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Introduction: Preoperative gastric ischemic conditioning (IC) improves the outcome of esophageal replacement gastroplasty and is associated with low morbidity. However, when the stomach cannot be used for esophageal replacement, a colonic replacement is required. The study aim was to assess the viability of right colon and terminal ileum IC in a rat model and the histological damage/recovery sequence and determine if neovascularization is a potential adaptive mechanism. Methods: The study was conducted in Rattus norvegicus with ileocolic vascular ligation. Seven groups of animals were established (6 rats per group) with groups defined by the date of their post-IC euthanasia (+1, +3, +6, +10, +15, and +21 days). Comparisons were made with a sham group. Viability of the model was defined as Results: Transmural colon necrosis occurred in 1/36 animals (2.78%) with no animal demonstrating transmural ileal necrosis. The maximum damage was observed in the colon on +1 day post-IC (average Chiu score 1.67, p = 0.015), whereas in the ileum, it was on days +1, +3, and +6 (average Chiu score 1.5, 1.3, and 1.17; p = 0.015, 0.002, and 0.015, respectively). In the +21-day group, histological recovery was complete in the colon in 4 (66.7%) of the 6 animals and in the ileum in 5 (83.3%) of 6 animals. There were no significant differences in quantitative neovascularization in any of the groups when compared with the sham group or when comparisons were made between groups. Conclusions: The tested animal model for IC of the colon and terminal ileum appeared to be feasible. Histological damage was maximal between the 1st and 3rd day following IC, but by day 21, recovery was complete in two-thirds of the rats. There was no evidence in this preliminary IC model that would suggest neovascularization as an adaptive mechanism.

Aim: to study a sample of patients with morbid obesity who are on the waiting list for a surgical intervention, to establish various scores of surgical risk (Possum and severity score), and to assess potential criteria for list prioritization. Design: we calculated physiological and surgical Possum scores for every patient, and analysed comorbidities and other associated factors to calculate the severity score. Likewise, we calculated the predictive rates of morbimortality. Differences between associated comorbidities in body mass index (BMI) were also analyzed. The correlation between Possum score, prediction rates, and severity score were analyzed. Patients: fifty-two patients on the surgical waiting list in our institution (San Juan University Hospital, Reus) from 26/4/02 to 5/03/04. Results: the mean qualitative score is significantly higher in the female sex. Invalidating arthropathy and socio-occupational and/or psychiatric criteria are significantly higher in women. There is a significant correlation between the severity score and Possum score. Age does not correlate with any of the variables studied. Conclusions: possum scores are significantly related to BMI, particularly in terms of morbidity rates. The degree of correlation between the Possum score and the qualitative score tells how useful the latter is to cover other determinant factors in the severity of this condition. Socio-occupational and psychiatric criteria, and invalidating arthropathy are the main variables to be taken into account for postsurgical prediction, and are directly related to BMI degree.Objetivo: estudio de una muestra de pacientes afectos de obesidad mórbida y en lista de espera para intervención quirúrgica, determinar el riesgo quirúrgico según diferentes scores (Possum y score de gravedad) y valorar los posibles criterios en la priorización de dicha lista. Diseño: cálculo del Possum fisiológico y quirúrgico para cada paciente y análisis de las comorbilidades y otros factores asociados para el cálculo del score de gravedad. Cálculo de los ratios predictivos de morbi-mortalidad. Análisis de las diferencias observadas, según el índice de masa corporal (IMC), de las comorbilidades asociadas. Análisis del grado de correlación entre el Possum, los ratios de predicción y el score de gravedad. Pacientes: Cincuenta y dos pacientes incluidos en la lista de espera quirúrgica de nuestro centro (Hospital Universitario San Joan de Reus) durante el periodo del 26/4/02 al 5/03/04. Resultados: el score cualitativo tiene una media superior significativa en el sexo masculino. La artropatía invalidante y los criterios socio-laborales y/o psiquiátricos son significativamente superiores en el sexo femenino. Existe una correlación significativa entre el score de gravedad y el Possum. La edad no se correlaciona en nuestra serie con ninguna de las variables estudiadas. Conclusiones: los valores del Possum están relacionados significativamente con el IMC, en especial en base al ratio de morbilidad. El grado de correlación entre el Possum y el score cualitativo nos indica la utilidad de este para cubrir otros factores determinantes en la gravedad de esta patología. Los criterios socio-laborales y psiquiátricos y la artropatía invalidante, son las principales variables a tener en cuenta en la predicción postquirúrgica, estando directamente relacionados con el grado de IMC.