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Background Abdominal perineal excision (APE) was originally described with levator ani removal for rectal cancer. An even wider, more aggressive extralevator resection for APE has been proposed. Although some surgeons are performing a very wide ‘extralevator APE (ELAPE)’, there are few data to recommend it routinely. This multicentre study aimed to compare outcomes of APE and ELAPE. Methods A multicentre propensity case-matched analysis comparing two surgical approaches (APE and ELAPE) was performed. All patients who underwent abdominoperineal resection of a rectal tumour were considered for the analysis. Tumour height was defined by magnetic resonance imaging measurement and patients with stage II–III tumours had neoadjuvant radiochemotherapy. Involvement of the circumferential resection margin (CRM) and intraoperative tumour perforation were the main outcome measures. A logistic regression model was used to study the relationship between the surgical approaches and outcomes. Results From January 2008 to March 2013 a total of 1909 consecutive patients underwent APE or ELAPE, of whom 914 matched patients (457 in each group) formed the cohort for analysis. Intraoperative tumour perforation occurred in 7·9 and 7·7 per cent of patients during APE and ELAPE respectively (P = 0·902), and there was CRM involvement in 13·1 and 13·6 per cent (P = 0·846). There were no differences between APE and ELAPE in terms of postoperative complication rates (52·3 versus 48·1 per cent; P = 0·209), need for reoperation (7·7 versus 7·0 per cent; P = 0·703), perineal wound problems (26·0 versus 21·9 per cent; P = 0·141), mortality rate (2·0 versus 2·0 per cent; P = 1·000) and local recurrence rate at 2 years (2·7 versus 5·6 per cent; P = 0·664). Conclusion ELAPE does not improve rates of CRM involvement, intraoperative tumour perforation, local recurrence or mortality.

Aim The study aimed to assess the diagnostic yield of a colonoscopy screening programme in first-degree relatives of colorectal cancer (CRC) patients and to identify factors associated with advanced neoplasia. Method We conducted a cross-sectional study. Individual characteristics, family trees and colonoscopy findings of asymptomatic first-degree relatives of CRC patients were collected. The findings were classified into cancer (invasive carcinoma and/or non-invasive high-grade neoplasia), high-risk adenomas (≥ 10 mm and/or a villous component) and low-risk adenomas (tubular

Lactose malabsorption (LM) is a very common problem with high prevalence in Southern Europe. The lactose tolerance test (LTT) is a basic probe, which is widespread in local hospitals, because it requires non-complex and inexpensive infrastructure. The aims of our study are to determine that a reduction in the duration of LTT does not affect its diagnostic accuracy to detect LM and to calculate the savings that this reduction may represent. A prospective study of consecutive patients who underwent LTT for suspected LM was conducted. We analyzed and compared the clinical results and costs (extraction, analytical measurement, time spent by nursing staff, technicians and patients) of suppressing LTT points at 30 and 120 min. The study included 201 patients. Pathological LTT was found in 119 cases. Eliminating the measurement of glucose at 120 min did not alter the LTT interpretation in any patient; however, up to 18.4% of patients had a LTT misinterpretation when the 30 min point was suppressed. If the LTT 120 min measurement would have been suppressed, 41 334 euros could have been saved. Suppressing the 120 min LTT point does not imply any changes in clinical results and reduces patient’s waiting time; it also benefits the health system by saving time, manpower and materials.

A 77-year-old asymptomatic male was referred by his family doctor with this liver test: total bilirubin (TB) 1.84 mg/dl, WBC 3,700/μL, platelets 109,000/μL, and GGT 71 U/L. Past medical history: no allergies to medication. Hypertension treated with captopril 25 mg/day. No abdominal surgery or trauma or liver biopsies. Drinker of 40 g alcohol daily. No known liver disease. No family history of interest. Physical examination showed no stigmata for chronic liver disease, and the abdomen was soft. CBC: leukocytes 2,990/μL, neutrophils 860/μL, lymphocytes 1,570/μL, platelets 112,000/μL, hemoglobin 138 g/L, hematocrit 0.396 L/L, MCV 90.4 fl, prothrombin activity 75.6%, cephalin time 33.6 seg, TB 1.73 mg/dl, GGT 72 U/L, with glucose, urea, creatinine, AST, ALT, ALP, Ca, serum ferritin, amylase, Na, K, TSH, AFP, and autoantibodies (ANA, AMA, SMA) within normal values. Hepatitis B and C were negative. Doppler ultrasounds and computed tomography (CT) + abdominal reconstruction with volume-rendering phase (Figs. 1 and 2) showed a dilated right suprahepatic vein, in its distal end an expansion in the two converging aneurysmatic segmental right portal branches. At this stage no portal flow is seen in the other branches. The main portal branch and the left branch had a normal caliber. The spleen was normal in size. The gallbladder and pancreas had no changes. No free fluid. An inferior vena cava to the left, with retroaortic iliac bifurcation and iliac veins being prominent. There is some increased density in the mesenteric fat due to diffuse, likely venous engorgement.

La hidatidosis es una zoonosis con una elevada prevalencia aún en nuestro medio. Generalmente afecta a hígado y pulmón, debiendo considerarse la afectación músculo-esquelética una localización atípica de la enfermedad. Presentamos el caso de un paciente con lesiones en cresta iliaca y glúteo medio izquierdos, con fistulización espontánea a través de la piel. Se realizó tratamiento combinado con un ciclo de albendazol previo a la intervención y exéresis quirúrgica de la lesión. En el postoperatorio se completaron dos ciclos más de tratamiento con albendazol en un intento de disminuir el riesgo de recurrencia de la enfermedad. El paciente se encuentra asintomático y no ha presentado ninguna complicación hasta la fecha.