Formacion post-MIR: Capacitación específica y visión crítica, un compromiso con nuestra práctica clínica.

La intención de estas líneas no es otra que realizar una breve reflexión sobre mi experiencia como alumna en el Master de Coloproctología de la Universidad de Zaragoza. Son numerosos los aspectos que podría destacar, aunque creo que la trayectoria del Master desde el comienzo de su andadura habla por sí misma. Personalmente, aparte de la necesaria puesta al día teórica, una aportación fundamental que destacaría dentro de la parte práctica, y que sin duda lo diferencia, es la formación en análisis crítico de la literatura

Manejo minimamente invasivo de sinus anastomótico mediante terapia de vacio endoluminal (EndoSPONGE®)

Mujer de 51 años, sin antecedentes medicoquirúrgicos de interés, que inicia estudio por cuadro de alteración del hábito deposicional y rectorragia, con diagnóstico de neoplasia de recto medio estadio IIA (T3aN0M0) (Fig. 1). Valorado el caso en Comité Multidisciplinar se remite para completar tratamiento neoadyuvante con quimioradioterapia según protocolo. Diez semanas tras finalizar el tratamiento, es sometida a una resección anterior baja laparoscópica mediante abordaje mesorrectal transanal (TaTME), realizándose anastomosis terminoterminal mecánica a 5 cm de margen anal, más ileostomía derivativa. El postoperatorio inmediato cursó sin incidencias por lo que se da el alta hospitalaria el 5º día

Formacion post-MIR: Capacitación específica y visión crítica, un compromiso con nuestra práctica clínica.

La intención de estas líneas no es otra que realizar una breve reflexión sobre mi experiencia como alumna en el Master de Coloproctología de la Universidad de Zaragoza. Son numerosos los aspectos que podría destacar, aunque creo que la trayectoria del Master desde el comienzo de su andadura habla por sí misma. Personalmente, aparte de la necesaria puesta al día teórica, una aportación fundamental que destacaría dentro de la parte práctica, y que sin duda lo diferencia, es la formación en análisis crítico de la literatura

Tumores neuroendocrinos: Análisis de nuestra casuística y presentación de un caso

Los tumores neuroendocrinos (TNE) del aparato digestivo se originan a partir del sistema endocrino gastrointestinal y en los islotes pancreáticos. Tienen una baja incidencia y suponen un reto diagnóstico y terapéutico. Se realiza un estudio retrospectivo de 15 años de los TNE digestivos en el Hospital Clínico Universitario de Valladolid. Se estudiaron 85 pacientes. La incidencia media anual fue de 5.6 casos, la edad media fue de 57 años, el 50,6% fueron varones. El 25 % fueron tumores gástricos. En 20 casos (23,5%) el paciente estaba asintomático y el diagnóstico fue incidental. La prueba diagnóstica más empleada fue la TAC. En 49 pacientes se realizó un tratamiento quirúrgico, en 22 el tratamiento fue endoscópico y en 14 sólo se realizó una biopsia. La mortalidad operatoria fue de 2 casos (4%). El seguimiento fue de 33.4 meses de media. La mortalidad fue de un 18% (n=15).Presentamos un caso de tumor neuroendocrino originado en un divertículo de Meckel.Neuroendocrine gastroenteropancreatic tumors (NGPT) have their origin in the gastrointestinal endocrine system and pancreatic islets.Having a low incidence, they are diagnostic and therapeutic challenge. Patients with NGPT were reviewed in a retrospective study over a period of 15 years at the Hospital Clínico Universitario de Valladolid. 85 patients were found. The median incidence was 5.6 cases per year. Themedian age was 57 years and 50.6 % were male. Gastric tumors were found in 25% of cases. In 20 out of 85 of patients (23.5 %), there were no symptoms and was an incidental diagnosis. The preferred diagnostic test was computed tomography scan.Surgical treatment was done in 49 patients, endoscopic treatment was performed in 22 cases and biopsy was taken only in 14. Per operative mortality were 2 patients (4%). The mean follow up period was 33.4 months. The global mortality was 18% (n=15).We report a case of neuroendocrine tumor originated in a Meckel's diverticulum

A genome-wide association study identifies risk alleles in plasminogen and P4HA2 associated with giant cell arteritis

Giant cell arteritis (GCA) is the most common form of vasculitis in individuals older than 50 years in Western countries. To shed light onto the genetic background influencing susceptibility for GCA, we performed a genome-wide association screening in a well-powered study cohort. After imputation, 1,844,133 genetic variants were analysed in 2,134 cases and 9,125 unaffected controls from ten independent populations of European ancestry. Our data confirmed HLA class II as the strongest associated region (independent signals: rs9268905, P = 1.94E-54, per-allele OR = 1.79; and rs9275592, P = 1.14E-40, OR = 2.08). Additionally, PLG and P4HA2 were identified as GCA risk genes at the genome-wide level of significance (rs4252134, P = 1.23E-10, OR = 1.28; and rs128738, P = 4.60E-09, OR = 1.32, respectively). Interestingly, we observed that the association peaks overlapped with different regulatory elements related to cell types and tissues involved in the pathophysiology of GCA. PLG and P4HA2 are involved in vascular remodelling and angiogenesis, suggesting a high relevance of these processes for the pathogenic mechanisms underlying this type of vasculitis

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation