RESUMEN Introducción: La cirugía de Whipple, también conocida como duodenopancreatectomía cefálica (DPC), es un procedimiento muy usado para varios tipos de cáncer peri ampular. Objetivos: Establecer los factores asociados a la evolución con complicaciones post DPC en el Servicio de Cirugía de Páncreas del Hospital Nacional Edgardo Rebagliati Martins en Lima, Perú. Métodos: Se realizó un estudio observacional, cuantitativo, analítico, transversal y retrospectivo en 81 pacientes durante el período comprendido entre enero de 2017 hasta diciembre de 2019, quienes fueron sometidos a una DPC. La variable dependiente fueron las complicaciones postquirúrgicas y las independientes fueron indicadores preoperatorios, perioperatorios y post operatorios. Se revisaron las historias clínicas. Se realizó regresión logística para hallar los OR crudos y ajustados. Resultados: La media de la edad fue 65,97±10,14 y el sexo más frecuente fue el masculino. La complicación más frecuente fue la fístula pancreática (34,6%). Los factores asociados a complicaciones post DPC fueron el sexo masculino (ORa: 4,46, IC95%: 1,35-14,77), ampuloma (ORa: 6,92, IC95%: 1,75-27,48) y la consistencia blanda del páncreas (ORa: 4,52, IC95%: 0,07-0,58). Conclusiones: Los factores asociados a complicaciones en la evolución post DPC fueron el sexo masculino, el ampuloma, y la consistencia blanda del páncreas.

ABSTRACT Introduction: Whipple procedure, also known as pancreatoduodenectomy (PD), is a widely used procedure for several types of peri-ampullary cancer. Objectives: To establish the factors associated with postoperative complications after PD in the Pancreas Surgery Service of the Edgardo Rebagliati Martins National Hospital in Lima, Peru. Methods: An observational, quantitative, analytical, cross-sectional, and retrospective study was carried out on 81 patients during the period from January 2017 to December 2019, who underwent PD. The dependent variable was postoperative complications and the independent variables were preoperative, perioperative, and postoperative variables. The medical records were reviewed. Logistic regression was performed to find the crude and adjusted ORs. Results: The mean age was 65.97±10.14 and the majority of patients were male. The most common postoperative complication was pancreatic fistula (34.6%). Factors associated with postoperative complications after PD were male sex (aOR: 4.46, 95% CI: 1.35-14.77), ampullary cancer (aOR: 6.92, 95% CI: 1.75-27.48), and soft consistency of the pancreas (aOR: 4.52, 95% CI: 0.07-0.58). Conclusions: The factors associated with postoperative complications after PD were male sex, ampulloma, and soft consistency of the pancreas.

The incidence of periampullary neoplasms substantially increases with age. If we take into account that this incidence is higher in the elder patient and that life expectancy is nowadays longer, questioning surgical approach in this group of patients turns out to be controversial. Objetive: Asses if in the elder patients the duodenopancreatectomy has a higher mortality and complications. Materials and methods: A retrospective study including patients who underwent duodenopancreatectomy between October 2002 and June 2012 was undertaken to assess whether the elder ones had a higher morbidity and mortality after surgery. Patients were distributed in two groups according to age. The first group included 240 patients younger than 75 years, and the second one included 74 patients older than 75 years. There wasn't NO significant difference in morbidity between the two groups. Results: General mortality for the whole series was 4%. The first group had a 2.9% mortality whereas in the second one mortality reached 4.9%, a significant difference. However, when we changed the reference age from 75 years to 65 or 70 years the difference was not significant any more. Conclusion: From this study we can ascertain that an age more than 75 years significantly increases the mortality risk in duodenopancreatectomy patients. This age, however, doesn't proscribe surgical approach, since surgery is the only choice for curative treatment in patients with this type of cancer.

La incidencia de las neoplasias peri ampulares se incrementa sustancialmente con la edad, teniendo en cuenta que la incidencia de estas neoplasias se presenta mucho más en pacientes mayores y que la expectativa de vida cada vez es más alta es muy difícil cuestionar la cirugía en este grupo de pacientes. Objetivo: Evaluar la conveniencia de realizar una duodenopancreatectomía en los pacientes adultos mayores y si ésta presenta mayores complicaciones y mortalidad en este grupo de pacientes. Materiales y métodos: Durante el periodo comprendido entre octubre del 2002 hasta junio del 2012 se realizó un estudio retrospectivo en 314 pacientes sometidos a una duodenopancreatectomía para evaluar si los pacientes ancianos presentaban una mayor morbilidad y mortalidad luego de esta cirugía. Se distribuyó a los pacientes en dos grupos de acuerdo a la edad. En el primero se incluyeron a 240 pacientes que eran menores de 75 años y en el segundo se incluyeron a 74 pacientes mayores de 75 años. No existió diferencia significativa en la morbilidad de los dos grupos. Resultados: La mortalidad general en toda la serie fue de 4%. En el primer grupo la mortalidad fue de 2,9% mientras que en el segundo grupo subió a 9,4% ,siendo esta diferencia significativa. Sin embargo, cuando redujimos la edad de comparación a 65 años y a 70 años pudimos comprobar que la diferencia ya no fue significativa. Conclusion: Luego de este estudio podemos afirmar que la edad mayor de 75 años aumenta el riesgo de mortalidad de manera significativa en los pacientes sometidos a una duodenopancreatectomía, pero no contraindica la cirugía ya que es la única opción para tratar de curar a una paciente con este tipo de cáncer.

Sessenta amostras de fragmentos de tecidos com lesões sugestivas de tuberculose provenientes de abatedouros bovinos, conservadas em solução saturada de borato de sódio, foram submetidas a quatro tratamentos: descontaminação através dos métodos NaOH 4% (Método Petroff), H2SO4 12% e HPC (Cloreto de hexadecilpiridínio) 1,5%, e solução salina (controle). O método HPC apresentou a menor proporção de contaminação (3%), em relação ao controle (88%, p<0,001), NaOH (33%, p<0,001) e H2SO4 (21,7%, p=0,002). Em relação ao sucesso no isolamento, o método HPC apresentou o melhor resultado (40%), em relação ao controle (3%, p<0,001), NaOH (13%, p=0,001) e H2SO4 (1,7%, p<0,001). Os resultados indicam que o HPC é uma alternativa à utilização do método Petroff.

Sixty samples of tissue fragments with lesions suggestive of tuberculosis from bovine abattoirs, kept in saturated solution of sodium borate, were subjected to four treatments: 4% NaOH (Petroff Method), 12 % H2SO4 and 1.5% HPC (1-Hexadecylpyridinium Chloride) decontamination, and physiological saline solution (control). The HPC method showed the lowest contamination rate (3%) when compared to control (88%, p<0.001), NaOH (33%, p<0.001) and H2SO4 (21.7%, p<0.002). Regarding the isolation success, the HPC method was better (40%) than the control (3%, p<0.001), NaOH (13%, p=0.001) and H2SO4 (1.7%, p<0.001) methods. These results indicate that HPC is an alternative to the Petroff method.

A partir de 20 amostras fecais de bezerros, com quadro clínico de diarréia, positivas para BCoV por hemaglutinação/inibição da hemaglutinação (HA/HI), procedeu-se o isolamento viral em monocamadas de células da linhagem HmLu-1. Até a quinta passagem seriada, 13 apresentaram efeito citopático do tipo sincicial, semelhante à amostra padrão Kakegawa de BCoV. Ao serem submetidas a uma reação de soroneutralização com gamaglobulina anti-coronavírus bovino, 8 delas foram consideradas positivas, uma vez que o efeito citopático foi neutralizado. Ao serem tituladas e submetidas à reação de soroneutralização em microplacas, apenas 3 delas puderam ser confirmadas como positivas. As células da linhagem HmLu-1 mostraram-se permissivas para o isolamento de BCoV, todavia a baixa intensidade na replicação viral demonstrou ser necessário o desenvolvimento de novas metodologias para se poder alcançar esse intuito e a confirmação do isolamento por soroneutralização.

Isolation of BCoV was performed in monolayers of HmLu-1 cells, using 20 fecal samples from clinical cases of diarrhea in calves. Samples were positive for BCoV by means of hemagglutination / hemagglutination inhibition (HA/HI). Up to the fifth serial passage, 13 of these isolates presented syncytial cytopathic effect, similar to Kakegawa standard strain. When isolates were submitted to seroneutralization with gammaglobulin anti-bovine coronavirus, 8 of them were considered to be positive, once cytopathic effect was neutralized. After titration and seroneutralization in microplates, only three of them were confirmed as positive. The lineage HmLu-1 showed higher permissivity to BCoV isolation, but the low intensity of viral replication demonstrated that new methodologies should be developed for this purpose and then submitted to confirmation of isolation by means of seroneutralization.

The results of the surgical treatment for gastric cancer within a specialized surgical service in this pathology are described in this work. This system for surgical treatment of gastric cancer is new in our country. The implementation process included prepare a team of surgeons and establish protocols and guides to surgical treatment, based on the recommendations of the Japanese Gastric Cancer Association. Additional training in the Japanese advanced surgical technique was required, as well as a strict documentation of the cases. During 2004, 139 surgical interventions were carried out on 137 patients with tumoral gastric pathology. Surgical mortality was 2.1% and morbidity was 21.8%. The average resected glands was 38.6 ± 13.7 (range: 20-87) for distal gastrectomy and 46.6 ± 16.2 (range: 24-87) for total gastrectomy. The stay in the hospital was 11.7 ± 6.3 days (range: 5-37) for distal gastrectomy and 14.8 ± 11.3 days (range: 7-56) for total gastrectomy. The hospital and surgeon volumes are underlined as important factors in determining the short and long term results. Implementation of specialized surgical units in general hospitals, for surgical treatment of gastric cancer, is recommended.

En el presente trabajo se describen los resultados del tratamiento quirúrgico del cáncer gástrico dentro de un servicio de cirugía especializado en ésta patología. Este sistema de trabajo para el tratamiento quirúrgico del cáncer gástrico es una experiencia nueva en nuestro país y su proceso de implementación incluyó la conformación del equipo de cirujanos, el establecimiento de protocolos y guías de tratamiento quirúrgico basados en las recomendaciones de la Asociación Japonesa de Cáncer Gástrico; el entrenamiento y perfeccionamiento en técnica quirúrgica japonesa y la documentación rigurosa de los casos. Durante el año 2004 se realizaron 139 intervenciones quirúrgicas en 137 pacientes con patología gástrica tumoral. La mortalidad quirúrgica fue de 2.1 % y la morbilidad de 21.8 %. La media de ganglios resecados fue de 38.6 + 13.7 (rango: 20-87) para gastrectomía distal y 46.6 + 16.2 (rango: 24-87) para gastrectomía total. La estancia hospitalaria fue de 11.7 + 6.3 días (rango: 5-37) para gastrectomía distal y 14.8 + 11.3 días (rango: 7-56) para gastrectomía total. Se resalta el volumen hospital y volumen cirujano como importantes factores determinantes de los resultados a corto y largo plazo, recomendándose la implementación de unidades quirúrgicas especializadas en hospitales generales para el tratamiento quirúrgico del cáncer gástrico.

O rotavírus é um agente etiológico de diarréias de distribuição mundial, responsável por grandes prejuízos econômicos. Pesquisou-se a soroprevalência de anticorpos anti-rotavírus do sorogrupo A em bovinos criados no município de Uruará, utilizando a técnica da contraimunoeletroosmofore com a amostra NCDV como antígeno padrão. A prevalência de propriedades positivas foi de 95.6-100%. Diferenças significativas foram observadas entre as sucessivas faixas etárias, quando a soropositividade aumentou dos grupos mais jovens para os mais velhos, bem como entre fêmeas e machos maiores de 1 ano, quando a soropositividade foi maior no primeiro grupo.

Rotavirus is a worldwide etiologic agent of diarrhea, responsible for large economic losses. We studied the seroprevalence of antibodies to group A rotavirus in cattle in 67 smallholder farms from Uruará municipality, using counterimmunoelectroosmophoresis with the NCDV strain as a standard antigen. Prevalence of positive smallholder farms was 95.6-100%. Significant differences were seen between age groups when the seropositivity rose from the youngest to the oldest groups and between females and males older than 1 year, when the seropositivity was higher in the first group.