Prevention of incisional hernia after kidney transplantation: study protocol for a randomized controlled trial

12 p.Background: Incisional hernia is a common complication after kidney transplantation with an incidence of 1.6-18%. Concerning non-transplant patients, a recently published meta-analysis describes a reduction of the incidence of incisional hernia of up to 85% due to prophylactic mesh replacement in elective, midline laparotomy. The aim of our study is to show a reduction of the incidence of incisional hernia after kidney transplantation with minimal risk for complication. Methods/design: This is a blinded, randomized controlled trial comparing time to incisional hernia over a period of 24 months between patients undergoing kidney transplantation and standardized abdominal closure with or without prophylactic placement of ProGrip? (Medtronic, Fridley, MN, USA) mesh in an onlay position. As we believe that the mesh intervention is superior to the standard procedure in reducing the incidence of hernia, this is a superiority trial. Discussion: The high risk for developing incisional hernia following kidney transplantation might be reduced by prophylactic mesh placement. ProGrip? mesh features polylactic acid (PLA) microgrips that provide immediate, strong and uniform fixation. The use of this mesh combines the effectiveness demonstrated by the macropore propylene meshes in the treatment of incisional hernias, a high simplicity of use provided by its capacity for self-fixation that does not increase significantly surgery time, and safety. Trial registration: ClinicalTrials.gov NCT04794582. Registered on 08 March 2021. Protocol version 2.0. (02-18-2021)Medtroni

Role of sarcopenia in complex abdominal wall surgery: does it increase postoperative complications and mortality?

12 p.Background: Sarcopenia is defined as the loss of skeletal muscle mass and is associated with an increased risk or morbidity and mortality in complex surgical patient populations. Its role in complex abdominal wall surgery (AWS) is yet to be determined. The aim of this study is to establish if sarcopenia has an impact on postoperative complications, mortality and hernia recurrence. Methods: Retrospective study of patients undergoing elective surgery for complex incisional hernias > 10 cm (W3 of European Hernia Society classification) between 2014-2023. Sarcopenia was stablished as the skeletal muscle index (SMI), measured at L3 transversal section of a preoperative CT-scan. Previously defined literature-based SMI cutoff values were used: men ? 52.4 cm2/m2, women ? 38.5 cm2/m2. Results: 135 patients undergoing complex AWS were included. Of them, 38 were sarcopenic (28.1%). The median follow-up time was 13 months (IQR 12-25). In total, 11 patients died (8.1%). We found that sarcopenia was associated with a higher risk of mortality [HR 7.494 (95% CI 1.985-28.289); p 0.003]. There were no statistically significant differences in postoperative complications or hernia recurrence between both groups. Conclusion: Although sarcopenia does not seem to have an influence on hernia recurrence or the development of postoperative complications, whether local or systemic, in our study sarcopenia is associated with a higher risk of mortality after complex abdominal wall surgery. Nonetheless, with the results obtained in our study, we think that prehabilitation programs before complex AWS is advisable

Papel de los fibroblastos peritumorales en la progresión del cáncer de páncreas humano: estudio del gen erizo

INTRODUCCIÓN El cáncer de páncreas es la cuarta causa de muerte por cáncer en el mundo. Con un pronóstico muy desfavorable, continúa siendo objeto de estudio su tratamiento para conseguir mejorar la supervivencia con nuevas medidas terapéuticas. El estroma peritumoral, en el cáncer de páncreas, no es solo un espectador, sino que juega un papel muy importante en la invasión y la progresión tumoral. Debido a esto, la tesis se basa en tres objetivos, analizar la influencia de los fibroblastos peritumorales en el crecimiento local e invasión tumoral, los genes implicados en la vía del gen erizo por su implicación en la proliferación e invasión tumoral y la eficacia de la proteína BMP7 en el cáncer de páncreas. MATERIAL Y MÉTODOS Utilizamos como modelo animal ratones inmunodeprimidos, SCID y nude. Realizamos xenotrasplantes para analizar los resultados. Se cultivaron los fibroblastos normales, peritumorales y tumorales, “in vitro”, de muestras quirúrgicas de cáncer de páncreas para estudiar su capacidad de crecimiento local. Además de teñir con anticuerpos específicos de proCOL11A1, SMA y Vimentina. Xenotrasplantes en ratones SCID en la cabeza del páncreas con células CAPAN1 asociadas o no a fibroblastos peritumorales. Por último, se realizaron xenotrasplantes, en ratones nude, de cáncer de páncreas para tratar con la proteína recombinante BMP7. RESULTADOS Se consiguieron cultivar los fibroblastos peritumorales “in vitro”, con una curva de crecimiento mayor que los fibroblastos normales. Además la tinción con proCOL11A1 fue positiva para este tejido tumoral. En la expresión de genes demostramos como existe una sobreexpresión en los fibroblastos peritumorales de SMO y BMP7, y la sobreexpresión de SMO activa la vía del gen erizo y favorece la progresión tumoral. Creamos un modelo animal de cáncer de páncreas humano con tamaño tumoral mayor y más metástasis en el modelo de xenotrasplante de CAPAN1 y fibroblastos peritumorales. El tratamiento con proteína BMP7 controla el crecimiento local del tumor pero no parece que tenga el mismo efecto una vez que el tumor a metastatizado. CONCLUSIONES La obtención de fibroblastos es factible “in vitro”. La curva de crecimiento es mayor en los fibroblastos peritumorales. Los fibroblastos peritumorales estimulan la proliferación de células CAPAN1, lo que nos ha permitido crear un modelo animal de cáncer de páncreas humano. Favorecen la invasión tumoral. La proteína BMP7 parece inhibir la invasión local del tumor pero favorecer las metástasis

Guía de orientación clínica para pacientes con patología tiroidea y paratiroidea

19 p

Osteitis Fibrosa Cystica A Rare Presentation of Primary Hyperparathyroidism

Abstract Introduction: Osteitis fibrosa cystica (OFC) is the most serious bone involvement of primary hyperparathyroidism (PHPT), it is characterized by subperiosteal resorption, lytic lesions and the appearance of brown tumors; this is why, in some cases, this condition can easily be mistaken for a malignant neoplasm. Its prevalence in developed countries is only 5%. Clinical Case: We present a 58-year-old woman, with no relevant personal history, who came to the emergency room with pain in her right shoulder after an accidental fall on the bus. The humerus radiograph shows a pathological fracture of the right humerus, with significant osteopenia. In the emergency analysis, serum Calcium 13.3 mg / d), Ionic Calcium 7.03 mg / dL, Phosphorus 2.4 mg / dL, Alkaline Phosphatase 248 U / L and normal kidney function stand out. With a diagnosis of severe hypercalcemia, treatment was started in the emergency room with serum therapy (1000 ml of 0.9% physiological saline in 4 hours) and intravenous diuretic treatment (furosemide 40mg) with a decrease in calcemia to 12.8mg / dL. Later, she was admitted to the Internal Medicine hospital ward to perform a differential diagnosis of hypercalcemia secondary to a primary tumor, Multiple Myeloma or Primary Hyperparathyroidism. The study findings are: Calcium metabolism: PTH 660 pg / ml (12 - 65), 25 Hydroxyvitamin D: 14.00. Thyroid ultrasound: Posterocaudal to right thyroid lobe, an area of ​​echogenicity slightly lower than the thyroid is identified, of dimensions not estimated by endothoracic component, which could correspond to a parathyroid adenoma. Body CT: Neck: Heterogeneous nodule dependent on the posterior region of the right thyroid nodule with endothoracic extension. Skeleton: Lytic lesions with a tumor aspect in the humerus, right scapula and bilateral seventh rib and right pubic branch. Skull: Diffuse increase in bone density of the calvaria, showing multiple punctate lytic lesions with a permeative appearance. Bone densitometry: Femur neck: - &amp;lt;1.5, Lumbar spine: - &amp;lt;3.0 With the diagnosis of PHPT causing osteitis fibrosa cystica, surgical intervention was decided. Under general anesthesia, a selective right approach was performed, finding a large parathyroid adenoma weighing 17 grams. PTH fell to 36 pg / ml after surgery. At 9 months after surgery, the patient presented calcium levels of 9 mg / dl and PTH 146 pg / ml with clear radiological improvement. Discussion: Osteitis fibrosa cystica is rare in our environment, it is often confused with other neoplasms. After parathyroidectomy, patients with PHPT have a marked and sustained recovery from OFC, although in some cases this recovery can only be achieved after several years. We consider this case of interest, since it illustrates the importance of evaluating the study of phospho-calcium metabolism and parathyroid function in all patients with bone lesions to rule out Primary Hyperparathyroidism with OFC.</jats:p

Influence of the peritumoral matrix on colon cancer

Virtual Congress of the Spanish Society for Surgical Research (1st. 2021. Virtual

A new aggressive xenograft model of human colon cancer using cancer-associated fibroblasts.

Background Colorectal cancer is the second leading cause of cancer death. Almost half of the patients present recurrence within 5 years after the treatment of the primary tumor, the majority, with metastasis. On the other hand, in the search for new animal models that simulate metastatic cancer, it has been suggested that fibroblasts immersed in the peritumoral stroma (cancer-associated fibroblasts (CAFs)), play a relevant role in the development of cancer. The objective of this study was to identify an adequate animal model to study metastatic colon cancer and the application of new treatments. Methods Human CAFs and normal fibroblasts (NF) for transplant and culture were obtained from surgical fresh samples of patients with adenocarcinoma of sigmoid colon. Stromal cell purity was evaluated by morphology and immunostaining with vimentin (VIM) as a fibroblast marker and anti-proColXIα1 as a specific human CAF marker. Phenotypic characterization of cultured stromal cells was performed by co-staining with mesenchymal and epithelial cell markers. For identification in mice, human CAFs were labeled with the PKH26 red fluorescence dye. Cell line HT-29 was used as tumor cells. Transplant in the head of the pancreas of 34 SCID mice was performed in four different groups, as follows: I. 150,000 CAFS (n = 12), IIa. 1.5 million HT29 cells (n = 7), IIb. 150,000 NF+1.5 million HT29 cells (n = 5), III. 150,000 CAFS+1.5 million HT29 cells (n = 10). After euthanasia performed one month later, histological analysis was made using hematoxylin-eosin and anti-proColXIα1. A histopathological score system based on three features (tumor volume, desmoplasia and number of metastasized organs) was established to compare the tumor severity. Results The CAFs and NF cultured were proColXIα1+/VIM+, proColXIα1/alphaSMA+ and proColXIα1+/CK19+ in different proportions without differences among them, but the CAFs growth curve was significantly larger than that of the NF (p < 0.05). No tumor developed in those animals that only received CAFs. When comparing group II (a + b) vs. group III, both groups showed 100% hepatic metastases. Median hepatic nodules, tumor burden, lung metastases and severity score were bigger in group III vs group II (a + b), although without being significant, except in the case of the median tumor volume, that was significantly higher in group III (154.8 (76.9-563.2) mm3) vs group II (46.7 (3.7-239.6) mm3), p = 0.04. A correlation was observed between the size of the tumor developed in the pancreas and the metastatic tumor burden in the liver and with the severity score. Conclusion Our experiments demonstrate that cultured CAFs have a higher growth than NF and that when human CAFs are associated to human tumor cells, larger tumors with liver and lung metastases are generated than if only colon cancer cells with/without NF are transplanted. This emphasizes the importance of the tumor stroma, and especially the CAFs, in the development of cancer