Duodenopancreatectomía cefálica y tutorización externa del conducto de Wirsung. Resultados de una serie de 80 casos consecutivos

IntroductionThere is controversy regarding the ideal pancreaticojejunostomy technique after pancreaticoduodenectomy. Many authors consider the external Wirsung stenting technique to be associated with a low incidence of fistula, morbidity and mortality. We analyse our experience with this technique.Patients and methodsA retrospective analysis of the morbidity and mortality of a series of 80 consecutive patients who had been treated surgically over a 6.5-year period for pancreatic head or periampullary tumors, performing pancreaticoduodenectomy and pancreaticojejunostomy with external Wirsung duct stenting.ResultsMean patient age was 68.3 ± 9 years, and the resectability rate was 78%. The texture of the pancreas was soft in 51.2% of patients and hard in 48.8%. Pylorus-preserving resection was performed in 43.8%. Adenocarcinoma was the most frequent tumor (68.8%), and R0 was confirmed in 70% of patients. Biochemical fistula was observed in 11.2%, pancreatic fistula grade B in 12.5% and C in 2.5%, whereas the abdominal reoperation rate was 10%. Median postoperative hospital stay was 16 days, and postoperative and 90-day mortality was 2.5%. Delayed gastric emptying was observed in 36.3% of patients, de novo diabetes in 12.5%, and exocrine insufficiency in 3. Patient survival rates after 1, 3 and 5 years were 80.2, 53.6 and 19.2%, respectively.ConclusionsAlthough our low rates of postoperative complications and mortality using external Wirsung duct stenting coincides with other more numerous recent series, it is necessary to perform a comparative analysis with other techniques, including more cases, to choose the best reconstruction technique after pancreaticoduodenectomy.     

Resecciones pulmonares anatómicas por vía robótica: análisis de la curva de aprendizaje

IntroductionRobotic surgery has become a safe and effective approach for the treatment of pulmonary surgical pathology. However, the adoption of new surgical techniques requires the evaluation of the learning curve. The objective of this study is to analyze the learning curve of robotic anatomical lung resections.MethodsRetrospective analysis of all robotic anatomical lung resections performed by the same surgeon between June 2018 and March 2020. The learning curve was evaluated using CUSUM charts to estimate trend changes in surgical time, surgical failure and the occurrence of post-operative cardiorespiratory complications throughout the sequence of cases.ResultsThe study included a total of 73 cases. The median duration of all complications was 120 min (interquartile range: 90-150 min), the prevalence of surgical failure was 23.29%, while 4/73 patients had any postoperative cardiorespiratory complication. Based on the CUSUM analysis, the learning curve was divided into 3 different phases: phase i (from the first to the 14th intervention), phase ii (between the 15th and 30th intervention) and phase iii (from the 31st intervention).ConclusionsThe learning curve for robotic anatomical lung resections can be divided into 3 phases. The technical competence that guarantees satisfactory perioperative outcomes was achived in phase iii from the 31st intervention.     

Low-dose Thymoglobulin vs Basiliximab Induction Therapy in Low-Risk Living Related Kidney Transplant Recipients: A Prospective Randomized Trial

ContextThymoglobulin is used effectively as induction agent in kidney transplantation but the optimal dose is not well established.ObjectiveDemonstrate that low-dose thymoglobulin (3 mg/kg) has similar efficacy and safety compared to basiliximab induction in low-risk kidney transplantation under standard maintenance immunosuppressionDesign, Setting, ParticipantsProspective randomized study in kidney transplant patients (12/2016-05/2018). Inclusion criteria: Recipients > 18 years, first living donor transplant. Exclusion criteria: Second and multiorgan transplant, ABO incompatibility, positive cross-match, panel reactive antibodies (PRA) > 30%, positive donor-specific antibody, human immunodeficiency virus, hepatitis B surface antigen, hepatitis C virus positive, white blood cells < 2000 cells/mm³, platelets < 75,000 cells/mm³ and malignancy.InterventionGroup A: basiliximab (20 mg D0 and D4). Group B: thymoglobulin (3 mg/kg total). Maintenance immunosuppression: tacrolimus, mycophenolate mofetil, and steroids.Main Outcome MeasuresBiopsy-proven acute rejection (BPAR), delayed graft function, slow graft function, leukopenia, infections, adverse events, graft loss, estimated glomerular filtration rate, and death within 12 months.Results100 patients (basiliximab, n = 53) (thymoglobulin, n = 47) were included. Donor and recipient characteristics were similar except for longer dialysis (basiliximab), PRA class I (1.2% basiliximab, 4.5% thymoglobulin), HLA match (basiliximab 2.8, thymoglobulin 2.2), and cytomegalovirus status. BPAR rate was basiliximab 3.8% and thymoglobulin 6.4% (P = ns). Delayed graft function (basiliximab 3.8%; thymoglobulin 4.3%), slow graft function, and 12-month leukopenia (basiliximab 11.3%, thymoglobulin 21.3%) were similar between groups (P = ns). There was no difference in infections and adverse events between groups. Patient and graft survival were as follows: basiliximab 98.1% and 92.5%, thymoglobulin 100% and 93.6% (P = ns).ConclusionLow-dose thymoglobulin induction (3 mg/kg) can be used effectively and safely in low-risk kidney transplantation with good results during the first year post-transplant.     

Cytomegalovirus DNAemia and risk of mortality in allogeneic hematopoietic stem cell transplantation: Analysis from the Spanish Hematopoietic Transplantation and Cell Therapy Group

The net impact of cytomegalovirus (CMV) DNAemia on overall mortality (OM) and nonrelapse mortality (NRM) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a matter of debate. This was a retrospective, multicenter, noninterventional study finally including 749 patients. CMV DNA monitoring was conducted by real-time polymerase chain reaction (PCR) assays. Clinical outcomes of interest were OM and NRM through day 365 after allo-HSCT. The cumulative incidence of CMV DNAemia in this cohort was 52.6%. A total of 306 out of 382 patients with CMV DNAemia received preemptive antiviral therapy (PET). PET use for CMV DNAemia, but not the occurrence of CMV DNAemia, taken as a qualitative variable, was associated with increased OM and NRM in univariate but not in adjusted models. A subcohort analysis including patients monitored by the COBAS Ampliprep/COBAS Taqman CMV Test showed that OM and NRM were comparable in patients in whom either low or high plasma CMV DNA threshold (<500 vs ≥500 IU/mL) was used for PET initiation. In conclusion, CMV DNAemia was not associated with increased OM and NRM in allo-HSCT recipients. The potential impact of PET use on mortality was not proven but merits further research.     

Testing Women’s Trust in Other Women and Same-Sex Attracted Males in Three Cultures

Heterosexual women trust mating-relevant advice received from gay men more than that received from heterosexual women. This trust is predicated on women’s perception that gay men lack ulterior sexual motives and romantically pursue other gay men. However, this trust may not hold in all cultures. For example, in both Samoa and the Istmo Zapotec of Southern Mexico, women take part in mate competition against feminine same-sex attracted males—referred to as fa’afafine and muxe, respectively—who regularly engage in sexual activity with masculine men. The present studies sought to replicate and extend research on women’s trust in males who are same-sex attracted. Experiments were conducted in Canada, Samoa, and the Istmo Zapotec, with women randomly assigned to consider the likelihood of various mate-poaching behaviors performed by either a rival woman or a same-sex attracted male. In Canada, women were more trusting of cisgender gay men than other women. Similarly, Samoan women were more trusting of fa’afafine than other women. In the Istmo Zapotec, women were equally distrustful of women and feminine muxe gunaa, whereas more masculine muxe nguiiu were rated as more trustworthy than women and muxe gunaa. These results illustrate that women’s trust in same-sex attracted males varies both between and within cultural contexts, perhaps impacted by the relative femininity of the male in question.

     

Pristane (2,6,10,14-Tetramethyl-pentadecane) inhibits disease progression in Leishmania-infected Balb/c mice

The course of Leishmania infection in pristane-primed BALB/c mice infected with either Leishmania major or Leishmania donovani was examined. Pristane-primed L. donovani infected mice had spleen parasite-loads that were 13 times less than controls. Likewise pristane-primed L. major infected animals had significantly smaller footpad lesion areas than controls. Pristane-primed mice had an atypical haematology compared to controls. To the best of our knowledge, this is the first report to demonstrate that pristane inhibits progression of disease in Leishmania-infected BALB/c mice.     

Screening of metal ion chelators against Leishmania donovani-infected Syrian hamsters

Leishmania donovani-infected Syrian hamsters were treated intraperitoneally with 0.23 mmoles/kg/day of EDTA, EGTA, HEEDTA and 100 mg/kg/day of Pentostam R. The control group received 0.1 ml of phosphate buffered saline. After 30 days of treatment, the animals were sacrificed. Of the Pentostam-treated animals, 5 out 6 had negative spleen cultures, while all the chelator and PBS-treated ones yielded parasites. While all the Pentostam-treated animals had negative bone marrow cultures, only 1 out of 6 HEEDTA-treated hamsters yielded parasites. Spleen, liver and bone marrow parasite- loads calculated from chelator-treated animals were consistently significantly higher than for Pentostam-treated animals. These results suggest that although metal ion chelators have some antileishmanial potential, their in vivo activity against L. donovani is low compared to Pentostam.     

The Uniqueness of Child and Youth Care: A Personal Perspective

The author draws upon 30 years of experience in the child and youth care field, personally carrying a dual diagnosis as a professional child and youth care worker and a professional social worker for most of that time. A definition of child and youth care is offered, and differences in focus and emphasis within the two disciplines are explored. Two underlying paradigms are suggested as contributing to the tensions apparent between the professions internationally, and the author concludes that the continuing struggle to develop a free-standing profession of child and youth care needs to be vigorously pursued because competent child and youth care workers are good for children and play a unique role in their lives.