RESUMEN
BACKGROUND: Patients with peritoneal carcinomatosis often suffer from loss of skeletal muscle mass and require extensive surgery. Multimodal prehabilitation may improve physical status but its benefits for these specific patients remain unknown. This study aimed to evaluate the effect of prehabilitation on functional walking capacity and skeletal muscle mass, as well as its association with postoperative complications. PATIENTS AND METHODS: A prospective study of patients with peritoneal carcinomatosis following a home-based trimodal prehabilitation program was carried out. Functional walking capacity was assessed with the 6-min walk test (T6MWT), and by the appendicular skeletal muscle index (ASMI) estimated by bioelectrical impedance analysis. Data were collected at the first medical appointment and on the day before surgery. A 90-day postoperative morbidity was registered according to the Clavien-Dindo classification. RESULTS: A total of 62 patients were included in the analysis. Women were more prevalent (77.4%) and peritoneal metastasis from ovarian origin accounted for 48.4%. Clavien II-V grades occurred in 30 (57.7%) patients. After prehabilitation, functional walking capacity improved by 42.2 m (39.62-44.72 m) compared with baseline data (p < 0.001), but no improvement was observed in the ASMI (p = 0.301). Patients able to walk at least 360 m after prehabilitation suffered fewer Clavien-Dindo II-V postoperative complications (p = 0.016). A T6MWT of less than 360 m was identified as an independent risk factor in the multivariable analysis (OR 3.99; 1.01-15.79 p = 0.048). CONCLUSIONS: This home-based trimodal prehabilitation program improved functional walking capacity but not ASMI scores in patients with peritoneal metastasis before surgery. A T6MWT of less than 360 m was found to be a risk factor for postoperative complications.
Asunto(s)
Procedimientos Quirúrgicos de Citorreducción , Músculo Esquelético , Neoplasias Peritoneales , Ejercicio Preoperatorio , Caminata , Humanos , Femenino , Neoplasias Peritoneales/secundario , Neoplasias Peritoneales/cirugía , Masculino , Estudios Prospectivos , Persona de Mediana Edad , Caminata/fisiología , Estudios de Seguimiento , Pronóstico , Complicaciones Posoperatorias/prevención & control , Anciano , AdultoRESUMEN
INTRODUCTION: Similar to bladder cancer, about one third of upper tract urothelial carcinoma (UTUC) present variant histology (VH). We aim to evaluate the incidence, clinical characteristics and the impact on outcomes of VH in UTUC. METHODS: We consecutively enrolled 77 patients treated between 2009 and 2022 by radical surgery for UTUC from a secondary and a tertiary referral center. A pathology review of all specimens was performed by 1 independent uropathologist for each center. We compared pure UTUC and UTUC with VH and the accuracy of endoscopic biopsy. Descriptive and comparative analysis was performed to assess the association with clinical characteristics and the Kaplan-Meier estimator to compare outcomes. RESULTS: Median follow-up after surgery was 51 months. VH was present in 21/77 (28%) patients and 4/21 (19%) patients had multiple variants. The most frequent VH was squamous 12/21 (57%), followed by glandular 7/21 (33%) and micropapillary 3/21 variants (14%). Neuroendocrine carcinoma was present in 2 patients. Nested variant was found in 1 patient. Muscle invasive tumor (≥pT2) was present in 30/56 (54%) patients with pure UTUC and in 18/21 (86%) patients with VH (P < 0.05). Presence of carcinoma in situ was seen in 24/56 (43%) patients with pure UTUC and in 16/21 (76%) with VH (P < 0.05). Cumulative 8/56 (14%) with pure UTUC had a nonintravesical recurrence (6 patients with local and 2 distant recurrence) compared to 8/21 (38%) (3 local, 3 nodal, 2 distant) in the subgroup with VH (P < 0.05). Opposite effect was noted for bladder recurrence: 60% for pure UTUC vs. 29% for tumors with VH (P < 0.05). Review of preoperative endoscopic biopsy did not show the presence of VH in any patients. Differences in outcomes did not reach significance: 3yr-OS 63% vs. 42% (P 0.28) and 3yr-CSS 77% vs. 50% (P 0.7). CONCLUSION: Almost a third of UTUC present VH. Presence of VH is related to more aggressive tumor characteristics and associated with unfavorable outcomes. Due to a higher rate of extravesical recurrences in UTUC with VH, Follow-up controls should include cross sectional imaging and cystoscopy.
Asunto(s)
Carcinoma de Células Transicionales , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Carcinoma de Células Transicionales/patología , Carcinoma de Células Transicionales/cirugía , Anciano de 80 o más Años , Estudios Retrospectivos , Neoplasias Urológicas/patología , Neoplasias Urológicas/cirugía , Neoplasias Ureterales/patología , Neoplasias Ureterales/cirugíaRESUMEN
El síndrome de pseudo-Meigs es un cuadro caracterizado por la presencia de ascitis y derrame pleural asociados a tumores pélvicos diferentes a tumores ováricos tipo fibroma. El cuadro simula un proceso neoplásico; sin embargo es una patología benigna que se resuelve tras la extirpación de la tumoración. El síndrome de pseudo-Meigs secundario a leiomioma uterino es una asociación muy poco frecuente, existen menos de 40 casos publicados. Presentamos el caso de una mujer de 28 años que acude a urgencias por ascitis y derrame pleural con elevación de Ca-125 en el contexto de síndrome pseudo-Meigs que se resolvió tras miomectomía.(AU)
Pseudo-Meigs syndrome is a condition characterised by the presence of ascites and pleural effusion associated with pelvic tumours other than fibroid-type ovarian tumours. Although the clinical picture simulates a neoplastic process, it is, however, a benign pathology that resolves after the removal of the tumour. Pseudo-Meigs syndrome secondary to uterine leiomyoma is a very rare combination, with less than 40 cases published in the literature.The case is presented of a 28 year-old woman attending the emergency department due to ascites and pleural effusion, with an elevated Ca-125 in the context of pseudo-Meigs syndrome that resolved after myomectomy.(AU)
Asunto(s)
Humanos , Femenino , Adulto , Síndrome de Meigs , Leiomioma , Ascitis , Derrame Pleural , Examen Físico , Pacientes Internos , Ginecología , EmbarazoRESUMEN
The aim of the study was to determine whether routine probiotic supplementation (RPS) with Lactobacillus rhamnosus GG (LGG) or Lactobacillus acidophilus +Lactobacillus bifidum is associated with reduced risk of necrotising enterocolitis (NEC)≥Stage II in preterm neonates born at ≤32 weeks' gestation. We conducted a retrospective cohort study on the effect of probiotic supplementation in very low birth weight infants in our neonatal unit by comparing two periods: before and after supplementation. The incidence of NEC≥Stage II, late-onset sepsis and all-cause mortality was compared for an equal period 'before' (Period I) and 'after' (Period II) RPS with LGG or L. acidophillus+L. bifidum. Multivariate logistic regression analysis was conducted to adjust for relevant confounders. The study population was composed of 261 neonates (Period I v. II: 134 v. 127) with comparable gestation duration and birth weights. In <32 weeks, we observed a significant reduction in NEC≥Stage II (11·3 v. 4·8 %), late-onset sepsis (16 v. 10·5 %) and mortality (19·4 v. 2·3 %). The benefits in neonates aged ≤27 weeks did not reach statistical significance. RPS with LGG or L. acidophillus+L. bifidum is associated with a reduced risk of NEC≥Stage II, late-onset sepsis and mortality in preterm neonates born at ≤32 weeks' gestation.
Asunto(s)
Infección Hospitalaria/prevención & control , Enterocolitis Necrotizante/prevención & control , Microbioma Gastrointestinal , Fenómenos Fisiológicos Nutricionales del Lactante , Enfermedades del Prematuro/prevención & control , Nacimiento Prematuro/terapia , Probióticos/uso terapéutico , Estudios de Cohortes , Terapia Combinada , Infección Hospitalaria/epidemiología , Infección Hospitalaria/inmunología , Infección Hospitalaria/microbiología , Enterocolitis Necrotizante/epidemiología , Enterocolitis Necrotizante/inmunología , Enterocolitis Necrotizante/microbiología , Microbioma Gastrointestinal/inmunología , Humanos , Incidencia , Lactante , Mortalidad Infantil , Recién Nacido , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/inmunología , Enfermedades del Prematuro/microbiología , Recién Nacido de muy Bajo Peso , Unidades de Cuidado Intensivo Neonatal , Lactobacillus acidophilus/inmunología , Levilactobacillus brevis/inmunología , Lacticaseibacillus rhamnosus/inmunología , Guías de Práctica Clínica como Asunto , Nacimiento Prematuro/inmunología , Nacimiento Prematuro/microbiología , Nacimiento Prematuro/fisiopatología , Probióticos/efectos adversos , Estudios Retrospectivos , Riesgo , Sepsis/epidemiología , Sepsis/inmunología , Sepsis/microbiología , Sepsis/prevención & control , España/epidemiologíaRESUMEN
OBJECTIVE: The goals were to isolate and study the genetic susceptibility to retinopathy of prematurity (ROP), as well as the gene-environment interaction established in this disease. METHODS: A retrospective study (2000-2014) was performed about the heritability of retinopathy of prematurity in 257 infants who were born at a gestational age of ≤ 32 weeks. The ROP was studied and treated by a single pediatric ophthalmologist. A binary logistic regression analysis was completed between the presence or absence of ROP and the predictor variables. RESULTS: Data obtained from 38 monozygotic twins, 66 dizygotic twins, and 153 of simple birth were analyzed. The clinical features of the cohorts of monozygotic and dizygotic twins were not significantly different. Genetic factors represented 72.8% of the variability in the stage of ROP, environmental factors 23.08%, and random factors 4.12%. The environmental variables representing the highest risk of ROP were the number of days of tracheal intubation (p < 0.001), postnatal weight gain (p = 0.001), and development of sepsis (p = 0.0014). CONCLUSION: The heritability of ROP was found to be 0.73. The environmental factors regulate and modify the expression of the genetic code.
Asunto(s)
Retinopatía de la Prematuridad/epidemiología , Retinopatía de la Prematuridad/genética , Interacción Gen-Ambiente , Genotipo , Humanos , Recién Nacido , Modelos Logísticos , Estudios Prospectivos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Objetivos: Principal: determinar las diferencias por categoría profesional y provincias en los conocimientos y actitudes de los profesionales sanitarios sobre el Documento de Voluntades Anticipadas (DVA) en 4 provincias andaluzas: Córdoba, Jaén, Cádiz y Granada. Secundarios: conocer el número de documentos realizados en esas zonas y el número consultado en situaciones terminales. Material y métodos: Estudio observacional descriptivo multicéntrico en 17 zonas básicas de salud de 4 provincias de Andalucía. Población diana: médicos, enfermeros y trabajadores socia- les de las zonas estudiadas (n = 340). Intervenciones: Cuestionario validado autoadministrado sobre conocimientos y actitudes de voluntades anticipadas. Se realizó análisis descriptivo y bivariante (×2) de los datos. Resultados: Edad media de 46 ± 8,8 años, 53,2% mujeres. Médicos 56,1%, enfermeros 41,1%, trabajadores sociales 2,6%. La puntuación media (de 0-10) de sus conocimientos fue 5,42 ± 2,41. El 78,4% creía que las voluntades anticipadas estaban reguladas en Andalucía (diferencias por provincias; p=0,001). Había leído dicho documento un 36,7% (diferencias por profesiones; p = 0,001). La puntuación media sobre la conveniencia de que los ciudadanos realizaran un DVA fue 8,27 ± 2,16 (diferencias por provincias; p = 0,02). La puntuación media sobre si el profesional respetaría los deseos expresados por un paciente en un DVA fue de 9,14 ± 1,64 (diferencias por provincias; p = 0,03), y la puntuación de la pregunta que expresaba los deseos del profesional acerca de realizar su DVA en el próximo an ̃o fue 4,85 ± 3,74 (p = 0,02). Conclusiones: Existen diferencias entre profesiones en la realización de la lectura del DVA. Existen diferencias entre provincias en los siguientes aspectos: saber si están reguladas, conveniencia de realizar el DVA y respeto a lo previsto en el DVA (AU)
Objectives: Primary: To determine the differences, by occupational category and province, in the knowledge and attitudes of health professionals on the Living Wills Document (LWD) in 4 Andalusian provinces: Cordoba, Jaen, Cadiz, and Granada. Secondary: To determine the number of documents prepared in these areas and the number consulted in terminal situations. Material and methods: Descriptive observational multicenter study, with 17 health areas in 4 Andalusian provinces. Target population: Family doctors, nurses and social workers of the areas studied (n = 340). Interventions Validated self-administered questionnaire about advance directives. Descriptive and bivariate (×2) analysis of data was performed. Results: Mean age 46 ± 8.8 years, 53.2% women. Physicians 56.1%, nurses 41.1%, social workers 2.6%. The mean score (0-10) of their knowledge was 5.42 ± 2.41, with 78.4% believing that LWD are regulated in Andalusia (provinces differences, P = .001). More than one-third (36.7%) had read the document (differences by occupation, P = .001). The mean score on the advantage of preparing a LWD for the patient was 8.27 ± 2.16 (significant differences between provinces P = .02). Mean score about the practitioner would respect the wishes of a patient in a LWD was 9.14 ± 1.64 (significant difference between provinces P = .03). The mean score of the question about expressing the desires of the professional on preparing their LWD in the following year was 4.85 ± 3.74 (P = .02). Conclusions: There are different behaviors between professions on reading the LWD. There are differences between provinces in the following aspects: whether the documents are regula- ted, whether the professionals prepare the LWD, and whether the professionals respects the provisions of the LWD (AU)
Asunto(s)
Humanos , Directivas Anticipadas/estadística & datos numéricos , Adhesión a las Directivas Anticipadas/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , /estadística & datos numéricosRESUMEN
BACKGROUND: The lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) have been proposed to minimize the stage migration phenomenon. The value of the LODDS and LNR staging systems to predict and discriminate prognosis was assessed and compared to the International Union Against Cancer (UICC) TNM classification (pN). METHODS: Three hundred and twenty-six patients with gastric carcinoma were retrospectively studied. Disease-specific survival rates were calculated for every pN, LNR, and LODDS category. RESULTS: Four LNR categories (0, 1-25, 26-75, and >76 %) and four LODDS categories (-5 to -3, > -3 to -1, > -1 to 3, and >3 to 5) were established. In the multivariate analysis, only the stage pT3-4 versus pT1-2 (HR 1.88, 95 % CI 1.11-3.20, p=0.02) and LODDS as continuous variable (HR 1.40, 95 % CI 1.21-1.61, p<0.001) remained as independent prognostic factors. In patients with <16 lymph nodes retrieved, only the LODDS system could discriminate different disease-specific survival curves for every category. LODDS categories were able to discriminate subgroups with different prognoses in pN stages and LNR categories. CONCLUSIONS: The LODDS staging system was superior to the pN classification and LNR system to discriminate risk prognosis especially in patients with an insufficient number of retrieved lymph nodes.
Asunto(s)
Ganglios Linfáticos/patología , Estadificación de Neoplasias , Neoplasias Gástricas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Gastrectomía , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Neoplasias Gástricas/cirugía , Tasa de SupervivenciaRESUMEN
OBJECTIVES: Primary: To determine the differences, by occupational category and province, in the knowledge and attitudes of health professionals on the Living Wills Document (LWD) in 4 Andalusian provinces: Cordoba, Jaen, Cadiz, and Granada. Secondary: To determine the number of documents prepared in these areas and the number consulted in terminal situations. MATERIAL AND METHODS: Descriptive observational multicenter study, with 17 health areas in 4 Andalusian provinces. TARGET POPULATION: Family doctors, nurses and social workers of the areas studied (n=340). Interventions Validated self-administered questionnaire about advance directives. Descriptive and bivariate (×2) analysis of data was performed. RESULTS: Mean age 46±8.8 years, 53.2% women. Physicians 56.1%, nurses 41.1%, social workers 2.6%. The mean score (0-10) of their knowledge was 5.42±2.41, with 78.4% believing that LWD are regulated in Andalusia (provinces differences, P=.001). More than one-third (36.7%) had read the document (differences by occupation, P=.001). The mean score on the advantage of preparing a LWD for the patient was 8.27±2.16 (significant differences between provinces P=.02). Mean score about the practitioner would respect the wishes of a patient in a LWD was 9.14±1.64 (significant difference between provinces P=.03). The mean score of the question about expressing the desires of the professional on preparing their LWD in the following year was 4.85±3.74 (P=.02). CONCLUSIONS: There are different behaviors between professions on reading the LWD. There are differences between provinces in the following aspects: whether the documents are regulated, whether the professionals prepare the LWD, and whether the professionals respects the provisions of the LWD.
Asunto(s)
Directivas Anticipadas , Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Voluntad en Vida , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros/estadística & datos numéricos , Médicos/estadística & datos numéricos , Trabajadores Sociales/estadística & datos numéricos , España , Encuestas y CuestionariosRESUMEN
BACKGROUND: To assess the effectiveness of vitamin A supplementation in very low birth weight (VLBW) infants to prevent complications of prematurity. METHODS: This was a retrospective cohort study to determine the effectiveness of vitamin A in preventing complications of prematurity in VLBW infants. Vitamin A was delivered intramuscularly at a dose of 5000 IU, three times weekly during the first 28 days of life. RESULTS: Of the 187 eligible VLBW infants, we excluded from the analysis (due to death or transfer to another hospital), 16 infants weighing <1000 g and 17 weighing 1000-1500 g. Sixty VLBW infants received the vitamin supplement. We observed no differences between the groups in the duration of oxygen therapy or in the risk of bronchopulmonary dysplasia. The risk of sepsis was up to three times higher among the infants who were given the vitamin A supplement. CONCLUSION: Given the increased risk of sepsis in patients weighing >1000 g, the risk associated with repeated intramuscular injections of vitamin A and the modest clinical results described, we do not believe the universal administration of vitamin A to VLBW infants to be justified as prophylaxis for bronchopulmonary dysplasia.
Asunto(s)
Enfermedades del Prematuro/prevención & control , Recién Nacido de muy Bajo Peso , Vitamina A/uso terapéutico , Displasia Broncopulmonar/prevención & control , Hemorragia Cerebral/prevención & control , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Terapia por Inhalación de Oxígeno , Retinopatía de la Prematuridad/prevención & control , Estudios Retrospectivos , Factores de Riesgo , Sepsis/prevención & controlRESUMEN
BACKGROUND: The optimal system for lymph node (LN) staging in gastric cancer is still a subject of debate. The aim of our study was to analyse the probability of error in negative LN (pN0) gastric carcinomas when a low number of LNs were harvested using a probabilistic model. METHODS: Patients with gastric carcinoma who underwent R0 resection at three university hospitals between 2004 and 2009 were retrospectively included. A Bayesian model was used to analyse the probability of error for negative LNs (pN0) gastric carcinomas. Kaplan-Meier survival curves and the log-rank test were used to compare the overall and specific mortality of prognosis groups. RESULTS: Of the 291 patients included, 123 were classified as pN0 (42%). A significant correlation was found between the extent of the LN dissection performed and the number of the LNs retrieved. According to the Bayesian model the carcinomas with 9 or fewer negative lymph nodes were considered to have a high risk (HR) of misclassification, whereas patients with 10-25 LNs analysed and those with more than 26 negative lymph nodes were considered to have a moderate risk (MR) and low risk (LR), respectively. The log-rank test showed a significant improvement in the disease-specific survival for the MR pN0 (p < 0.001) and LR pN0 (p < 0.04) but not for the HR pN0 patients compared to pN1 patients. CONCLUSIONS: The proposed probabilistic model is clinically useful for differentiating the prognosis in pN0 gastric carcinomas when an insufficient number of negative lymph nodes are retrieved.
Asunto(s)
Adenocarcinoma/mortalidad , Adenocarcinoma/secundario , Ganglios Linfáticos/patología , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Teorema de Bayes , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Gastrectomía/métodos , Gastrectomía/mortalidad , Humanos , Estimación de Kaplan-Meier , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/cirugía , Metástasis Linfática , Masculino , Persona de Mediana Edad , Análisis Multivariante , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , España , Estadísticas no Paramétricas , Neoplasias Gástricas/cirugía , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND AND PURPOSE: It has been previously reported that a short FOLFOX-4 induction significantly improves pathologic complete response in locally advanced rectal cancer (LARC) patients treated with preoperative chemoradiation (CRT). In a larger and updated patient series, we analyzed FOLFOX-4 efficacy in terms of sphincter preservation and long-term outcomes. PATIENTS AND METHODS: From January 1995 to December 2010, 335 LARC patients were treated with preoperative chemoradiation (4500-5040 cGy). Starting in May 2001, 207 consecutive patients additionally received induction FOLFOX-4. Surgery was performed 6 weeks (range 3-12 weeks) after chemoradiation. RESULTS: Incidence of total tumor (63 vs. 54 %, p = 0.02) and nodal downstaging (60 vs. 43 %, p = 0.002) was significantly increased by induction FOLFOX-4. In an analysis of tumors located below 5 cm from the anal verge (n = 114, 34 %), sphincter preservation was feasible in 30 % in the FOLFOX-4 versus 13 % in the upfront CRT group (p = 0.04). Median follow-up time for the entire cohort of patients was 72.6 months (range 4-205 months). FOLFOX-4 was not associated with superior locoregional control (HR 0.88, p = 0.78), disease-free survival (HR 0.83, p = 0.55), distant metastases-free survival (HR 0.94, p = 0.81), or cancer-specific survival (HR 0.70, p = 0.15). CONCLUSION: Short-intense induction FOLFOX-4 significantly improves downstaging and sphincter preservation in low rectal tumors. Long-term outcomes were not improved in the FOLFOX-4 group of patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioradioterapia , Terapia Neoadyuvante , Neoplasias del Recto/terapia , Adulto , Anciano , Anciano de 80 o más Años , Canal Anal/cirugía , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Terapia Combinada , Supervivencia sin Enfermedad , Estudios de Factibilidad , Femenino , Fluorouracilo/administración & dosificación , Estudios de Seguimiento , Humanos , Leucovorina/administración & dosificación , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tratamientos Conservadores del Órgano , Compuestos Organoplatinos/administración & dosificación , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología , Resultado del TratamientoRESUMEN
RATIONALE AND OBJECTIVES: To analyse the programme activity and clinical innovation and/or technology developed over a period of 17 years with regard to the introduction and the use of intraoperative radiotherapy (IORT) as a therapeutic component in a medical-surgical multidisciplinary cancer hospital. MATERIAL AND METHODS: To standardise and record this procedure, the Radiation Oncology service has an institutional programme and protocols that must be completed by the different specialists involved. For 17 years, IORT procedures were recorded on a specific database that includes 23 variables with information recorded on institutional protocols. As part of the development and innovation activity, two technological tools were implemented (RADIANCE and MEDTING) in line with the standardisation of this modality in clinical practice. RESULTS: During the 17 years studied, 1,004 patients were treated through 1,036 IORT procedures. The state of the disease at the time of IORT was 77% primary and 23% recurrent. The origin and distribution of cancers were 62% gastrointestinal, 18% sarcomas, 5% pancreatic, 2% paediatric, 3% breast, 7% less common locations, and 2% others. The research and development projects have generated a patent on virtual planning (RADIANCE) and proof of concept to explore as a professional social network (MEDTING). During 2012, there were 69 IORT procedures. There was defined treatment volume (target or target region) in all of them, and 43 were conducted by the virtual planning RADIANCE system. Eighteen have been registered on the platform MEDTING as clinical cases. CONCLUSION: The IORT programme, developed in a university hospital with an academic tradition, and interdisciplinary surgical oncology, is a feasible care initiative, able to generate the necessary intense clinical activity for tending to the cancer patient. Moreover, it is a competitive source for research, development, and scientific innovation.
RESUMEN
The unilateral boarding of the primary hiperparatiroidism constitutes a technical option increasingly secondhand and adapted for the characteristics of this surgery. This type of boarding has been possible for the appearance of the Tc sestamibi, of the subspecialization of the surgery and of the determination of the PTH intraoperatory. Later we expose an epidemiological, descriptive and retrospective study from january 2004 to December 2008. During this time there were controlled in the hospital Ramon and Cajal of Madrid a total of 195 patients for primary hiperparatiroidism. Of them, 140 were submitted to unilateral exploration by suspicion of the solitary adenoma. The correlation between the findings of Tc sestamibi and surgical was correct in all the cases (139) except one concerns to right or left side. It failed in 30 cases in which there was detected badly the top and low location. As for the results the adenoma was extirpated correctly in 135 of 140 patients. This way we can say that the combination of the gammagraphy, a surgeon with experience and the support of the PTH intraoperatory they meet a high rate of treatment in case of adenomas in the unilateral boarding on a rate of hipercalcemia appellant or persistently between 3 percent-5 percent, rate similar to the obtained one for expert surgeons on having fulfilled an exploratory cervicotomy (considered "gold standard") but with minor postoperatory morbidity, minor pain and minor surgical time.
El abordaje unilateral del hiperparatiroidismo primario constituye una opción técnica cada vez más usada y apropiada debido a las características de esta cirugía. Este tipo de abordaje ha sido posible por la aparición del Tc sestamibi, de la subespecialización de la cirugía y de la determinación de la PTH intraoperatoria. A continuación exponemos un estudio epidemiológico, descriptivo y retrospectivo desde enero de 2004 a diciembre de 2008. Durante este tiempo fueron intervenidos en el hospital Ramón y Cajal de Madrid un total de 195 enfermos por hiperparatiroidismo primario. De ellos, 140 fueron sometidos a exploración unilateral por sospecha de adenoma único. La correlación entre los hallazgos gammagráficos y quirúrgicos fue correcta en todos los casos (139) menos uno en cuanto a lo que a lateralidad se refiere. Falló en 30 casos en los que se detectó mal la localización superior e inferior. En cuanto a los resultados, se extirpó el adenoma correctamente en 135 de los 140 pacientes. Así podemos decir que la combinación de la gammagrafía, de un cirujano con experiencia y el apoyo de la PTH intraoperatoria proporciona una elevada tasa de curación en el caso de adenomas paratiroideos en el abordaje unilateral con una tasa de hipercalcemia recurrente o persistente entre el 3 por ciento-5 por ciento, tasa similar a la obtenida por cirujanos expertos al realizar una cervicotomía exploradora (considerada gold standard) pero con menor morbilidad postoperatoria, menor dolor y menor tiempo quirúrgico.
Asunto(s)
Humanos , Masculino , Adulto , Femenino , Persona de Mediana Edad , Anciano de 80 o más Años , Hiperparatiroidismo Primario , Hiperparatiroidismo Primario/cirugía , Adenoma , Adenoma/cirugía , Calcio/sangre , Hiperparatiroidismo Primario/sangre , Hormona Paratiroidea/sangre , Procedimientos Quirúrgicos Mínimamente Invasivos , Neoplasias de las Paratiroides , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía , Estudios Retrospectivos , RadiofármacosRESUMEN
We report a 53 years old male consulting for chest pain and dyspnea. On physical examination, an epigastric mass was detected. A TC scan showed a collection located in the omental bursa, which protruded over the posterior gastric wall and ascended to the mediastinum. Due to the presence of pancreatic calcifications, a pancreatic pseudocyst was suspected. The mediastinal cyst was drained percutaneously, leaving pig tail drainage in the cavity. Afterwards a cyst excision and Roux en Y gastrostomy was performed. After the surgical procedure the cyst became infected, requiring antimicrobials. After two weeks he was discharged in good conditions.
Los pseudoquistes de páncreas representan el 75 por ciento de las lesiones quísticas del páncreas y generalmente se circunscriben en el abdomen. Se presenta el caso de un paciente con un pseudoquiste de páncreas con extensión transhiatal a mediastino. Estos casos deben sospecharse mediante una historia clínica detallada y preguntando por antecedentes de dolor abdominal previo porque la clínica con la que se suelen manifestar es muy poco específica. El tratamiento de los pseudoquistes con extensión a mediastino debería ser el drenaje definitivo, bien de forma quirúrgica o endoscópica.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Quiste Mediastínico/cirugía , Quiste Mediastínico/diagnóstico , Seudoquiste Pancreático/cirugía , Seudoquiste Pancreático/diagnóstico , Drenaje , Gastrostomía , Quiste Mediastínico/complicaciones , Seudoquiste Pancreático/complicacionesAsunto(s)
Aborto Espontáneo/etiología , Neoplasias de la Corteza Suprarrenal/complicaciones , Adenoma Corticosuprarrenal/complicaciones , Hiperaldosteronismo/complicaciones , Hipertensión/diagnóstico , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Neoplásicas del Embarazo/diagnóstico , Neoplasias de la Corteza Suprarrenal/diagnóstico , Neoplasias de la Corteza Suprarrenal/diagnóstico por imagen , Adenoma Corticosuprarrenal/diagnóstico , Adenoma Corticosuprarrenal/diagnóstico por imagen , Adulto , Antihipertensivos/uso terapéutico , Diagnóstico Diferencial , Diagnóstico por Imagen , Femenino , Humanos , Hiperaldosteronismo/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Hipertensión/etiología , Hipertensión Inducida en el Embarazo/diagnóstico , Embarazo , Complicaciones Cardiovasculares del Embarazo/tratamiento farmacológico , Complicaciones Cardiovasculares del Embarazo/etiología , Complicaciones Neoplásicas del Embarazo/diagnóstico por imagen , Radiografía , Espironolactona/uso terapéuticoAsunto(s)
Humanos , Femenino , Carcinoma Ductal de Mama/complicaciones , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/cirugía , Metástasis de la Neoplasia/patología , Recurrencia Local de Neoplasia/complicaciones , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/diagnóstico , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama , Metástasis de la Neoplasia/terapia , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia , Glándula Tiroides/patología , Glándula Tiroides , Neoplasias de la Tiroides/patología , Neoplasias de la TiroidesRESUMEN
OBJECTIVE: Spigelian hernia is an uncommon abdominal wall defect. We present our series of patients with Spigelian hernia and a literature review. PATIENTS: We carried out a retrospective review of patients operated on from 2001 to 2008. Epidemiological aspects, diagnostic methods, surgical technique characteristics, morbidity, hospital stay, recurrences and follow up are analyzed. RESULTS: We have treated 39 patients, 25 female and 14 male, with a mean age of 70 years. Left side was the most frequent location. Risk factors were present in 74% of patients. Diagnosis was made clinically in 72% of cases. Open hernioplasty followed by laparoscopic hernioplasty are the most frequent techniques performed. Emergency operation was needed in 20% of patients. Postoperative morbidity is very low. CONCLUSIONS: Diagnosis of Spigelian hernia is basically clinic. The gold standard is TC in doubtful cases. An important percentage of patients will present with an acute complication of the Spigelian hernia as their first symptom. Surgical technique depends on patient characteristics, type of hernia and surgeon experience.
Asunto(s)
Hernia Abdominal/cirugía , Pared Abdominal/anomalías , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hernia Abdominal/diagnóstico , Hernia Abdominal/epidemiología , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Objetivo: la hernia de Spiegel es una variedad poco frecuente de defecto de la pared abdominal. Presentamos nuestra serie de pacientes intervenidos con éste diagnóstico, así como una revisión de la literatura. Pacientes: se realiza un estudio retrospectivo de los pacientes intervenidos por hernia de Spiegel en nuestro centro entre los años 2001 y 2008. Se analizan factores epidemiológicos, forma de diagnóstico, características de la técnica quirúrgica, morbilidad, estancia hospitalaria, recidivas y seguimiento. Resultados: han sido intervenidos 39 pacientes, 25 mujeres y 14 hombres, con una edad media de 70 años. La localización más frecuente es la izquierda. El 74% de los pacientes presenta 1 o más factores de riesgo. El diagnóstico fue clínico en el 72% de los casos. La técnica más empleada es la hernioplastia seguida de la hernioplastia laparoscópica y en el 20% de los casos la intervención tuvo que realizarse de forma urgente. La morbilidad postoperatoria es escasa. Conclusiones: el diagnóstico de la hernia de Spiegel es fundamentalmente clínico. En caso de duda diagnóstica el TAC es la prueba de elección. En un porcentaje importante de pacientes la primera manifestación es la incarceración. La técnica quirúrgica dependerá de las características del paciente, la hernia y la experiencia del cirujano(AU)
Objective: Spigelian hernia is an uncommon abdominal wall defect. We present our series of patients with Spigelian hernia and a literature review. Patients: we carried out a retrospective review of patients operated on from 2001 to 2008. Epidemiological aspects, diagnostic methods, surgical technique characteristics, morbidity, hospital stay, recurrences and follow up are analyzed. Results: we have treated 39 patients, 25 female and 14 male, with a mean age of 70 years. Left side was the most frequent location. Risk factors were present in 74% of patients. Diagnosis was made clinically in 72% of cases. Open hernioplasty followed by laparoscopic hernioplasty are the most frequent techniques performed. Emergency operation was needed in 20% of patients. Postoperative morbidity is very low. Conclusions: diagnosis of Spigelian hernia is basically clinic. The gold standard is TC in doubtful cases. An important percentage of patients will present with an acute complication of the Spigelian hernia as their first symptom. Surgical technique depends on patient characteristics, type of hernia and surgeon experience(AU)