RESUMO Racional: A gastrectomia laparoscópica tem numerosas vantagens perioperatórias, mas a sobrevivência em longo prazo após este procedimento tem sido menos estudada. Objetivo: Comparar resultados de sobrevivência, oncológica e perioperatória entre a gastrectomia completamente laparoscópica vs. aberta para câncer gástrico precoce. Método: Este estudo foi retrospectivo e os principais resultados foram a sobrevivência global e específica de cinco anos, contagem de linfonodos e taxa de ressecção R0. Resultado secundário foi a morbidade pós-operatória. Resultados: Foram incluídos 116 pacientes (59% homens, idade 68 anos, comorbidades 73%, IMC 25) que foram submetidos a 50 gastrectomias laparoscópicas e 66 gastrectomias abertas. As características demográficas, a localização do tumor, o tipo de operação, a extensão da dissecção dos linfonodos e do estágio não diferiram significativamente entre os grupos. A taxa geral de complicações foi semelhante em ambos os grupos (40% vs. 28%, p=ns) e complicações classificadas Clavien 2 (36% vs. 18%, p=0,03), respiratórias (9% vs. 0%, p=0,03) e as da parede abdominal (12% vs. 0%, p=0,009) foram significativamente menores após a gastrectomia laparoscópica. A contagem de linfonodos (21 contra 23, p=ns) e a taxa de ressecção R0 (100% vs. 96%; p=ns) não diferiram significativamente entre os grupos. A sobrevida global de cinco anos (84% vs. 87%, p=0,31) e a sobrevida específica (93% vs. 98%, p=0,20) não diferiram significativamente entre os grupos de gastrectomia laparoscópica e aberta. Conclusão: Estes resultados suportam resultados oncológicos similares e sobrevida em longo prazo para pacientes com câncer gástrico precoce após gastrectomia laparoscópica e gastrectomia aberta. Além disso, a abordagem laparoscópica está associada com morbidade menos grave e menor ocorrência de complicações respiratórias e da parede abdominal.

ABSTRACT Background: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.

El objetivo del presente trabajo fue estudiar la emisión foliar de plátanos del tipo Falso Cuerno y su relación con el proceso de la diferenciación floral. Se efectuaron cuatro estudios de noviembre del 2000 a enero del 2014, bajo las condiciones de la región Caribe de Costa Rica. Se emplearon registros del tipo y número de hojas emitidas. El cambio del meristemo se determinó por la disección de las plantas a diferentes etapas de emisión foliar. En el Estudio I (cvs. Hartón alto y Hartón enano, segundo ciclo productivo) la emisión foliar fue similar entre cultivares altos (P>0,2417), enanos (P>0,05735) y entre ambos (P>0,4170). En el Estudio II (cv. Hartón alto, primer ciclo productivo) el meristemo en fase vegetativa se observó en el 100% de las plantas hasta la emisión de la hoja 21 inclusive. El mayor porcentaje de plantas en fase de transición (55, 60, 72 y 60%) ocurrió a las 24, 25, 26 y 27 hojas verdaderas. En el Estudio III (cvs. Hartón alto y Hartón enano, tercer ciclo sucesorio productivo) la diferenciación se observó a partir de la hoja 20 en el 10% y en el 60% de las plantas de los cultivares de porte alto y bajo, respectivamente. En la hoja 24 el 100% de las plantas disectadas estaba en transición o en diferentes etapas de la fase reproductiva. En el Estudio IV (cv. Hartón alto, tercer ciclo sucesorio productivo) no fue posible relacionar la fase de diferenciación floral con el cambio morfológico en la base de los semilimbos de la hoja.

The objective of this study was to determine the relationship between foliar emission and floral differentiation in False Horn plantains. Four studies were carried out on the Caribbean coast of Costa Rica between November 2000 and January 2014. Recoded variables were type and number of emitted leaves. In Study I (tall and dwarf cultivars, first ratoon) leaf emission was similar among tall (P=0.2417) and dwarf (P=0.5735) cultivars and between both of them (P=0.4170). In Study II (cv. Harton tall, plant crop) the vegetative phase of the meristem was observed in 100% of plants until the emission of leaf 21. The highest percentages of plants in which the meristem was in transition stages was 55%, 60%, 72% and 60%, and occurred in plants with 24, 25, 26 and 27 leaves, respectively. In Study III (cvs. Hartón tall and Hartón dwarf, second ratoom) differentiation was observed from leaf 20 in 10% and 60% of plants of tall and dwarf cultivars, respectively. A 100% of the dissected plants were in transition or at different stages of the reproductive phase by the time they reached leaf 24. In Study IV (Harton tall, second ratoon) it was not possible to find a relationship between the floral differentiation phase and the morphological change in the basal blades of the leaf.

Background: The laparoscopic approach for the treatment of gastric tumors has many advantages. Aim: To evaluate the results of a laparoscopic gastrectomy program developed in a public hospital. Patients and Methods: Retrospective review of epidemiological, perioperative and follow-up data of patients who were treated with a laparoscopic gastrectomy due to gastric tumors between 2006 and 2013. A totally laparoscopic technique was used for all cases. Complications were evaluated according to the Clavien-Dindo classification. Results: Fifty one patients, aged 65 (36-85) years, underwent a laparoscopic gastrectomy. In 22 patients a total gastrectomy was performed. Conversion rate to open surgery was 8%. Operative time was 330 (90-500) min and bleeding was 200 (20-500) ml. Median hospital stay was 7 (3-37) days. Postoperative morbidity was present in 17 (33%) patients, 3 (6%) patients had complications grade 3 or higher and one patient died (1.9%). Tumor pathology was adenocarcinoma in 39 patients. A complete resection was achieved in 97%. Twenty nine patients (74%) with gastric adenocarcinoma had early gastric cancer and 84% of patients were in stage one. Median lymph node count was 24. Median follow-up was 26 (1-91) months. There was no cancer related mortality among patients subjected to a curative resection. Overall survival for patients with adenocarcinoma was 92% at 3 years. Conclusions: This study supports the feasibility and safety of a laparoscopic gastrectomy program in a public hospital; with low morbidity, adequate lymph node dissection and long-term survival. This approach must be considered an option for selected patients with gastric cancer.

An expert panel analyzed the available evidence and reached a consensus to release 24 recommendations for primary and secondary prevention of gastric cancer (CG) in symptomatic patients, with indication for upper GI endoscopy. The main recommendations include (1) Search for and eradicate H. pylori infection in all cases. (2) Systematic gastric biopsies (Sydney protocol) in all patients over 40 years of age or first grade relatives of patient with CG, to detect gastric atrophy, intestinal metaplasia or dysplasia. (3) Incorporate the OLGA system (Operative Link on Gastritis Assessment) to the pathological report, to categorize the individual risk of CG. (4) Schedule endoscopic follow-up according to the estimated risk of CG, namely annual for OLGA III- IV, every 3 years for OLGA I- II or persistent H. pylori infection, every 5 years for CG relatives without other risk factors and no follow-up for OLGA 0, H. pylori (-). (4) Establish basic human and material resources for endoscopic follow-up programs, including some essential administrative processes, and (5) Suggest the early CG/total CG diagnosis ratio of each institution and the proportion of systematic recording of endoscopic images, as quality indicators. These measures are applicable using currently available resources, they can complement any future screening programs for asymptomatic population and may contribute to improve the prognosis of CG in high-risk populations.

El objetivo de este trabajo fue determinar la respuesta del racimo de banano a un desmane intensivo. El estudio se efectuó en el Caribe de Costa Rica del 2010 al 2011 en racimos de seis y ocho manos provenientes de racimos de nueve, diez y once (experimento 1) y de once, doce y trece manos (experimento 2). Mensualmente se midió en la segunda y quinta mano, el grosor y la distancia entre el ápice del fruto y el raquis y, a la cosecha, el peso del racimo, el grosor y el largo externo e interno del fruto, la distancia del ápice del fruto al raquis y se calculó, mediante la relación de ambos largos, el índice de curvatura. El grosor presentó un comportamiento lineal creciente y fue similar (P>0,0508) entre desmanes en la mayoría de las evaluaciones de cada tamaño de racimo. La distancia tuvo una fase exponencial decreciente hasta la evaluación cuatro o cinco y, posteriormente se incrementó linealmente. No se observaron diferencias significativas (P>0,3797) para esta variable entre evaluaciones en los racimos de menor tamaño (nueve y diez manos, experimento 1) pero aumentó (P<0,0497) en aquellos con mayor desmane, aspecto que no alcanzó a ser significativo (P>0,0540) en algunas comparaciones. El intervalo floración-cosecha y el peso del racimo disminuyeron en los racimos más desmanados. A la cosecha, el grosor y el largo del fruto fueron similares (P>0,0732) entre desmanes y tamaños de racimo. La distancia solo varió en el experimento 2 donde fue mayor (P<0,0295) en los racimos más desmanados. El índice de curvatura no presentó diferencias (P>0,0645) en la mayoría de los casos.

The aim of this work was to study the response of banana bunches and fruits to extreme dehanding intensities. The study was performed from 2010 to 2011 in the Caribbean of Costa Rica in bunches with 6 and 8 fruit hands at harvest originating from bunches of 9, 10 and 11 and 11, 12 and 13 hands for experiment 1 and 2, respectively. Thickness and distance of fruit tip to rachis of the second and fifth hand were measured at monthly intervals. At harvest, bunch weight, finger girth, external and internal fruit length, distance between fruit tip to rachis were measured, and the ratio between the two lengths was used to calculate the curvature index. Thickness linearly increased as fruit developed, being similar (P>0.0508) between hand trimming intensities in most evaluations. Distance from fruit tip to rachis had an exponential decreased until evaluations 4 or 5 and then linearly increased. There were no differences (P>0.3797) for this variable on smaller bunches (9 and 10 hands, experiment 1) but increased (P<0.0497) in those with the highest trimming intensities. Some comparisons of this last variable among larger bunches were not significant (P>0.0540). The blooming-to-harvest interval and bunch weight decreased (P<0.0494) in bunches with higher hand trimming intensity. At harvest, thickness and fruit length were similar (P>0.0732) in all treatments regardless of bunch size. The distance varied only in experiment 2 which was higher (P<0.0295) in bunches with higher hand trimming intensities. The curvature ratio did not differ (P>0.0645) in most cases.

Gastric lipoma is a rare benign gastric tumor. We report a 62-year-old man, who presented with abdominal pain, vomiting and weight loss. An upper gastrointestinal endoscopy showed a gastric antral, submucosal tumor. Abdominal ultrasound and computed tomography revealed a large antral lesion with content of high echogenicity and fat density, measuring 11 x 6 cm. The patient was treated with a laparoscopic distal subtotal gastrectomy, and a Roux-en-Y reconstruction. The patient had no postoperative morbidity, was started on a liquid diet on the third postoperative day and was discharged on the third postoperative day. The pathological study revealed a gastric lipoma with clear margins. This laparoscopic procedure represents a good alternative in the treatment of this benign gastric tumor.

El objetivo de este trabajo fue determinar la relación entre el grosor del fruto central de las manos última y segunda, como criterio de cosecha en el banano. Las mediciones se efectuaron semanalmente (mm) de la segunda a la décima semana después de la floración y fueron transformadas a treintaidosavos de pulgada (tdp) donde 1 tdp= 0,7914 mm, para la generación de ecuaciones de regresión para ambas manos, considerando, o ignorando, el tamaño del racimo. El grosor del fruto central de la última mano fue estimado a partir del grosor del fruto central de la segunda mano, y viceversa para el grosor del fruto de la segunda mano. Los valores de grosor del fruto central de la última mano (valores Y) obtenidos aplicando los grosores mínimos preestablecidos de cosecha para el fruto central de la segunda mano (valores x: 43; 44 y 45 tdp) fueron superiores a 40 tdp, independientemente del tamaño del racimo, e inclusive superó en la mayoría de las veces, a 41 tdp. Inversamente, aplicando los valores mínimos de grosor de la última mano, predefinidos para la cosecha (valores x: 39; 40 y 41 tdp), se obtuvieron valores de grosor del fruto central de la segunda mano (valores Y), que no superaron el valor de 43 tdp excepto para x=41 en los racimos de siete a nueve manos. Los racimos cosechados con la exigencia mínima de empaque aplicada para la última mano, tuvieron menos peso, por estar conformados de frutos con menor grosor, que aquellos que se cosecharían mediante la medición en la segunda mano.

The objective of this work was to determine the relationship between the thickness of the last and second hand of fruits as harvest criteria in banana. The measurements were done weekly (mm) from the second to the tenth weeks after flowering, and were transformed to thirty two inch/22 (tti), where 1 tti=0,794 mm for the calculation of regression equations for both fruit hands, considering or ignoring the bunch size. The thickness of the central fruit of the last hand was estimated from the central thickness of the second hand, and vice versa for the fruit thickness of the second hand. The values of thickness of the central fruit of the last hand (Y values), obtained by applying a pre-established minimum value for the harvest of the second hand central fruit (x values: 43, 44 and 45 tti) were over 40 tti, regardless of the bunch size, and even, exceeded in most cases, 41 tti. Conversely, applying the minimum values of the central fruit of the last hand predefined for harvest (x values: 39, 40 and 41 tti), were obtained thickness values of the central fruit of the second hand (Y values) that did not exceed the value of 43 tti, except for x= 41 tti in bunches of 7 to 9 hands. The results clearly demonstrate that bunches harvested with the minimum requirement of packing in the last hand, would have less weight because they are formed by fruits of less thickness than those reaped by measuring the second hand.

Background: The diagnosis and treatment of periampullary tumors represents a challenge for current medicine. Aim: To review the results of pancreaticoduodenectomy (PDD) in the treatment of periampullary tumors and to identify risk factors that impact the long-term survival. Patients and Methods: We performed a retrospective study of patients who underwent a PDD for periampullary tumors between 1993 and 2009. We reviewed perioperative results and long term survival. We performed a multivariate analysis for long-term survival. Results: A PDD was performed in 181 patients aged 58 ± 12 years (98 females). Piloric preservation was done in 53% and a pancreatogastric anastomosis was used in 94% of cases. Morbidity was 62% and postoperative mortality was 5.5%. Pancreatic cancer was the most frequent pathological finding in 41%, followed by ampullary cancer in 28% and distal bile duct cancer in 16%. Median survival was 17 months, with a five years survival of 24%. Survival for ampullary tumors was 28 months with a five years survival of 32%. The median and five years survival were 14 months and 16% for bile duct cancer and 11 months and 14% for pancreatic cancer. Multivariate analysis identified tumor type (pancreas /bile duct) and lymph node dissemination as independent predictors of mortality. Conclusions: One quarter of patients experienced long term survival. Mortality predictors were tumor type and lymph node dissemination.

Two experiments were conducted in Costa Rica Caribbean, both in favorable climatic period (experiment 1) and unfavorable (experiment 2). Treatments and the new type of polyethylene foam slide (low thickness and closed cell) were: 1) without lamellae between hands or between rows of each hand (control); 2) with lamellae just between hands; 3) with lamellae between rows of each hand; and 4) with lamellae between hands and between rows of each hand. Measured variables were: bunch weight (kg), thickness (1/32") and length (cm from pulp to tip) from the central fruit of the external row of the second, fourth and sixth hand and number of days since lamellae placement until harvest. Additionally factors of rejection and the number of boxes per bunch (ratio) were identified. Bunch weight (experiment 1: p= 0.9571 and experiment 2: p= 0.5662), thickness and length of the central fruit of the outer row of the second, fourth and sixth hand (experiment 1: p> 0.2378, experiment 2: p> 0.1137) as well as days since lamellae placement until harvest (experiment 1: p= 0.5169 and experiment 2: p= 0.6916) did not differ between treatments. Regardless of the treatments, it was a higher number of rejected fruits per cluster during the favorable climatic period (64.5 to 86.5 fruits) respect to adverse climatic period (9.6 to 16.4 fruits). Lamellae placing did not influence the expression of rejection by fruit growth scar without deflowering in the field and did not improve, compared with control, boxes per cluster relation.

Dos experimentos fueron realizados en el Caribe de Costa Rica, tanto en época climática favorable (experimento 1) como adversa (experimento 2). Los tratamientos y el nuevo tipo de laminilla de espuma de polietileno (bajo espesor y celda cerrada) fueron: 1) sin laminillas entre manos o entre filas de cada mano (testigo); 2) con laminillas solo entre manos; 3) con laminillas solo entre filas de cada mano; y 4) con laminillas entre manos y entre filas de cada mano. Las variables medidas fueron: peso del racimo (kg), grosor (treintaidosavos de pulgada) y largo (cm de pulpa a punta) del fruto central de la fila externa de la segunda, cuarta y sexta mano y número de días de la colocación de las laminillas a la cosecha. Adicionalmente se determinaron los factores de rechazo y el número de cajas por racimo (ratio). El peso del racimo (experimento 1: p= 0.9571 y experimento 2: p= 0.5662), el grosor y la longitud de los frutos centrales de la fila externa de la segunda, cuarta y sexta mano (experimento 1: p> 0.2378; experimento 2: p> 0.1137), así como los días de la colocación de las laminillas a la cosecha (experimento 1: p= 0.5169 y experimento 2: p= 0.6916) no difirieron entre tratamientos. Independientemente de los tratamientos se observó una mayor cantidad de frutos rechazados por racimo en la época climática favorable (64.5 a 86.5 frutos) con respecto a la adversa (9.6 a 16.4 frutos). La colocación de laminillas no influyó sobre la expresión del rechazo por cicatriz de crecimiento de frutos sin desflora en el campo y no mejoró, en comparación con el testigo, la relación cajas por racimo.

Efecto de dos tipos de fundas sobre el fruto de banano (Musa AAA). El objetivo de este estudio fue determinar el efecto de dos fundas en la protección del racimo de banano (Musa AAA ). En dos épocas climáticas (adversa y favorable) bajo condiciones del Caribe de Costa Rica se evaluaron dos fundas: 1- azul Santa Lucía (bifentrina 0,1%, polietileno de 12,7 μ de grosor, con perforaciones de 4 mm y 86,4 cm de ancho) y 2- transparente con aditivos para filtrar la luz ultravioleta e infrarroja (bifentrina 0,1%, 20,3 μ de grosor, con perforaciones de 4 mm y 88,9 cm de ancho). El peso del racimo asν como el grosor y la longitud del fruto central de la fila externa en la segunda, cuarta y sexta mano no difirieron (P> 0,0556) entre ambas fundas. Tampoco hubo diferencias entre estas en la apariencia del racimo (P>0,4699) ni en la firmeza de la cáscara en grado 1 de maduración (P= 0,6268). En las variables de medición del color del fruto solamente L* presentó un valor (56,48) más alto (P=0,0109) con la funda transparente fotosensible, mientras que las otras dos variables relacionadas (a* y b*) no fueron diferentes (P>0,1011) entre las fundas. El incremento adicional de 7,6 μ en el grosor del polietileno de la funda transparente con respecto a la azul Santa Lucνa, no ocasionσ un incremento productivo ni una mejor apariencia del racimo de banano y sus frutos.

Effect of two banana (Musa AAA) bunch covers on fruit quality. The objective of this study consisted to determine the effect of two protective covers of the banana (Musa AA) bunch. The study was carried out in two climatic seasons (adverse and favorable) at the Caribbean of Costa Rica. The covers compared were: 1-blue Santa Lucia (bifentrin 0.1%, polyethylene 12.7 μ thickness, with perforations of 4 mm and 86.4 cm wide) and 2- transparent photosensitive (bifentrin 0,1%, 20.3 μ, 4 mm holes and 86.4 cm wide). The bunch weight and the thickness and length of the central fruit of the outer row in the second, fourth and sixth hands did not differ (P> 0.0556) between bunch covers. There were no differences between bunch covers in bunch appearance (P> 0.4699) or in the peel firmness in grade 1 of maturation (P> 0.6268). For fruit color parameters, only L* showed a greater (P= 0.0109) value (56.48) in the transparent photosensitive bunch cover relative to the blue Santa Lucia, whereas the other two related variables (a* and b*) did not differ between treatments (P>0.1011). The increment of 7.6 μ in the polythene thickness of the transparent photosensitive with respect to the blue Santa Lucia bunch covers did not result in increased production or in improvement of bunch and fruit appearance.

Durante el 2006 se realizaron 2 experimentos en plantaciones comerciales de banano (Musa AAA, cv. Grande Naine) del Caribe de Costa Rica. En ambos el primer tratamiento fue la eliminación periódica y el segundo la retención total, hasta el colapso, del tejido deteriorado del pseudotallo luego de la cosecha. Se midieron las variables de crecimiento, producción, enfermedades e insectos plagas. Excepto por el largo de la segunda mano en el experimento 1 (p=0,0309) y de la sexta mano en el experimento 2 (p=0,0455), no hubo diferencias entre tratamientos en las restantes variables de crecimiento (p>0,1480) y de producción (p>0,0652), ni presencia de pudrición por Erwinia spp. En ambos experimentos se observó la ocurrencia de daño por larvas de C. sordidus, pero éste, además de que fue de una baja magnitud, solo difirió entre tratamientos (p=0,0227) en el experimento 2. Se observó pudrición del cormo asociada con el picudo negro únicamente en el experimento 1, cuya expresión, además de ser baja, no difirió entre tratamientos (p>0,7574). Se determinó la presencia de Pseudococcus elisae y de Periplaneta spp., solamente en el experimento 1; con ambos insectos, los mayores valores (p<0,0412) se observaron en el tratamiento 2 (retención total). No se observó la presencia de escamas y áfidos en ninguno de los 2 experimentos. Dado que no hubo diferencias en crecimiento y producción entre tratamientos, la selección de uno de ellos estaría dada por factores de riesgo asociados con insectos plaga y/o enfermedades comunes al cultivo del banano.

Evaluation of two modalities of management of the pseudostem after the harvest on the growth, production and health of banana plants (Musa AAA). In order to evaluate 2 modalities of common use in the management of the pseudostem after the harvest of the mother plant, 2 experiments were performed during the year 2006 in commercial banana (Musa AAA, cv. Grande Naine) plantations in the Caribbean region of Costa Rica. The treatments in both experiments were: 1-periodic elimination and 2-total retention, until collapse, of the deteriorated tissue of the pseudostem after harvest. Growth, yield, diseases and insect- est variables were measured. Except for the length of the second hand in experiment 1 (p=0.0309), and of the sixth hand in experiment 2 (p=0.0455), there were no differences between treatments in the remainder growth (p>0.1480) and production (p>0.0652) variables. Presence of Erwinia spp., soft rot was not observed. In both experiments, damage by larvae of Cosmopolites sordidus was observed, which nevertheless was of little magnitude and only differed between treatments (p=0.0227) in experiment 2. Corm rotting associate of with black weevil was only observed in experiment 1, at a low value, and with no differences between treatments (p>0.7574). The presence of Pseudococcus elisae and Periplaneta spp. was determined only in experiment 1; with both insects, the greater values (p<0.0412) were observed in treatment 2 (total retention). The presence of scales and aphids was not observed in either experiment. Since there were not differences in growth and production between treatments, the selection of one of them would be given by risk factors associated with inse pest and/or common diseases to the banana crop.