Coloproctology Unit, Service of General and Gastrointestinal Surgery, Hospital General Universitario, Elche, Alicante, Spain.
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Lacueva FJ, Oliver I, Costa D, Calpena R. To perform or not D2 extended lymphadenectomy in patients with gastric cancer in the West. Effectiveness and limits. Clin Transl Oncol 2006; 8:139-41. [PMID: 16648110 DOI: 10.1007/s12094-006-0001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Arroyo A, Perez-Vicente F, Serrano P, Candela F, Perez-Vazquez MT, Calpena R. Proctitis complicating stapled hemorrhoidectomy: report of a case. Int J Colorectal Dis 2006; 21:197-8. [PMID: 15723190 DOI: 10.1007/s00384-004-0705-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2004] [Indexed: 02/04/2023]
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Lacueva J, Perez-Ramos M, Soto JL, Oliver I, Andrada E, Medrano J, Perez-Vazquez T, Arroyo A, Carrato A, Ferragut JA, Calpena R. Multidrug resistance-associated protein (MRP1) gene is strongly expressed in gastric carcinomas. Analysis by immunohistochemistry and real-time quantitative RT-PCR. Histopathology 2005; 46:389-95. [PMID: 15810950 DOI: 10.1111/j.1365-2559.2005.02100.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS To assess MRP1 protein and MRP1 mRNA levels in gastric carcinomas and in non-neoplastic mucosa remote from the tumours. MRP1 gene expression may play a role in the complex pattern of chemoresistance present in gastric carcinomas. METHODS AND RESULTS A total of 57 carcinomas and respective gastric tissues were included for immunohistochemical assessment with the anti-MRP1 monoclonal antibodies MRPr1 and QCRL-1. Of these, 35 tumour and gastric mucosa tissues were also assessed by real-time quantitative reverse transcriptase-polymerase chain reaction. Medium or high MRP1 protein expression was detected in 89% and 77% of carcinomas and in 96% and 93% of non-neoplastic gastric mucosa by MRPr1and QCRL-1, respectively. No difference in MRP1 mRNA levels was detected between carcinomas and non-neoplastic gastric mucosa tissues in 77% of the patients. A significant correlation was found between MRP1 mRNA level and protein expression detected in carcinomas related to non-neoplastic gastric mucosa, although they were non-concordant in 29% of the patients. CONCLUSIONS MRP1 gene is usually expressed in most gastric carcinomas and does not differ substantially from that observed in non-neoplastic gastric mucosa remote from the tumour. However, a decrease in MRP1 gene expression is found in some carcinomas. For accurate assessment of changes in MRP1 expression between tumour and normal tissues both protein and mRNA detection are necessary.
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Affiliation(s)
- J Lacueva
- Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain.
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Oliver I, Costa D, Lacueva J, Calpena R. An upper abdominal swelling causing nausea and vomiting. Gut 2005; 54:813, 842. [PMID: 15888790 PMCID: PMC1774526 DOI: 10.1136/gut.2004.058644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- I Oliver
- Department of Pathology and Surgery, Elche University General Hospital, Camí de ĺAlmazara, # 11, 03202 Elche (Alicante), Spain.
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Arroyo A, Pérez-Vicente F, Miranda E, Serrano P, Pérez-Vázquez M, Calpena R. [Manometric factors associated with recurrence in botulinum toxin treatment for chronic anal fissure]. Gastroenterol Hepatol 2005; 28:311-4. [PMID: 15989810 DOI: 10.1157/13076346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
INTRODUCTION AND AIM To evaluate the effectiveness of botulinum toxin in the treatment of chronic anal fissure after long-term follow-up and establish the manometric factors related to recurrence. PATIENTS AND METHOD We performed a prospective study in 50 consecutive patients with chronic anal fissure who were treated with 25 U botulinum toxin injected into the internal sphincter. Clinical and manometric parameters were recorded until the fourth year of follow-up. RESULTS There was a tendency to progressive recurrence over time (54% at 4 years) associated with manometric factors indicating hyperexcitability of the internal anal sphincter (persistently elevated mean resting pressure, percentage of time with slow waves, and number of patients or percentage of time with ultra-slow waves after treatment). CONCLUSIONS Treatment of chronic anal fissure with botulinum toxin leads to long-term cure in less than 50% of patients. In patients with manometric factors related to recurrence, this treatment is insufficient for definitive cure.
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Affiliation(s)
- A Arroyo
- Unidad de Coloproctología, Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Elche, Elche, Alicante, España.
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Arroyo A, Perez F, Serrano P, Candela F, Calpena R. Long-term results of botulinum toxin for the treatment of chronic anal fissure: prospective clinical and manometric study. Int J Colorectal Dis 2005; 20:267-71. [PMID: 15526113 DOI: 10.1007/s00384-004-0644-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2004] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this prospective trial was to analyse the effectiveness and morbidity of chemical sphincterotomy in the treatment of chronic anal fissure after a 3-year follow-up. METHODS One hundred consecutive patients with chronic anal fissures were treated by chemical sphincterotomy with 25 U botulinum toxin injected into the internal sphincter. Clinical and manometric results were recorded. RESULTS No major complications were found; initial incontinence at the 2-month review (6%) spontaneously reversed at 6 months. There was a tendency of progressive recurrence over time, with an overall healing after 3 years of 47%. We found a group of patients with clinical (symptoms longer than 12 months and presence of a sentinel pile before treatment) and manometric factors (persistently elevated mean resting pressure, percentage of time with slow waves, and number of patients or percentage of time with ultra slow waves after treatment) associated with a higher recurrence of anal fissures. CONCLUSION Since it avoids the greater risk of incontinence associated with surgical sphincterotomy, we recommend the use of botulinum toxin as the first therapeutic approach for patients with chronic anal fissure and risk factors for incontinence; despite the higher rate of recurrence associated with this treatment. In patients with factors related to recurrence, re-injection with higher doses of botulinum toxin or complementary medical-surgical treatment should be considered.
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Affiliation(s)
- A Arroyo
- Coloproctology Unit, Department of Surgery, University Hospital of Elche, C/Huertos y Molinos s/n., 03203 Elche (Alicante), Spain.
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Affiliation(s)
- I Oliver
- Department of Pathology and Surgery, Elche University General Hospital, Elche (Alicante), Spain.
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Arroyo A, Pérez F, Miranda E, Serrano P, Candela F, Lacueva J, Hernández H, Calpena R. Open versus closed day-case haemorrhoidectomy: is there any difference? Results of a prospective randomised study. Int J Colorectal Dis 2004; 19:370-3. [PMID: 15170517 DOI: 10.1007/s00384-003-0573-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2003] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Nowadays there is still controversy as to whether open or closed haemorrhoidectomy is the surgical treatment of choice for haemorrhoidal pathology. PATIENTS AND METHODS We carried out a randomised prospective study in the Day Surgery Unit comparing 100 patients undergoing Milligan-Morgan haemorrhoidectomy (group A) versus 100 patients undergoing Ferguson haemorrhoidectomy (group B) for symptomatic haemorrhoids, in whom medical treatment or rubber band ligation had failed. RESULTS Characteristics of the population were: mean age 43.5 years, with predominance of males, 123 vs. 77; 88% ASA I-II. CLINICAL PRESENTATION 95% rectal bleeding; 87.5% third-fourth degree. The anaesthetic technique of choice was local anaesthesia plus sedation in 180 patients (90%). Length of surgery: 24 min (group A) and 30 min (group B) (p=n.s.). Resection of three haemorrhoidal cushions was done in 87.5% of cases. There were no re-operations or re-admissions after discharge. Symptomatic recurrence, stenosis and incontinence were not found during the follow-up of the first year. Postoperative pain during the first postoperative week was greater in the open haemorrhoidectomy group, but the difference was statistically significant (p<0.05) only during bowel movements. There was complete healing in 40% of the patients in group A and 90% of those in group B (p<0.05) after 1 month. After 1 year, the results and complications were similar in both groups (p=n.s.). CONCLUSIONS Closed haemorrhoidectomy gives better results in terms of pain and healing than open haemorrhoidectomy, whereas recurrence and complications are similar after 1 year.
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Affiliation(s)
- A Arroyo
- Coloproctology Unit, Department of Surgery, University Hospital of Elche, C/Huertos y Molinos s/n. C.P., 03203 Elche (Alicante), Spain.
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Oliver I, Lacueva FJ, Pérez Vicente F, Arroyo A, Ferrer R, Cansado P, Candela F, Calpena R. Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment. Int J Colorectal Dis 2003; 18:107-10. [PMID: 12548410 DOI: 10.1007/s00384-002-0429-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2002] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Anal abscess is a frequent acute proctological disorder and whether the underlying fistula should be treated at the same time when the abscess is drained remains controversial. We examined indications for drainage alone versus drainage plus fistulotomy in terms of recurrence and continence. PATIENTS AND METHODS We carried out a randomized prospective study of 200 consecutive patients with anal abscess. One group received drainage alone, while in the other group drainage plus fistulotomy was performed when a subcutaneous-mucosa, low transsphincteral, or intersphincteral fistula was found. Delayed progressive fistulotomy with suture threads was performed in cases of high transsphincteric or suprasphincteric fistula. RESULTS The internal opening of the fistula track was found in 83% of the patients. The recurrence rate was related to the surgical technique employed: 29% in the group with drainage alone and 5% in the group for which treatment of the fistula track was attempted. The incontinence rate was also related to the surgical option. In those receiving drainage and treatment of the fistula track incontinence was restricted mostly to patients with delayed fistulotomy (36.7%), compared to 2.8% of patients when simple fistulotomy was performed. There was no incontinence in the drainage alone group. CONCLUSION Drainage of anal abscess with fistulotomy can be safely performed in cases of subcutaneous, intersphincteral, or low transsphincteral fistulae with a minimal recurrence rate. However, drainage alone and posterior treatment of the fistula track is recommended for high transsphincteral or suprasphincteral fistulae.
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Arroyo Sebastián A, Pérez F, Serrano P, Costa D, Oliver I, Ferrer R, Lacueva J, Calpena R. Is prosthetic umbilical hernia repair bound to replace primary herniorrhaphy in the adult patient? Hernia 2002; 6:175-7. [PMID: 12424596 DOI: 10.1007/s10029-002-0076-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2001] [Accepted: 07/02/2002] [Indexed: 10/27/2022]
Abstract
Given the outstanding outcome that prosthetic repair has recently achieved in the repair of inguinal hernia, we wonder whether it should be implemented as the gold-standard technique for umbilical hernia repair. We report on 213 adult patients who underwent surgery for umbilical hernia at our Day Surgery Unit from June 1992 to January 1998. Criteria for exclusion included problematic social and family environment and ASA IV status. A polypropylene plug was placed in small umbilical defects, whereas large defects (> 3 cm in diameter) were repaired with a polypropylene mesh. The mean follow-up was 64 months. The mean age was 57.1 years, with females accounting for the majority (57.8%). Most patients (88.3%) were classified as ASA I-II. With regard to the hernia size, 143 patients (67.1%) presented with small defects (< 3 cm). The anaesthetic technique of choice was local plus sedation. Reported complications included seroma (5.6%), haematoma (2.3%), wound infection (1.4%), and intolerance to prosthesis (0.95%), the last causing recurrence. The overall recurrence rate at a mean follow-up of 64 months was 0.95%. Prosthetic umbilical hernia repair can safely be performed in adults, and the rate of recurrence in this study is low in comparison to primary tissue repair.
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Affiliation(s)
- A Arroyo Sebastián
- Abdominal Wall Surgery Unit, Department of Surgery, University Hospital of Elche, Alicante, Spain.
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Ferrer RL, Medrano J, Calpena R, Diego M, Graells ML, Molto MV, Pérez MT, Oliver MI, Salido GM. Effect of exogenous cholecystokinin and secretin on pancreatic secretion of insulin and glucagon in rats: in vivo model without hepatic filter. Dig Dis Sci 2001; 46:2127-33. [PMID: 11680586 DOI: 10.1023/a:1011994327575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
In order to study the effect of cholecystokinin and secretin on the endocrine function of the pancreas, we have developed an experimental model that we have applied to a total of 30 anesthetized rats stimulated with physiological or supraphysiological doses of cholecystokinin and secretin administered intravenously by continuous infusion. Our results show that the serum insulin concentration increases after the supramaximum dose of cholecystokinin is infused, while that of glucagon increases after the maximum dose of this hormone. In case of secretin, the serum glucagon level increases after the supramaximum dose, while that of insulin is not affected by any dose. We conclude that after infusion of physiological doses of cholecystokinin, the pancreatic secretion of glucagon is modified but not that of insulin, while secretin has no effect on the endocrine pancreatic secretion of either insulin or glucagon upon the same conditions.
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Affiliation(s)
- R L Ferrer
- Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Alicante, Spain
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Abstract
BACKGROUND Prosthetic repair has become the standard method for inguinal hernia and has excellent results. The question remains of whether the mesh technique could also improve results for umbilical defects. METHODS The study was a randomized clinical trial comparing herniorrhaphy (primary suture) with hernioplasty (polypropylene mesh or plug) in 200 adult patients with a primary umbilical hernia. Patients at high anaesthetic risk (American Society of Anesthesiologists (ASA) grade IV) or those who needed emergency surgery were excluded. The mean postoperative follow-up was 64 months. The population studied included 118 women and 82 men with a mean age at presentation of 57 years. Some 173 patients were ASA grade I-II and 27 were ASA III. The anaesthetic technique of choice was local anaesthetic infiltration plus sedation (98 per cent). RESULTS There were no significant anaesthetic complications or surgical deaths. The mean duration of surgery was greater for mesh than for suture repair (45 versus 38 min). Rates of early complications such as seroma, haematoma or wound infection were similar in the two groups. The hernia recurrence rate was higher after suture repair (11 per cent) than after mesh repair (1 per cent) (P = 0.0015). CONCLUSION Prosthetic repair could become the standard treatment for primary umbilical hernia in adults.
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Affiliation(s)
- A Arroyo
- Ambulatory Surgery Unit, Department of Surgery, University Hospital of Elche, Elche, Spain.
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Arroyo A, Pérez F, Ferrer R, García P, Serrano P, Candela F, Calpena R. Hernia surgery for the third millennium. Does classical herniorraphy still play a role? Ambul Surg 2001; 9:73-75. [PMID: 11454484 DOI: 10.1016/s0966-6532(01)00075-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The steadily increasing use of prosthetic grafts in hernia repairs can be said to play down the classical approach for repairing groin hernia. We retrospectively report on 894 patients operated on for groin hernia at our out-patient surgery clinic from June 1992 to May 1998. Herniorraphy was widely performed (96.3%). The recurrence rate was of 1.6% (overall). For patients younger than 45 yr with no systemic concurrent disease, as few as 0.1% relapsed after a 58-month average follow-up. According to our results, ambulatory herniorraphy can provide an excellent degree of efficiency in selected young patients suffering from indirect unilateral primary groin hernia. Likewise, we regard the prosthetic repair as the gold standard technique in those patients with a weakened posterior inguinal wall.
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Affiliation(s)
- A Arroyo
- Ambulatory Surgery Unit, Department of Surgery, Hospital General Universitario Elche, C/Huertos y Molinos s/n, C.P. 03203 (Alicante), Elche, Spain
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Arroyo A, Costa D, Lacueva J, Serrano P, Candela F, Oliver I, Pérez F, Ferrer R, García P, Calpena R. Hernia inguinal como causa de íleo biliar colónico. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71796-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ferrer R, Medrano J, Calpena R, Diego M, Moltó M, Graells M, Pérez M, Cansado P, Oliver I, Pérez F, Arroyo A. Interacción hormonal endoexocrina pancreática: modelo in vivo sin filtro hepático en la rata. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arroyo A, Andreu J, García P, Jover S, Arroyo M, Fernández A, Costa D, Oliver I, Hernández H, Schwartz H, Reillo M, Calpena R, Arenas C. [Analysis of a programme of direct referral between primary and specialist care in potential surgery patients]. Aten Primaria 2001; 28:381-5. [PMID: 11602117 PMCID: PMC7684138 DOI: 10.1016/s0212-6567(01)70399-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To describe the results of a programme of direct referral of potential surgery patients between primary and specialist care, designed to lessen waiting-times.Design. Prospective, longitudinal and descriptive study. SETTING Health Area N. masculine 19 (Valencian Health Service): Surgery Service of Elche Hospital and 6 Health Centres. PARTICIPANTS Patients with pathologies that do not need special techniques for diagnosis except examination and who have a clear irrefutable indication of surgery without risk factors (ASA I-II).Intervention. The referral protocol consists of: a) diagnosis of pathology and pre-operative study in primary care (PC); b) appointment made by phone for the surgery clinic at the hospital, where diagnosis and pre-operative study are confirmed; c) referral and operation in the unit of non-hospital major surgery (UCMA); d) monitoring post-operation by the home hospitalisation unit (HHU) or preferably by the health centre, and e) check-up at the surgery clinic. Main measurements. The degree of agreement between PC and the specialist, assessment of the pre-operative study, and waiting time. RESULTS 86 patients were referred (average age, 35; 76% male) by 28 doctors. The most common pathologies were hernia (36%), pilonidal sinus (23.2%) and miscellaneous (32.5%). There was general agreement in diagnosis in 90.7% of cases. 89.5% of patients brought the proper pre-operative study. Mean waiting time between the primary care consultation in the different procedures and the first hospital consultation was 19 days; with 44 more days elapsing till the surgical operation. CONCLUSIONS This new programme is effective and economic, in that there is <<adequate referral>> of patients, waiting time is reduced by over 7 months for pilonidal sinus and by over 2 years for hernia pathology, and the procedure can be used for a large number of patients, as the pathologies involved are very common.
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Affiliation(s)
- A Arroyo
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario, Elche.
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Arroyo A, Costa D, Fernández A, Pérez F, Serrano P, García P, Carvajal R, Rodríguez J, Candela F, Calpena R. ¿Debe ser la hernioplastia la técnica de elección en el tratamiento de la hernia umbilical del adulto? Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71846-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lacueva FJ, Calpena R, Medrano J, Teruel A, Mayol MJ, Graells ML, Camarasa MV, Perez-Vazquez MT, Ferragut JA. Changes in P-glycoprotein expression in gastric carcinoma with respect to distant gastric mucosa may be influenced by p53. Cancer 2000. [PMID: 10896996 DOI: 10.1002/1097-0142(20000701)89:1%3c21::aid-cncr4%3e3.0.co;2-t] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The effectiveness of some chemotherapeutic agents used to treat gastric carcinoma patients may be impaired by the presence of P-glycoprotein (P-gp) and the status of p53. A modulation of P-gp expression by p53 or other alterations during tumorigenesis have been reported. The authors analyzed P-gp expression in relation to p53 and histopathologic features in gastric carcinoma. METHODS Forty-one resected gastric carcinomas and mucosa distant from the tumor were assessed for P-gp expression by immunohistochemistry with C494 and JSB-1 antibodies. p53 expression was also immunohistochemically assessed by DO7 antibody in tumor samples. P-gp and p53 expression were semiquantitatively analyzed according to the percentage of stained cells. Histologic type, grade, vessel invasion, and stage were also studied. RESULTS Moderate or high P-gp expression was detected in gastric carcinoma in 29 cases (71%) and in gastric mucosa remote from the tumor in 36 cases (88%). This reduction in P-gp expression was observed in 22% of the carcinomas, all but 1 being p53 immunonegative tumors. Thus, 8 (42%) of the p53 immunonegative carcinomas showed a loss of P-gp expression compared with their distant gastric mucosa. All p53 immunopositive carcinomas coexpressed P-gp. No correlation between P-gp expression and histologic type, grade, vessel invasion, or stage was found. CONCLUSIONS P-gp expression in gastric carcinomas is frequent and coexpression with p53 is found. The analysis of P-gp expression in carcinomas and distant mucosa show that it is not regulated by p53, but a loss of P-gp detected in some of these carcinomas is mainly associated with a lack of p53 protein accumulation.
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Affiliation(s)
- F J Lacueva
- Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Alicante, Spain
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Ferrer R, Medrano J, Diego M, Calpena R, Graells L, Moltó M, Pérez T, Pérez F, Salido G. Effect of exogenous insulin and glucagon on exocrine pancreatic secretion in rats in vivo. Int J Pancreatol 2000; 28:67-75. [PMID: 11185712 DOI: 10.1385/ijgc:28:1:67] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The physiological roles of the islet hormones insulin and glucagon in the control of exocrine pancreatic secretion is not clear. It is still unknown whether these hormones have a stimulatory or an inhibitory effect on the basal exocrine pancreatic secretion. METHODS Thirty anesthetized rats were stimulated with doses of insulin and glucagon administered by continuous intravenous infusion. Doses varying from physiological to supraphysiological were used. Different groups of 5 rats were given each of these doses. The volume of pancreatic juice and amylase, lipase and trypsin activity, as well as enzyme output, were measured 0, 20, 40, and 60 min after starting infusion. The insulin, glucagon, and glucose levels were determined in serum at 0, 10, 30, and 60 min. RESULTS In the insulin group, the secreted volume of pancreatic juice increases with the maximum dose. All insulin doses results in amylase and lipase decreased activity. When submaximum and maximum insulin doses are administered, the trypsin activity also decreases. In the glucagon group, the activity of lipase and trypsin decreases regardless the dose, whereas the amylase activity decreases with submaximum and supramaximum doses. CONCLUSION Both insulin and glucagon affect the basal exocrine pancreatic secretion in vivo when physiological doses are administered.
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Affiliation(s)
- R Ferrer
- Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Alicante, Spain.
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Lacueva FJ, Calpena R, Medrano J, Teruel A, Mayol MJ, Graells ML, Camarasa MV, Perez-Vazquez MT, Ferragut JA. Changes in P-glycoprotein expression in gastric carcinoma with respect to distant gastric mucosa may be influenced by p53. Cancer 2000; 89:21-8. [PMID: 10896996 DOI: 10.1002/1097-0142(20000701)89:1<21::aid-cncr4>3.0.co;2-t] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The effectiveness of some chemotherapeutic agents used to treat gastric carcinoma patients may be impaired by the presence of P-glycoprotein (P-gp) and the status of p53. A modulation of P-gp expression by p53 or other alterations during tumorigenesis have been reported. The authors analyzed P-gp expression in relation to p53 and histopathologic features in gastric carcinoma. METHODS Forty-one resected gastric carcinomas and mucosa distant from the tumor were assessed for P-gp expression by immunohistochemistry with C494 and JSB-1 antibodies. p53 expression was also immunohistochemically assessed by DO7 antibody in tumor samples. P-gp and p53 expression were semiquantitatively analyzed according to the percentage of stained cells. Histologic type, grade, vessel invasion, and stage were also studied. RESULTS Moderate or high P-gp expression was detected in gastric carcinoma in 29 cases (71%) and in gastric mucosa remote from the tumor in 36 cases (88%). This reduction in P-gp expression was observed in 22% of the carcinomas, all but 1 being p53 immunonegative tumors. Thus, 8 (42%) of the p53 immunonegative carcinomas showed a loss of P-gp expression compared with their distant gastric mucosa. All p53 immunopositive carcinomas coexpressed P-gp. No correlation between P-gp expression and histologic type, grade, vessel invasion, or stage was found. CONCLUSIONS P-gp expression in gastric carcinomas is frequent and coexpression with p53 is found. The analysis of P-gp expression in carcinomas and distant mucosa show that it is not regulated by p53, but a loss of P-gp detected in some of these carcinomas is mainly associated with a lack of p53 protein accumulation.
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Affiliation(s)
- F J Lacueva
- Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Alicante, Spain
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Abstract
PURPOSE A case of anal tuberculosis in an otherwise asymptomatic patient with bleeding anal ulcers is presented. The clinical features of this entity and the problems in differential diagnosis between anal infectious vs. inflammatory diseases are discussed. METHODS The management and outcome of the case of an adult patient who presented with perianal ulcers is described. RESULTS On a three-drug antituberculous regimen, symptoms abated, radiographic infiltrates improved, and perianal ulcers healed. CONCLUSION Anal tuberculosis is an extremely rare disease. A tuberculous origin must be considered when the cause of perianal ulcers is unclear to avoid undesirable delays in the diagnosis and treatment of this disease.
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Affiliation(s)
- F Candela
- Department of Surgery, Hospital General de Elche, Alicante, Spain
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Abstract
To study the effect intracolonic perfusion of nutrients has on exocrine pancreatic secretion, six dogs were prepared with gastric, duodenal, and cecal cannulas using a modified Thomas technique. In our study protocol, we collected pancreatic juice by selective ductal cannulation after having applied several types of intracolonic stimulation: perfusion of sodium chloride, tryptophan, rice starch + glucose, or sodium oleate. All these solutions were applied together with a background dose of intravenous secretin. Our results showed a significant increase in the volume of pancreatic juice and bicarbonate output after intracolonic perfusion of sodium oleate. Other perfusions did not change these parameters. Protein output did not change in any of the cases. It seems that the ascending colon plays a regulating role in pancreatic secretion; in some conditions the colon could increase exocrine pancreatic function.
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Affiliation(s)
- A F Compañ
- Departamento de Patología y Cirugía, Universidad Miguel Hernández, San Juan de Alicante, Spain
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Lacueva FJ, Calpena R, Medrano J, Oliver I, Carvajal R. Failure to detect early recurrence of gastric cancer. J Clin Gastroenterol 1998; 26:219-21. [PMID: 9600374 DOI: 10.1097/00004836-199804000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Early gastric cancer recurrence is sometimes difficult to diagnose even by protocols using imaging techniques and tumor markers. We report a gastric cancer recurrence diagnosed by the appearance of a Sister Mary Joseph's nodule that illustrates the lack of sensitivity of these methods. We also discuss the protocol we currently follow for these patients.
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Affiliation(s)
- F J Lacueva
- Pathology and Surgery Department, Miguel Hernandez University School of Medicine, Elche University General Hospital, Spain
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Yago M, Serrano P, Mañas M, Mataix J, Medrano J, Calpena R, Martinez-Victoria E. Release of Secretin and Somatostatin After Test Meals with Different Fatty-Acid Composition in Cholecystectomized Humans. J Nutr Biochem 1998. [DOI: 10.1016/s0955-2863(97)00180-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lacueva FJ, Teruel A, Calpena R, Medrano J, Mayol MJ, Perez-Vazquez MT, Rufete C, Camarasa MV, Ferragut JA. Detection of P-glycoprotein in frozen and paraffin-embedded gastric adenocarcinoma tissues using a panel of monoclonal antibodies. Histopathology 1998; 32:328-34. [PMID: 9602329 DOI: 10.1046/j.1365-2559.1998.00381.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS Most chemotherapeutic regimens used against gastric carcinoma include anthracyclines whose effectiveness can be impaired by the presence of P-glycoprotein. In order to obtain a reliable pattern of P-glycoprotein expression in these tumours an immunohistochemical study using a panel of anti-P-glycoprotein antibodies was performed in frozen and paraffinized tissues. METHODS AND RESULTS Frozen and paraffinized samples from 25 gastric carcinomas were immunohistochemically analysed using a panel of four anti-P-glycoprotein monoclonal antibodies including C219, MRK16, JSB-1 and C494. Semiquantitative analysis indicated that moderate or high P-glycoprotein levels were detected in 40% to 76% of gastric adenocarcinomas, depending on the anti-P-glycoprotein antibody used. The antibody C494 was the most sensitive in detecting P-glycoprotein in both frozen and paraffinized gastric carcinoma samples. Moreover, C494 showed a pattern of staining exclusively associated with the plasma membrane, in contrast to the cytoplasmic with reinforcement of plasma membrane pattern displayed by the other three antibodies. Significant differences in P-glycoprotein levels were obtained when C494 and MRK16 were used in frozen tissues. Finally, detection of P-glycoprotein in frozen samples did not improve when compared to paraffinized ones. CONCLUSIONS It appears that P-glycoprotein is frequently expressed in gastric adenocarcinomas, and the use of C494 complemented by JSB-1 is recommended for reliable detection of P-glycoprotein in this neoplasm.
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Affiliation(s)
- F J Lacueva
- Department of Pathology, Alicante University, Spain
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39
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Affiliation(s)
- M I Oliver
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Elche, Spain
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40
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Yago MD, Gonzalez MV, Martinez-Victoria E, Mataix J, Medrano J, Calpena R, Perez MT, Mañas M. Pancreatic enzyme secretion in response to test meals differing in the quality of dietary fat (olive and sunflowerseed oils) in human subjects. Br J Nutr 1997; 78:27-39. [PMID: 9292757 DOI: 10.1079/bjn19970116] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of the present study was to investigate in human subjects whether or not the ingestion of two liquid meals that differed only in their fatty acid composition (due to the addition of olive oil (group O) or sunflowerseed oil (group S) as the source of dietary fat) would lead to differences in the pancreatic enzyme activities secreted into the duodenum. The experiments were performed in eighteen cholecystectomized subjects who, during the 30 d period immediately before surgery, modified their habitual diets in such a way that their fat composition would reflect, as far as possible, that of the experimental meals. Lipase (EC 3.1.1.3), colipase, amylase (EC 3.2.1.1), chymotrypsin (EC 3.4.21.1) and trypsin (EC 3.4.21.4) activities were measured in duodenal contents aspirated before and after the ingestion of the test meals. The plasma levels of secretin and cholecystokinin (CCK) were also examined. Duodenal enzyme activities were similar in resting conditions. No significant differences were revealed in postprandial enzyme activities, except for lipase activity, which was higher in group O, probably in relation to the greater plasma CCK concentrations observed in this group. In the absence of enzyme output data, we should not exclude the possibility that the type of dietary fat will affect human pancreatic enzyme secretion to a greater extent than is evident from the present study, for instance through a flow-mediated effect, as we previously observed in dogs.
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Affiliation(s)
- M D Yago
- Department of Physiology, University of Granada, Spain
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41
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Serrano P, Yago MD, Mañas M, Calpena R, Mataix J, Martínez-Victoria E. Influence of type of dietary fat (olive and sunflower oil) upon gastric acid secretion and release of gastrin, somatostatin, and peptide YY in man. Dig Dis Sci 1997; 42:626-33. [PMID: 9073149 DOI: 10.1023/a:1018819714756] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The effects of adaptation to two diets differing in the type of dietary fat on the gastric acid secretory response to food and on the circulating levels of gastrin, somatostatin and peptide YY (PYY) were examined in humans. The study involved 18 cholecystectomized subjects previously submitted to a 30-day adaptation period to diets containing olive (group O) or sunflower oil (group S) as the fat source. During the experiments, physiological stimulation was achieved by ingestion of 200 ml of oleic acid- (group O) or linoleic acid-enriched (group S) liquid mixed meals. These resulted in an immediate rise in gastric pH. In group S, the return to the premeal value was completed within 60 min, and a further decline to values significantly lower than the basal ones was observed at the end of the study period. In contrast, ingestion of the meal containing olive oil attenuated and prolonged the pH decrease after the meal, this being associated with the suppression of postprandial gastrin response. Food ingestion induced no significant changes in plasma somatostatin concentration in either group, and no significant differences were revealed between them during the basal or postprandial situations. Plasma PYY levels were consistently higher in group O throughout the entire study period, although significance was reached only at resting. In conclusion, our results show that a 30-day adaptation period to diets containing olive oil as the main source of dietary fat results, compared with those containing sunflower oil, in an attenuated gastric secretory function in response to a liquid meal in humans. The effects of olive oil were associated with a suppression of serum gastrin and higher levels of PYY.
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Affiliation(s)
- P Serrano
- Department of Physiology, University of Granada, Spain
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42
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Abstract
In this study we used a cost-outcome analysis to evaluate our follow-up protocol for patients who had been resected for gastric cancer. We designed a descriptive cross-sectional trial through consecutive sampling of patients who had undergone resection of gastric carcinoma and were followed in our outpatient department during 1991. Serological (CEA) and or imaging procedures were pathologic at least two months prior to the onset of symptoms in 33% of recurrences. No significant correlation was found between serum CEA levels and CEA tumor tissue staining in patients who recurred. Only 17% of patients who relapsed underwent further treatment (surgery and chemotherapy) with no improvement found in terms of survival. The overall cost per year has been estimated at US$ 6118. Our results show that serological levels of CEA and available imaging techniques for routine follow-up provide little advantage in diagnosing gastric cancer recurrence over clinical surveillance alone.
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Affiliation(s)
- F J Lacueva
- Department of General Surgery Service, Elche University General Hospital, Spain
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43
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Serrano Paz P, González Bueno V, Diego Estévez M, Medrano J, Ballesta MC, Martínez-Victoria E, Calpena R, Mataix J, Yago MD. [Postoperative enteral nutrition with a high content of mono- and polyunsaturated fatty acids]. NUTR HOSP 1995; 10:223-7. [PMID: 7662760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We have done a clinical study in patients with benign biliary disease and indication for surgery, with the aim of analyzing some parameters of gastric secretion, biliary and pancreatic function, and gastrointestinal hormones in relation to the quantity and quality of the dietary fat (monounsaturated and polyunsaturated fatty acids), acting on the postoperative enteral ingestion, modifying the lipid source by its elaboration. In the present work we show the results derived from the analysis of the gastric and duodenal juices in relation to the type of fat administered, with a global description of the study being necessary. The studied sample consisted of 20 patients diagnosed with simple gallstones, who were divided into two groups (n = 10) according to the usual ingestion of fats: olive oil (Olive Group) or sunflower oil (Sunflower Group). A control group (n = 10) has also been considered, without taking into account their dietary habits. The patients were subjected to surgery, and after the immediate postoperative period they were fed, orally, with an enteral diet prepared with commercially available formulae (modular EDA); as a lipid source we have added olive oil, rich in monounsaturated fatty acids, for the Olive Group, and sunflower oil, rich in polyunsaturated oil, for the Sunflower Group. In the control group cream was added as lipid source (mono and polyunsaturated fatty acids). The caloric value of the diet is calculated based on the caloric value of its components (protein: 17%, carbohydrate: 53%, lipid 30%). The daily caloric requirements are determined based on the daily basal metabolism, according to the Harris-Benedick formula.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Serrano Paz
- Servicio de Cirugía, Hospital Universitario de Elche, España
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González Bueno V, Serrano Paz P, Mataix J, Martínez-Victoria E, Medrano J, Calpena R, Diego Estévez M. [The use of the Dreimlich probe for obtaining samples in a postoperative study of biliopancreatic function in cholecystectomized patients]. NUTR HOSP 1995; 10:123-8. [PMID: 7756390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We have performed a clinical study involving patients with symptomatic gallstones and indications for surgery, to analyze the biliary and pancreatic response to the quality of dietary fat (degree of unsaturation). As part of the investigative method, we have designed a clinical protocol adapted to the needs of the study, in this respect, we have used gastrointestinal intubation to obtain independent samples of gastric and duodenal juices, by means of a long nasoduodenal tube or a modified Dreimlich tube, placed manually in the intraoperative period, during the cholecystectomy. The characteristics of the tube are such that its manipulation is difficult, which led to situations postoperatively and during sampling, which may alter or invalidate the obtained drainage material. In the present study we define the protocol and the phases of the investigation, and we reflect on the usefulness of the Dreimlich tube as a method, analyzing its advantages and disadvantages.
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Affiliation(s)
- V González Bueno
- Servicio de Análisis Clínicos, Hospital Universitario de Elche, España
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45
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Morales M, Pérez V, Picón G, Vander J, Calpena R, Candela F, Compañ A, García S, Meroño E, Medrano J. [A retained surgical sponge simulating a hepatic cyst]. Rev Esp Enferm Dig 1994; 85:488-9. [PMID: 8068430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Compañ AF, Medrano J, Calpena R, Diego M, Lacueva J, Serrano P, Moltó M, Pérez-Vázquez MT. Gastric carcinoma: study of the most eminent prognostic factors. Eur J Surg Oncol 1993; 19:533-8. [PMID: 8270039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
In order to analyse some prognostic factors in relation to gastric cancer, 218 patients were included in a prospective protocol at 'Hospital General de Elche' (Spain) with a follow-up of 100%. Survival curves were calculated using Kaplan-Meier analysis and compared using the log-rank test. The number of patients who underwent resection was 122 (63.5%). In 70 cases (36.5%) the resection was not possible. The postoperative mortality was 4.9%. In the survival of patients with gastric cancer we find the following prognostic factors are significant: age, tumour site, macroscopic type, depth of gastric wall affection, presence of lymph nodes, staging, resectability and surgical intention (curative vs palliative).
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Affiliation(s)
- A F Compañ
- Servicio de Cirugia General, Hospital General de Elche, Spain
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Calpena R, Bellot L, Pérez-Vázquez MT, Compañ A, Del Fresno J, Serrano P, Parera M, Medrano J. [Metabolic disorders in the gastrectomized patient]. Rev Esp Enferm Dig 1990; 78:278-82. [PMID: 2090170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The present study attempts on one hand to study the metabolic disorders which may present themselves in the gastrectomized patient, such as the malabsorption of fat, vitamin B12, folic acid and iron as well as the possible correlation between steatorrhea and the presence of exocrine pancreatic insufficiency. For this purpose a group of 71 patients have been studied who have undergone a subtotal gastrectomy (70.42%) or total (29.58%) in the General Surgery Services of Elche. The results obtained show the presence of ferropenic or megaloblastic anemia in 61.97% of the group, serious steatorrhea in only 3 patients (4.22%) and calciumphosphorous metabolism alterations appeared in 21.13%. With this we conclude that anemia is the most frequent ferropenic alteration in the gastrectomy patient; steatorrhea does not seem to be produced exclusively by the presence of exocrine pancreatic insufficiency and bone alterations in the gastrectomized patient appear in an insidious manner, being more a question of biochemical alterations than actual clinical lesions.
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Affiliation(s)
- R Calpena
- Hospital General de Elche, Departamento de Patología y Cirugía (Divisíon de Cirugía General), Universidad de Alicante
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